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Why are aftercare instructions so different between doctors?


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  • Regular Member

I am 12 days post-op, and naturally, I began browsing the internet for guidance in the immediate post-op phase. I began noticing that post-op instructions vary widely between doctors. For example, my doctor instructed me two spray saline on the grafts every two hours for two weeks in order to prevent the grafts from drying out (which I plan on doing). However, I noticed that other doctors do not require saline application at all. I’m curious to hear if others were required to apply saline as part of their aftercare regime. Also, do you believe that saline can promote graft survival? I look forward to hearing from you guys! Thanks in advance!

Edited by bsmit
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  • Senior Member

I'm surprised you started doing post op research 12 days after the fact.  Have you scrubbed off the crusts yet?

During the procedure a lot of things can happen.  Sometimes the grafts are placed as soon as they're harvested.  Other times, the grafts are placed in saline until the clinical staff is ready to trim.  It all depends on how many cases are scheduled, if grafts are placing well, etc.  It's all a timing issue.  So, in a way, you are correct in assuming saline does have something to do with graft survival.

Dryness of follicles can happen either because they're not kept moist, (prior to placing), or due to the equipment being used.  There are units, similar to a vacuum cleaner, that aspirate the graft into the unit...The same unit is then used to place the grafts in the site the doctor made.  The entire time "air" is used. This tends to dry the grafts.  Other units are wet...same theory but the unit aspirates the graft along with saline to avoid dryness.  But, once the graft is in the scalp, there can not be dryness.

I know of a couple of doctors that do suggest saline post operative.  They feel this will help minimize crusting or to facilitate removing the crusts.  The use of saline will harm nothing...So, if the doctor suggested it, do it.

You only brought up one element but did state post op instructions vary widely between doctors.  How else do they vary?

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  • Regular Member

thank you so much for the detailed response! I really appreciate it. 

I just want to clarify a point that you made. You said, “once the graft is in the scalp, there can not be dryness.” When you said “...in the scalp...”, do you mean when the graft is anchored, or are you simply referring to the initial placement?

Another way that post-op differs is in washing. I see that some surgeons instruct their patients to gently massage the recipient area during cleaning in order to remove the scabs early on. I was instructed not to touch the recipient area for two weeks. Instead, I was instructed to spray the recipient area with baby shampoo. As such, my recipient area is still very much littered with crust. Is there a benefit to removing the crust early?

Thanks again!

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  • Senior Member
1 hour ago, bsmit said:

thank you so much for the detailed response! I really appreciate it. 

I just want to clarify a point that you made. You said, “once the graft is in the scalp, there can not be dryness.” When you said “...in the scalp...”, do you mean when the graft is anchored, or are you simply referring to the initial placement?

Another way that post-op differs is in washing. I see that some surgeons instruct their patients to gently massage the recipient area during cleaning in order to remove the scabs early on. I was instructed not to touch the recipient area for two weeks. Instead, I was instructed to spray the recipient area with baby shampoo. As such, my recipient area is still very much littered with crust. Is there a benefit to removing the crust early?

Thanks again!

!. When the graft has been transplanted.....and it's inside your head.

Most clinics will request you start washing 7-10 days post op. Gently massage with the tips of your fingers.  in the ensuring days you'll see crusts just falling off.  At about the 14th day - all will be gone.;

If the doctor suggested you touch nothing for 14 days, follow his instructions. He is your surgeon after all.

Spraying baby shampoo?  Do you know how difficult is to spray something that thick?  Most will tell you to pour the shampoo on to the recipient area and then rinse using the "cup" method.  Put water on to a cup and pour on to the recipient area until the soap is gone.  This is what was explained to me when I had my first 2 procedures.  By the third procedure I just got under the shower, put my hand over the recipient area and let the water hit the back of my hand and let the water trickle down to the recipient area.  I found this to be an effective way to get a lot of water into the area to rinse.  It was just taking too long to rinse a cup at a time.

Most times, I feel, patients are too gingerly when dealing with the removal of crusts.  They feel they will harm the grafts if they scrub.  7-14 days post op you will not harm anything.  Again, I suggest you follow your doctor's instructions.  Don't leave the crusts there much longer.  Hygiene is important as it will help to avoid infections, etc.

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  • Senior Member

I think it differs due to lack of concrete solid evidence from research, most likely due to lack of research.

HT isn't the common to start with, and most patients are -relatively speaking-well endowed and value their privacy. Very unlikely you will get so many of them to accept working with research institutes to work about such fine details. Never mind it is actually hard at times to get which thing is right with hundreds of human factors that affects success of the procedures. 

This lead to suggestion being based on doctor experience and theoretical knowledge.

For example, look at the thread about gym after HT, clinic like Dr Blake Bloxham recommend 2 weeks off and this is just it, others like Hattingen recommend up to 6 months. And those are 2 of the top -if not the top- young doctors in FUT 

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  • Regular Member

thank you for your feedback! you make some valid points. 

what is your position on post-op saline spray? do you think that doctors are warranted in their belief that post-op saline spray contributes to graft survival?

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  • Senior Member

i think once the grafts are planted in your head and “anchored” down and fused with your scalp (around day 4), there’s not much more you can do... it’s up to your body’s response at that point... the rest is about how to deal with the crusts which don’t mean anything as far as graft survival

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  • Regular Member

Great observation from the op. It is pretty insane how variable post op instructions can be -- there is not much as far as 'standard of care' in hair transplantation because so little has been formally studied. I mean think about it, who would pay for a study to analyze under microscopy the effects of aloe vera vs no aloe vera, vitamin e vs placebo, etc etc in the setting of hair loss. The best you can do is to look at studies about wound healing.

The analysis isn't hard, it's just the current model of research in the west is a business model because that's the way capitalistic medical economies work. Companies pay to investigate therapies that will provide a return on your investment.

I will google many different doctors' advice and then combine that with advice from the forums and my own general instincts. Beyond that, there's not much you can do.

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