As with all medical procedures, there are certain things to expect after a hair transplant procedure. One such thing is hair transplant scabs, which often appear within 24 to 48 hours post-surgery. These are perfectly normal, and with an estimated 703,183 hair transplant surgeries performed globally in 2021, thousands of people experience these scabs each year [1].
However, most people do not know what they are, why they form, or how to deal with them. If you’re planning a hair transplant, being well-informed about the healing process can help you recognise what’s normal and what’s not in the days and weeks following your procedure.
Are you worried about hair transplant scabs? In this article, we’ll explore:
Key takeaways
Here, Wimpole Clinic hair transplant surgeon Dr Michael May shares his insights and experiences with long-term hair transplant results.
A study conducted by The American Society for Dermatologic Surgery found interesting results regarding hair transplantation. They discovered that the presence of crusting increased the risk of transplanted hair grafts being dislodged in the long-term, but could actually help preserve the grafts in the immediate days after surgery [2].
Therefore, it’s best to let scabs form at first, as they help protect and secure your grafts. But knowing how and when to remove them is just as important, so always follow your surgeon’s aftercare advice.
Scabs can occur after a hair transplant procedure and are part of the natural healing process. Just like other scabs, these can be dry and crusty and are there to protect wounds. They are not the nicest thing to look at, but they help the scars to heal underneath.
Whether you go for an FUE or FUT hair transplant, both procedures take healthy hair follicles from a safe donor area and transplant them into the affected areas.
Small incisions are made in the scalp with FUE and a single, larger incision is made with FUT. Like with all injuries, our bodies form blood clots to stop blood loss and create a barrier to prevent infection.
Although soft to begin with, these clots harden and become crusty, forming scabs which protect the exposed tissues underneath as it heals.
These scabs usually appear within the first 24 to 48 hours after surgery. You may also see some hair transplant swelling, and/or redness of the scalp.
Learn more about how hair transplants work to understand what else to expect with this type of surgery.
Find out how long scabs normally last and what to do if you bump your head after a hair transplant.
See how to encourage optimal scab formation immediately after your hair transplant from our patient advisor Caj.
Learn when and how to soften up scabs post-transplant with gentle shampoo and massage techniques.
There can potentially be several issues with scabs after a hair transplant. Scabs can be quite itchy at times, but it is important not to scratch them as you could dislodge the grafts or create recurring scabs in the same spot on your scalp.
You also want to avoid infection, which is rare after a hair transplant but can have negative effects on the grafts. The risk is low — one study found the risk of a hair transplant infection was less than 1% [3]. However, picking at scabs may increase your risk.
It’s vital to follow the aftercare instructions after hair transplant surgery. Your surgeon will give you precise guidelines to follow, and you’ll be able to use specific shampoo after a set number of days to wash your hair gently.
According to Dr May, the Medical Director and Principal Surgeon of the Wimpole Clinic,
“High adherence [to post-op scab care protocols] is linked to better cosmetic outcomes, faster healing, reduced risk of folliculitis, more predictable graft survival and smaller scars.”
“Poor adherence (such as aggressive scratching, skipping washes, or over-drying the scalp) is associated with graft loss, uneven density, and prolonged redness or scabbing. Overall, compliance is one of the strongest predictors of smooth recovery.”
Many people worry that these crusts may affect the transplanted hair follicles. They do not generally affect follicles, but they should be removed if they do not fall off within the time frame.
If the scabs haven’t fallen off after 14 days, you should consider speaking to a doctor or your surgeon. However, you may not be shampooing vigorously enough and may be told to try this first.
Whilst transplant scabs may fall out on their own, you might need to remove them if they don’t seem to be dislodging. There are a few reasons why it is important to remove them.
One reason is reducing itchiness — it can be tempting to scratch the itching area, but it is important not to. Proper growth of the grafts can be affected, as scabs can potentially hamper hair growth if not washed off. You can safely rub your head around 3 weeks after a hair transplant; use the flats of your fingertips to apply light pressure, and avoid using your nails.
It is also essential to remove them to prevent scarring. Whilst scabs remain, the chances of scratching at them are increased. Scratching and picking could lead to scarring or damage to the hair grafts implanted underneath.
While scabs may fall off naturally, it is essential to remember that the fall-off time will vary from person to person. However, if they are causing you concern, it is vital to ask for advice.
Scabs are likely to be gone by day 7-14 if you have followed the recommended washing guidelines after hair transplant surgery. Dr May shares his typical post-op scab care protocol:
For the first 3 days post-op, Dr May recommends using a saline spray on hair transplant scabs. He advises that this keeps the grafts and surrounding tissue hydrated, preventing hard crust formation as it forms a barrier over the transplant and donor areas.
Saline spray reduces itching and the temptation to scratch. It also aids in faster, gentler scab softening, which can improve graft survival and comfort. However, saline is usually phased out once regular washing is established (around day 3-5). Dr May’s top tip is to keep the saline in the fridge, as it is very soothing when sprayed on your head.
After day 3, to soften the scalp and crusts, wet your hair with warm water and massage your scalp gently with a conditioner. This should be done carefully to remove and potentially dislodge the dry skin. You should not use your nails during this process.
It is important to note that some short hairs that were implanted may fall out with your scabs. This is expected, and you shouldn’t worry about it if there is no scalp bleeding. Do not try to remove them early, which could damage the hair follicles underneath.
Follow your surgeon’s instructions to the letter, and don’t use treatments like hydrogen peroxide to help remove scabs unless you’re advised to. One study highlighted the effects of excessive use of hydrogen peroxide to remove hair transplant scabs, shown below:
Source: Loganathan E, Sarvajnamurthy S, Gorur D, Suresh DH, Siddaraju MN, Narasimhan RT. Complications of hair restoration surgery: a retrospective analysis. Int J Trichology. 2014 Oct;6(4):168-72. doi: 10.4103/0974-7753.142861. PMID: 25368473; PMCID: PMC4212293 [4]
Although it’s tempting, you should avoid picking off your scabs at all costs. Scabs act as natural protective barriers over the wounds on your scalp until they’re healed, reducing your risk of infection and helping grafts settle in.
Picking or scratching at them could dislodge your new follicles before they have time to anchor in your scalp. It also puts you at risk of infection and delayed healing, which could lead to visible scarring in the areas where scabs are picked at.
Research highlights that physical trauma to implanted follicles (such as picking, scratching or rubbing) could lead to inflammation of the hair follicles, called folliculitis after a hair transplant [5].
There are several early warning signs that may indicate a problem with your scabs, such as an infection or abnormal healing. Contact your surgeon straight away if you have any of the following symptoms:
FUE and FUT both lead to scabbing as a normal part of recovery, but the nature of these scabs differs. Scabs in the recipient area are the same, but scabs in the donor area are completely different.
This is due to the nature of how follicles are harvested from the donor area in FUE vs FUT. With FUE, surgeons use a micro-punch tool to harvest individual follicular units. This leaves tiny, circular wounds which produce tiny, circular scabs.
FUT, on the other hand, involves removing a strip of skin from the donor area which contains all the follicles needed for the transplant. This leaves a single larger, linear hair transplant scar at the donor area which produces a long, thin scab.
While both FUE and FUT scabs form and heal within a similar timeframe, recovery time from FUE is slightly shorter [7]. This is because stitches or sutures often need to be removed at a follow-up appointment for FUT, adding an extra step in the healing process.
The wound is also larger with FUT, so healing of the underlying tissue takes slightly longer. The donor area may still feel tender for several days longer with FUT than with FUE.
It’s not unusual for some scabs to remain up to 14 days after a hair transplant. Some people take longer to heal than others, which may be more likely if you’ve had a larger number of grafts placed.
By 14 days post-op, most clinics expect the majority of crusts to have shed with gentle hair washing after your transplant, but a few can linger a bit longer. You should be having regular follow-up appointments with your clinic, so ask their advice if you still have visible scabs by day 14.
Dr May advises on several circumstances in which scabs after 14 days may be worth getting checked out at the clinic:
However, scabs are usually more of a cosmetic issue than a medical one at this stage, provided there are no signs of infection. You don’t usually need to delay going back to normal activities unless you feel self-conscious about your appearance, but your clinic will advise on the best course of action if you have signs of delayed healing.
Dr May shares some of the most common myths surrounding hair transplant scabs that he often has to correct during follow-up visits. Here are some of the top myths and his responses to them:
Quality aftercare is vital to make sure your transplant heals as it should, including any scabs. While scabs are a normal part of recovery, you need regular checkups after your procedure to prevent any complications and get the best results possible.
At the Wimpole Clinic, awarded best hair transplant clinic for four years running, we pride ourselves on our aftercare. Here’s what a few of our patients had to say about their hair transplant aftercare:
You should avoid wearing hats for at least 10 days after a hair transplant. This gives the transplanted hair follicles a chance to take root in any balding areas without being disturbed. Start with loose-fitting hats or headbands — many surgeons advise waiting up to a month to wear heavier, tighter-fitting headgear like helmets.
The best way to speed up healing after a hair transplant is by following your surgeon’s aftercare advice. Avoid picking at scabs, follow your hair washing protocol, protect your scalp from the sun and trauma, and avoid smoking and alcohol.
Avoid scratching or rubbing your scalp after a hair transplant until the grafts have healed and taken root, usually around 14 days. It’s safest not to use your fingernails on the transplanted area for a few months. Gentle rubbing with your fingertips is usually fine after about three weeks.
The donor area can feel sore for several days after a hair transplant, especially with FUT, which involves stitches or staples. FUE usually causes less discomfort. Pain is generally mild and manageable with over-the-counter medication, and most people notice significant improvement within a week.
Wimpole Clinic Services:
Hair Transplants, Beard Transplants & Eyebrow Transplants.
Talk to a specialist
Dr. Michael May (GMC No: 1642315) is the Medical Director and Principal Surgeon of the Wimpole Clinic. He has 25 years experience in the field of hair transplant surgery has completed over 10,000 hair transplant procedures, accumulating an unmatched breadth and depth of experience that is exclusively available to Wimpole Clinic patients.
Dr. May entered private practice in 1982 when he first became involved with hair surgery, since then, he has dedicated his career exclusively to the science and practice of hair transplant surgery and hair restoration.
He qualified at St Bartholomew’s Hospital in London after which he trained and registered as a Fellow of the Royal College of Surgeons. Dr. May was instrumental in developing the revolutionary technique of follicular unit transplant (FUT), and subsequently he also presented papers and lectures in the UK and Europe to professional colleagues. He quickly became recognised by his peers and colleagues as a leader in the field of follicular unit hair transplantation. He specialises in hair restoration surgery covering; FUE, FUT lateral slit, eyebrow, eyelashes, beards, side burns, burns, repairs
As a leading authority in his field, Dr. May became a founder member and past President of the BAHRS and is the current president of the European Society of Hair Restoration Surgeons. In addition, Dr. May is a registered member of The Trichological Society and a Diplomat of Hair Restoration Surgery (ABHRS) in 2002. Dr. Michael May full list of associations are as follows:
Dr. May is available to prospective Wimpole Clinic patients during their consultation and carries out many of the hair transplant procedures at the clinic.
