Hair transplantation surgical procedure is a promising, quickest, easiest and permanent method of hair rejuvenation among the several treatment options for Androgenetic alopecia. There are several serious complications that might arise from surgical hair restoration and are relatively uncommon that follows a well-performed and well-planned surgery. As the number of hair transplant surgeries continues to hike up, so will the number of complications that might surface in the course of these surgeries as their after-effects, presenting huge challenges to new comer and seasoned surgeons alike.
Complications might arise in the process or in post-surgery period because of surgical techniques and methods, because of the surgeons’ planning and technical errors or due to the patients’ physiology or compliance errors. Complications might occur either at the recipient or at the donor site or even both.
There are also isolated case reports that focus on complicating factors, such as persistent hiccups, hereditary angioedema, von Willebrand disease, herpes zoster, and even malignant hyperthermia, all of them manifest themselves during or after the hair transplant procedures. The complications of the procedure have included changes in scars, disturbances of pigmentation, hair kinking, dehiscence, arteriovenous fistulas, scar enlargement as well as necrosis, scalp infection, areas of postoperative folliculitis, and even osteomyelitis of the cranium.
MATERIALS AND METHODS
The study was a retrospective analysis of the patients who underwent hair restoration surgeries. Data were collected and out of the 197 patients underwent HRS for AGA, and only 73 patients’ data were available. Of the 73 patients, 65 patients had undergone hair transplantation through the Follicular unit hair transplant technique, while 7 of the remaining had undergone Hair Restoration Surgery by Follicular Unit Extraction method and only 1 patient had undergone body hair transplantation (BHT).
All the patients had trimmed their hair short prior to the hair transplantation surgery. Anxiolytics, pain killers and antibiotics were administered at the beginning of surgery. Strict surgical asepsis was taken care of and the Ring block anesthesia had been administered to the donor area using a blend of xylocaine and bupivacaine. Then, this was followed by the tumescent injection that was a mixture of bupivacaine with adrenaline, along with saline/ringer lactate and triamcinalone acetate. The follicles were then harvested by extraction method using micro motor punches, from the donor area. After extraction method, the donor area was closed using 3-0 vicryl rapide through the trichophytic closure method. The strip was then slivered and the follicular units were dissected and preserved in chilled saline/ringer lactate until final implantation. Tumescent solution was also injected after giving supra orbital and supra trochlear block into the recipient area. Slits were made and the follicular units were implanted into the slits with the help of two forceps. The dressing on the donor area was removed after 10 to 12 days. Patients were recommended to visit in the immediate postoperative period, at regular intervals of 3, 7, and 14 days, and then monthly for about 1-year postoperatively.
All the complications during the surgery and post- surgery were recorded by data collection.
Of the 73 patients, 65 patients underwent FUT technique of hair transplant, 7 patients underwent FUE method and 1 patient had BHT treatment. The youngest one who underwent HRS was of 21 years and the oldest was nearly 60 years. Postoperative edema was the most common complication that was found in 31 patients. Another common complication that was recorded in 17 patients was due to sterile folliculitis in the recipient area, there was even a wide donor scar observed in 11 patients, numbness/paresthesia and bacterial folliculitis were reported in 8 patients each. Other complications included raised donor scar, postoperative hiccups, excessive bleeding during surgery, syncope, changed skin texture in the recipient area, postoperative pruritus were reported in very few patients. 44 patients gave a report of less than 50% growth of the transplanted hair after the surgery and 20 of them reported of less than 25% growth.
This article was written by Dr. Mayank Singh, an Experienced hair transplant doctor in India & founder of Radiance Cosmedic Centre. He has done 2500+ Cosmetic, Plastic, and Hair Surgery in Delhi, India.