As with any medical and surgical procedure hair transplantation also has few complications so as to say. As compared to most other surgical procedures, hair transplantation is considered the safest of all. Hair transplantation is an elective (non-emergency) procedure and hence it is or rather it should be done after full optimisation of patient and the operation site (scalp).
Never the less it has few complications worth mentioning. The complications, their causes and how to avoid these complications are listed below:
- Bleeding: it can be divided into two categories: intra-operative (during the surgery/procedure) and post operative (after the surgery/procedure).
Intra-operative bleeding can occur due to faulty operator techniques: wrong choice & concentration of infiltrate, inadequate knowledge and experience leading to deeper plane dissection and cutting of major vessels which supply the scalp and inability to control the bleeding specially by a person belonging to non-surgical background (eg homeopaths, allied medical sciences, dermatologists, ENT specialists & other MBBS doctors). Do ask for qualification of the doctor or hair transplant person before you fix an appointment to avoid wasting your time and energy, least to mention about your money. Even if you happen to get hair transplant done by them then please do ensure that they have support of a surgeon (preferably a well qualified Plastic Surgeon) or get it done in a multispeciality hospital rather than their clinics.
Few patient factors can also lead to excessive bleeding during hair transplantation like familial or constitutional bleeding disorders, platelet deficiency disorders, clotting factor deficiency and capillary fragility disorders. Tell your hair transplant doctor for any past history of prolonged or excessive bleeding from small injuries. And if such history is present then get yourself properly investigated which should at least include complete coagulation profile.
Few drugs specially ayurvedic, Homeopathic or Unani medications, aspirin or other allopathic medications which alter or hamper the coagulation pathway can also lead to increased bleeding during the procedure. Consult your doctor beforehand and stop these medications on his/her advise. The hair restoration procedure can be safely postponed for a specified period (varies from drug to drug) of time as this is not an emergency procedure.
Excessive stress and anxiety also increase the chances of bleeding during the procedure. This can be avoided by taking adequate rest and good night sleep, the day before undergoing this procedure.
Post procedure bleeding can occur from the donor area as well as the grafted area of scalp. Bleeding from the donor area can occur due to inadequate hemostasis during the procedure and reasons being same as mentioned above. Poor surgical technique can result in faulty suturing of the donor areas leading to opening of the donor site at places and continuous oozing of blood from these areas.
Bleeding from the recipient area (area of scalp where follicles have been grafted) can be specially perilous as it can lead to immediate loss of hair follicles (hair follicles come out of the sites where they were implanted) and poor outcome of the hair transplant surgery in the long run. Faulty surgical placement of hair follicles increases the risk of expulsion of hair follicles from their site.
- Infection: it is one of the most important factors for poor surgical outcome of the hair restoration procedure. Hair shafts will be visible above the skin but the underlying hair follicle cells will get eaten away the bacteria leading to death of hair follicles. Once the hairs fell, new hair will not germinate in their place and the area will become bald again after few months leading to total wastage of time, effort and money. In few cases infection can spread to the whole of the scalp leading to severe folliculitis and abscess formation resulting in severe scarring and loss of hair at the donor area also. Non compliance of the standard surgical aseptic protocol at the centre and by the hair transplant team is the most common cause of such disaster.
- Anaesthesia problems: this is rare as hair transplant is done under local anaesthesia in which lignocaine is used in various strengths. In few patients there can be drug reaction due to lignocaine. Some other common side effects of lignocaine are light headedness, nausea and vomiting. Though rare but well documented serious adverse affects of lignocaine include seizures and cardiovascular collapse. Proper qualified and well experienced team of surgeons with a well equipped centre is needed to handle such rare unfortunate event.
- Scar formation: this is the complication which is more unique to the hair transplantation procedure. The donor site scar can be wide if proper surgical techniques and guidelines are not followed as taught during surgical postings. Most common cause of scar formation is poor surgical techniques including single layer closure, poor choice of suture material, poor choice of suturing technique (specially when continuous suturing technique is used by the surgeon/doctor to save his/her time without giving due consideration to the poor final outcome of such shortcuts) and too tight or too lax approximation of the two edges. Sometimes the donor site scar can get transformed into hypertrophic scar due to excessive tension, infection and improper approximation of the two edges. This is more common in persons with hypertrophic scar formation tendencies. Do tell your doctor if there is any history of hypertrophic scarring or poor wound healing in the past. This can also occur due to excessively tight suture placement or from the use of cautery or LASER during the making of donor site incision. There can also be “ridging”, “cobblestoning”, and hypopigmentation over the donor area(s). People with keloidal tendencies can get keloid formation over the donor and recipient areas. Keloid can be understood as an overgrown and enlarging scar. This is more common in people with African origin. In other races it is more common over the presternal area due to continuous move of chest during respiration and over the ear lobule for unknown reasons. There is plethora of treatment modalities to treat this condition starting from intralesional steroids to LASER treatment, but the crux of matter is that people with family history of keloidal tendencies or who have developed keloid in any part of their body should refrain from undergoing hair transplantation procedure.
- Loss of sensation over scalp: normally there is reduced sensation over the recipient site for few hours following the hair transplantation procedure. But if this persists for more than few hours then it suggests injury of the sensory nerves of the scalp during making slits for hair follicle insertion. Again the only cause for this is faulty technique by the hair transplant surgeon. Lack of knowledge of the anatomy of the scalp and poor understanding of the proper depth of the hair follicle graft placement are the main reasons behind it. If it occurs then one has to wait for few months to a year and half for the adequate sensations to return.
- Faulty hair line: this is purely due to judgemental error because of lack of understanding and experience on part of the transplant doctor leading to irregular and poorly constructed frontal hairline. Improper planning and execution of the plan leads to such faulty results. Though small errors can be hidden well when the hairs grow in length, major faults are difficult to cope with.
- Poor hair growth: poor or no growth of considerable number of hair follicles can occur if the transplant procedure is not done properly. Traumatic extraction of hair follicles, dessication of hair follicles during follicle separation, faulty preparation of the grafts, rough handling of the grafts during graft insertion and follicle insertion at wrong depths can all result in limited hair growth. Lack of proper post operative care is also an important factor leading to lack of adequate hair growth. Telogen effluvium is loss of original hairs in the transplanted areas, which usually results from poor circulation or inadvertent trauma to already existing hair follicles.
- Transplanted look: the head of the person after hair transplantation must not look as if he has undergone hair transplant after 1 year of the procedure. The growth of hair and the pattern of transplanted hair should be uniform and blend well with the rest of the hairs of the scalp. If the technique is faulty then Errors of technique and of poor planning are preventable but occur all too often. The most common of these technical errors, which results in a transplanted appearance, is the use of excessively large grafts and unaesthetic hairline design. The importance of using 1- and 2-hair grafts, placed in the proper direction to create an irregular hairline of gradually increasing density as the surgeon proceeds centrally, cannot be overstated.