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

Question

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.

Stefan Mark Szczerba, MD · Answer

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..

Levent Acar, MD · Answer

The crusts you see are  blood  rests and dry skin and it’s normal. During the first week, wash your hair with a glass of water, to help the crusts to fall, without touching it.
At 7 days you can start doing small massage to help more these crusts to fall, but do not rub, it can damage.After 15 days the grafts are well implanted.Losing grafts with crusts is normal

Jae Pak, MD · Answer

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

Satinder Singh, MBBS, DNB · Answer

During initial 10 to 14 days, one should not rub the transplanted area because this much time is generally required for the graft to take up. For washing during this period one should gently pour the shampoo solution over the transplanted area and rinse it with gentle pouring of water. Some crust may come off with the hairs in it that are generally not grafts, they are the hair shafts which breaks from above and comes out and embedded in crust. Grafts have a bulb like structure which is papilla at the end of the hair which is embedded in the scalp. It generally comes off with the bleeding from that spot.

Adam Saad, MD · Answer

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.

Roy A. David, MD · Answer

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!

William Rassman, MD (retired) · Answer

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,.

Michael Meshkin, MD - Account Suspended · Answer

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.

Amiya Prasad, MD - Account Suspended · Answer

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

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