Missing chunk of grafts?

[geneticked]

Hey all I woke up with no scabs or grafts  in a certain part of the recipient area. I haven't done a contact wash yet, haven't experienced any bleeding or ever hit my head or something like that.

Here's what it looked like a few days ago:

 

And here's what I found this morning (Day 8):

[Melvin- Admin]

I wouldn’t be worried, the grafts are anchored by day 8. You’ve simply lost dead hair follicles. The grafts are under the skin dormant. Only worry if this happens before day 5. That said you need to start cleaning those scabs. Apply conditioner and gently begin to loosen up the skins using luke warm water. 

[geneticked]

Ok, I'm just worried cause it seems early for hair to shed in that area.

[Melvin- Admin]

2 hours ago, geneticked said:

Ok, I'm just worried cause it seems early for hair to shed in that area.

Yea it’s because of the scabs. They can pull adherent dead grafts. This is why you need to clean the area.

[geneticked]

54 minutes ago, Melvin-Moderator said:

Yea it’s because of the scabs. They can pull adherent dead grafts. This is why you need to clean the area.

How do you recommend cleaning the area? Im following dieps instructions that seem to counter themselves once in awhile.

Right now it's just shampoo, and light massage the recipient area with my fingers.

So are you saying the grafts died? Or just the hair follicle? 

I really appreciate the response!

[Melvin- Admin]

4 hours ago, geneticked said:

How do you recommend cleaning the area? Im following dieps instructions that seem to counter themselves once in awhile.

Right now it's just shampoo, and light massage the recipient area with my fingers.

So are you saying the grafts died? Or just the hair follicle? 

I really appreciate the response!

Just the hair follicles not the grafts. You want to let your scabs soak for a while so the scabs loosen up and then gently massage them off.

[Dr Blake Bloxham]

The dreaded "cracking." I think I receive at least one email per week from an understandably nervous post-op patient. Rest assured that this is expected. You did not lose an entire row of grafts, nor did you some how dislodge a perfect row or "chunk" of grafts. 

I have heard differing explanation as to why doctors think this occurs. I believe these cracks occur because the skin contracts as it heals. When you have thousands of small wounds covering tissue that has been stretched and swollen, you will get contractions that will appear like little rivers, canyons, cracks, or roads in the grafted area -- I have heard it described using all these different illustrative analogies. It happens even more frequently when dense packing is utilized. It can also appear more dramatic when you are scabbed up and a larger region of superficial scabbing (with or without some hairs attached) falls out. 

Rest assured, however, that even if you see these "cracks" or missing "chunks" above the surface, the grafts are safely anchored below the skin. They may be temporarily displaced from where they will eventually settle, but they are secure. Many people also assume that areas were missed during the transplant itself, and this is typically not the case. Just part of the healing process. 

Graft dislodging is a pretty specific event that happens within the first 3 days (when true follicular units are used). If you did not see an active bleed accompanied by an event within the first few days post-op, it is very unlikely that you lost a graft. And this to me just appears like the classic contraction from healing. 

Of course you should always keep your doctor in the loop and run this by him/her as well. 

Hope this helps. 

Dr. Blake Bloxham 

Feller & Bloxham Medical, PC | Great Neck, NY 

[Melvin- Admin]

^ great information hopefully you’ll feel better after reading.

[PlzRespond]

3 hours ago, Dr Blake Bloxham said:

The dreaded "cracking." I think I receive at least one email per week from an understandably nervous post-op patient. Rest assured that this is expected. You did not lose an entire row of grafts, nor did you some how dislodge a perfect row or "chunk" of grafts. 

I have heard differing explanation as to why doctors think this occurs. I believe these cracks occur because the skin contracts as it heals. When you have thousands of small wounds covering tissue that has been stretched and swollen, you will get contractions that will appear like little rivers, canyons, cracks, or roads in the grafted area -- I have heard it described using all these different illustrative analogies. It happens even more frequently when dense packing is utilized. It can also appear more dramatic when you are scabbed up and a larger region of superficial scabbing (with or without some hairs attached) falls out. 

Rest assured, however, that even if you see these "cracks" or missing "chunks" above the surface, the grafts are safely anchored below the skin. They may be temporarily displaced from where they will eventually settle, but they are secure. Many people also assume that areas were missed during the transplant itself, and this is typically not the case. Just part of the healing process. 

Graft dislodging is a pretty specific event that happens within the first 3 days (when true follicular units are used). If you did not see an active bleed accompanied by an event within the first few days post-op, it is very unlikely that you lost a graft. And this to me just appears like the classic contraction from healing. 

Of course you should always keep your doctor in the loop and run this by him/her as well. 

Hope this helps. 

Dr. Blake Bloxham 

Feller & Bloxham Medical, PC | Great Neck, NY 

Dr Bloxham

within the first 6-7 days is It still possible to damage grafts permanently say by more forceful massage in the shower even if there is no bleeding?

[Dr Blake Bloxham]

1 hour ago, PlzRespond said:

Dr Bloxham

within the first 6-7 days is It still possible to damage grafts permanently say by more forceful massage in the shower even if there is no bleeding?

Do you mean by day 6-7? In my mind and per my post-operative instructions, no. I let people start scrubbing at day 4 (only pouring with water and shampoo for the first 3 days). Although it probably could use another update because the study looked at slightly larger grafts than what we use today, the best data says grafts are essentially permanent by day 10. Before they become permanent, however, they anchor pretty darn well. It would be hard to dislodge a graft after day 4 or so, but they are technically not a permanent part of your body like the rest of the follicles until day 10. I bring this up because some clinics rely on this more than others and pretty much don't want much washing until closer to this mark. If this is what they recommend, then I suggest following their specific instructions closely. If you were my patient, I would tell you there is really nothing you could do while washing to dislodge a graft after day 4. And I would not worry if you did not see a very specific flow of blood from that area -- a little speck of blood here or there while cleaning is not uncommon. 

[PlzRespond]

1 hour ago, Dr Blake Bloxham said:

Do you mean by day 6-7? In my mind and per my post-operative instructions, no. I let people start scrubbing at day 4 (only pouring with water and shampoo for the first 3 days). Although it probably could use another update because the study looked at slightly larger grafts than what we use today, the best data says grafts are essentially permanent by day 10. Before they become permanent, however, they anchor pretty darn well. It would be hard to dislodge a graft after day 4 or so, but they are technically not a permanent part of your body like the rest of the follicles until day 10. I bring this up because some clinics rely on this more than others and pretty much don't want much washing until closer to this mark. If this is what they recommend, then I suggest following their specific instructions closely. If you were my patient, I would tell you there is really nothing you could do while washing to dislodge a graft after day 4. And I would not worry if you did not see a very specific flow of blood from that area -- a little speck of blood here or there while cleaning is not uncommon. 

Yes exactly, by day 6-7. I’m asking because by that time I began to shower then after while the crusts were moist/swollen I would massage with more force to remove the crusts and they indeed start coming off. I’m wondering if by massaging too hard by day 6-7 there is still the possibility of damaging grafts (there was no blood or dislodged grafts). Thanks