Risks, side Effects and Possible Complications

In the majority of hair transplant procedures there are fortunately no complications. However there are a few side effects, risks and complications which can occur. For the purpose of putting these in perspective, we have divided them into two categories: those that occur occasionally and those that occur very rarely (most of those included here have not occurred in our several years of experience , but have occurred in other doctors practices or have been mentioned in the medical literature and are therefore included here for the sake of completeness).

Side Effects that Occur Occasionally:

1. Forehead swelling: This occurs in about less than 2% of our procedures. If it does occur it generally comes around the third day and lasts for about three days before getting back to normal. It is slightly more common in women than in men, and after transplant sessions in which large number of grafts have been implanted . This swelling can occasionally extend down around nose and eyes, and on extreme rare occasions have “black and blue “
2. Cysts: These are small sterile cysts that can occur in the recipient scalp where the grafts are placed . When one of these occurs, it generally appears around 2 to 4 months after the procedure, and is usually caused by either accidental piggybacking of one graft on the top of another, or by a hair growing inward. Since we use “minimal depth” technique for making recipient sites, these are very uncommon in our practice.
3. Temporary numbness: It is common for most patients to experience a small area of numbness in the top, rear area of scalp, which lasts usually for several weeks and then returns to It is caused by the severing of a couple of superficial sensory nerve branches in the donor area skin.
4. Mild shock loss of existing hair: In probably less than 5% of patients who have some residual hair in the area being transplanted, there can occur a mild “shocking” of some of these hair, such that the patient notices in those first few weeks a slight thinning of that hair. This hair is almost always only affected for a three month period of “Telogen” and then begins to regrow. If some of these shocked hair are Vellus (thin, wispy on their last life cycle) then those hair may be lost permanently. Strong thick hair in the transplanted area are almost never affected by this phenomenon.
5. Post-operative pain or headache : Post-operative pain is actually somewhat unusual. For most patients, the donor area is generally a little “achy” for the first night or two, as when lying on the pillow at night , but quickly feels much better after the sutures are removed 10 to 12 days later. In our experience, around 1 in 20 patients have any significant discomfort following hair transplant surgery. We provide pain-relieving medications to tide over the situation.
6. Minor side effects: Itching in the area of new grafts or along the donor area can occasionally occur. Sometimes there is slight pinkish discolouration to some of the grafted area for few weeks which gradually fades into skin’s normal colour.

Side Effects that Occur Uncommonly or Rarely:

1. Irregular, uneven or delayed hair growth: Most transplanted hair are shed shortly after each session, within the first 1 to 6 weeks . Generally 4 to 5 months after transplant procedure the new hair begin to grow. This may occur at irregular rates , with some hair coarser, finer, darker or lighter in colour, or different in texture than the characteristics of the original hair. In most instances this eventually normalises . However in some patients, it may take as long as 15 months or more from the starting point before cosmetically satisfactory results are seen.
2. Discolouration of grafts: Redder, paler or differently pigmented (light, dark or mottled) skin at the grafts sites may occur that looks slightly different from the surrounding scalp. In most instance should this occur, it gradually becomes normal and the same colour as the surrounding skin over time..
3. Elevation or depression of grafts: Following healing at the new site, the skin of the graft could be above or below the lever of the surrounding skin, or feature and uneven texture or blending with its surrounding skin. These phenomena have been almost non-existent in our practice in recent years.
4. Bleeding: The donor wound or one of the graft sites could bleed later on, either soon after the procedure or even sometime within the first week , even though we haven’t seen bleeding happening after 72 hours of surgery . If the donor area is undermined then it’s possible for a hematoma (collection of blood) to form under the skin. Since we don’t routinely undermine, this has not occurred in any or our patients.
5. Scarring: Very occasionally, especially in persons with “stretchy skin” a donor scar may heal somewhat wider than normal. Some patients form what we call “keloids” when they heal, which is thick pearly scar. We attempt to determine beforehand by history and examination that a patient doesn’t heal in this manner. If this suspected then usually a few “test grafts” are done first to be certain the grafts heal without formation of keloid.
6. Dizziness or fainting: This could occur and would usually be related to excessive anxiety , not having eaten any food, recent viral infection, dehydration, diarrhoea, or from medications a patient takes at home. This virtually never occurs in our practice.
7. Allergy or reaction to anaesthetics or medications used: Medications and equipment is always at hand to treat any allergic reaction.
8. Failure to Improve my “Quality of life”: This is refers to a patient’s disproportionate perception that the surgery has interrupted his or her work, job or home or family or social life or has failed to live up to his or her goals or expectations from the procedure and its effect upon their life. It’s critical to have realistic expectations and be prepared mentally.
9. Infection: Very rare because of rich blood supply in the scalp. The surgeon should be called if any sign of redness, fever, pus discharge or not feeling well.
10. Very rare complications :
    a) Arteriovenous malformation: A small pulsatile bump under the skin where a small vein and artery come together. b) Neuroma : A small bundle of nerve tissue that can be painful , usually caused by a nerve being trapped in the scar. c) Neck ache/ back ache etc.: Resulting from a position the patient may have been in during the procedure. d)Hiccups: Occasionally occurs after use of Valium lasting only a day or two. e) Miscellaneous : There is also a possibility that other effects or complications not presently known, recognized , or understood may develop now or in the future.