When Transplanted Hair Grafts are Secure Enough to Allow Scalp Cleaning and Scrubbing

When Transplanted Hair Grafts are Secure Enough to Allow Scalp Cleaning and Scrubbing

Thank you for your question. You submitted your question with a single
photo and you stated in your question that you’re 15 days after undergoing 4000 hair
grafts and that you are a little bit concerned about potentially dislodging grafts because
there are a lot of scabs that seem to be attached to hairs. And you want to know how safe it
is to essentially be aggressive about shampooing and at what point after surgery are these
grafts are in a secure enough position not to be dislodged. I can certainly share with you how I counsel
patients for many years performing hair transplant. A little bit of 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, a system we developed using extracellular matrix
and platelet-rich plasma (PRP) to help patients expedite healing after hair transplant. And
this is actually a treatment we developed that has evolved into a very significant non-surgical
treatment for men and women with androgenetic alopecia or genetic pattern hair loss. In
addition to people who have had hair transplant who want to further manage their hair loss
beyond the time of their transplant. So to answer the question as to when is a
graft basically secure, I would say 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, well that’s not a graft that’s
going to make it anyway. A certain percentage of grafts do not make it. And as I said, that’s one of the reasons
why we developed what ultimately became Hair Regeneration was to help people during the
time, the critical period as well as beyond the critical period to expedite healing. The
biggest challenges of transplant especially with the strip method was to get the donor
area to heal as well as possible and get the grafts to heal as well as possible. If you
think about it, you have 4000 grafts that means you had 4000 incisions made into your
scalp. That is fairly traumatic. There’s a fair amount of bleeding and there’s a
fair amount of inflammation. We found that with extracellular matrix and
platelet-rich plasma (PRP) that we got improvement in the healing of the donor area as well as
graft survival. And 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 also able to manage their hair loss with this
treatment where injections are placed to the scalp to reactivate hair that is not growing,
to thicken thinning hair and to prolong the lifespan of hair that is thinning. Now as
far as the past 7 or 8 years of doing this, I also developed a classification system further
to optimize the dosage and delivery techniques to maximize the outcome and coverage of every
patient in addition to the use of any pharmaceuticals such as DHT blocker like finasteride and minoxidil
when appropriate. As far as patients who have had hair transplants
are concerned, again, I would say that, going back to your question you may wash your hair
aggressively. I can tell you that whenever we would tell our patients to wash their hair
aggressively, we found that they would still be very tentative about washing their hair.
And some patients, we would often ask them to come into the office and my technicians
would wash their hair and they would realize that 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 that the scalp can actually heal well and existing hair isn’t affected
by your scalp hygiene as well as the grafts themselves. But by 48 hours 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, I can tell you that a lot of
patients who have come to us who have had transplants done elsewhere and we’ve actually
been able to expedite the regrowth process as well as help the existing thinning hair
when they come in somewhere between the 1 and 3 month point after undergoing a transplant
and doing the injection of Hair Regeneration and there’s a protocol for that as well.
That’s not saying that you need that but it’s just to help you understand the wound
healing process. Wound healing is still a physiological process
that has a pretty stable schedule. There’s a hemostatic phase, inflammatory phase, proliferative
phase and then remodeling phase. And those processes will take their own time and thanks
to newer technologies, there are ways to help further expedite further stages of that process
and that’s something you can certainly discuss with your transplant surgeon. So I would encourage you to wash your hair
and expect that you will see some grafts not quite make it. You know, when you do a transplant,
the bleeding can push some of these grafts up and some of them might come up regardless.
And whether or not they do come up, I’ve had patients for example who have had mega
sessions done elsewhere and have lost 90% of their grafts. So I don’t want to scare
you but understand that there is a certain amount of attrition that happens with every
transplant and hopefully as long as everything goes as planned, you’ll get the desired
outcome. Certainly, you’ve already experienced how hard it is to have hair transplant and
how many hours it took to have it done. So I know your surgeon wants the outcome for
you but you should follow your surgeon’s advice as to washing your hair to appropriately
maximize from your side whatever can be done to help your transplant heal. So I hope that was helpful, I wish you the
best of luck and thank you for your question.


  • nimish dhakan says:

    Hello doctor how r u?
    Im using minoxidil since 1 year.. is it safe to continue?

  • Imran Muhammad says:

    Hello sir I had surgery in Istanbul 2 March 2018 after surgery I wash my head 16 March I fall my transplant hair grass with some small hair it’s normal

  • Aji A Vahid says:

    Sir ..how are u…sir i have hair transplnt in india..after 12 days i am cleaning scab..but some scab with hair is falling..it is normal sir?..i am very tensed about that..please help me..

  • muhammad khan says:

    good evining Mr M.D, Prasadhope that you are doing very welli did like a 2 weeks befor hair transplant in the germany and would like to knowif i can oil and massage my scalps ?and what do you thing about Vitamin E capsules to mix with babay oil and massage the scalps or transplanted hair ?i hope to answer my question
    wish you all the best and thank you for your videos and helping us
    mohammad humraz

  • mallu experiments says:

    hii doctor after 2 months of transplant I can see dandruff accumulated in the transplanted hairs my doctor advised me to wet your hair and remove it with toothbrush. while doing this I can see all the hairs falling out with dandruff will the lost come back or is there any problem

  • Bobby P says:

    Thanks Dr.Prasad I feel a bit more comfortable washing my hair a bit more aggressively. My doctor did clearly state in his Post Op Instructions that After Day 6 of the surgery there is almost no chance for the grafts cells to fall out since they are already healed in place. It seems that you also have the same consensus as him – but you also need to understand the patients worry since most of us do not have medical school training and do not know all the intricacies of how the scalp and follicles function. And also can you give me some of your hair!? Ha! You are lucky. My dad also has great hair and he is almost 60 and I have been thinning and losing hair…it's tough – but I just completed a transplant to add density, going on 1mg finasteride and using laser therapy. Praying and hoping for best and judging by your videos you also have a very warm personality and seem very humble. Take care doctor.

  • Sharik Wani says:

    Hi doctor. . Can i wear winter cap for 2 hours a day after 5 days of transplantation?

  • Emre Bilge says:

    Dr. Prasad, I've shed scabs in 10-12 days, but some of them returned weeks after that. I didn't shed them at first, because I thought they're hair roots sprouting. So these new scabs remained on my scalp for several weeks till I shed them once again. Might this have harmed my transplant?

  • vatsal joshi says:

    Doc i have used high intensity water with spry water bottle to wash crust present after 1 month and due to which i shed many hairs so was shedding due to high water pressure or is it normal

  • vatsal joshi says:

    Crust present after 1 month of hair tranaplant dose it affect the hairs plz rply why it is need to clear early i got late i am worried dose it affect rhe result

  • *Mission_possible* says:

    Thank u doctor!very very informative!

  • Eng. Altamimi says:

    Hi doctor, i had a beard transplant 7 days ago, and I’m stuck at home because i cant face the world with the black spots all over my cheeks. Is it okay to be more aggressive in shampooing at this stage? Today is the 7th day after operation and black spots are still covering my cheeks which makes me look like a monster

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