View Full Version : Thick crusting pulls out grafts....Dr. Lindsey

Dr. Lindsey
07-13-2015, 08:42 AM
For years now I've seen a few patients a year who really did NO cleaning at all. Now we go through pretty detailed postop cleaning instructions with patients and we offer every patient to come in the next day...even on weekends...to be cleaned up...and we also offer to see patients a couple of times during the first 7 days...to make sure they are cleaning correctly.

And we also have about 1 case a year that really doesn't grow well, but 2 or 3 where there end up being a few "thin spots".

Now on occasion, those thin spots or diffuse poor growing are in guys who followed every instruction...and still had trouble. I saw one of these guys last week and have NO idea why he didn't turn out perfectly.

But fairly frequently it seems to me that its in areas of extremely poor cleaning and crust buildup that this occurs. I've had a theory that the attachment strength of the grafts into the recipient scalp eventually is surpassed by the lateral contraction force/stress of really thick crust...and then the hair is avulsed from the recipient slit.

This guy is a great example of this. He's a highly educated professional who was too timid to follow the specific cleaning instructions for fear of pulling out hair...even though I tell them they need to clean. I see this in lawyers, politicians, regular guys...and the worst offenders of all...physicians.

Note these pics where he had really thick crusts and it looks clear that he has missing grafts on day 7. He grew in great...his thread is posted: https://www.baldtruthtalk.com/threads/20451-Dr.-Lindsey-1-year-out-from-3000-up-front-on-former-hairpiece-wearer

But at his second case we had to address these few thin areas with more grafts in exactly the crusty/auto-extracted regions shown here.

I have a couple of other guys with this sequence, and while it doesn't "prove" my theory...it simply makes sense that you have to limit crusts by good postop cleaning.

Dr. Lindsey McLean VA