I am appealing to any experienced FUT professional (doctor or patient) for a favor. I did my surgery on last week and I cannot tell if my doctor (who is highly reputable) did as many grafts as he said. Could you kindly look at the attached photo and give me your opinion as to how many incisions/grafts this appears to you (we focused just on the frontal area)?

Many thanks to any one who gives me some guidance.

If you really want to improve your capacity to know exactly how many recipient sites were made, you should insist that your physician use the Counting Incision Device from Device For Hair. You can see this at Counting Incision Device (C-ID) . This device will cost your physician only 22.00 to use and he can give it to you at the end of the case. This device allows you to know precisely the number of incision sites filled with grafts and it is the only way you can know for certain how many incision sites were made. Of course, if you have a site that is not filled with a graft, then you should not be charged for the graft.

We have found that most physicians are not willing to spend the extra 22.00 to be accurate with their incision site count. While the Physician is making thousands of dollars on your procedure, he appears to be less concerned with accuracy and more concerned with the extra expense. Therefore, you might want to purchase one for your physician and insist that he use it and then give it to you at the end of the case. This way you can be certain what was done.

Don’t rely on the surgery staff to count your grafts or your incision sites. They have no real interest in being accurate and they are often more concerned with what they are going to have for dinner than an accurate graft count. Try sitting at a counter and cutting grafts day in and day out. It becomes routine and monotonous. Over time, the surgery tech’s mind begins to wander and they next thing you know, they have lost count.
Insist that your physician use the Counting Incision Device (CID) so that you can be certain what the exact graft count is.

One important point to consider with the CID is that it is disposable. There is no way to properly sterilize it once it has been used. Insist that the physician use a new one on you and not one that he used on someone else the day before. It really is up to you to insure that you get what you pay for and that your physician use properly sterilized single use CID instruments on your case.

Getting back on the subject of your grafts, there is some elongation noted and many of the hairs appear to be falling over to the side suggestive that they are about to be expelled from the skin and lost in your shower drain. This would not happen one day after a procedure.

Read more Accurate Graft Count with...

I had hair transplant procedure a week ago and I’ve note that the hair is still growing in the grafts. Does this mean the hair has been accepted and that it will continue to grow?

Following hair transplantation hair in the grafts will continue to elongate for about 10 days. Some of this may be continued hair growth, but it also reflects a move toward anagen effluvium. In anagen effluvium the dermal sheath begins to contract and move toward the surface of the skin much like an accordion. This shortening of the dermal sheath will push the bulb of the hair shaft toward the surface of the skin. Therefore, some of the elongation of the hairs is not due to growing, but rather due to a contraction of the dermal sheath toward the skin surface.

Once the dermal sheath contracts, the hairs will either begin to shed on their own beginning in two to three weeks after the transplant. Some of the hairs will continue to rest on the surface of the skin for a prolonged period of time. Eventually the scalp skin will either begin to form a wall around the resting, non-growing hair, or the scalp will form a pustule or pimple like reaction that will eventually burst and the non-growing hair will exit the skin with the exudate from the pimple or cyst like structure.

It is probably a good idea to minimize the number of the cyst like structures that you get because they represent unnecessary inflammation. Inflammation may not always be a good thing. In theory inflammation might sometimes lead to an autoimmune response toward one’s own hair and this in turn may compromise future graft growth.

In order to minimize inflammation, we generally recommend that patients begin removing non-growing hair fragments beginning three weeks after the hair restoration procedure. The best way to manage this is to aggressively wash the scalp with soap and a wash cloth. Non-growing hair will come out easily like removing a pin from a soft stick of butter. Growing hairs on the other hand must be plucked and it takes a good bit of force to accomplish this.

Sometimes hairs do continue to grow following a hair transplant without ever going into the resting phase, but it is unlikely that you will see more than 10% go into the resting phase. It is far more likely that the hairs will shed. Occasionally hairs almost shed, but then continue to grow. We can easily recognize these hairs because they have a dark tip that is coarse followed by a narrow constriction that is of lighter color. This is followed by a gradual darkening of the hair shaft and increase in hair diameter once again. We call these hairs that exhibit signs of this trauma pol pinkus hairs and they are a sure sign of recently transplanted hairs that have continued to grow.