Preparing for Hair Transplant Surgery: Medical Checks and What to Disclose

A hair transplant is a surgical procedure. It involves incisions, local anaesthetic, bleeding, and a healing process that can be helped or hindered by what is going on elsewhere in your body.

Most of what determines whether surgery goes smoothly is settled before the day itself. This page covers what gets assessed, what you need to disclose, and why each item matters.

Why the pre-surgical assessment matters

The purpose is not administrative. It is to establish three things: that surgery is appropriate for you at all, that nothing in your medical history increases your risk unacceptably, and that the plan accounts for anything relevant.

A consultation where nobody asks about your medical history, medications or previous surgery is not a thorough consultation, and that is worth noting regardless of where you are considering having the procedure done.

Your medical history

Bring or be ready to discuss the following.

Current diagnoses. Anything you are being treated for or monitored for, whether or not it seems related to your scalp.

Bleeding tendency. Any known bleeding or clotting disorder, or a history of unusual bleeding after dental work, minor cuts or previous surgery.

Cardiovascular conditions. Including hypertension, whether controlled or not.

Diabetes. Both the diagnosis and how well controlled it is, since poorly controlled blood glucose impairs wound healing and raises infection risk.

Thyroid conditions. Relevant both to healing and because thyroid dysfunction can itself cause hair loss, which may change the diagnosis.

Autoimmune conditions. Particularly anything affecting skin or scalp.

Immune suppression, whether from a condition or from medication.

Previous surgery, especially any previous hair restoration, and how you healed.

Known allergies, including to medications, latex and topical antiseptics.

Previous reactions to local anaesthetic. Important, since both techniques are performed under local anaesthetic.

Any history of keloid or hypertrophic scarring. This affects the expected appearance of the donor scar and may influence technique choice.

Medications and supplements

This is the section people most often under-report, usually because they do not think of supplements as medication.

Disclose everything you take regularly or have taken recently, including over-the-counter products and anything herbal.

Categories that matter most:

Anticoagulants and antiplatelet medication. Warfarin, the newer oral anticoagulants, clopidogrel and similar agents all increase bleeding during surgery. Do not stop any of these on your own initiative. Whether and how they are managed around surgery is a decision for the prescribing doctor and your surgeon together.

Aspirin and non-steroidal anti-inflammatories. Including ibuprofen and similar. These affect platelet function and are commonly stopped for a period beforehand on advice.

Supplements with anticoagulant effects. Fish oil, high-dose vitamin E, ginkgo biloba, garlic supplements, ginseng and turmeric in supplement doses can all contribute to bleeding. These are frequently missed because people do not consider them drugs.

High-dose vitamin A and retinoid medication. Relevant to both bleeding and healing, and excess vitamin A can itself cause hair shedding.

Isotretinoin. Affects wound healing. Recent or current use needs disclosing.

Immunosuppressants and systemic corticosteroids.

Beta blockers, some of which are associated with hair shedding.

Antidepressants, some of which affect platelet function or are associated with shedding.

Any hair loss medication you are already taking. This affects planning, and in most cases you will be advised to continue rather than stop, since stopping tends to accelerate loss in the untransplanted areas.

Do not adjust or stop any prescribed medication without instruction. The point of disclosure is so that decisions can be made properly, not so that you can make them yourself.

Smoking

Smoking is worth its own section because the effect is direct and significant.

Nicotine is a vasoconstrictor. It narrows the small blood vessels that transplanted grafts depend on for survival in the days after placement, and it impairs the microcirculation wound healing requires. The evidence in surgical wound healing generally is consistent: smokers have higher rates of delayed healing, infection and poorer scarring.

For a procedure whose entire outcome depends on grafts establishing a blood supply, this matters more than it does for many other operations.

You will generally be advised to stop for a period before and after surgery. The longer the better. This is not a moral position, it is about graft survival.

Alcohol

Alcohol affects clotting and, in significant quantities, wound healing and immune function. You will be advised to avoid it for a period before surgery and during early recovery, partly for those reasons and partly because it interacts with post-operative medication.

Scalp condition

The scalp needs to be in reasonable condition for surgery.

Active infection, significant inflammation, or an uncontrolled condition such as severe seborrhoeic dermatitis or psoriasis affecting the surgical area will generally mean deferring until it is settled.

Any scarring scalp condition needs to be stable. Transplanting into actively inflamed or progressively scarring tissue has a poor prognosis.

Hair evaluation

Alongside the general medical assessment, the scalp itself is examined.

This covers the pattern and extent of loss, density and calibre of hair in both the recipient and donor areas, scalp laxity, and the presence of miniaturisation, which indicates follicles in the process of being lost.

The assessment determines whether surgery is appropriate, which technique suits, how many grafts are available and needed, and where the hairline should sit.

This is also where a diagnosis other than pattern hair loss may become apparent, in which case investigation comes before any discussion of surgery. See when hair loss isn't genetic.

Risks and possible complications

Every surgical procedure carries risk, and these are discussed in full before you consent.

Possible complications include bleeding, infection, swelling, pain and discomfort, numbness or altered sensation in the donor or recipient area, folliculitis, cyst formation, poor graft survival, visible or widened scarring, and an aesthetic result that does not meet your expectations. Shock loss, where transplanted and sometimes surrounding hairs shed in the weeks after surgery, is expected rather than a complication, but it takes people by surprise if it has not been explained.

Some of these are common and resolve. Others are less common and may be lasting.

Read our risks and complications page in full. Do not rely on a summary.

Practical preparation

Closer to the day:

• Arrange for someone to drive you home. You will not be able to drive yourself
• Wash your hair as instructed, usually the morning of surgery
• Do not apply any styling product
• Wear a button-up or loose shirt, so nothing needs pulling over your head afterwards
• Eat beforehand unless told otherwise. You are awake throughout
• Bring your medication list, including anything you have stopped and when
• Clear the following few days, and about a week for a strip procedure
• Have your prescribed medication filled beforehand rather than on the way home
• Save the clinic's contact number in your phone

The GP referral

A GP referral is required before a cosmetic surgery consultation in Australia.

This is a regulatory requirement rather than a formality, and it exists so that your general health and the underlying cause of your hair loss are considered by a doctor who knows your history before you proceed to a cosmetic consultation.

If you are unsure how to arrange one, contact the clinic and we will explain the process.

What good preparation looks like

The pattern with straightforward surgery and straightforward recovery is fairly consistent: full disclosure of medications and supplements, medical conditions properly managed rather than mentioned in passing, smoking stopped for a meaningful period, instructions followed rather than approximated, and realistic expectations discussed rather than assumed.

None of it is complicated. It just needs doing before rather than after.

Next steps

Dr Jassim Daood has practised for over 30 years across Australia, New Zealand, the United States and Europe, and performs both FUE and FUT hair transplant surgery at our Bankstown clinic.

Book a consultation.

Related reading: are you a suitable candidate, hair transplant recovery: the first two weeks, hair transplant surgery in Sydney: the complete guide.