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Whole Follicles Coming Out, Not Just Hairs

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Hello everyone. I just recently had a hair transplant 8 days ago. I have a question that has been troubling me since about 2 days ago, and I have searched and searched and gotten nothing but conflicting answers, and it is really frustrating me.

 

The thing is this: While I have been lightly rubbing the scalp to get rid of scabs in the shower, the scabs have been coming off. However, along with the scabs oftentimes a whole graft comes out. Basically, it looks exactly like what the doctor showed me was a follicular unit graft, but it was dried out. It's not just a hair attached to the graft. This happened at 6 days after the surgery. It is still happening as scabs come off, on day 8. Sometimes I do see only hairs come off with the scabs, but it has mostly been what appear to be dried-out follicular unit grafts.

 

For what it's worth (apparently it's important, for reasons unclear to me), there has been no bleeding associated with the grafts coming out. However, Bernstein Medical's page on the graft-pulling study clearly indicates two situations: One where the graft hairs are pulled out, indicating no loss of the graft, and one where the whole follicle is pulled out (along with blood loss), indicating loss of the graft. My question, then, is what happens if the scab comes out with the whole follicle, but there is no bleeding? My other question is this: I mistakenly used the saline spray given to me by the doctor on the donor area for the first two days, rather than on the recipient area (the nurse that did my first hair wash told me to use it on the donor area). Does this mean that the grafts were not properly hydrated and are now dead and beginning to fall out?

 

Most everyone asks about single hairs coming out with their scabs, and that is apparently perfectly normal. Not too many people ask about whole follicular units coming out, and that is where I see nothing but conflicting answers, some saying that the graft is lost and some saying that that is normal as well. Is there a definitive answer as to what I should expect going forward at this point? I asked my consultant but he said it was normal and wouldn't cause issues as long as there was no bleeding, but again, this conflicts with what a lot of people have said, including Bernstein Medical's study. Thanks in advance for any responses.

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jimbob,

 

Welcome! It might be easier for us to give an informed opinion if you could provide photos of the grafts that have fallen out.

 

Not having used the saline spray on the recipient area should not be a problem. Not all doctors recommend saline spray. I did not use any on my recipient area.


David - Forum Co-Moderator and Editorial Assistant

 

I am not a medical professional. All opinions are my own and my advice should not constitute as medical advice.

 

View my Hair Loss Website

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I know that the pictures are of awful quality, but you can see what I mean when I say that it's not just the hair, and that it essentially looks like a dried-out graft. When I told the consultant, he said that it's okay, it's just the top half of the graft, but this is clearly not just the top half. The top half is the visible half, which is just the small hair above the head, if I understand correctly. He said that as long as there is no bleeding (again, there isn't), the graft isn't lost, but that doesn't look to be the case, although I admittedly know little about hair transplantation. The grafts are 3-5mm in length. You can barely see the tiny hair coming out because of the low picture quality, but you can clearly see the white area (dried out, it looks yellow) around the hair shaft that goes below the surface hair. The second image is a 2-hair follicular unit, while the third is a 1-hair unit (as are the others), although I also saw a couple 3-hair units fall out as well (plenty more have fallen out as well, these are just the ones that I kept).

 

So the saline spray is just to help with the healing of the incisions, right? Seeing as how the grafts look rather dead and dried-out, I thought it was because I hadn't sprayed the recipient area (rather, I sprayed the donor area like the nurse or whoever washed my hair the day after). I figured that meant that they weren't kept hydrated, although I also thought that that is done by the body since the living part of the graft is kept under the skin, and the hair above the skin is just dead cells anyways.

 

I don't know what I'm supposed to make of this, but I will definitely bring these to my suture removal appointment on Monday.

 

Edit: For comparison, here is what I see as normal (the last picture, number 24). It is just scabs and hair falling out, but most of what falls out is graft-like in appearance.

Photo-0021.jpg.da96031433ceef20cbc6e0e88a954c9a.jpg

Photo-0022.jpg.7bd0ee464bd23694b5c112b5441a2204.jpg

Photo-0023.jpg.383506b2f7a14f0545430dd4ce9fbad7.jpg

Photo-0024.jpg.ecf9c23138b8f06e8e012eff2677f012.jpg

Edited by jimbob88888888
Attached another picture

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Though the pics are poor quality, it does seem like the tissue is substantially more than just the typical root sheath. At the same time, I've never heard of grafts becoming dislodged after the first couple of days and especially with no bleeding.

 

I honestly have no answer but I'd would remain optimistic. Trust in the advice of your clinic but also open a dialogue about what your options are if the result is subpar.


David - Forum Co-Moderator and Editorial Assistant

 

I am not a medical professional. All opinions are my own and my advice should not constitute as medical advice.

 

View my Hair Loss Website

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I'll definitely ask what would be possible to do in the case that the results are subpar. What have people who have had subpar transplants get as compensation for subpar results? Money back? Free grafts? Something else?

 

This is just speculation on my part, but is it possible that during implantation the technicians may have tried to put too small a graft into too big a hole, resulting in the graft's exposure to air and subsequent drying out, death, and eventual fall-out with the scabs? This would explain why there was no bleeding [since the hole scabbed up as normal, but the graft never got a chance to connect to the blood supply (apparently it takes more than a day, at least) before drying out, which takes a lot less time].

 

Again, this is total speculation on my part, and likely just paranoia, but do any doctors know if this makes sense as a possibility? Thanks for your help so far, David.

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deadgraft_zpsee4ff41c.jpg

 

Popped grafts aren't always accompanied by bleeding as this photo shows. Typically, this happens when the graft hasn't been inserted deeply enough into the incision and basically dries out and dies.

 

As patients are being particularly careful with recipient areas post op, the grafts will only come out when the area is being rubbed in accordance with instructions a week or so later.

 

My first procedure was a bust because the incisions - made by the techs - weren't deep enough on one side. As a result, they dried out/died and I had a lot of these dead grafts when I started rubbing lightly to loosen scabs.

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I thought it would be possible to have grafts that died because of air exposure and didn't bleed because they never took root in the blood supply. So you had clearly worse results in the area where most of those grafts fell out? What did you tell the doctor to get the issue fixed (if you got it fixed at all)?

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I thought it would be possible to have grafts that died because of air exposure and didn't bleed because they never took root in the blood supply. So you had clearly worse results in the area where most of those grafts fell out? What did you tell the doctor to get the issue fixed (if you got it fixed at all)?

 

Yeah growth on one side was awful. I told the doc point blank - I believed his techs were to blame. Why else would yield on one side be far worse than the other after more than 12 months?

 

Surgeon - recommended here - offered 500 grafts free via another strip procedure which I wasn't interested in going through again not to mention the fact that I'd completely lost confidence in his ability.

 

I politely declined.

 

I asked for and got a 50% refund which I put towards a 1200 FUE procedure with another surgeon

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That's exactly my concern, that they would offer me x free grafts on my next procedure. I absolutely would not accept such an offer unless it was a whole lot of grafts, at least 1,000. I would lose confidence in their ability as well, and would probably prefer a refund if the number of grafts does not equal 150% of the refund. I really hope that any issues can be resolved with little pushing on my part. I still will wait 1 year for the full results, though, but it will probably be obvious sooner than that if there is an issue. I really lost a lot of hairs that looked like grafts.

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Cryingoutloud the example you showed does not appear to be a follicular unit but rather a epithelial scab with an attached hair. The papilla or bulb of that follicle is still likely intact.

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Cryingoutloud the example you showed does not appear to be a follicular unit but rather a epithelial scab with an attached hair. The papilla or bulb of that follicle is still likely intact.

 

Exactly!

 

I lost three grafts proper when I rubbed them during sleep. They all bled and all were accompanied by a full white sheath. By the time scabs come off the follicles are rooted. Scabs and crusts commonly fall off with the jettison hair shaft. The follicle is still in your scalp.

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I know that the pictures are of awful quality, but you can see what I mean when I say that it's not just the hair, and that it essentially looks like a dried-out graft....

 

Actually, the blurry focus makes it hard to discern anything. What sort of camera did you use in this day & age that made them that blurry? Dim light?

 

On this general topic, I've had hairs pull out cleanly with little effort at 10 days post-op FUE, and the tiny bulb indicated that the actual papilla was probably OK (the part that will later regrow a new hair). Shock-loss has also been used to describe those hairs coming out easily while the productive base cells stay intact.

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