Hair Transplant Risks, Complications and Safety
Written by Hair Transplant Surgeon Ali Emre Karadeniz
Publish Date: 31.07.2019
Hair transplant procedures are relatively safe procedures with as few as possible complications. However there are some worth mentioning. These complications should be rarely or even never encountered if hair transplant is done professionally.
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Local Anaesthetics Toxicity
If you look at the steps of a hair transplant procedure you see that this is a long procedure frequently taking up to eight hours or sometimes even more done under local anaesthesia. This is one of the longest surgical procedures to be done under local anaesthetics.
The first risk associated would be risks related to the application of local anaesthetics. Local anaesthetics can potentially be toxic to the human body if they are used at too high concentrations or if the daily dosage per patient is exceeded significantly.  Professional handling and application of local anaesthetics is necessary for the surgical safety of these anaesthetics. Potential risks associated with too much or wrongly administrated local anaesthetics are vascular, cardiological and neurological complications including toxication leading to coma and even death.
So, it is a mistake by unprofessionals who think that hair restoration surgery has no risks, some people wrongly think that it is not even surgery. This is wrong: Hair transplant is surgery! It needs to be taken seriously and handled professionally.
Daily dosage depends on patient's body weight as well as the hours it's administered. A certain dosage administered within intervals during the period could be safe whereas the same amount could be toxic if it's all injected at once. So, all of these things need to be taken care of.
The other thing is that if local anaesthetics are applied wrongly like injected into the blood vessel directly they can be very very toxic, they have to be injected by professionals in a professional way, applied at the correct surgical depths. This is the first risk that should practically be non-existent if it's handled professionally, but if it's done by non-professionals this complication could be very dangerous.
The other risk related to the hair transplant is one of the acute complications that can be happening during the procedure immediately, that is bleeding. Although major blood vessels are not cut during hair transplant procedures, sometimes the surface area of the surgical field can be quite large. Especially in FUE procedures there could be thousands of skin punctures done all across the donor area as well as thousands of incisions on the recipient site, so the surgical field is quite wide. If uncontrolled surgery is performed, there could be significant bleeding or blood clotting problems are not diagnosed before surgery the patient can experience unusual bleeding. Or if the patient is on blood thinning medication and this is not asked before the procedure, patient can have severe bleeding that is very hard to stop. If it is properly handled, bleeding shouldn't be a problem and the amount of bleeding would be insignificant.
More mid-term and long-term complications could be infection. If sterilization and sterile techniques are not properly used, if surgical instruments and the surgical environment is not sterile then the patient could catch an infection during the surgical procedure. This would be evident a few days after the procedure, showing redness at the surgical site, high fever and all other signs of infection. So this could be dangerous as well. However again, this should be rarely or even never encountered if hair transplant is done professionally.
Necrosis is the death of the tissue due to being deprived of its blood supply.  Some type of blood vessel injury always occurs when there's a cut done through the human skin. But if this is done beyond a certain threshold, then the tissue is not nourished enough by blood vessels and the blood flow could be insufficient. This leads to the death of the tissue which is seen as a very dark colored tissue - pale or purple at first and then a few days after the surgery turns into a black tissue - that is actually a dead tissue. This not only will cause the hair transplant to fail but will also cause severe wound healing problems. This is again a risk when the surgical procedures are not handled professionally and the tissue is traumatized beyond a certain threshold, beyond a safety limit.
Vasovagal reaction is a phenomenon when mostly a psychological reaction to the surgery happens in the first few minutes of the surgery in general and sometimes in the middle of the surgery, the patient faints. This is not a dangerous complication, if it is handled properly the patient recovers with no problems in a few minutes.
Scarring is another complication, some of the scarring are normal but if it is handled wrongly there can be extensive scarring beyond a certain limit at donor and recipient sites.
Damage to the Hair Follicles
In practice the most important risk and complication of a hair transplant is the damage to the hair follicles both at the donor and the recipient sites. This could lead to a moth eaten appearance at the donor area and significant thinning much beyond the amount of hair that is removed. This also causes loss of existing hairs at the recipient site and also poor growth due to poor handling of the follicular unit grafts.
So practically vast majority of poorly handled surgery results in hairs wasted and lost at the donor area, hairs wasted and damaged and lost at the recipient site and then poor growth happens as a result.
The most important complication is an unnatural result. Even if hairs are not wasted and lost, if it's not designed and executed well, the patient can end up with a good amount of hairs but unnatural direction, distribution and placement. (Further reading: Will My Hair Look Natural After A Hair Transplant?)
The first more frightening complications that I mentioned above are very rare unless surgery is done very wrong. 99% of the risk and complications we would see in hair transplant procedures are:
- Donor damage,
- Wastage of donor hairs showing moth eaten appearances at the donor area,
- Severe scarring,
- Loss of hair follicles,
- Reduction of density at the donor area
(Click here to learn more about hair transplant coverage and density.)
- The damage of the hairs at the recipient site and then poor growth of the transplanted hairs and
- Unnatural distribution, density and placement of those hairs.
This is a summary of some of the risks and complications related to hair transplant. There may be more, but these are the main things to consider.
1) Local anesthetic systemic toxicity: current perspectives, Kariem El-Boghdadly, Amit Pawa, and Ki Jinn Chin
2) Necrosis, Wikipedia
Written By Dr. Ali Emre Karadeniz, MD, PhD
Ali Emre Karadeniz, MD (Dr. K) is the only American Board of Hair Restoration Surgery Certified Turkish plastic surgeon. He has performed over 3000 hair operations. He is an active member of the International Society of Hair Restoration Surgery (ISHRS). Her performs hair restoration surgery at AEK Hair Clinic in Istanbul, Turkey.