Patient with persistent redness in the recipient area (with Photos)

Thank you for the baldingblog. The answers you’ve give over the years are a very valuable resource for patients before, during and after hair transplants.

It’s now 9 weeks after my FUE. My recipient area is very red and incision marks are all visible. The color and texture of the recipient area improved until the 2 week mark, but since then it hasn’t changed in the last 7 weeks. I understand from your baldingblog that your patients have at most 6 to 8 weeks of redness (you wrote about it in separate posts in March and May, 2014). Unfortunately, my redness has lasted longer than that and shows no signs of improving any time soon. For what it’s worth, I’ve seen internet posts by guys who have had similar redness, so I imagine this is a topic of interest for quite a few men.

I’ve had no sun exposure, swelling, pus, warmth, fever, or health issues. I did thorough blood both tests before the operation as well as last week; all results were and still are good. There’s no hair growth yet obviously, but at 9 weeks, that’s normal. My HT surgeon said it’s the reddest he’s ever seen. He has no idea what’s going on. He said it doesn’t seem infected or to have any problems except that it’s still very, very red with incision marks still visible to the naked eye. He very honestly told me that he doesn’t know what to advise and suggested speaking to other doctors.  I’ve consulted several doctors, both hair surgeons and dermatologists. They all have very different ideas for diagnosis and treatment, as well as reasons why the other proposed treatments aren’t good. I’m confused by the different ideas and would like to ask your opinion about them:

Treatment #1.
Diagnosis: small dilated blood vessels near the surface of the skin (“broken capillaries”), i.e. a form of telangiectasias caused by the trauma of surgery. If you push with finger on the redness and release, the skin becomes white for a second and then returns to red. That brief whiteness happens because of these dilated blood vessels. Treatment: pulsed dye laser (“V-beam”). Targets only the red wavelength of the capillaries, so the laser will reduce the redness but not hurt the (soon-to-arrive) growth of the transplanted follicles.

Counter-argument: The range of wavelengths of the V-beam laser cannot be made so narrow as to ONLY work on the blood vessels. The laser will probably hurt the hair follicles and harm my eventual transplant result.

Treatment #2.
Diagnosis: inflammation caused by the HT surgery. Treatment: 100 little PRP injections throughout the red area as an anti-inflammatory to stimulate angiogenesis. In addition to promoting healing of the redness, it will help the eventual hair growth.

Counter-argument: PRP won’t help much, while 100 injections into an already red area would just irritate the skin more and cause even more redness.

Treatment #3.
Diagnosis: inflammation similar to eczema. Treatment: a mid-level topical corticosteroid with potency around 100-150x hyrocortisone, perhaps mixed with an anti-bacterium. It’s anti-inflammatory, immunosuppressive, vasoconstrictive. Doesn’t affect the hair follicles. Try it 3-4 weeks. If it helps, great; if not, stop after a month and there’s no danger of harm or long-term damage.

Counter-argument: The vasco-constrictive properties of steroids is exactly what I don’t want while my body is trying to heal itself now. And steroids have lots of bad side affects: red skin syndrome from withdrawal, thinning of the skin, etc.

Treatment #4.
Diagnosis: That’s life. I’m blonde, light blue eyes, fair skin (stereotypical Scandinavian look). Redness can happen. Treatment: can’t do anything. Will take 6 months to 1 year to heal. Bad luck. Buy lots of hats.

Counter-argument: At 9 weeks post-op – and 7 weeks of no change – the extreme redness is not going to get better on its own, no matter how many months or years I wait. Moreover, the time to treat is now while it’s still relatively fresh. As time goes on, it becomes an area of chronic, long-term wounds, and it will become much harder to treat. And there will be no hiding it: because of my hair color, density, and skin tone, the redness will be visible even after all my hairs have grown in. So fix it now.

I’m quite confused about what to do, so I’d love to ask your thoughts based on your years of experience and observations.

Thank you very much for your kind attention and the very helpful information on the baldingblog.

My Answer:  The above comments were this patient’s analysis of his problem and I was very impressed that he drilled down in such detail about his problem.  The following was my answer to his consult request:  Despite the fact that an infection has been ruled out, I would do a small tissue biopsy if the redness continued for another month or two and perform histology and a culture of the material from the biopsy to make sure you don’t have an indolent infection if the redness continues for more than another 4 weeks. I might also have you go on an antibiotic like Vibromycin and run this course about 10 days. After this if the redness is still there, the use of a topical steroid might be appropriate. Then, knowing nothing serious is wrong, I would wait it out until the pink color goes away. In my career, I had one patient like you who always got red after the four surgeries where he had a pinkish color which usually subsided but lasted always 12 weeks or so. I realize that you would have to show my answer to your doctor and ask for a response showing your doctor my suggestions.

Your suggestions about my redness is helpful. A skin biopsy is a good idea to be sure there’s no indolent infection. I understand your suggestion about antibiotics and then topical steroids.

And I appreciate that you related your experience with the patient who had redness from all 4 of his surgeries which only faded away by week 12. That definitely gives me hope!! :-)

I thought you would appreciate that I have now found several patients (via doctors I’ve consulted and through the internet) who have redness similar to mine. It reassures me – a bit, at least – that there are is definitely a not-so-tiny number of men who are red for months after the operation. The range of time that the redness lasts is highly variable: I’ve heard from men with 3 months all the way up to 1 year. I’ve also now spoken personally to 3 patients where the color became de facto permanent: one or several years after surgery, they still have a faded pinkness in their recipient area. In their case, the color is not the extreme redness that they had after the operation, but is a pinkness which is very noticeable in contrast to the natural color of the rest of their scalp. Their hair growth helps cover the coloration, but it’s still visible depending on the light and their hair characteristics. But even among those men with redness months after surgery, these long-term pinkness people seem to be the exception, so I’m hopeful that waiting it out, as you say, will see my redness fade.

Thank you again. It’s very kind of you to have taken the time to respond to my question, and I very much appreciate both your answer to me as well as the huge resource of information posted on baldingblog for many years.

Best wishes to you,