Dear Dr. Rassman:
Is this a good rule of thumb for any stage post op? “If there is no bleeding then you did not dislodge a graft”
The highest chance of graft dislodgement is within the first few days after surgery. As you go farther from the time of surgery, the chance of graft dislodgement decreases. When you pass day 5 you generally can not dislodge the graft with simple traction of the hair and even if you can pull the hair out, the graft stays in and is capable of making a new hair (see PDF file: Graft anchoring in hair transplantation. Dermatol Surg 2006; 32: 198-204 Â© 2006 R M Bernstein, MD, W R Rassman, MD). Dr. Bernstein and I published a paper that allowed us to pull out hair follicles from 1-10 days after surgery and then send off what was pulled out to find out if the growth centers of the grafts came out. What we found out was that after a few days they were generally secure, but that was when there was no crusting on the skin edge of the graft. If there was crusting, it would take up to about 10 days to risk losing a hair growth center when it is pulled out. But really now, who in his right mind other than Dr. Bernstein for experimental reasons, would want to pull hair out? Not any patient I know of.
Presence or absence of bleeding does not have to do with the survivability of a graft.