Are grafts secure by day 9 so I can remove the crusts?
About the 9 days, I put a bit pressure while doing the circular motion and there was no blood. Is this a safe time to have taken off the crusts?
9 days is safe, according to our article, which states: “Since crust formation only occurs in the 1-3 day post-op period, while there is still active exudate, vigorous irrigation during this period should be able to eliminate surface crusting while allowing the coagulum that formed around the graft, to hold it firmly in place. To this end, these authors are currently instructing patients to take very frequent showers, as often as every three hours the day following surgery. As anticipated, this one-day treatment seems to significantly decrease the crusting formed. Once patients pass through this “exudative” period, crusts no longer develop, and they are free to shampoo and shower as they normally do with low pressure on the shower head. Since there is no crusting, patients can theoretically resume their normal hair care activities such as shampooing, a light brushing with a large toothed brush, and styling by day 6 or, if one wants to be more cautious, at 11 days and I am still concerned about some patients whose entire recipient area is covered with a thick wall of crusts, I would add an additional 3 days before aggressively removing the crusts with good washing techniques is reasonable. I tell these patients to leave the shampoo on their scalp for 10 minutes to allow the crusts to get water-logged, then use their fingertips in a circular light motion. Keep doing this until all of the crusts are off. It might take quite a few washings.
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