What Are The Possible Complications of Hair Transplant Surgery?

Fortunately, the risk of complications is low when surgeons perform hair transplantation using modern surgical techniques.  This has to do with the fact that techniques have been refined over the years and the scalp has such a rich vascular supply giving it the ability to heal well after surgery.  Complications from hair transplantation can be divided into procedure specific and aesthetic specific.  It is important for the physician to discuss the possible complications that can occur with their patients prior to the procedure.

Although there are a multitude of complications that are possible, I will focus on the more relevant ones that patients should be aware of:

•    As with any surgical procedure, bleeding (hematoma) and infection are possible with surgical hair restoration, but rare; in fact, there are many hair restoration surgeons who do not place their patients on antibiotics because the risk of infection is so low.
•    Scarring at the donor site can be minimal or excessive.  The fact is that some people have intrinsic factors that cause them to develop a small scar, while others have a genetic propensity to scar more.  However, despite a person’s ability to heal, if the surgeon is aggressive in harvesting the strip resulting in significant tension at the wound, or their closure methods are poor, a larger then acceptable scar may develop.  
•    Numbness in the scalp occurs when the superficial sensory nerve branches of the scalp are transected when harvesting the donor strip.  The numbness is usually transient and returns in a few months following surgery.  If the surgeon was too aggressive and the main branches of the nerve are cut, then permanent numbness of the scalp can occur.
•    The recipient site where the hairs are transplanted can develop small cysts or ingrown hairs.  This typically occurs a few months after the transplant when the hair shaft starts growing and gets trapped under the skin.
•    It is important that the recipient sites are made with a proper sized instrument.  If a large instrument is used to make the recipient sites, the scalp skin may scar and have an alteration to its texture.  Secondly, if the grafts are not placed in the correct depth, one may develop cobblestoning or a rough appearance to the scalp.
•    Patients may develop temporary loss of the surrounding hairs, termed shock loss.  This occurs in about 10 – 15% of male patients, and to a higher percentage of female patients.  The hairs, if not directly damaged from the transplant itself, usually start to regrow a few months following surgery.  If the hairs were structurally damaged, then growth may not return to these hairs.
•    Poor growth of the transplanted hairs can occur for several reasons including structural damage when dissecting the hairs from the harvested strip or when placing the hairs in a traumatic fashion, desiccation (drying out) of the grafts, improper storage solutions, and for reasons we still do not understand (x-factor).
•    Aesthetic complications occur for several reasons.  When the patient’s expectations and goals of the procedure are not met, there is dissatisfaction on both the side of the patient and physician.  Therefore, it is extremely important to have a consultation by the operating surgeon prior to the procedure so these issues can be discussed and realistic expectations to the results are developed.  Also, future considerations of hair loss need to be discussed as the patient may require more then one procedure to accomplish their desired result.  If the patient’s goal of the procedure cannot be met, then surgery should not be performed as this will lead to an unsatisfactory result.