How long after a HT are grafts fully secure and can't be dislodged even with vigorous massaging and shampooing? (Photo)

Question

15 days after 4000 grafts hair transplant, My scalp still had some big scabs so the doctor advised me to massage my scalp while shampooing a bit harder than before in order to remove these scabs. I followed his instructions but I'm worried that I disloged some grafts since few scabs looked like clotted blood and had hairs attached to them. However there was no bleeding, pain, or redness. How long after ht are grafts secure can't be dislodged even with vigorous massaging.

Jae Pak, MD · Answer

It takes a few days for the grafts to be secure.  Many doctors give caution to their patients for the first two weeks.  If you are worried about dislodged grafts it is best to contact your doctor.

Karl Hekimian, MD · Answer

Usually by a week postop the grafts are stable and you can start massaging more vigorously.  If your surgeon is comfortable with you being more aggressive there should be no problems.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You submitted a single photo, and state you’re 15 days after undergoing 4000 hair grafts, and you are a little concerned about potentially dislodging grafts because there are a lot of scabs that seem to be attached to hairs. You want to know how safe it is to be aggressive about shampooing, and at what point after surgery are these grafts in a secure enough position not to be dislodged.
I can share with you how I counseled patients for many years performing hair transplants. 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, based on a system we developed using extracellular matrix and platelet-rich plasma (PRP) to help patients expedite healing after hair transplant. This is treatment we developed evolved into a significant non-surgical treatment for men and women with androgenetic alopecia (genetic pattern hair loss), and also for people who have had hair transplant who want to further manage their hair loss beyond the time of their transplant. 
To answer the question about when a graft is secure, from experience and doing every kind of hair transplant technique since the mid 90s, I would say that within 48 hours, a hair graft is pretty well secure. If a graft is above the  skin and attached by a clot, that’s not a graft that’s going to make it anyway. A certain percentage of grafts do not make it. 
One of the reasons we developed what ultimately became Hair Regeneration was to help people during the critical period, and beyond the critical period to expedite healing. The biggest challenges of transplant especially with the strip method are to get the donor area and grafts to heal as well as possible. If you think about it, you have 4000 grafts means you had 4000 incisions made into your scalp, which is fairly traumatic. There’s a fair amount of bleeding and inflammation in transplant surgery. 
We found that with extracellular matrix and platelet-rich plasma (PRP), we got improvement in the healing of the donor area as well as graft survival. As an additional benefit, we found that thinning hair became thicker. From this, we developed Hair Regeneration, TrichoStem™ Hair Regeneration where people with male and female pattern hair loss are able to manage their hair loss with injections to the scalp to reactivate hair that is not growing, thicken thinning hair, and to prolong the lifespan of hair that is thinning. As far as the past 7 or 8 years of doing this, I also developed a classification system to optimize the dosage and delivery techniques, maximize the outcome and coverage of every patient, and in addition to the use of any pharmaceuticals such as a DHT blocker like finasteride, and minoxidil when appropriate. 
As far as patients who had hair transplants, going back to your question, you may wash your hair aggressively. Whenever we would  tell our patients to wash their hair aggressively, we found they would still be very tentative about washing their hair. Some patients would come into the office, and my technicians would wash their hair, and they would realize they were not being aggressive enough. At a certain point, you have to scrub the scalp to get rid of the dead skin as well as the scabs so the scalp can actually heal well, and existing and grafted hair aren’t affected by your scalp hygiene. By 48 to 72 hours, it would actually take an instrument to remove those grafts, so I think you can feel secure about that. 
As an aside, a lot of patients who have come to us who had transplants done elsewhere were able to expedite the regrowth process, and help the existing thinning hair when  treated between 1 to 3 months after transplant surgery with Hair Regeneration.  There’s a protocol for that as well. Not saying you need that, but it’s just to help you understand the wound healing process. 
Wound healing is a physiological process that has a pretty stable schedule. There’s a hemostatic phase, inflammatory phase, proliferative phase, then remodeling phase. Those processes will take their own time, and thanks to newer technologies, there are ways to help expedite further stages of that process that you can discuss with your transplant surgeon. 
I encourage you to wash your hair, and expect some grafts not to make it. When you do a transplant, the bleeding can push some of these grafts up, and some of them might come up regardless. Whether or not they do come up, I’ve had patients who have had megasessions done elsewhere and lost 90% of their grafts. I don't want to scare you, but understand there is a certain amount of attrition happens with every transplant, and hopefully as long as everything goes as planned, you’ll get the desired outcome. You’ve already experienced how hard it is to have a hair transplant, and how many hours it took to have it done. I know your surgeon wants the outcome for you, but you should follow your surgeon’s advice on washing your hair to appropriately to maximize whatever can be done to help your transplant heal. I hope that was helpful, I wish you the best of luck, and thank you for your question.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.

William Rassman, MD (retired) · Answer

Grafts are secure about 5 days after all of the crusts are off. I wrote a paper on this and found that once the crusting was off, the grafts are secure within 12 days

Prabdeep Sohi, MS, MCh - Account Suspended · Answer

15 days after a hair transplant you cannot cause any harm to the grafts as they have healed completely by now. If you see some hair along with the scabs its normal as the implanted hair tend to shed in the first 3 months after the surgery. They will begin to grow from the third month. Massaging with slight pressure while washing your scalp should be helpful to clean the scalp. You could always consult your doctor for a better clarity.

How long after a HT are grafts fully secure and can't be dislodged even with vigorous massaging and shampooing? (Photo)

Answers (5)

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