Thank you for your question. I see you have several hair grafts and scabs that have shed 11 days after you had a 4500+ graft hair transplant, and you’d like to know if this is normal shedding versus actual grafts that have fallen out and are no longer viable.First a bit about my background — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have been performing hair transplants for that long as well. I’m also the founder of Trichostem™ Hair Regeneration centers, which offers a non-surgical alternative to a hair transplant for men and women with thinning hair. I can tell you right away that what you’re experiencing is not unusual. It is, in fact, part of a normal hair transplant that a certain percentage of grafts just don’t take, especially when it comes to megasessions. A 4500-graft hair transplant is quite a lot, and that number would usually be divided into two transplants in our practice. When these grafts are placed, it is to be expected that a certain percentage of these grafts may get dry, scab, and break off. In spite of this, it is still possible that the root of the hair follicle may still be in the skin. There will also be instances where the hair graft falls out along with the hair follicle or the dermal papilla. In fact, we’ve treated patients who came to us for additional surgery after undergoing a megasession and losing 90% of their grafts. Bottom line is, with a hair transplant, you can lose anywhere from 10% or more of your grafts, depending on a variety of variables.At this point, it is important to keep following your doctor’s instructions. Normally, within the first two days, the grafts are securely placed in the scalp, so anything that breaks off at 11 days is usually just the upper part of the grafts. In other words, the root is still in the skin while the hair on top may have just broken off. We usually advise our patients to be very gentle when washing their hair, and to keep the area moist if there is dryness, scabbing, and crusting.In our practice, we’ve noted that Hair Regeneration, which is a treatment we developed to help facilitate the healing of hair grafts and to improve the outcome in terms of the yield, has produced wonderful results for people who had transplant surgery elsewhere. This simply shows that proper wound healing is important, especially since a hair transplant can traumatize existing hairs. Think about it — you’re making thousands of openings on the scalp, in areas where there are existing hairs. Existing adjacent hairs are bound to get damaged in the process. It is frustrating to work very hard to place all the grafts you want to see grow, and yet still lose grafts due to poor wound healing and trauma. This is where Hair Regeneration helps a great deal - it is a combination of platelet-rich plasma and extracellular matrix, and it helps thicken existing hair, prevents losses due to traumatic injury, and improves the graft’s survivability. People who come to us a month after having had transplants done elsewhere can benefit from this in terms of accelerating the healing and regrowth process of their grafts.Just remember that in the first 48 hours, the grafts are in and they’re holding — you’d actually need a surgical instrument to take them out. If something falls out, it is likely that the root of the hairs are still intact and will still grow. Also, keep in mind that in the first few months, you will experience shock loss where the hairs will go into an early shedding phase of the top part of the hair. It usually takes about 3-4 months for those hairs to regrow. I recommend that you also meet with the original operating surgeon and discuss your concerns. It’s very important to keep the line of communication open to see if there’s anything else that can help facilitate the healing of your hair transplant.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.
