picking scabs completely ruins HT?

[LuciferLaconde]

So I have come across several threads on different forums on this topic, and not sure if there is a consensus on this issue. The conventional wisdom goes to suggest that by 10 days post HT, grafts and follicles are securely embedded in the scalp and cannot be displaced or damaged. After ten days, most doctors recommend to lightly (not sure how that is precisely defined) massage on the hair during shower to loosen and free up the scabs. In doing so, you inevitably end up using nails or 'pick' scab which initially feels very loose but not so much. I have seen posts my most people suggesting that while it's not recommended,but not a showstopper, but then there's this Dr William Rassman (co-author of the study which established the 10 day graft security research) who swears by some research he performed and published in a medical journal that picking scab uptil even 21 days would damage the graft underneath and no hair would grow under it, despite there being no physical dislodging of the follicle or no blood that most people seem to consider telltale of a damage graft. No other doctors on realself or other websites say that, and most standby it it that while picking scabs isn't recommended due to risk of infection, but if it's not within 10 day window, it should not be a problem or cause permanent damage to HT Op.

 

Can some wiser folks on this forum and docs shed some light on this? If this is true, then I would expect surgicle post op guidelines to say in BOLD and underlined to not ever under any circumstance do anything to scabs and especially no nail use. Mine never said anything, and my surgeon was very conservative IMO.

[Stuart01]

I would not suggest not picking the scabs. What you can do 5

days post op is to take some hair conditions and massage it on top of the scabs about 20 minutes prior to shampooing and this will help to soften up the scab and they will start to flake off. Repeat it every time prior to shampooing until they are all gone.

[Dr Blake Bloxham]

Laconde,

 

I don't think "picking" a scab after 10 days would damage the growth of the follicle underneath. However, I don't like patients "picking" because I think scratching the scalp in this manner can potentially introduce superficial infections in the area, and I don't want this kind of reaction anywhere near the newly implanted grafts.

 

I tell patients to massage with shampoo without using nails. If a scab is "stubborn" to the point where you feel the urge to use your nails, just leave it. Keep massaging it with fingertips and it will eventually break-up and come off when it's ready. But it's okay to still have 1-2 up there that just aren't ready to come off. In my opinion, at least!

[Bill - Seemiller]

10 days after hair transplant surgery, the follicular units are pretty well seated and it would be impossible other then by surgery to remove them. Picking scabs with your fingernails is generally not good for your scalp however, massaging the scabs off with your fingertips won't cause any harm. Every physician has their own unique set of postoperative instructions however, only if you pick the scabs off with your nails in the first couple of days should there be any problem with the growth of your hair transplant.

 

Best wishes,

 

Bill

[gillenator]

Although there are going to be some variances in how we all heal, generally speaking, the crusts are ready to dislodge from the scalp approximately 10-12 days post-op. There will always be ones that will linger a little bit longer and will come off when they are ready.

 

Most docs, if not all of them will want their patients to allow the water from the shower head to pass over the recipient area at normal pressure and luke warm temps. The shampoo mixture will soften the crusts and a gentle massage will begin to loosen them as they are ready to dislodge.

 

Scabs are dried blood but it's the crusts that are the dried out tips of the graft tissue situated above the scalp line. And I think the crusts are really what is being discussed here. When they dry out, they usually become hard, look grey in color and can be more difficult to remove compared to scabs. When removed, it is typical for the graft hair to come out with the crusts which is normal.

 

So again, there will be some variances as to how long they will linger, but after 10 days post-op, most of them will begin to loosen as they soften up in the shower and a gentle massage with the finer tips will dislodge most of them and they will rinse away with the suds. It is not necessary nor advisable to use the fingernails to remove them.

 

The grafts themselves are secure and will not get harmed at this point in time IMHO.

[Mbsingh]

Why not just let scabs fall off on its own ? Isn't that better and safe ?

[LuciferLaconde]

Just to clarify, this is not to suggest that one should be aggressive with removing their scabs post hair transplant, but just questioning whether if one does end up in that spot where the gentle scrubbing/massaging of the recipient area to encourage scabs to come off, and in that process slight picking using nails is a deal breaker or not. In my personal case, having underwent a 2300 graft fut procedure with a coalition surgeon, I was super careful the first 12 days and followed every post op instruction to the letter and spirit. However on thirteenth night, while taking shower (started showering twice a day since day 4 or 5), I was 'gently massaging at first then somewhat using a bit of nail in a couple of areas but don't remember anything too harsh. I'm about 14 weeks post transplant and so far have not witnessed any breakthrough of the grafts thru the skin, but my surgeon told me it shud be starting around week 16 to 17 mark, so just waiting and watching.

 

But obviously this is a thought that keeps coming to my mind whether I did something that one time or maybe the way I managed showering had any effect on damaging the follicles under the graft... Keep in mind, per my doc's instructions, I didn't begin even touching the transplant area in shower until after 10th day , and until like a month post transplant he had me not use the power wash shower, just drop water through a jug....

 

From my research so far (Google post ht scabs pick), I have come up with 90 percent results suggesting that after 10 days it shud not be a problem, but like I mentioned earlier, there is one particular Doctor William rassman who seems to be very vocal in suggesting that this results a lost follicle and no growth takes place through the hair which had scab on it, whether doing so causes any blood or sting on the scalp or not... So when I read that, I wonder if that is the case why is this not so heavily highlighted as a never ever, under no circumstances, do type thing.

[ArochaHair]

The issue also depends on how anchored the scabbing is and this has to do with how well the recipient zone was cleaned immediately after surgery. If the recipient was cleaned well and the scabs are separate from each other then ten days after surgery the scabs should be lifting by themselves unless you are being overly sensitive about touching them. If the area was not cleaned well and you have a confluence of scabbing over the recipient area then picking them off may cause damage as there is more scabbing to lift thus the potential for damage increases. Ultimately the post-op instructions should be followed to the letter, which is sounds like you did, and if they did not warn you of any issues then you should be fine.