Hair Restoration Blog

Q:

It’s been just over 4 weeks since I had my hair transplantation. I still have a few scabs. It just happened that while shampooing my hair, I ended up accidentally removing a scab and the area underneath the scab appeared red. The area that has gone red, I could not say for sure if there was any bleeding as I would have been washing it at the time with shampoo. Did I lose any graft? Its 4 weeks post op and I am not sure when I can get to my normal hair wash and I really don’t want to compromise with the results.

A:

Transplanted hair is vulnerable in the first 4 days. The most important day is the first day after surgery in which I would like to bring patients back to wash their hair professionally. You can read more on Dos and Don’ts after hair transplant in our web blog. Washing after hair transplant surgery is very meticulous, but after day 4 following a hair restoration surgery, transplanted hair follicles become part of your skin and you cannot dislodge them even if you remove hair. I usually recommend that my patients follow our washing and after hair transplant care directions on the first four days to minimize scabbing after hair transplant surgery and don’t use any other products.

In your case at 4 weeks after hair transplant, you should have been able to wash your hair in your routine long ago. At this time, you can use your regular shampoo and conditioner without being worried about losing your precious implanted hair grafts.

Hi Dr. Mohebi,

A couple of questions for you and the blog perhaps.

Just wondering - I’ve noted that one LA area hair transplant doctor has used Vaseline on patient’s heads after surgery to prevent graft scabbing - what’s your opinion on this?

By the way I’m mentioning this as I feel I may have a greater tendency to scab as despite the twice daily washings my three grafts that you so kindly placed scabbed up and still are scabbed on this 6th day out, Sunday, but seeming to loosen up a bit now (patient had a FOX test with us to check his candidacy for FUE procedure and we implanted the three intact grafts that we biopsied to his crown). I’ve had prolonged scabbing before despite the washings and frequent wetting that I was advised with prior procedures. Also, I don’t necessarily mind the scabs other than I’d prefer not to have to return to work with them if they could be minimized with the Vaseline possibly or something similar.

Otherwise I’m wondering if Neutragena shampoo is okay post op vs. baby shampoo? Here’s a Neutragena link for reference.

http://www.drugstore.com/qxp14485_333181_sespider/
neutrogena_shampoo/shampoo_anti_residue_formula.htm

Thanks much,

Patient’s name

A:

Scabbing after hair transplant is very important and if not treated properly may affect the growth of the transplanted hair grafts. We are very meticulous on the care after hair transplant especially hair wash after hair transplant.

Many shampoo s are recommended and used by different hair transplant doctors, but we really don’t have a strong researched based proof for many of those. The only thing that I can tell you is to increase the number of washing in every day to minimize the chance of scabbing. In terms of using shampoos, I prefer using baby shampoo for the first 4 days that skin incisions area still healing, but after that you can use whatever you were using before. We know that there are some solutions and shampoos that can minimize the scabbing and crusting that is seen in the process of wound healing, but since we don’t know how they affect the growth of transplanted grafts we really cannot recommend them in our Los Angeles hair transplant centers. Not until we can have the evidence of their safety on the grafts from a medical study.

Using Vaseline falls in the same category. I prefer not using it in the first two days when the tiny incisions on the recipient area might not be quite sealed.

 

Q:

I have had a hair transplant surgery of 1500 grafts 2 weeks ago. I have been told that scabs should be gone in 5 to 6 days, but I still have scabs. I am very careful with washing my hair once a day since the day of surgery. I don’t scrub my scalp. Yesterday I tried to be a bit more aggressive and I picked and pulled a scab and it came off with a hair. Did I lose a hair graft? When should one start scrubbing scalp and at what point can I go back to my regular washing and cleansing of my hair?

A:

Scabs are almost always seen after hair transplant surgeries. You may continue to see scabs for a variable amount of time. One of the common causes of losing a graft is pulling scabs during washing and combing hair within the first few days after hair transplant surgery. Fortunately, we have researched evidence that shows pulling scabs with hair can dislodge hair grafts if done in the first five days after hair transplantation.

At US Hair Restoration, we recommend washing transplanted areas twice a day to prevent formation of scabs within the first four days after hair transplant surgery. After day five patient can start his regular hair wash, but if scabs continue to be present at transplanted area, more frequent washing is recommended until the scabbing is all gone.

The good news is; if you lose hair after this day, active part of the hair follicle stays in skin and can generate a new hair. When fully healed, the follicle becomes part of the recipient skin and will keep its ability to generate new hair. At this time you are well beyond day five and it is unlikely that what you saw was a lost graft. My recommendation to patients is that they can start their normal hair wash and styling methods and use their usual shampoo or conditioner after first week. At this time you should be able to get back to your normal life and scrub and style your scalp as you wish.

Q:

Great blog Dr. Mohebi, Thanks,

I have had a hair transplant 5 days ago. I have been washing my hair in last 5 days with my regular shampoo. I don’t rub the transplanted area, except for some dabbing with shampoo for about 4 to 5 minutes every day. Can you please explain how I should wash at this point and how long I need to continue with any special care after hair transplant surgery? Do you recommend any after hair transplant care product or shampoo?

Thank you for your time.

A:

There is not a certain standard in washing hair after hair transplant surgery. I previously posted an article on the blog “After hair transplant Care” and explained the care that is needed after a hair transplant surgery. We fine-tuned our after hair transplant care procedures to minimize the risk of hair graft dislodging, which is a threat in the first few days after hair transplant surgery. A study showed that there is a decreasing risk of dislocation of grafts within the first few days after hair transplant surgery “Graft anchoring in hair transplantation Drs. Bernstein and Rassman”.

Patients always ask whether or not they can skip washing the first few days when there is risk of dislodging for the newly transplanted grafts. The truth is, hair washing reduces the chance of scab formation and extensive scabbing after hair transplant increases the risk of graft dislodging. The above mentioned study shows that the scabbing after hair transplant extends the interval that grafts are at risk of being dislodged.

We at US Hair Restoration recommend frequent but gentle hair wash in the first few days post-operation with only dabbing and without rubbing in the recipient area. We recommend professional hair wash for the first day to all our patients and during that time teach patients how to wash their hair at home for the next few days. There are some products that are claimed to reduce the scabbing and infection rate after hair transplant with no documented evidence to support them.

I generally use and recommend baby shampoo for hair wash for the first few days after hair transplant surgery. I don’t recommend using any other commercially available products for hair wash after hair restoration surgery.

Best,

Dr. Parsa Mohebi