How to differentiate a crust coming out if it's with a follicle or without a follicle? (photo)

I'm 1 week post HT, per my doc instructions I started Gently with shampoo and conditioner beginning day 3. Over the past couple of days a lot of scab and crust came out with washing. I do not see any hair in the crust. I have tendency to rub my scalp and more crust comes out. I noticed few spots with little bleeding. I'm worried if my grafts are coming out. Your responses are appreciated. I'm attaching a photo.

Doctor Answers 7

Grafts are very strong shortly after the transplant, and having hair in a fallen scab does not mean the root is lost

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Your concern is very common. Everyone who had a transplant is afraid that they will dislodge the graft and think that grafts are very delicate. In our practice, we do a fair number of hair transplants and the routine is fairly straightforward. We do hundreds or thousands of grafts in a session and within the first 24-48 hours, the grafts are so well in place that it would take a surgical instrument to physically remove the graft from the scalp. We also use a material called extracellular matrix which further facilitates the healing process and treats the thinning hair concurrently.

The scabs that you see are the combination of some old blood, some very dry skin and are a part of a normal healing process. In the first week, we have our patients wash their hair with a bowl of water and pour it gently to let this superficial scabbing dislodge. We also let them spray the hair with some saline to keep it just a little bit moist. By the second week, we encourage our patients to scrub a bit. Of course, we do examine our patients before we give them this advice to make sure that they are not doing anything that can be traumatic.

Seeing a hair in the scab doesn’t mean you lost the graft. The base of that graft is called the dermal papilla which is the root of the hair. It’s actually the one that does the growing. Sometimes, what happens is that the hair will break or shed and that is normal. I think communicating with your doctor is critically important. Every experienced hair restoration surgeon will be able to give you an advice from their experience. I’m sure that with a little bit of guidance, you can anticipate what will happen beyond this initial early point in your healing process. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Try not to rub the crusts

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At 1 week after hair transplant the grafts should be well on their way to healing.  The only concern is if you rub the crusts too vigorously you can dislodge them and you will see bleeding.  Most likely you have not disturbed too many grafts and will have a good result.  Just be patient and allow the crusts to fall off on their own.  Good luck.

Adam Saad, MD
Atlantic City Plastic Surgeon

Washing after surgery

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An FUE is treated just like a regular hair transplant with regard to the recipient area, but the donor area has open wounds which require daily washing with soap and water. Within 3 days of surgery, you can resume full activities, heavy exercises if you wish. The recipient area requires daily washes as well to keep the recipient area free of crusts. I generally recommend the use of a sponge and supply my patient with a surgical sponge to fill with soapy water and press on the recipient area daily. By repeating this daily, all crusts can be washed off without any fear of losing grafts. IF any crust are present, use a Q tip and dip it into soapy water, and roll it on the crusts and that will lift them off without dislodging them, but never rub them, just roll the Q tip on the recipient crust. I like to see no evidence of any crusting in the recipient area and the crusts from the donor area gone in 7-10 days with daily washing,.

William Rassman, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 29 reviews

Post op care

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The hair shaft usually detaches from the hair follicle and falls off with the scabs.  The follicle looks like a little bulb and if it is attached to the hair shaft while shedding then the implanted hair is lost. 

Michael Meshkin, MD
Newport Beach Hair Restoration Surgeon
4.9 out of 5 stars 29 reviews

Call your doctor if something doesn't seem right.

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If you are concerned please follow up with your doctor for an exam.
You will have hair loss after surgery. You may have graft loss after surgery. Not all the grafts will take. You won't really know until you see results in 6 to 12 months

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 106 reviews

Hair transplant - how to tell if we are losing grafts

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Be gentle with your grafts for at least a month.  This is not the time to be rubbing your scalp.  You have invested in your self, take the time to heal and your grafts will take fine.  Best Wishes..

Crusting after hair transplant

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Dear sam, thank you for your question. It is important to be careful with recipient sites for the first week after your hair transplant. We advise our San Diego hair transplant patients to avoid rubbing and gently rinse the area with lukewarm water and baby shampoo. During this time you may notice the scabs loosening and falling out. Once the scabs are gone, your grafts will become more solid and are generally safe after two weeks. Follow up with your surgeon to express any concerns. Good Luck!

Roy A. David, MD
San Diego Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.