Secure Grafts 3 or 10 Days

[Maxxy]

Hi All,

 

This no longer affects me as I'm almost a month post op, but I'm curious to know the answer to this question and I'm sure it will help other guys to know.

 

While reading the forums on this site and others this answer keeps catching my eye, alot of guys say "don't worry by 3 days your grafts are secure" but then just as many if not more guys say "Don't worry by day 10 the grafts are secure"

 

So which is it guys are the grafts secure by the 3rd day or infact not until the 10th day?

[Bill - Seemiller]

Maxxy,

 

I've only ever heard Spex say that the grafts are secure after 3 days and I'm waiting for his explanation (I don't recall him answering me when I asked).

 

However, the way I see it is this. You're not going to wake up one morning and be able to say "the grafts are secure today". It's a gradual process of healing. After the first few days, the grafts are going to be a lot more secure than the day of your transplant.

 

After a week, depending on your healing characteristics, the size of the incisions and grafts, etc, your grafts will all be most likely completely secure.

 

BUT - to be safe - giving it a few more days to heal before wearing a snug fit hat or doing anything that will rub against them won't hurt.

 

In that respect, I think it's safer not to be too vigorous with the grafts for the first 10 days. Where 10 may be on the conservative side of the spectrum, messing with the grafts 3 days after surgery may be on the dangerous side.

 

I'm all about minimizing risks, especially after you've spent a truck load of money to restore your hair.

 

Best wishes,

 

Bill

[Maxxy]

I have to say I agree with everything Bill says guys.

 

My advise to anyone going for surgey is to play it safe and go easy for 10 days.

 

Even if the grafts are secure after 3 days why risk it, after spending that much time and money on your transplant what's another 7 days for the peace mind.

[latinlotus]

I think there is an issue of healing as well. The quicker you remove the scabs (once grafts are secured), the quicker your recipient site will heal, and the quicker/the more blood will flow to nourish the grafts. It is a great balancing act.

[mochi]

I'm wondering as well... I had my operation 5 days ago. I noticed a lot of scabs obviously and when some fall out after some gentle nudging. Looking at the scab i see a strand of hair attached to them, but no bleeding on my scalp afterwards... no idea if that means i lost the graft or if the hair just fell out...

[Maxxy]

Hey Mochi,

 

Don't worry m8 the same happened with me and after researching it, it's very common for hair to come out with some scabs.

 

My doc actually told me it would happen but I was still worried when it did however after reading posts you'll find its totally normal and expected.

[mochi]

Now at day 8... all my scabs actually fell out after day 7. I started to gently wash my hair at day 4 with shampoo then conditioner at day 7. I feel as if all my grafts are in place by now... the 5 or 6 I lost due to my "idle hands" happened the previous days. I would definitely say that by day 3 grafts were not resistent to my probing fingers.

[Maxxy]

Sorry to bring this thread up again, but this topic keeps coming to my attention.

 

Steve Gabel MD (a coalition doctor), in a recent post said the following:-

 

16 days out from the transplant should be fine. By that time, the grafts have "seeded" and it is more difficult to dislodge the them.

 

At what point will surgery be the only thing that is going to remove these grafts?

 

I've heard 3 days, 10 days and now from a coalition doctor - "well in 16 days they are more difficult dislodge".

 

There has to be a point when the grafts are in and are in to stay surely - where no amount of hair washing, hat wearing or head bumping is going to "dislodge" the grafts, isn't there?

 

Im sure people and doctors are not just picking these numbers out of the air, so why does Spex and Dr. Feller say you are safe at 3 days? A lot of people say 10 days and now Dr. Gabel says "they are more difficult to dislodge at 16 days" - where do these numbers come from? What studies have been done to give surgeons these timelines? What were the findings and why do they vary so much?

 

Sorry if I come across as if I'm pi**ed off, I just find it worrying that guys can be reading the forums and coming to the conclusion that they are safe to wear a hat or wash their hair a little harder at 3 days when in fact they are not totally safe at 16 days.

[crow1]

Can you wear a loose fitting baseball hat 7 days post op, without risking the grafts?

[dreamermerlin]

I think there is an issue of healing as well. The quicker you remove the scabs (once grafts are secured), the quicker your recipient site will heal, and the quicker/the more blood will flow to nourish the grafts. It is a great balancing act.

 

I don't think so. Blood comes to the graft underneath the skin, the scab is above, i don't think there's any connection between scab and blood flow.

[Spidey]

I think the reason for the various numbers are because no one person heals the same. I would suggest that those who are smokers, don't eat very healthy, drink alcohol, older in age , and/ or had larger number of grafts, be on the conservative side, and wait the ten days. People who are the opposite of the things I listed probaby heal more quickly.

 

At the end of the day you should follow your surgeon's advice whether or not it conflicts with what others say on the forum or even Google.

[gillenator]

I don't think so. Blood comes to the graft underneath the skin, the scab is above, i don't think there's any connection between scab and blood flow.

 

I agree as the blood supply is established in the underlying dermis layer of scalp tissue.

[Dr Blake Bloxham]

I think the confusion in numbers comes from a few seemingly conflicting studies.

 

The first study, done "back in the day," looked carefully and closely at how long it took for grafts to "anchor." The results showed the "7-10" day mark that we all quote today. The problem, however, is that the study didn't look at follicular unit grafts (FUGs). Remember how I said "back in the day?" Back then, micro, minis, multiple-FUGs -- however you'd like to describe it -- were used in hair transplant procedures, and this is what they looked at in the study. However, this data doesn't really apply to actual FUGs because these modern grafts are so much smaller and more physiologically normal.

 

Drs Bernstein and Rassman followed up with a study in 2006. These studies were done on actual FUGs. The results? Grafts are unstable and non-anchored for the first 2 days. By day 3, the anchoring process was more matured and the chance of losing a graft via manipulation "decreased." Between days 3-8, grafts could still be dislodged with pretty severe manipulation. By day 9/10, grafts were -- for all intents and purposes -- anchored and permanent.

 

So this is where a few of the conflicting points of view come from. As you can see, this is why some are more comfortable with 3 while others say 9-10.

 

Now, the real question: why would anyone say less than 9-10 days? Well, the 2006 study was only done with "large" follicular units and incision sites made with 18 gauge needles. The study also looked at scabbing and how this influenced graft dislodging. The theory behind 3 days, 5 days, 7 days, is the following: when using smaller and smaller incision sites, like those made by custom cut blades, the anchoring process is quicker and risk of dislodging decreases.

 

We tell patients they are anchored by day 3. And we use custom cut blades with lateral incisions and dense packs. But, I do usually throw in a few things I still don't recommend until day 7-10 or so. These aren't usually big concerns, but those FUGs are precious!

 

But, do you want to know the real "moral of the story" or answer to this question? Just follow your clinics instructions to a T! If they say 10, they have their reasons. And I would recommend taking the necessary precautions during the first 10 days. Same story if they say 3, 5, or 7. This is a "win-win" for everyone involved!

 

Reference:

 

Robert M. Bernstein, MD, New York, NY and William R. Rassman, MD, Los Angeles, CA

Dermatol Surg 2006; 32: 198-204