Hair Transplant Complications

Hair restoration surgery can be life changing in many ways for patients. However, patients should be made aware of a number of possible complications and/or side effects that may occur after undergoing FUE or FUT surgery. Not every complication listed below will happen to all patients. In fact, the vast majority of patients might not experience any complications. Listed below are some of the most common complications that can occur after a hair transplant:

Early Onset Complications

  • Pain – Contrary to what many people believe, there is very little pain during the actual hair restoration surgery. There might be some post-operative pain for the first few days after strip FUT procedure and patients may require pain medications for the first night after the procedure. FUE procedures typically do not have any associated pain even during the first night.
  • Hiccups – As odd as it may seem, hiccups are a post-surgery complication that can last for several hours or several days. If the hiccups persist for longer than a few hours, patients should call their doctor for medication to treat it.
  • Itching – One common complication following hair transplant surgery is itching of the affected scalp areas. Postoperative scratching in the first 4 days after a hair transplant can be detrimental and result in damage to the newly transplanted grafts. The good news is that itching after hair transplantation is usually minimal and, in most cases, no intervention is needed. Simply keeping the recipient area moisturized with skin moisturizers can alleviate the itching in most cases. If the itching is more severe and persists beyond four days, you need to discuss this with your doctor and he or she can prescribe a mild topical steroid.
  • Bleeding – The donor area of the scalp is generally covered with a dressing that keeps some light pressure applied to the harvested area whether the procedure is FUE or a strip.  This minimizes the risk of bleeding after the hair transplant. There may be some bleeding at the donor or recipient areas of scalp following the hair transplant. If bleeding occurs, it can usually be stopped by placing gauze with light pressure on the area for a few minutes. Contact your doctor if bleeding is not controlled after a few attempt to stop it by applying pressure.
  • Swelling– Most patients undergoing a hair transplant will see some swelling. In general, swelling is more likely at the transplanted areas and this is especially true over the forehead and around the eyes. Some patients can use prophylactic steroids to minimize the risk of swelling. The steroids could be given through an injection the day of the procedure or by pill for the first few days after hair transplants. If swelling occurs, it will appear at day 3 after procedure and peak at day 4. Thankfully, the swelling usually subsides rapidly by day 5 after the hair transplant.
  • Numbness – Local anesthesia is used for most hair transplant procedures and its effect can last for hours after the hair restoration procedure. The other reason for numbness after the procedure is irritation of the superficial nerves of the skin in the donor or recipient areas. The nerve irritation occurs during the first few days of the healing phase. Occasionally, mechanical damage to the superficial nerve may cause numbness which could last longer. Permanent numbness is reported after hair transplantation but it is extremely rare if the proper techniques are used during harvesting of the hair and implanting of the grafts. You need to contact your doctor if your sensation has not completely returned within the first few days after hair transplant surgery.
  • Infections – The risk of an infection after head and neck elective surgery is extremely low thanks to the great blood supply of these areas. Diabetic patients, immune compromised patients and others with a greater risk of infection may be an exception to this rule. For these patients, prophylactic antibiotics may be considered by the doctor.

Late Onset Complications

  • Scalp Folliculitis

    Left: Scalp folliculitis in recipient area after hair transplant, Right: Scalp folliculitis shown microscopically

    Folliculitis –  This is inflammation of the hair follicles that appear as small pimple-like lesions in the transplanted areas or in the donor area of the scalp. Folliculitis usually does not affect the growth of the transplanted hair. Within a few days or weeks, these lesions clear without medication. If you have a persistent painful lesion, or if they become infected, you will need to see your doctor. These lesions can easily be incised and drained in the office.

  • Thinning hair after hair transplant

    Thinning of preexisting hair 3-5 months after hair transplant around transplanted area due to shock loss

    Thinning Hair – Many patients may become alarmed following their transplant when they discover the native scalp hair they already had has become thinner. This complication is also known as shock loss and can happen after any major stress on the scalp. In hair transplantation, shock loss is due to the stress of the procedure and the healing period that will be happening within the first few months after hair transplant. Some mild thinning of hair is considered an expected consequence of a hair restoration procedure and can easily be mediated by starting finasteride around the time of the procedure. Patients must continue finasteride for at least 3 to 6 months to minimize the shock loss. Fortunately, some of the thickness of the hair may return within a few months after surgery. This coincides with the hair follicles entering the resting phase and the growing of new hair shafts.

  • Scarring – The development of scarring in the donor area is common in strip procedures. The scar could be as narrow as 1-mm or it can occasionally stretch to about 1-cm.
    Scar after strip hair transplant

    Widened strip donor scar from old technique hair transplants

    A FUE procedure does not cause any linear scarring. Hypertrophic and keloid scars are also rare complications of hair transplants and generally tend to only occur in patients who are predisposed to developing this type of scar.

  • Hypopigmentation – After a FUE procedure, there might be some small dotted areas, which may appear lighter in color on the donor area. These circular lighter spots used to be a more common complication of hair transplant procedures when larger punches were used to extract the grafts. Today, the size of FUE punches range between 0.7 and 0.9-mm. Therefore, hypopigmentation is very rare with the advent of the smaller size punches currently being used for graft harvesting.