Infection and folliculitis
The skin around the grafts reddens, pustules appear, pain increases, and fever may develop.
CONDITION / HAIR
Complications after hair transplantation.
Complications after a hair transplant are problems that go beyond normal healing: infection, skin necrosis, coarse scar at the back of the head, thinning of the donor area, or an unnatural hairline. They are assessed and treated even if the transplant was done in another clinic.
CONCEPTUAL VISUALIZATION- What it is
- Problems after hair transplantation — from infection in the first days to scars and unnatural hairline.
- How common
- In two large series, the overall complication rate is 1.2% and 4.7%.
- Most frequently described are
- Pain, swelling, and discomfort in the donor area; scars in the transplant area.
- Who treats it
- The surgeon who performs the hair transplant and scalp reconstruction.
01 / WHAT IS ITWhat is
What is
Transplant complications.
During a hair transplant, groups of 1–4 hairs (grafts) are taken from the donor area, usually from the occipital region, and transplanted to areas with hair loss. Grafts are taken individually (FUE) or a strip of skin is removed and divided into grafts (FUT).
Some changes are normal healing. According to the NHS, for a few days the scalp is tight, sore, and swollen; there may be temporary scabs at the transplant site. After a few weeks, the transplanted hair often falls out and then grows back: new hair appears approximately after 4 months, with the full result visible in 10–18 months.
Complications are what go beyond these limits: infection, skin necrosis, prolonged numbness, coarse scarring, noticeable thinning of the donor area, unnatural hairline. Serious complications in experienced hands are rare, but for a person who has opted for a planned procedure, any of them can be severe.
If the transplant was done at another clinic or abroad, this is not an obstacle: the doctor assesses what is present now and how much donor hair remains.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat can
What can
go wrong
Signs depend on where the problem is: in the donor area, in the transplant area, or in the overall concept.
Dying skin
The area in the transplant zone darkens, becomes covered with a dark scab, and the wound heals slowly.
Skin necrosis after surgeryCoarse scar at the back of the head
After the strip method, the scar became wide, thick, or red and is noticeable even under the hair.
Hypertrophic scar"Depleted" donor area
The occipital area has noticeably thinned, light spots or "bald patches" are visible — too many grafts were taken.
Unnatural hairline
The forehead line is too low or unnaturally straight, hair grows at the wrong angle or in clumps.
Numbness
The scalp does not feel touch for a long time after surgery.
03 / REASONSWhy do they arise?
Why do they arise?
complications
According to a 2020 review, most complications can be prevented: they most often occur due to poor planning or technical errors. Health status and post-operative care also matter.
Future hair loss not considered
A good plan should consider that natural hair may continue to thin. According to the NHS, hair around the transplanted area may keep thinning — in that case, the hairline eventually looks unnatural.
Too many grafts from the occipital area
Only a portion of hair from a safe donor area can be taken before it becomes noticeably thin.
Volume and density
In a multicenter study of 1,317 patients, the chances of folliculitis were higher when 4,000 grafts or more were transplanted or denser than 45 grafts per cm².
Smoking, diabetes, blood pressure
Among the risk factors for skin death in the transplant area, researchers mention smoking, diabetes, and high blood pressure.
Strip technique
The most common complication of the donor area after FUT is a hypertrophic scar or keloid, in studies up to 15.1%.
Technique
In FUE, the instruments, graft handling, transplant density, and the time grafts spend outside the body are important.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
If the transplant was a long time ago and you are concerned about the scar, the hairline, or thinning at the back of the head, — this is a planned situation and usually does not require urgent care. However, if the problem appeared in the first days or weeks, and there are no signs from the 103 list, first contact the clinic where the transplant was done.
103 immediately if:
- bleeding from the transplant or donor area that does not stop when pressed;
- blood beats in a stream;
- very rapid breathing or heartbeat;
- very high or, on the contrary, low temperature, chills;
- confusion or slurred speech;
- skin has become bluish, pale, spotted, or cold and clammy;
- purple spots on the skin;
- rash that does not disappear when pressed;
- the person has fainted or is unresponsive.
When to see a doctor:
Immediately — to the clinic where the transplant was done, and if this is not possible — to the emergency department: severe or increasingly severe pain, rapidly swelling head skin. On the same day: The transplant or donor site is red and hot, pus is flowing from it, the temperature has risen to 38°C or higher, or there is general malaise, the skin in the transplant area darkens or turns black. Planned: Coarse scar, thinning at the back of the head, unnatural hairline, hair did not grow — the full results of the transplant are visible in 10–18 months, but you can see the doctor earlier as well.
05 / DIAGNOSTICSAs defined,
As defined,
what to fix
- Conversation and documents
When, where, and by what method the transplant was done, how many grafts were transplanted; discharge summary and pre-operative photos, if available.
- Examination of the donor area
The doctor assesses hair density at the back of the head, skin mobility, and scars: this determines how many more grafts can be taken.
- Examination of the transplant area
Hairline, direction and angle of hair strands, density, scars; examination under magnification.
- Examination as needed
Analysis of wound discharge in case of signs of infection; determination of causes if natural hair continues to thin.
06 / TREATMENTHow we treat
How we treat
complications
Treatment depends on what exactly happened and how much time has passed. Acute problems are treated immediately, while correction of scars and the hairline is planned when the full result of the first transplant is visible.
01
The first days and weeks
Acute complications.
- Infection
- According to a review of 43 publications, infection occurred up to 11%, bleeding requiring intervention — up to 8%. Infection is treated with antibiotics and wound care.
- Folliculitis
- Inflammation around hair strands after transplantation in a multicenter study of 1,317 patients was 12.11%.
- Dying skin
- In a series of 18 patients, necrotic tissue was removed and the wound was cared for; all had scars and some grafts did not survive. Therefore, early identification of the problem is important.
- Numbness and shedding
- Prolonged numbness has been reported up to 11%, hair shedding — up to 6.5% in the transplant area and up to 4.1% in the donor area.
02
Donor area
Scar and depletion.
- A rough scar
- A scar after the strip method can be camouflaged by transplanting hair into it. The scar has poorer blood circulation and denser tissue, so it is more difficult than transplanting into healthy skin and may require several procedures.
- How much more can be taken
- The supply of donor hair is limited by its density, skin mobility, and the location of scars. Combining FUE with the strip method, according to the authors' limited experience, can help take more grafts with less risk of depletion.
- Body hair
- When hair at the back of the head is lacking, grafts are taken from the beard or body—either separately or together with scalp hair. Such hair may differ in thickness, length, and growth cycle.
03
Transplant area
Hairline, scars, micropigmentation.
- Unnatural hairline
- Poorly positioned grafts are excised and transplanted to places where they will look more natural, or masked with new grafts; sometimes grafts are removed with a laser without re-transplantation.
- Experience of one clinic
- In a series of 246 women who had their hairline corrected, hair was retransplanted using the strip method (63.4%) or FUE; in 18 cases, old grafts were removed with a laser, in 24 cases very coarse scars were treated with hormone injections (triamcinolone) before surgery.
- Transplantation into a scar
- In a series of 25 cases (scars after burns, surgeries, and injuries) 18 were observed for over half a year, and among them, the result was excellent in 44.4% and good in 38.9%. In scars from incisions, the result is worse than after burns.
- Unsuccessful micropigmentation
- Tattoos that mimic hair, in a retrospective study of 120 patients, were most often masked with hair transplantation (61.7%), less often removed with a laser and redone (13.3%).
04
Before redoing
- when
- The final appearance after transplantation develops over 10–18 months. Corrections often require more experience and calculation than the first transplantation because there is already less donor hair.
- Plan for years
- The new plan takes into account that one's own hair may continue to thin; the doctor may prescribe treatment to preserve it.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Complications after hair transplantation at the Dr. Valikhnovskyi Surgery Institute are treated in the 'Robotic Hair Transplant' direction — including when the first transplant was done in another clinic.
CLINIC SERVICE
Robotic hair transplantation
Own hair in baldness — with the ARTAS robot and manually, as well as after burns, injuries, and surgeries.
View service
What we do for this condition
- Robotic FUE (ARTAS) — the robot selects follicular units by camera images and excises them according to given parameters; the surgeon controls the process and forms the hairline.
- Manual FUE — follicles are extracted individually using a fine tool; small dot-like scars remain, barely noticeable under the hair.
- FUT — strip method — allows transplanting more grafts per session; combining with FUE can help take more grafts with less risk of donor area depletion, but there is little data on this so far.
- BHT — body hair — if donor hair on the back of the head is insufficient, follicles are additionally taken from the beard or body.
- Transplantation into a scar — hair is transplanted into scarred tissue; survival there is usually lower, and often several sessions are needed.
- Scar excision — small bald areas at the scar site are excised.
- Medication treatment — the doctor can prescribe it together with a transplant to preserve own hair.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of your head from multiple angles — the transplant area and the back of the head — and, if available, a discharge summary from the clinic where the transplant was done.
- ConsultationExamination of the donor area, hairline, and scars; assessment of how many grafts can still be taken.
- PlanWhat to treat now and what — after the full result of the first transplant, and how to preserve the donor area for the future.
- TreatmentRepeat transplant (ARTAS robot, manual FUE, FUT, hair from the body), transplant into a scar or excision — depending on the problem.
- RecoveryReviews until healing; the growth of new hair is assessed no earlier than a few months later.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Hair fell out a few weeks after the transplant. Is this a complication?
Most often no. According to NHS data, transplanted hair often falls out after a few weeks and then grows back: new hair appears in about 4 months, with full results visible in 10–18 months.
Is it possible to correct a transplant done at another clinic?
Yes. The doctor evaluates what is present now and how much donor hair is left, and makes a plan. Bring the discharge from that clinic and photos before the operation, if available.
The back of my head became thinner after FUE. Can I transplant more?
It depends on how much hair is left and how flexible the skin is. Sometimes FUE can be combined with the strip method or hair can be taken from the beard or body. What is possible specifically for you, the doctor will say after the examination.
The hairline looks unnatural. What do they do about this?
Poorly placed grafts can be excised and transplanted to another place, masked with new grafts, or removed with a laser. The choice depends on how many grafts there are and where they are located.
The scar on the back of my head has become wide. Can it be hidden?
Often it happens like this: hair is transplanted into a scar. But circulation in the scar is worse, so the survival rate is lower than in healthy skin, and several procedures may be required.
When can a repeat transplant be done?
Usually after the full result of the first one is visible — after 10–18 months. Acute complications, such as infection, are treated immediately.
Is it necessary to treat hair loss after a transplant?
According to the NHS, hair around the transplanted area may continue to thin. Therefore, a doctor may prescribe treatment to preserve your own hair.
Sources
16 sources · systematic reviews, multicenter studies, case series, and NHSshowCollapse
- Complications Following Hair Transplantation: A Systematic Literature Review and Meta-AnalysisAesthetic Plastic Surgery, 2025doi:10.1007/s00266-025-05125-y ↗
- A Scoping Review on Complications in Modern Hair Transplantation: More than Just Splitting HairsAesthetic Plastic Surgery, 2025doi:10.1007/s00266-024-04316-3 ↗
- Complications in follicular unit excision hair transplantation: current evidence and practical approachesFrontiers in Medicine, 2026doi:10.3389/fmed.2026.1750989 ↗
- Complications with Hair TransplantationFacial Plastic Surgery Clinics of North America, 2020doi:10.1016/j.fsc.2020.01.003 ↗
- Characterization and Risk Factors of Folliculitis after Hair Transplantation: A Multicenter Retrospective StudyPlastic and Reconstructive Surgery, 2024doi:10.1097/PRS.0000000000011175 ↗
- Recipient Site Necrosis After Follicular Unit Excision Technique For Hair Transplantation: Evaluation of 18 PatientsAesthetic Plastic Surgery, 2024doi:10.1007/s00266-024-04305-6 ↗
- Follicular Unit Excision-Linear Ellipse Donor Harvesting Technique: Combining Standard Follicular Unit Excision with Follicular Unit Excision inside a Linear Strip (Modified Linear Strip Excision) to Optimize Graft YieldFacial Plastic Surgery, 2024doi:10.1055/a-2198-2703 ↗
- The art of repair in surgical hair restoration part I: basic repair strategiesDermatologic Surgery, 2002doi:10.1046/j.1524-4725.2002.02030.x ↗
- Secondary Revision of Female Hairline Correction Surgery: Personal ExperienceAesthetic Plastic Surgery, 2019doi:10.1007/s00266-019-01372-y ↗
- Hair follicle transplantation on scar tissueJournal of Craniofacial Surgery, 2013doi:10.1097/SCS.0b013e31828a78ad ↗
- Revision for unsatisfactory outcomes of scalp micropigmentationInternational Journal of Dermatology, 2025doi:10.1111/ijd.17260 ↗
- Body to Scalp: Evolving Trends in Body Hair TransplantationIndian Dermatology Online Journal, 2017doi:10.4103/idoj.IDOJ_283_16 ↗
- Hair transplantNHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/hair-transplant ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
The transplant was successful
not as desired?
Send photos of your head from several angles and a discharge summary from the clinic where the transplant was done. A doctor will tell you what can be corrected and when.