Extreme massaging - what are the chances that I have damaged/lost grafts? (Photo)

Question

I had a FUE hair transplant about 4.5 months ago. However, I massaged my head extremely hard 6 weeks after my hair transplant and noticed a lot of small hairs fall out. As of today, there has not been much growth, specifically in the area that I massaged hard (frontal region). Of course I learned afterwards that I should have only gently massaged my hair. What are the chances that I have damaged/lost grafts from massaging too hard?

Marco Barusco, MD · Answer

Hello,

At 6 weeks post-transplant, the grafts are typically well-anchored, so it’s unlikely that massaging too hard caused permanent damage. The hairs that fell out were likely in the shedding phase, which is a normal part of the hair transplant process. Growth in the frontal region may take longer to become noticeable, as full results often take 9–12 months to develop. Be patient, and consult your surgeon if concerns persist.

Best regards,
Dr. Marco Barusco

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns regarding your FUE hair transplant. It’s understandable to be worried about the potential impact of massaging your scalp too vigorously after the procedure. Here are some insights that might help:

Graft Stability: By 6 weeks post-transplant, the grafts are typically well-secured in their new location, making it less likely that vigorous massaging would dislodge them. However, excessive force might still affect the surrounding scalp and hair follicles.

Shedding Phase: It’s normal to experience some shedding of transplanted hairs in the weeks following the procedure. This is part of the natural growth cycle, and new hair growth usually begins within a few months.

Growth Timeline: Hair growth after a transplant can vary significantly from person to person. It is common not to see substantial growth until 6-12 months post-procedure. The lack of growth in the massaged area might not necessarily indicate graft loss.

Consult Your Surgeon: It would be beneficial to consult with your hair transplant surgeon. They can assess your scalp and provide a more definitive answer regarding the condition of your grafts and expected growth.

Gentle Care: Continue to follow your surgeon’s post-operative care instructions, including gentle handling of your scalp, to support optimal healing and growth.

I hope this information helps alleviate some of your concerns, and I recommend reaching out to your healthcare provider for further evaluation.

Best regards,

Ross Kopelman, DO · Answer

At 4.5 months post-FUE transplant, the grafts should generally be securely rooted by that point. However, massaging your scalp too aggressively, especially at the 6-week mark, may have caused trauma to the delicate new grafts. If you noticed a lot of small hairs falling out during that time, it could have been shock loss&mdash;a temporary shedding of transplanted or existing hairs, which sometimes occurs as the hair follicles cycle through their growth phases.
The fact that you haven’t seen much growth in the area where you massaged hard could mean that the grafts were stressed or dislodged. However, it’s also possible that this area is just slower to show regrowth, which can vary from person to person.
While it’s difficult to say with certainty whether you lost grafts permanently, the good news is that in most cases, damaged grafts don’t always mean permanent loss. I’d recommend giving it more time, as full growth can take up to 12 months or longer to manifest. If the growth still seems sparse after a year, a follow-up with your surgeon might be necessary to discuss options such as PRP therapy or another touch-up procedure.

Matt Tahsini, MD · Answer

Hello and thank you for your question. I don't think massaging harmed your results although it didn't necessarily help either. You are 4.5 months post op and it takes a good 9 months to notice results. Be patient until 12-18 months and if your results are not acceptable see your surgeon. Best wishes to you.

Dr. T

Dr. T

George Abrahamian, MD · Answer

Hello, Dr. George Abrahamian MD here, from La FUE Hair Clinic in Pasadena, CA. 
At the 6 week mark after a hair transplant, the grafted hair follicles are securely anchored in place. It would be very difficult to damage those grafts with a massage. The vast majority of grafts are set in place after about 2 weeks, and typically only blunt force trauma (hitting your head), chemical trauma, surgical removal, laser removal, and sun damage to the head can traumatize the grafted area after that point. The small hairs that fell out during your massage were likely vestiges of the grafts that were implanted, would never have grown, and needed to be cleared for the new hair follicle to grow new and more stable hair. That being said, you should exercise caution with your transplanted area regardless. You are only at 4.5 months post transplant, and that means you should only see about 25-30% of your growth, and not all of the grafts will sprout at the same time. The middle of the scalp can often also lag behind in growth, as it is known as a Watershed Area, where the blood flow is the weakest due to arterial anatomy, so that area being delayed in growth is quite common and often catches up between months 6 and 12. The best timeline to judge the results of a transplant are at 6 months, 9 months, and 1 year. If after one year the results are not where you want it to be, it would be time to consider a second transplant. 
I hope this helps, and best of luck on your hair restoration journey!

Ilhan Serdaroglu, MD · Answer

I  dont think  that Extreme massaging may cause a  serious  damage . Also 4,5 months is  very  early  to  assess the yield and to be  disappointment  .New hair at transplant area start to grow at 3-4 th month after surgery and continues until the 6th month. But the hair that grows within 6 months becomes dull, thin and weak. It may take 8-13 months for the hair to take its full form and regain its original thickness and full  donor site character.

Audrey G. Bauer, MD · Answer

Without a direct exam & inspection of the grafted area it will be impossible to tell.  I think the most prudent thing to do would be to follow up with your surgeon for an in person visit so that they can look at your scalp with a dermatoscope or magnifying loupes and see what is going on.  It may be that the hairs you saw falling out were not full grafts but just loose hairs that normally fall out around the 3-4 month mark and now you are just waiting for the new hairs to emerge from the stem cell at the base of the follicular unit, which is very typical appearance-wise this early on.  It's often hard to see much new growth until 6-8 months post op.  But please do contact your surgeon, as I know we all want to be aware of any problems as early as possible and also want to be able to reassure our patients too.  Hope this helps.

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