Hair transplant - 4200 grafts - 24 days and no hair shed - is this normal? (Photos)

Thank you for your question. You state you underwent 4200 hair grafts, are at day 24, and you are concerned about the lack of hair shedding. You’re also concerned about damage from your head being rubbed significantly at day 21.
I can share with you my perception of what you’re going through.  A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers from a system we developed using regenerative medicine technology that evolved from application to hair transplant surgery.
The time in which hair sheds is variable soon after surgery. There is something called shock loss that is not uncommon where hair from grafts will shed, and even native hairs in an area where the grafts are placed will also shed, which can happen in the first couple of months. The results of a hair transplant require just waiting about a year after a transplant. It’s not unusual for people to be concerned because of some shedding a few weeks out where things can look patchy. For now, don’t be worried that there wasn't shedding, and be prepared that there may be some shedding in the upcoming weeks.
For the scalp rubbing, once a graft is in place for a few days, it takes a lot of effort to dislodge it. In other words, wound healing occurs in such a manner that if a hair graft is going to survive, it will survive the hair rubbing. Often, patients are very scared to do anything like wash their hair, and actually have to come in the office to have our staff rub and clean the scalp.
When it comes to this type of scenario, we have a lot of experience when we were doing a lot more transplant surgery. We wanted to achieve less shedding because that can be very distressing. We wanted to have better graft outcomes with the healing, survival of the grafts, and the donor area to heal better. We used this material called Acellular matrix combined with platelet-rich plasma (PRP). We did find there was less shedding after this combination of treatment, but also saw that thinning hairs became thicker. We have been using this method we derived after treating so many patients over the past 7-8 years who travel from around the world with thinning hair, that we’ve developed a protocol and system for different classifications of patients that factors in age of onset of hair loss, degree of progression, current age, other medical procedures such as having a hair transplant. We’ve been able to help people in a way that’s non-surgical using regenerative medicine technology.
This particular aspect of our practice has been leveraged further in helping patients who had hair transplant done elsewhere. Patients who have undergone hair transplants like yourself are frequently scanning the web to learn about ways to optimize hair growth. Often, people come across our information, and come in somewhere between the first and third month after a transplant. What we can do in many patients, expedite their healing, have regrowth of their grafts sooner than the one year point, and help their existing thinning hair. There seems to be a certain group of patients, not saying this is applicable to you, who were able to benefit from regenerative medicine technology even if it wasn't used at the time of the surgery. This is something to learn about, but not something that’s required for you to have a successful outcome.
It’s very important to maintain communication with your doctor. These are the questions that every one who does hair transplant surgery gets asked regularly. It’s important for you to maintain this dialogue, and do your follow-up visits with your doctor so the optimal management of your transplant healing process is maximized. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Sometimes it can take a while for hair to shed and sometimes it might not even shed at all. Your condition looks normal.

It is normal to shed transplanted hairs weeks after surgery.  The new hairs may take 6 to 12 months to grow.Some may take more or less time to shed.