Scalp Necrosis After Hair Transplant

Scalp Necrosis After Hair Transplant

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Every surgery comes with its risks and complications. It’s important that you’re fully aware of them. Spotting early signs of the complications can result in quick diagnosis and treatment. It can help in preventing further damage to the surgical outcome. Scalp necrosis after a hair transplant is a rare but dangerous complication of this surgery. Knowing that the condition can permanently damage the results of the surgery causes even more alarm among patients. It’s important that you know about it as it can result in quick intervention and limit the impact area. Scalp necrosis can occur both in the donor area and the recipient area. Although the complication rate of hair restoration surgery is low, you should know all about it.

What is Necrosis?

Necrosis involves permanent tissue damage. It is not genetically programmed (unlike necrobiosis) and, in fact, occurs prematurely and accidentally. It can occur due to many reasons, such as temperature, chemicals, disease-causing pathogens, physical trauma, and infections.

One type of necrosis that many people are familiar with is frostbite. The water in the skin freezes, blood vessels constrict, and the supply of blood and oxygen to body cells is blocked. This can cause the cells in the tissues to stop functioning.

What happens is that the cell first swells, and then it bursts, spilling out its contents in the surrounding tissue. This then triggers an inflammatory response by the body. This can also occur in an autoimmune disorder. Unfortunately, necrosis is irreversible, and the surgeon has to remove the skin. A necrotic tissue will appear black, leathery and, maybe, loose.

At first, you’ll feel pain. Usually, it’s quite intense. When a heart attack occurs due to a blockage of the blood vessel, the pain immediately prompts the person to seek treatment. That’s because the heart tissue isn’t receiving enough oxygen and nutrients. So, if you feel pain in your scalp, you should immediately get in touch with your surgeon. After that, the skin can also become red, swollen, discoloured, and numb.

Why Does Scalp Necrosis After Hair Transplant Occur?

There are different causes of scalp necrosis after hair transplantation surgery. Let’s take a look at them:

Close Transplantation of Hair Grafts

Almost every patient wants to achieve high hair density following a follicular unit extraction (FUE) hair transplant, but it’s not always possible or wise. The surgeon should inform the patient of the density that can be achieved through the procedure.

Attempting to densely pack hair grafts in the balding region will require the surgeon to make a lot of small incisions. It is like a large wound with many small cuts close together due to the damage done to the skin. This will disrupt the blood flow to the area and permanently damage the tissue.

A small study, comprising photographs of 18 patients, published in Dermatology Practical & Conceptual, showed that commonly necrosis occurred in the top-centre, often to the right. The reason for recipient site necrosis was the dense packing of grafts in the hair transplant procedure.

Keep in mind that scalp necrosis is permanent. Even inserting new hair follicles in the area won’t result in hair growth. It will permanently damage the results of hair transplant surgery. The surgeon has to remove (excise) the tissue to allow wound healing to take place.

Deep Incisions

Scalp necrosis after hair transplant occurs due to the inexperience of the surgeon in this case. According to a study published in the Journal of Cutaneous and Aesthetic Surgery in 2018, deep recipient incisions can cut the arteries underneath the skin, which can result in the death of the tissue.

A closely related problem is when a surgeon’s unable to properly close the wound site. This can also end up reducing the blood flow to the area and cause necrosis around the surgical wound. It will cause a healing delay. It results in donor site necrosis in follicular unit transplantation (FUT) scalp surgery.

Trauma to the Scalp

Researches have indicated that local anaesthetics containing a high concentration of adrenaline can result in necrosis. However, the action of taking out hair grafts from the donor area also equals trauma for the scalp, according to a case report published in the Journal of Plastic, Reconstructive & Aesthetic Surgery. It resulted in donor site scalp necrosis and cicatricial alopecia after follicular unit extraction hair transplant.


Patients are recommended to stop smoking before and after the surgery takes place. That’s because the substances in the smoke can cause the blood vessels to constrict. This will limit the oxygen and nutrients that the surgical wound will receive. Consequently, you’ll end up with scalp necrosis.

Other Causes

A reason why usually scalp necrosis occurs in the centre of the scalp is that it has reduced blood flow in contrast to other regions of the scalp. The process of formation of blood vessels, also known as vascularization, is also reduced in people who have androgenetic alopecia. This further puts them at risk of scalp necrosis.

Hair transplant mega-sessions can also increase the risk of scalp necrosis, according to one study published in the Journal of Cosmetic Dermatology in 2020. This study also showed that patients with diabetes mellitus were at a higher risk of developing scalp necrosis. Moreover, the researchers found that a topical nitroglycerine spray can even prevent necrosis.

How You Can Prevent Scalp Necrosis After Hair Transplant

Looking at the causes, you can see it either comes down to the surgeon or the patient. Make sure you do the following for its prevention.

Find A Good Surgeon

Most of the causes of scalp necrosis are consequent of poor surgical technique and inexperience of the surgeon. Make sure that you find a surgeon who doesn’t make false promises and communicates realistic expectations to you. An experienced surgeon won’t damage the underlying major blood vessels or try to achieve unnaturally high density through dense hair transplantation.

No Smoking or Alcohol

You need to stop smoking for at least 10 days after the hair transplant as it will affect your blood circulation and cause skin necrosis.

Keep the Surgical Area Clean

You have to make sure that the surgical wound is clean and dry so that your scalp isn’t at a high risk of infection. Infections can also result in necrosis.

Topical Nitroglycerine

Several studies have shown the safety and efficacy of topical nitroglycerine spray in preventing scalp necrosis. It works by dilating the blood vessels and increasing blood flow in the area.

How To Treat Scalp Necrosis?

If the patient has developed skin necrosis after a hair transplant, the surgeon will have to remove the skin. That’s because leaving it will prolong the healing process and can even result in an infection. To make sure that it doesn’t spread elsewhere, the surgeon also needs to identify the cause of necrosis. Identified early on, this can be prevented. However, once the tissue has died, the roots of the hair grafts will also die. The damage is permanent.

How Common is Scalp Necrosis After Hair Transplant?

As mentioned above, scalp necrosis is a very rare complication. In one study with 425 patients who had gotten a hair transplant, the general complication rate of hair transplant was 4.7%, of which donor site necrosis had an incidence rate of 0.8%. The study concluded that it is important for the patient to communicate with the surgeon and the medical team to be sufficiently qualified to reduce complication rates in hair transplants.

How Quickly Does Necrosis Occur in Hair Transplantation?

It can depend on different factors. If necrosis occurs due to problems in the surgical technique, the process of necrosis will start immediately in the postoperative period. However, if the necrosis results from poor blood flow due to smoking or drinking, cell death will occur around a week after the surgery, when the wounds are still fresh. Necrosis can physically deform your scalp.

How To Tell Necrotic Tissue & Scabs After Hair Transplant Apart?

The formation of scabs on a patient’s head is a sign of healing. These will appear as small brown dots on the scalp. Eventually, they’ll go away with washing. However, necrotic tissue’s size can equal that of your palm. Moreover, the colour of necrotic is usually tan, dark brown or black. The texture of the skin is also leathery.

Bottom Line

Necrosis of the scalp occurs due to different reasons. It can affect the recipient skin, usually in the central scalp area. This could be due to poor vascularization, very deep incisions, dense splitting of the recipient sites, smoking, and alcohol, among other reasons.

The problem is not limited to the recipient area. It can also occur in the donor area due to the trauma of extracting follicles from the area. Regardless, scalp necrosis is very rare. It is possible to prevent it. However, there’s no way to reverse it. The surgeon will have to remove the necrotic tissue. Make sure that you find a good surgeon and follow your aftercare instructions. Whatsapp