What are the complications that may arise after a hair transplant surgery?

August 15, 2019 | By Dr. Satinder Singh & Dr. Sangay Bhutia (Hair Transplant Specialist in Delhi)

Hair transplantation is nothing short of a miracle for those undergoing genetic hair loss. There was a time when people suffering from male pattern baldness or Androgenic Alopecia were forced to live with hair loss, and with mild to severe stress and depleted self confidence, because of the lack of good transplant procedures and surgeons. Of course there are those who take hair fall in their stride and don’t let it impact their self confidence, but a lack of options for the rest meant they would never regain their self worth. And, it’s not hearsay, research proves that hair loss and baldness lead to stress and even depression in people who suddenly start being perceived as old and lacking in vitality. Modern hair transplant has changed that.

Hair transplant procedures are now accessible, affordable, advanced, and deliver natural-looking and aesthetically-pleasing results. However, like any other surgery there are complications associated with hair transplant as well. And before you opt for this life-altering procedure, it is important to have a holistic view on it and understand not just the techniques but also the complications associated with it. Let’s begin with the different kinds of hair transplant techniques. Most surgeons today use FUE or Follicular Unit Extraction, or FUT or Follicular Unit Transplantation techniques. FUE involves extracting individual grafts from the hair-loss resistant areas of the scalp and then transplanting them on to the bald spots, while FUT involves extracting a strip of grafts, dissecting it into individual units and then transplanting those.

Here are some of the temporary side-effects and complications associated with hair transplant procedures. For the purpose of understanding these can be divided into:
- General Complications
- Surgery Related Complications



General Complications

Anesthesia related complications
This is majorly due to the apprehension and the anxiety related to the procedure. Although the true allergic reaction is rare we at our clinic always perform allergy or hypersensitivity test for patients before the procedure. Some adverse reactions are related to the toxicity. This can happen if excessively long procedure is done as then more of local anesthesia will be required. At our place, we calculate the dose as per the weight of the patient and if large session is to be done, we generally split the session over two days.

Syncope
This may happen due to long surgery hours and sudden standing from lying down posture. This may also occur due to pain, dehydration and hypoglycemia. Proper analgesia and anesthesia during the surgery alleviate pain related anxiety. Maintaining proper hydration and electrolytes and avoiding sudden standing after long surgery helps in reducing the incidence of syncope.

Surgery related complications

Shedding
After the surgery, this may start 2-3 weeks after surgery and may go on till 10-12 weeks. Hair growth generally starts by 4th month. This is temporary and the hair returns to its normal condition within a few months of the surgery. This is a normal post-operative condition but sometimes it may be permanent which happens in patients who have pre-existing hairs in transplant area and they are under miniaturization. Use of minoxidil, finasteride or steroid may help in reducing this incidence.

Bleeding
The occurrence of bleeding or hemorrhage is quite rare, however since there are small incisions made during the surgery, bleeding can happen sometimes. If it does, applying pressure on the area for 10-15 minutes can reduce the risk of bleeding and stop it. If you put pressure on the wound it shouldn’t be so excessive that it dislodges the grafts. However, if the bleeding does not stop, you should go back to the surgeon.
A good surgeon will ensure that there is minimum blood loss during the surgery and none after. Although a little bleeding and scabbing is quite normal post the procedure and it is nothing to worry about. Important point to keep in mind is always ask whether patient is on any anti-hypertensive or blood thinning medicines. The use of multivitamins is also to be asked as these also increase the chances of bleeding.

Scarring
One of the biggest fears for patients getting a transplant is the visible scar. Both FUT and FUE leave scars. In case of FUE, there are tiny, circular, dot-like scars left from the extraction of individual follicles. These may be like small white dots which fades away over a period of time. These are easily hidden when the new hairs grow in the donor area. In FUT, one will observe a linear scar on the scalp because of the extraction of the strip from the donor area which is then dissected into individual follicular units. This is generally due to wide strip harvesting and subsequent closure of wound under tension. This can also be due to improper position of the harvesting strip. At our center, we always do trichophytic closure so that scar is minimally visible.
However, there are patients who are prone to keloids, who, post-surgery, may end up with keloids or a slightly raised scar on the donor site, such patients should let the surgeon know in advance about their condition so necessary precautions can be taken.

Infections
One of the concerns in any surgery is the occurrence of infection. One should be rest assure that infection will not happen if they have selected a reputed clinic or a good and experience surgeon. But rarely it can happen if proper hygiene and sterilization techniques are not followed or if the patient is having some medical problems like diabetes or if the patient is having excessive crusting in the post-operative period. At Hair & Senses, we follow strict sterilization protocols and use sterile disposable materials wherever possible to ensure maximum level of hygiene and sterilization. Post operatively we advise all our patients to do head wash with mild medicated shampoo as advised by us and to use the medicines as prescribed in the post-operative advice.

Temporary Swelling/ edema
This is actually not a complication but a sequel of the surgery. Some patients may observe temporary swelling around the forehead and eyes after the procedure which may persist for 3-5 days Swelling starts within 2-4 days and descends slowly from the forehead to the eyelids and nose. While it doesn’t look nice, it subsides on its own within a few days. This may be due to use of tumescent solution or due to lymphatics of this region or due to the gravity. The patient can sleep with their head slightly elevated for 3-4 days to avoid or reduce the swelling. Some surgeons use ice packs or forehead massage for this purpose.

Numbness
This is a common side effect which patients may feel within the first few days of the surgery. While some patients are unable to feel any sensation on the scalp, others may feel a burning or itching sensation. It can last a few days to even a few weeks. It is nothing to panic about, as it generally subsides on its own.

Pain
As it is with any other surgery, some amount of discomfort is inevitable during a hair transplant surgery as well. Whether it’s FUE or FUT, one will feel mild to almost no pain during the procedure. During the surgery, proper dose and technique for local anesthesiaensures a comfortable surgical experience. One may use massager or vibrating devices while injecting anesthesia. In FUT the discomfort or pain may be due to the wide scar, closure of donor wound under tension. If the patient reports any pain after the surgery than it can be overcome with the help of painkillers and anti-inflammatory medicines.

Itching
This is a very common problem that might arise after a hair transplant. It can happen in donor as well as in recipient area. This may be due to the formation of scabs or crusting on the scalp. Use of saline sprays or the use of mild baby or medicated shampoo may help in reducing this problem. If it is troublesome, use of oral antihistaminics may help and dryness may be treated with either steroid cream or moisturizing gel. The patient should be careful not to scratch or rub as it may dislodge the grafts and may also cause infection.

Hiccups
Hiccups is rare but important complication which may last for 2-3 days. This may develop due to irritation of cervical nerves like C2, C3.

Cysts
Cysts can occur in the recipient area and may occur in donor area. In recipient area it occurs if small graft slips under the skin or if one graft is inserted on top of the other. This may present as painful red swelling. Topical antibiotic can be used but in some cases incision of the cyst may be required. In donor area, it can happen if blunt punches are used and the follicle gets buried in the dermis. It is advisable to be extra careful and remove all the punched grafts so that no graft is left buried.

Other complications worth mentioning:
- Folliculitis — This is inflammation of the skin as a result of fungal or bacterial infection. Folliculitis occurs when hair follicles are blocked, rubbed, or there is an infection causing redness and bumps. Folliculitis can be easily cured by topical or oral medicines
- Poor hair growth after transplant
- Unnatural hairline (know more about your hairline)
- Overharvesting
- Necrosis in donor area leading to cicatricial alopecia
- Wound infection and dehiscence in FUT

Most of the complications can be avoided by following post operative instructions carefully, and with antibiotics. Most of these are also rare occurrences which can be easily avoided by getting a transplant from an experienced and reputed surgeon, who doesn’t just perform the surgery expertly, but is also a good guide in case of any complications.

How does Hair & Senses help avoid complications?
At Hair & Senses, we follow strict protocols so as to minimize the chances of side effect and also to provide optimal result:
- By maintaining high standards of sterilization and disinfection at our centre.
- The surgeon takes charge of the procedure and all pre- and post-operative consultations. Regular follow-up by the team ensure the best possible result without complications.
- Procedure done by highly experienced surgeon
- Highly experienced and dedicated team
- We prescribe prophylactic antibiotics in all cases
- We ensure that patient follows proper post operative instruction by regularly reminding the instructions

Consult with Dr. Sangay Bhutia, hair transplant surgeon at Hair & Senses in order to get complete consultation for your hair loss treatment. Call for Appointment or more details: 09891038822. You can also email us at contact@hairnsenses.co.in