A hair graft procedure, such as Follicular Unit Extraction (FUE) or Follicular Unit Transplantation (FUT), involves relocating hair follicles from a donor site to an area of thinning. Patients often worry about the stability of these newly placed grafts. While the follicles are initially delicate, the body begins securing them immediately after insertion. However, the grafts remain vulnerable to external forces during the initial healing period until they fully integrate into the scalp tissue.
The Critical Timeline for Graft Security
The process of a graft transitioning from a loosely held implant to a secure part of the scalp is a biological progression that occurs in distinct phases. In the first 24 to 72 hours following the procedure, the primary mechanism of adherence is the fibrin clot. This clot acts like a temporary glue, mechanically holding the graft in the recipient site incision.
Following the initial mechanical fixation, the graft begins plasmatic imbibition, where it absorbs nutrients from the surrounding plasma to survive since it lacks a blood supply. Around day three to four, the graft starts early cellular integration, and the fibrin mesh strengthens, making the graft semi-secure. At this stage, the graft is resistant to light disturbances but still easily dislodged by friction or impact.
Between day four and day seven, the body initiates angiogenesis and starts laying down an initial layer of collagen. This marks the beginning of true vascularization and connective tissue formation, which significantly stabilizes the follicle. By the end of the first week, the grafts have established a basic connection to the surrounding tissue, but these connections remain fragile.
Grafts are considered permanently fixed and fully secure by most surgeons around the 10-day mark, though some protocols extend this to 14 days. At this point, stronger types of collagen have been laid down, fully locking the follicles into place. Once this full dermal integration is achieved, the grafts can no longer be dislodged by normal activities like vigorous washing or combing.
Mechanics of Dislodgement: What Causes Grafts to Move?
Graft dislodgement is typically caused by forces that apply shear force, friction, or direct trauma to the recipient area while the grafts are still in the fibrin adhesion phase. During the first week, any action that aggressively rubs or scrapes the scalp can pull the delicate follicle out of its site. Post-operative instructions strictly forbid scratching the scalp, even when itching occurs as part of the healing process.
Aggressive washing techniques are a common cause of accidental dislodgement. Patients must use a gentle, patting motion rather than rubbing or scrubbing to clean the scalp, as friction easily breaks the initial fibrin bonds. The impact of a strong jet of water from a showerhead can also pose a risk if not carefully controlled.
Heavy friction from contact with external objects, particularly during sleep, can compromise graft stability. Catching the transplanted area on a pillowcase or towel can generate enough force to extract the graft, which is why sleeping with the head elevated and using a protective neck pillow is often advised. Any direct impact, such as accidentally bumping the head, is a significant risk that can break the fragile connections and cause the graft to pop out.
Recognizing and Addressing a Dislodged Graft
It is important to distinguish between a dislodged graft and the normal shedding of the hair shaft, which is an expected part of the recovery known as shock loss. When a graft is truly dislodged, the entire follicular unit—including the hair shaft, the visible bulb, and a small plug of tissue—is removed from the scalp. This event is often accompanied by a small amount of bleeding from the recipient site, indicating a disturbed follicle.
Conversely, normal shock shedding involves only the hair shaft falling out, while the hair follicle itself remains safely anchored beneath the skin. If you notice a small hair with a tiny white speck on the end, it is usually just the shed hair shaft and scab, which is not a cause for concern. A dislodged graft will appear much longer and contain more tissue than a normally shed hair.
If a patient suspects a dislodged graft—especially if they see bleeding or a visible plug of tissue—they should not panic or attempt to reinsert it. The immediate action is to gently stop any bleeding with light pressure and contact the transplant clinic immediately. The medical team can provide guidance on what steps should be taken next to protect the surrounding follicles.