Possible complications in the recipient area

[jeff1986]

As a newbie to hair transplantation, I have been trying to understand what are the worst case scenarios that could happen in recipient area. This is what I have realized so far:

 

1. Not enough yield that leads to lesser density. If my understanding is right then this most likely can easily be fixed with second surgery that would increase density. Of course assumption is that you still have enough donor hairs.

 

2. Follicles were transplanted in the wrong direction. I guess if something like this happens then the only options for you are to 1)redo surgery by pulling out these hair and replant them; or 2)adjust hairstyle to something that looks messy and hope that this defect will blend into your image; or 3)shave your head short so that hair misdirection would not be that obvious.

 

3. Hair line too low. Simply remove excess hairs by replanting them somewhere else. Of course there is chance that you will have scars. I guess you can do this with laser removal without leaving any scars.

 

4. Obsolete technologies being used that lead to patchy look (e.g. Plug-style hair transplant). But seriously who is doing this anymore, if you can do FUE or FUT that transpant single graft at a time?

 

5. Ingrown hairs that lead to folliculitis I think this is something that could happen when follicles were transplanted too deep. I still haven't found out if this is something transient or permanent.

 

6. Healthy follicles could be damaged if transplanted hairs are too close to existing hairs . This should not be an issue for those who are having first surgery where recipient area does not have that many healthy follicles nearby.

 

7 Ridging (mentioned by Joe). Typically caused by bulky grafts. If ridging is caused by excess fat then apparently this can be fixed with some steroids [http://www.realself.com/question/when-kenalog-injections-dissolve-ridging-raised-hairline-due-hair]

 

8. Pitting (mentioned by Joe). Typically caused by too large holes in recipient site [http://www.bernsteinmedical.com/answers/removing-tiny-holes-due-to-a-hair-transplant/]

 

9. Orangle peel effect (mentioned by Joe) Could not find much on Internet what causes this. Is this simply a combination of Ridging and Pitting at the same time?

 

10. Loss of sensitivity (mentioned by Joe). Typically is temporary, but could also be permanent.

 

11. Necrosis (mentioned by Joe). Really rare. I believe this could only happen due to infection, severely damaged scalp or something like that.

 

12. Bad or no growth (mentioned by Joe). I think we could classify this as an extreme case of Not enough yield that leads to lesser density.

 

Are there any other possible implication in recipient area that I might have missed in the list above? Have I underestimated some of the complications in my list above?

 

P.S. If you want to give answer that simply goes like "Choose a qualified HT surgeon" without actually contributing to the discussion, then please don't bother to answer.

Edited November 19, 2014 by jeff1986

[romanino]

Another possible complications in the recipient area is a seborrheic dermatitis on the scalp....

[JoeTillman]

1. Not enough yield that leads to lesser density. If my understanding is right then this most likely can easily be fixed with second surgery that would increase density. Of course assumption is that you still have enough donor hairs.

 

True.

 

2. Follicles were transplanted in the wrong direction. I guess if something like this happens then the only options for you are to 1)redo surgery by pulling out these hair and replant them; or 2)adjust hairstyle to something that looks messy and hope that this defect will blend into your image; or 3)shave your head short so that hair misdirection would not be that obvious.

 

I think option 3 is not so much of an option as misdirected hairs are more easily disguised by longer hair unless you are talking about shaving to a 0 guard.

 

3. Hair line too low. Simply remove excess hairs by replanting them somewhere else. Of course there is chance that you will have scars. I guess you can do this with laser removal without leaving any scars.

 

Laser remove won't necessarily add more scars but it will not fill the "divot" scar that may be left behind. FUE will probably be the better option, taken slowly to monitor the healing.

 

4. Obsolete technologies being used that lead to patchy look (e.g. Plug-style hair transplant). But seriously who is doing this anymore, if you can do FUE or FUT that transplant single graft at a time?

 

Not all FUE or FUT is created equal. Those are extraction techniques and have little impact on the final result with regards to the aesthetics. The size of the "single graft" is determined also by the standards set in place by the clinic. Some clinics will trim the graft to be more "skinny" which means that a smaller incision can be made which then means that higher densities can be achieved and a less pluggy appearance. Also, I've seen many times where a patient has come in for a consultation and they have shown their FUE or FUT result from a clinic where the hairline was full of follicular units but they were multi-hair follicular units. This just doesn't look good much less natural. There are also certain kinds of hair that have a naturally pluggy appearance no matter how finely they are trimmed such as jet black coarse hair on white skin. Cases like this require higher density in one pass with no "transition zone" of low to high density but even then it can be more difficult to avoid a pluggy appearance under close scrutiny due to the nature of the hair.

 

5. Ingrown hairs that lead to folliculitis I think this is something that could happen when follicles were transplanted too deep. I still haven't found out if this is something transient or permanent.

 

Most cases of folliculitis are temporary and are caused by the growth of new hair follicles after surgery as they try to find new exit routes to freedom. Some of the hairs do not find an exit point so easily and irritate the scalp enough to cause a pimple. I've seen chronic cases of folliculitis, one case in particular that was so bad that he had multiple lumps under his hairline that were hairballs over two years old. The hair kept growing, into a ball trapped under the skin until they had to be surgically removed. This was the surgeon's fault however as the grafts were apparently placed upside down ( I have no idea how this could happen) and the hairs were growing INTO the scalp, not out of the scalp.The doctor would have to seriously screw up and be a complete novice, not to mention an idiot, to screw up so badly.

 

6. Healthy follicles could be damaged if transplanted hairs are too close to existing hairs . This should not be an issue for those who are having first surgery where recipient area does not have that many healthy follicles nearby.

 

 

This also depends on surgeon skill and if the recipient area is properly prepped. This comes from experience.

 

Are there any other possible implication in recipient area that I might have missed in the list above? Have I underestimated some of the complications in my list above?

 

The orange peel effect is never fun, neither is pitting or ridging. The orange peel effect is exactly how it sounds, the recipient zone looks like the surface of an orange peel. This is a result of the recipient zone being carpet bombed with a large instrument such as an 18 or 19 gauge needle and is the resulting scar tissue developing into an uneven and mottled surface. Pitting is from the incision being made too deep and the graft being pushed too far down. the area heals into a divot or a sharp dent. Ridging is the opposite and usually occurs around the hairline where the doctor attempted to dense pack. The resulting scar tissue builds up in the frontal permanent and it looks like a ridge.

 

Necrosis is another one to look at and while quite rare is is a game changer. It is usually caused from the surgeon trying to dense pack so much, and with the wrong tool, that it drastically alters the blood flow to a specific area of the scalp which in turn causes the tissue in that area to become necrotic, or dead. It starts out as a serious looking bruise that just gets darker and darker and eventually turns black, gets infected, and over the long term after it heals turns into a hairless zone of scar tissue. It is every hair surgeons' worst nightmare if it happens to them.

 

Permanent loss of sensation is something I think is extremely rare today but it is still possible nonetheless.

 

Bad or no growth. I think this one should be obvious and you should always factor this possibility into your considerations and is where the "find a reputable clinic" issue becomes valid. Reputable clinics have a track record that you can investigate to a degree as opposed to not having any track record for a new clinic.

 

I asked you in another thread where you were considering surgery because you said there is only one clinic in your country but your profile says you are in California. Where is it exactly (country) that you are writing from? I'm happy to help you investigate this new clinic further if you want some help. Send me a pm with the name of the clinic and the doctor as well as the location and I'll see what I can find out. I have many contacts in the industry and have worked in the industry myself for over a decade.

[kensington]

True.

..... jet black coarse hair on white skin. Cases like this require higher density in one pass with no "transition zone" of low to high density but even then it can be more difficult to avoid a pluggy appearance under close scrutiny due to the nature of the hair.

 

 

I am 51 years old and have jet black course hair with very white skin. Does that mean most likely a future transplant will produce that awful pluggy appearance in the my front area? I assume there must be some doctors who have experience with black hair white skin contrast and I am looking for someone in the Washington DC area.

 

Please advise

[JoeTillman]

I am 51 years old and have jet black course hair with very white skin. Does that mean most likely a future transplant will produce that awful pluggy appearance in the my front area? I assume there must be some doctors who have experience with black hair white skin contrast and I am looking for someone in the Washington DC area.

 

Please advise

 

It could, and yes different doctors have various levels of skill to address this but in the end it comes down to how attuned those around you are to how hair is supposed to look. Most people don't get it but if you come across someone that has an eye that is more keen than the average person then they will suspect something is up. It also depends on your own comfort level. Some guys that have surgery aren't the greatest critics. It's a hairline, they're happy, but others are far more hypercritical and even if it looks completely natural they will nitpick it to death to the point that it will ruin their perception of an otherwise awesome result. I think that if you pick a good surgeon then the result will turn out good but if the result will be one that if you look at it and try to pick out the inconsistencies or unnaturalness it will be visible to you. Whether or not you can handle it is a different story.

[romanino]

@ jotronikc.

Do you also know if the transplanted hair regrow after a S.D. ( I had it at the 6 months mark,never scratch my scalp)...

Will really appreciate your opinion.

Many thanks...

[gillenator]

jeff1986,

 

It always warms my heart whenever I see someone new doing thorough research and you bring up a number of vital issues regarding surgical hair restoration.

 

If you take the time and use the same approach when choosing the right surgeon, someone highly reputable and recommended, then you should not experience the pitfalls that you outlined in your initial post.

 

In fact, you can discuss each concern with any reputable surgeon and they should provide you a detailed response to each of them.

 

Yes it is possible to experience some of the misfortunes when choosing someone incompetent yet at the same time, this industry has come along way over the years and today, there are many competent and reputable surgeons to choose from...

[JoeTillman]

@ jotronikc.

Do you also know if the transplanted hair regrow after a S.D. ( I had it at the 6 months mark,never scratch my scalp)...

Will really appreciate your opinion.

Many thanks...

 

Romanino,

 

Are you referring to seborrheic dermatitis? Was this diagnosed by a dermatologist or is this an assumption due to dry scalp?

 

SD can cause hair to fall out at an accelerated rate and/or in patches but this hair can come back once you have the SD under control especially if the SD is a reaction to diet or lifestyle. I had this once about four years ago and the amount of hair I was losing scared me to death. I eventually learned about diet and how it affects the body (inflammation) and I've not had any real issues with it since. All the hair I lost has come back completely. This may be the same issue for you so watch your diet (avoid processed sugars, flour etc.), exercise, scrub your scalp when you wash and you will probably see improvements.

[romanino]

@jotronic

Thanks x your answer Joe, yes it was diagnosed by many dermatologist few years ago...

It's just back this summer,6 months after my hair transplant. My diet it's really good and I Do a lot of excercise, Thought I shouldn't scrub my scalp. I really hope I will get them back too. How long should it take to see some improvement? Some says 3 to 4 months but I couldn't see any. Did yours were transplanted hair? .

Tanks so much, all the best...

[JoeTillman]

If it was diagnosed by your doctor then you should follow his/her guidelines for treatment. However, the scrubbing issue is something overlooked far too often especially by new patients. They think that the recipient area shouldn't be touched much after surgery for fear of harming the new hairs. Non HT patients sometimes think that by being very delicate with their hair they are preventing or slowing their hair loss. Both are incorrect and you HT doctor should have told you to resume normal or even vigorous shampooing of your hair to help keep the scalp healthy and free of buildup.

 

The diet issue is something to look further into and I'm not talking about staying away from sweets and sodas either. I'm talking about processed foods in general, sugars and wheat products. Sometimes we have allergies to these foods and don't know it and it can manifest in ways similar to SD. Just something to think about but work with your derm to find a good shampoo to use, I recommend Tardan, and scrub your scalp, don't baby it.