Be careful with new grafts for long time..

[Patricia]

I have been really, really gentle with my new grafts....still using light "cup" method for washing my hair in the recipient area, using spray, etc. Overall, I have had very few scabs and things have been healing well. I was reading things on here around 2:00 a.m. this morning (which technically makes this day 12) and was gently massaging a couple of scabs with fingertips, (I do not have long nails at all) and all the sudden got bleeding and lost a graft. I was not scratching and thought I was being careful. I thought after 7-10 days (and certainly by 12) they would really be in there... Any thoughts?

 

gone today...hair tomorrow...

[Patricia]

I have been really, really gentle with my new grafts....still using light "cup" method for washing my hair in the recipient area, using spray, etc. Overall, I have had very few scabs and things have been healing well. I was reading things on here around 2:00 a.m. this morning (which technically makes this day 12) and was gently massaging a couple of scabs with fingertips, (I do not have long nails at all) and all the sudden got bleeding and lost a graft. I was not scratching and thought I was being careful. I thought after 7-10 days (and certainly by 12) they would really be in there... Any thoughts?

 

gone today...hair tomorrow...

[Peter Mac]

Yes, the grafts are held loosely in place for a few days. By day 8 or so they are fully secure. If you lose a graft at day 12 the matrix cells have been planted and the follicle will regenerate. A large percentage of transplanted follicles shed between 2-8 weeks. That is normal and expected. Did you spray your scalp with a solution like saline or Graftcyte every hour or two post op for a few days? I share the opinion that scabs should not be allowed to form on recipient sites. If some scabs did form, it means a few recipient sites were allowed to dry out and they formed scabs to protect themselves. Perhaps a few of them didn't get enough of the spray. That's why you are bleeding. You popped a scab where the body hadn't finished healing the skin underneath. Regardless, the follicle will likely regenerate so I don't think there's anything to worry about.

[Patricia]

Thanks for your reply...I didn't want to sound like a "wimp" so I just said "bleeding", actually blood went down my arm, on the keyboard and was a lot of blood. I held the area for 10 minutes with pressure like the post-op instructions say and there still was a good amount so I know I really did dislodge something.. Also I saw the hair and it was an interesting observation...it was quiite a bit longer than the couple of other grafts that fell out and half of it was red(blood I presume) How deep are they put in the scalp?

 

gone today...hair tomorrow...

[Peter Mac]

Ideally grafts should be placed into the hypodermis of the skin aka the subcutaneous fat. This usually extends about 3-4 mm deep. Not only does this depth vary by individual, it varies on different parts of the scalp. It's a very fine line. The surgeon wants to enter the subcutaneous fat with his slit or needle, but if he goes even slightly deeper he might nick or completely sever the subdermal vessels which nourish the scalp and provide the blood supply for new grafts to grow. If he does too much damage to the subdermal vasculature it could impede growth. Interestingly, we've seen body hair follicles don't usually grow out of the hypodermis. They are often found in the dermis which makes them much more difficult to extract. I've been watching body hair FUE extractions vs. head hair extractions lately. Head hair FUE is a walk in the park compared to body hair FUE which is why the surgeon can extract twice as many head hair grafts per day.

 

It could be your surgeon placed the graft extremely deep, below the hypodermis and in the area of the subdermal vessels. It could be that the follicle somehow tangled itself around a subdermal vessel. When the scab came off the hair pulled through and severed the vessel. Imagine if you tied a sharp chain around a thin garden hose and yanked really hard, severing the hose. Water would start to spray everywhere. That's kind of a bad example, but you get the picture. A hair follicle is only 100 microns in width. I think it's highly unlikely that it could tangle up with and sever a subdermal vessel, but still possible I suppose. Blood vessels run all through the dermis so it's more likely that the follicle ripped through quite a few dermal vessels on its way out and that's why you had so much bleeding. Or your dermal and/or subdermal vessels hadn't fully healed yet from the transplant and the hair that came out simply aggravated pre-existing injuries to these vessels. It's impossible to know precisely since we didn't stick a camera inside the skin to watch

 

In skin, the easiest way to think of your blood vessels is like a tree. The SUB-dermal vessels are like a tree trunk and the smaller DERMAL vessels are like branches. You stop the tree from bearing fruit by doing one of two things: 1) chopping the tree down at the trunk or 2) cutting off all of the branches. You can generate a lot of bleeding (killing the fruit) by damaging the subdermal vessel (chopping the tree at the trunk) or damaging many dermal vessels (cutting off the branches). Both will have the same cumulative effect on how how much blood you see.

 

I could wax my chest which would cause a lot of bleeding too, but the hair would all grow back. I waxed my back once and that happened (don't ask me why I was stupid enough to think that would work). But I bled a lot and all of my hair grew back.

 

Once the matrix cells of the follicle are safely in place in either the lower dermis or the Hypodermis (Subq fat), the hair will likely regrow. Interestingly, some dermatological studies have shown dying follicles reach deeper into the Hypodermis once the patient started Propecia. It could be theorized that some grafts may attempt to work their way into the Subcutaneous Fat even if their initial placement was only in the lower dermis. Perhaps like tree trunk roots reaching the right depth. I don't know of any dermal scans to prove the theory however post transplant, although it sounds like an interesting study.

 

If the follicle was damaged during the transplant (i.e. left out of storage solution too long, transected, inserted with too much force) it might also affect the growth. Many transplant patients see their hairs come out with scabs and panic. There is no reason to. The follicle is not the hair matrix cells that generate a new follicle. If you lose the graft replete with all of it's sebaceous glands and other surrounding skin cells immediately post transplant, then you've probably lost the hair. If that happens I must ask what on earth you are doing. Immediately post op your follicles are held in place by fibrin, the body's natural glue, which is created by a chemical reaction in the blood serum during the graft placement. The Fibrin helps to protect your grafts from displacement while your bodies wound healing agents generate new skin and repair the damage of the graft incision.

 

If you are at the 12 day point you should expect to start seeing more and more shedding every week for a few weeks.

 

However, this discussion is probably overkill. We're only talking one follicle right?

 

I hope I've answered your questions.

Feel free to contact me via e-mail if you have anything else you'd like to ask privately.

 

PeterMac@dhi.gr

 

[This message was edited by Peter Mac on December 15, 2003 at 12:36 AM.]

[JohnH]

Join the club Patricia. A couple of years ago I had a procedure and about 2 weeks into it I scratched a graph out. It bled pretty good and I was surprised that I could lose one at 2 weeks. I had felt a scab in my hair and thought it had come loose so I pulled at it and out it came! A lot of folks lose a graft or two. It's really hard to keep your fingers away from the scabs, especially when they are falling off by the dozens.