HAIR TRANSPLANT FORUM

I am in my second week post op to FIT. My scalp seems to be healing just fine and scabbing nicely and much of the scabs are loose and shedding off fairly effortlessly. None the less still visible scabbing.

At this stage I am massaging gently when I shampoo with a cup that I use to rinse. I feel I can scrub a little harder at this stage although my post-op directions specifically state to get aggressive 2 weeks after surgery. As far as I understand I am in a "safe period" when the grafts are in and not really going to be damaged so why not?

I have been using hair cycle like its going out of style and taking 2 showers a day to keep my head moist to promote faster healing... yet I have seen some results of patients posted 1 week after surgery scab-free. Don't understand how it can be achieved when you cant be aggressive in cleaning until 14 days after.

I certainly Don't want to be too aggressive before I am supposed in the risk of damaging any grafts but at the same time I do so I can just move on with my life.

Is there anyone thinking the same way I am? Is there something I am missing? Any experiences with post op healing or techniques that anyone would like to share? Are there different philosophies out there among doctors as to post op care?

I posted this on another forum but I wanted to hear IHTI's much respected response.

Thanks in advance

This is a difficult subject to explain.

First, you must recognize that scabs will begin to loosen on their own with or without hair cycle or the biotin spray. What we have found is that the biotin spray accelerates their removal.

Where do the scabs come from? They form from the seepage of clear fluid mixed with some of your red blood cells and body chemical out of the incision sites we make for your grafts and around the grafts. They often will cover the grafts entirely. The incisions we make are very small. If it were not for the grafts themselves, they would fall off within a few days with no evidence that we had done anything except for some pinkness of the scalp. The reason they stick around longer with a transplant is because the dried, glue like fluid sticks to the hair in the grafts. The scabs often come off as the hair falls out of the graft. This will typically take about 2 to 3 weeks to occur. people don’t always have 2 or 3 weeks for their scabs to come off so other measures have been tried.

The first was to keep the area moist. This can be done by spraying the grafted area with a saline spray. You can buy normal saline in a pharmacy or you can make it by adding one teaspoon of salt to 7 ounces of water. This moistens the scabs and helps loosen the dried glue from the hair.

Another way to loosen scabs is to coat them with an antiseptic ointment such as Neosporin, Bacitracin, or a triple antibiotic mixture that includes Neoporin, Bacitracin, and Polymixin. The primary ingredient is the emollient for loosening the scabs.

A third method is to use graftcyte. This is a very expensive mixture containing copper peptides that are supposed to help with wound healing and collagen synthesis. The most abundant ingredient is water, however, so for the price, you are better off with solution one or two in my opinion. I don’t think wound healing is a problem with the tiny incisions we make so I don’t really see any clear value to purchasing this product.

The biotin spray we recommend has proteolytic enzymes in it as well as antiinflamatories that help minimize the redness after surgery. The enzymes help to loosen the scabs from the surrounding hairs and help free them quicker. This is part of the hair cycle product line. The scabs will sometimes fall off on their own, but some people make a thicker glue-like mixture around their grafts. You may need to help them along.

The real danger time for grafts is the first night. After you get past the first night, you will be surprised how well the grafts are imbedded. You can still remove them quite easily, but you can be much more aggressive than you might think. You can rub the grafts with the tip of your fingers (not your finger nails) without dislodging them. Use the biotin every hour. If the scabs are still there after four days, try applying a Neosporin ointment to the grafted area. The next day, get up and wash the grafted area with shampoo, water, and your finger tips. You will find much of the scabbing will come off in the shower. If you have residual scabbing, you can repeat this process nightly. After 10 days, I turn my patients loose to get even more aggressive with the scabs. Moisten the scabs over night with the Neosporin ointment and use a fine tooth comb to help lift any scabs that are present off your scalp. These techniques will typically do the trip. I feel that the 10 day mark is a good time to allow the shower water to hit directly on the grafts and aggressive scrub the grafted area if you like.

Traditionally, the main thing that keeps scabs in place for a longer period of time is your fear that you will dislodge a graft by mistake. You can’t be too aggressive, but you can certainly be much more aggressive than you might think. In generally rubbing with your finger tips will not dislodge grafts. Just don’t apply too much downward pressure. This might cause some grafts to dislodge. Gentle finger tip massage will not. If you see any bleeding while doing these things, simply stop doing anything until the next day and you will probably not cause any harm. The next day you can resume trying to dislodge scabs. Slight bleeding will typically occur long before a graft comes out all the way.

We have found that a mixture of biotin and 4 to 5 days time will allow us to get rid of any scabbing. Therefore, if you simply must get the scabs off by 7 days, simply return to our office and we’ll get rid of the scabbing for you. Remember though, that it is very important to use the biotin every hour while awake to help digest these scabs. In our office we begin using the biotin every hour while awake beginning as soon as we make the first incision site. We start the timer then and apply biotin every hour while the patient is in our office.