Things That Can Go Wrong in Hair Transplant Surgery

Thank you for this illuminating website. I would like to know that when you are doing a hair transplant, what are the things that can go wrong and what can the surgeon do to prevent them?

I can write a book answering this question. Everything seems so simple. When a visitor comes to one of our open house events, they are amazed as to how simple it appears to be (we have a closed-circuit television setup where visitors can see the procedure as it happens). Alas, the beauty of what we do accounts for many of the things that you asked about and it is buried into the process. I will make a list, but the list may not be inclusive of every nuance. I will not discuss anesthesia right now, but will commit another blog entry to address that subject at some future time.

1. For donor area harvesting using the strip method, the issues are (1) damage to the important structures of the scalp (nerves, blood vessels, attaching muscles must be carefully avoided in the incision process) and (2) damage to the hair follicles as the strip is removed which can occur along the blade that is used to incise the scalp. When the wounds are closed, the tension at the time of the closure reflects the size of the donor strip. High tension closures tend to cause a higher degree of scars.
2. The hair follicles are dissected from the donor strip under a microscope and great care must be exercised to avoid damaging them as they are separated into 1, 2, 3, and 4 hair follicular units. The use of a microscope with a skilled staff guarantees the least amount of damage. The grafts must be kept moist at all times, as drying for even less than a minute will kill the delicate follicular units. Graft placement must be timely, for if the grafts are kept out of the body for more than 6 hours the survival decreases with each additional hour. The use of cold solutions can keep grafts alive for longer periods of time.
3. Graft handling is critical, because crush injuries are common if the grafts are not handled very gently. The long term tenure of our staff is what minimizes graft damage during placing the grafts.
4. Graft placement is critical. These grafts must be placed so that the top of the graft is flat to the skin. Placing them too deeply will kill the grafts.
5. Recipient site distribution, direction, and the type of instrument used dictate which direction the hair will grow and if it will be normal in texture. The graft direction and distribution reflect the experience of the surgeon. Improper direction or distribution will produce less-than-ideal aesthetic results. The closeness of the grafts vary between patients. Those with less blood supply should not have close packing of the grafts, while in some patients close packing densities can easily and safely be achieved.
6. Great care must be taken to fill each and every empty site with an appropriate size (# of hairs) graft. Stacking one graft on top of another graft is a common problem (piggybacking) in a less than experienced staff and it is the cause of folliculitis in many practices.

I hope this helps.