Just had HT done

[Hwrd]

Just had about 800 grafts done, I am post op day 3. I see a bunch of areas where little "nubs" of the grafts are higher than the scalp, almost if they are going to be pushed out. This is in quite a few places. Is this normal? I didnt/dont have much swelling, plus I am finishing up a dose pack. Is this normal? are the grafts going to sink back in or are they going to pop out?? I only had one come out so far. I just started washing my hair three times a day with baby shampoo/water and some H2O2 rinsing. Is this normal? I know towards the end of the surgery I had a few of the grafts popping out, just concerned.

[Hwrd]

Just had about 800 grafts done, I am post op day 3. I see a bunch of areas where little "nubs" of the grafts are higher than the scalp, almost if they are going to be pushed out. This is in quite a few places. Is this normal? I didnt/dont have much swelling, plus I am finishing up a dose pack. Is this normal? are the grafts going to sink back in or are they going to pop out?? I only had one come out so far. I just started washing my hair three times a day with baby shampoo/water and some H2O2 rinsing. Is this normal? I know towards the end of the surgery I had a few of the grafts popping out, just concerned.

[John_in_NC]

a Doctor will hopefully jump in, but I think that's normal--especially after a shower or moisture. The water makes go up a bit, but I believe you will be fine. Just don't touch them in any way, shape or form.

[Hwrd]

great thanks. I had one graft come out so far, bled like a stuck pig. Just worried about the others. I will give him a ring monday and see what he says, I dont think that anything can be done other than watchful waiting. I didnt traumatize them or anything. I will continue with the ice and pray for the best.

Also, I hope I am happy with the results in 9 months. He said I needed about 1000 and ended up with 800 or so grafts but I am around a stage 2, mostly receeding in the temporal areas. The doc filled in on top more than I thought he would, and less in the temporal areas where I wanted but I think he was thinking more long term. Hope the fill is adequate. Any comments??

[Mark H]

800 seems like a small number, but perhaps I'm simply jaded by all the large Hts we talk about here.

 

Who is your doctor? Didn't he give you a post op procedure? Did he tell you to wash your hair 3 times a day? I've never heard of such a thing. You do realize that your grafts are not seated in tightly. It will take a week, maybe two for that to happen.

 

Grafts popping out DURING surgery? My understanding is that shouldn't happen, although it can if your scalp isn't properly numbed.

 

How do you end up with 20 per cent less grafts than the doctor himself says you need. I've never heard of that. Typically a doctor will go over just a little, but less?

 

And why on earth would the doctor deviate from your agreed plan and put more grafts where you didn't want them?

 

You and your doctor appear to have a real disconnect here. Who is this guy?

 

Listen, there are guys on here more experienced than me, but I've got alarm bells going off.

 

mark

[JohnH]

Big red flag here!!! I too am curious who your doc is. Almost sounds like the recipient incisions were not made deep enough. For a 1000 graft session, he should have erred on the up side not the down side.

[the B spot]

When grafts pop out during surgery it usually means your surgeon and the assistants are trying to place grafts into incisions too large or too small.

 

I have NEVER heard of a good doctor stating a 1000 grafts are needed, only to harvest 800.

 

You need to get your strip measurements pronto, and find out what you donor density is from another doc.

 

The strip required for 1000 grafts is usually 12-13.5 cm X 1 cm wide (based on an average donor of 80-85 fu's cm/2)

 

The best thing about all of this is you had a relatively small session. Regardless of how much your doc bumbled, you should still see a fair amount of growth. Second a real top surgeon will be able to disguise any poor work with relative ease. Lastly, you probably will have learned a valuable lesson about where you need to go for a truly state of the art surgery.

 

I hope this helps and I hope you post who your doc is.

[Hwrd]

The dr is a plastic surgeon I work with. He gave me a pretty good rate on it. He does alot of cosmetic surgery, but only does 1 or 2 hair transplants per week. I really only needed the temporal areas filled, he told me during the consult that I probably only needed 1K grafts total. When it was over I asked how many he got, he replied about 800.

I misinformed you guys about the wash routine. He recommends baby shampoo once a day and Hydrogen peroxide Three times a day starting POD 3. I had approximatly two grafts come out so far. The rest seem fine, I think the little nubs I was asking about are just protrusions of the graft due to the swelling. I am still swollen some even after 5 days, a dose pack, icing.

Also, my BP was pretty high during the surgery even though he gave me catapress, plus I was snowed with demerol and versed. He had said my blood pressure and swelling was causing a couple of them to pop. So far so good. He has some before pics, once the afters are done I can post them.

[Hwrd]

also, I dont think we had a disconnect on what I wanted done. I wanted more temporal filling but when he evaluated me, he told me that he isnt going to put it all in the temporal areas because 5-10 years down the road, I will come back and say "What the hell did you do to me" if the rest of the thinning takes place behind the temporal area/crown. I think what I wanted was more temporal coverage but what he did was best long term. Practicing medicine as a PA, I know that what a patient wants may not always be what is best.

[Mark H]

I know that what a patient wants may not always be what is best.

 

You have clearly stated you didn't get what you wanted, and what you thought was going to be done.

 

If that isn't a disconnect, what is? I agree the doctor knows best, but shouldn't he accidentally tell you what is best before hand and then follow thru?

[Bill - Seemiller]

Hello Hwrd and welcome,

 

I too am a little concerned about this, just reading some of this doesn't seem quite right. Firstly when I read your post initially, I was thinking the "nubs" you were referring to were just simply the scabs around the grafts, and that is normal. It can give the appearance that the graft is above the surface of the skin when in reality it is not. The fact that one came out concerns me...but I do have to ask: how did it come out? Did you pull on it, rub it, play with it? You DO NOT want to touch the grafts on top of your head for a few days. You don't really start washing regularly until about Day 7, and about Day 4 or 5, you can hit the grafts with regular shower water and gently, very gently massage your finger tips over the grafts. But other than that, you don't want to touch them.

 

Another thing that I actually heard about from some of the techs that work wtih Dr. Hasson, is that they HAVE seen rare cases that when they were putting in grafts that other grafts were coming out. Of course, when the techs were aware of this, they would have to work extra hard at making sure all the grafts were seated correctly, but it can happen on certain scalps that are more "problematic". What causes that, however, is beyond me. But needless to say, by the time the Hasson and Wong techs are done, no grafts are popping out anymore. So this should NOT be happening to you a few days post op unless you are picking at them or the doctor did something wrong.

 

Do you have any pictures you can take and share with us? Maybe pictures will give us a more clear insight as to what is going on?

 

Also...why would the doctor tell you to use H202? I would just use saline solution. Peroxide will dye the hair and bleach it white. Unless you have white hair to begin with, you won't look normal for awhile.

 

Anyway...some general things:

 

1. Swelling doesn't start to occur until about Day 3 but can last up to Day 7+ depending. 800 grafts is not a lot, so the swelling will most likely be minimal

 

2. Don't pick at your grafts. You may not be, but I can't imagine them coming out on their own unless you are touching them, something else is touching them, like, how you sleep, or the doctor did something majorly wrong.

 

I'm also hoping a doctor will chime in here....something just doesn't sound right. Please post exactly what you are doing to care for these grafts at this point and any post op instructions your doctor gave you. Maybe things aren't as bad as they seem...but I would talk to your doctor first thing tomorrow morning.

 

 

Bill

[Hwrd]

As it was stated the little nubs are just some of the scabbing, I thought they may be popping. Overly concerned.

His post op regimen, Keep head dressing on for 48 hours. Sleep upright for the first 48 hours, rotate ice packs every 10-20min. He also gives you a medrol dose pack, Keflex, and vicoden PRN. At 72 hours you can gently wash with baby shampoo once a day (by wash I mean GENTLY message) and H2O2 three to four times per day to help break up scabs/crusts.

The one graft came out after I washed and was trying to remove a crust. The second one seemed like it was sticking out of the skin about the top 1/4 of the graft.

I dont have any pictures now. I can try and get some tomorrow.

[Hwrd]

Originally posted by Mark H:

I know that what a patient wants may not always be what is best.

 

You have clearly stated you didn't get what you wanted, and what you thought was going to be done.

 

If that isn't a disconnect, what is? I agree the doctor knows best, but shouldn't he accidentally tell you what is best before hand and then follow thru?

 

He did say during the consultation that he was going to spread it through the top, I was just hoping for more in the temporal area. I will really only know in about 9 months!

I trust him, I work with him, I have helped with other surgeries and he is good, conservative, but very good. So I have no reason to believe his hair transplants are not up to the same standards.

I was just very worried about the nubs so to speak.

[Bill - Seemiller]

Hello Hwrd,

 

Ok, so it seems that what I suspected was true...don't try picking the scabs off...that is/was the problem then. The only thing I wouldn't do, just for cosmetic sake is I wouldn't use H202...it will bleach your hair. I'd use saline solution. But whatever is more comfortable for you.

 

Bill