Recipient area not looking great (8 days post procedure)

[zerocool]

9 minutes ago, Yan bio said:

I seriously doubt it’s a necorsis, mine looked the same and healed completely and we’re in the same time frame

Hi Yan,

I also had my procedure done with Maras (just saw you posted about it).

From what I see, our cases are (unfortunately) not the same. You had dried blood that eventually cleared. I did my procedure 6 days after yours and my wound is showing no signs of clearing in the near future.

[Yan bio]

15 minutes ago, zerocool said:

Hi Yan,

I also had my procedure done with Maras (just saw you posted about it).

From what I see, our cases are (unfortunately) not the same. You had dried blood that eventually cleared. I did my procedure 6 days after yours and my wound is showing no signs of clearing in the near future.

You had it 8 days before me.. I see..

 

[Yan bio]

Also in your recent comment it actually looks better🧐

[Vann]

5 hours ago, zerocool said:

I'm continuing to update as I believe this will help future patients with a similar issue. If anyone has been in a similar situation I'd really appreciate if you could provide your insight (feel free to reach out in a private message if you prefer).

20 day post op:

Went to a local derma/hair transplant surgeon who confirmed that this is necrosis (😪). He disinfected and cleaned some of the dead tissue to promote healing. I've accepted that the dead tissue is unlikely to result in any growth, but still very concerned that surrounding tissue may have also been affected. As you can see, some grafts are not growing around the dark spot. I assume it means that they are dead.

Question: if I see pre-shed hair growth (the initial growth after the transplant and before the shed), is that a sign that the grafts have proper blood supply and are expected to grow again after they shed? this will help me understand the blast radius of this wound.

 

I am very sorry you had to go through that experience. Did your surgeon perform an I&D (Incision and drainage) if they cut out and cleaned your wound that means the follicles there are probably gone. Hopefully the area is very minor and will not impact anything further.

Thank you for keeping us updated. Infection can happen to do a complication of things. But hopefully, you do not have any blood supply issue because that could affect the rest of the grafts. But I think if you shed your hairs it could be a good indication that they are rooted underneath. Just stay positive of whats to come. This is only a small part of your future growth.

[zerocool]

42 minutes ago, Vann said:

Did your surgeon perform an I&D (Incision and drainage)

A local derma cleaned it ever so slightly, but right now the consensus (based on feedback from the clinic) is that I should continue applying topical antibiotics and monitor the progress.

It seems that the necrosis is almost isolated to the skin surrounding the grafts themselves, a result of the infection.

Is it true that something like this can just clear by itself?

[Yan bio]

Is this the usual size and shape of necrosis? I think it’s suppose to be circular in size and noticeably bigger. This looks very scattered/diffuse. 
 Can a surgeon reply maybe?

[Vann]

18 minutes ago, zerocool said:

A local derma cleaned it ever so slightly, but right now the consensus (based on feedback from the clinic) is that I should continue applying topical antibiotics and monitor the progress.

It seems that the necrosis is almost isolated to the skin surrounding the grafts themselves, a result of the infection.

Is it true that something like this can just clear by itself?

Things with this potential have very situational outcomes. Sometimes the skin itself could have just been bad without reaching much of the lower layers. Perhaps the whole skin cell got infected and looks bad. It’s hard to say without seeing it physically. 
 

as far as it clearing out by itself… it’s better to have it cleaned by a professional before it can become worse. The sooner the better of course but there might be references where it fixes itself but I find it unlikely. It’s best to keep monitoring and seeing how you progress. Perhaps ask your surgeon if you can take viagra or cialis to help with blood flow and run it by your local derm. Or if PRP might actually be suitable in this situation where you would want plasma in your skin (if so look up some Groupon deals to make it more affordable). 

just remember you’re only less than a month post op so don’t fret too much on what’s already happened and focus on getting yourself better results from here on out. 

[zerocool]

10 minutes ago, Vann said:

focus on getting yourself better results from here on out. 

Yes, this is totally my mental model. Just not sure what to do given the conflicting advice (leave the wound be or have it cleaned).

Here are two more zoomed-in photos that will hopefully show a better view:

 

 

 

[Vann]

19 minutes ago, zerocool said:

Yes, this is totally my mental model. Just not sure what to do given the conflicting advice (leave the wound be or have it cleaned).

Here are two more zoomed-in photos that will hopefully show a better view:

 

 

 

Definitely get another opinion by a medical professional.

[gillenator]

If it were me, I would get more opinions from reputable HT surgeons…the last photo is good quality and it looks like there could be a small spot of necrosis and if so, it’s probably related to the infection…I had this happen to my arm many years ago as a result from a amateur tattoo. 

Edited July 6, 2022 by gillenator

[zerocool]

Went to another derma who pealed it slightly to assess if it's still infected; she confirmed that the skin underneath is healthy.

It seems that the puss and blood have bonded together, along with the antibiotic cream, into a thick crust that got stuck to the scalp.

I've been instructed to stop applying fucidin so that it will get drier and eventually peal off by itself. 

[Vann]

5 minutes ago, zerocool said:

Went to another derma who pealed it slightly to assess if it's still infected; she confirmed that the skin underneath is healthy.

It seems that the puss and blood have bonded together, along with the antibiotic cream, into a thick crust that got stuck to the scalp.

I've been instructed to stop applying fucidin so that it will get drier and eventually peal off by itself. 

thats great! i am happy it is not worse than it already is. Glad you were able to get to another derm. Did she say anything about whether you have necrosis and what options you could have?

[zerocool]

4 minutes ago, Vann said:

Did she say anything about whether you have necrosis and what options you could have?

Derma said it’s not necrosis. The black shade you see in the photos is likely a combination of hair and dried blood. 

I will submit another update in a few days, hopefully it will peal off at some point. 

[zerocool]

Update 25 days post op:

Scabs/wounds have cleared 95%. In hindsight I doubt it was ever necrosis given how quickly and easily this resolved. Seems like pus, blood, hair, skin cells, and antibiotic cream have bonded together to form a sticky layer above the wound. This gave the appearance of necrosis as it was dark shaded and not improving. 

Once pealed, skin underneath seemed relatively healthy:

 

My main remaining question is: was the infection severe enough to have a significant impact on growth potential? Would appreciate the insight of the doctors or experienced patients on this forum. It would be good to set expectations or have reassurance as I enter my long waiting period.

See earlier photo when this all started, 6 days post op:

 

[Gatsby]

@zerocool you are out of the woods now. Happy growing and I look forward to following your results. Thanks for sharing!

[Vann]

4 hours ago, zerocool said:

Update 25 days post op:

Scabs/wounds have cleared 95%. In hindsight I doubt it was ever necrosis given how quickly and easily this resolved. Seems like pus, blood, hair, skin cells, and antibiotic cream have bonded together to form a sticky layer above the wound. This gave the appearance of necrosis as it was dark shaded and not improving. 

Once pealed, skin underneath seemed relatively healthy:

 

My main remaining question is: was the infection severe enough to have a significant impact on growth potential? Would appreciate the insight of the doctors or experienced patients on this forum. It would be good to set expectations or have reassurance as I enter my long waiting period.

See earlier photo when this all started, 6 days post op:

 

That’s good that it wasn’t necrosis. 
you seem like you may have had a pimple or some sort. Usually you get those from the hair root (on the face) similar to an ingrown hair. My assumption is that the surrounding skin may have got inflamed at some point to the infection but I think you’ll be fine. It’s just a waiting game at this point.

[Al - Moderator]

On 7/10/2022 at 6:11 AM, zerocool said:

My main remaining question is: was the infection severe enough to have a significant impact on growth potential?

 

It looks like you had two small infections with pus and blood oozing out and covering the surrounding areas making it look like the infections were larger than they were. So I will guess that except for possibly the grafts that were directly infected, the rest of the area will grow just fine.

For example if you had a neighborhood with one house on fire in the neighborhood, the smoke would spread out above the entire neighborhood, so if you saw it from above it may look like a large fire because you are seeing a huge area of smoke covering everything, but it's all from that one single house fire. Once the fire is out and the smoke clears, all of the houses will be fine except for the one that had the fire.

In any case, at this point you just have to wait some months and see how the growth is.

[Al - Moderator]

Just to add... many years ago I had a 3.75mm graft get infected. Once it healed it actually grew hair, but had to be punched out anyway as it was so distorted by the time we got it to heal that the hairs growing from it were growing sideways and into the skin causing ingrown hairs. Anyway, it only affected that one graft, so it was not a major loss.

 

[zerocool]

Thanks @BeHappy  

How can I tell from the photo which grafts were infected? (fire vs. smoke)

 

 

[nycshearling]

I had something similar to this happen to me and unfortunately there is no growth in the affected areas. For me, it ended up being a small area, but it’s still less than ideal

[Vann]

16 hours ago, zerocool said:

Thanks @BeHappy  

How can I tell from the photo which grafts were infected? (fire vs. smoke)

 

 

I don’t think you can tell since the grafts are underneath your dermis. I think the only way to tell would be to cut into it and test a small area. But that itself would probably cause just as much harm. 
 

just have patience for now. The affected area was only a very small part of the grand scheme.

[Al - Moderator]

The only way to know which grafts will grow is to wait and see which grafts grow. We can only take some guesses and really with all hair transplants even if you had a perfectly clean and easy first few weeks you would still have to wait to see if it all grows to know for sure how well it went.

 

[zerocool]

Thanks everyone. I'll check-in at the three months mark to report on progress (or earlier if anything goes bad).

[gillenator]

The area looks so much better and it appears the topical antibiotics have greatly helped reduce the infection.

[zerocool]

5 weeks update:

I've experienced shock loss to previously transplanted hair (i.e. hair from HT #1 has now shed). The growth is patchy overall (which is fine, I guess), but the center of my scalp is quite bold, and it seems to match the same area that had the infection. Below are photos from 7 days post (infected), from today, and before the 2nd transplant. 

Q: I'm ok with temporary shock loss. This is something I was aware of before the procedure. However, how likely is it that the infection caused permanent shock loss? 

7 days post:

.

5 weeks post:

 

Six years after first transplant; before second transplant: