Every person who schedules a hair transplant procedure expects a successful outcome. However, just as with any other surgical procedure, it carries the potential for complications. We at Tempus Hair Restoration consider our blog an important means of educating potential patients on every aspect of hair restoration – be it surgical or non-surgical. Our YouTube channel – Hair Loss Medical Advice – is another educational tool in which Dr. Marco Barusco – Founder and Chief Medical Officer at Tempus Hair Restoration – covers a hair loss-related topic in a conversational style. This article is based on his video, Complications in Hair Transplant Surgery, which we highly recommend you watch. Knowing what can possibly go wrong and how complications can best be prevented will make you a better informed patient able to ask the right questions and find an experienced, qualified surgeon specializing in hair transplant procedures.
What is a Complication?
A complication is an unanticipated problem that arises following – and is a result of – a procedure, treatment or illness. Fortunately, says Dr. Barusco, complications in hair restoration surgery are very rare. Serious complications are even rarer. However, although complications do not tend to be life-threatening, cosmetic complications can result in excessive scarring, decimation of the donor area caused by overharvesting, poor growth and unnatural-appearing growth patterns. In extreme cases, a complication can be permanently disfiguring.
Donor Area Complications – Follicular Unit Transplantation (FUT)
Also known as the strip method – in which hair follicles are harvested from the donor area of the scalp as strips – an FUT can result in tissue necrosis originating from wound dehiscence (the separation of the edges of a surgical incision) at the donor site. Dr. Barusco explains this complication as follows:
“Basically, if you take too much of an area too wide and you close it and there’s a lot of tension in the skin, you can stretch the vascular supply or the blood supply and the skin around the edges won’t survive so it’ll create these kind of dead areas there – and eventually it will heal, but it can leave a bigger scar that’s completely preventable. You just have to be careful in this area. Behind the ear there’s a little mastoid bone there where the skin is much tighter. There’s not a lot of movement, so when I train doctors on strict procedures, I warn them about this risk.”
Other complications with FUT procedures include a wider scar, rather than the typical “pencil line” scar that is eventually concealed by new hair growth. This can be a complication if the patient wants to keep his hair short.
Rare complications such as infections, bleeding, hematomas (a collection of blood outside of blood vessels) and a suture break that opens the incision back up can also occur.
Donor Area Complications – Follicular Unit Excision (FUE)
In this method, follicular units are extracted individually from the scalp. According to Dr. Barusco, complications in FUE transplants are more difficult to treat. The most common is scarring. Because patients who select this procedure tend to do so because they want to keep their hair shorter without the scars being visible, this complication defeats the purpose of the FUE – as the scars can be concealed if the hair is a longer length.
Why does this complication occur? Some people are more at risk for it. Dr. Barusco emphasizes the need for choosing a knowledgeable, experienced surgeon who is able to determine if the patient is a good candidate for the FUE. Also, punches that are too large in diameter and too close together can be another factor in scarring. This also limits the donor area, as no additional follicles can be harvested without resulting in a bald spot.
This leads into the fact that some bad outcomes are due to a botched surgery rather than a complication. Examples cited by Dr. Barusco include harvesting too many grafts from very high in the donor area – causing thinning – and a patient with already thin hair who was an inappropriate candidate for an FUE. Overharvesting in general, taking too many hair follicles from a small area and incisions too close together are other bad practices that result in disastrous outcomes.
“If you are going in for an FUE procedure, you have to be even more careful about who you let work on your scalp, because the burden of success for FUE procedures is much higher, and the problems with complications are much worse. So you want to go with someone who has a lot of experience and credentials – and you want a doctor performing it.”
Recipient Area Complications
Again, the following are not so much complications as they are botched surgical outcomes from bad medical practices. These include a poor hairline, low-density unnatural appearance, edema, necrosis (tissue death) and postoperative folliculitis/pustules.
Is the Person Performing Hair Transplants Qualified and Experienced?
Not everyone who performs hair transplants has the education, qualification and experience to do so – not even all surgeons! Dr. Barusco explains the situation as follows:
“Surgical specialty skills are not transferable. A surgeon who’s experienced at liposuction won’t necessarily be good at hair transplants, and vice versa.”
However, such surgeons are encouraged to see hair transplants as a new and profitable revenue stream by sales representatives of devices using robotic technology. The devices are typically sold as turnkey products, with the company providing non-medical technicians to not only operate the machine, but harvest and implant hair follicles. If you are not familiar with our practice and have not yet read Dr. Barusco’s insightful article – “The Truth Behind Advertising Devices Instead of Surgeons” – you owe it to yourself to learn the difference between marketing hype and medical best practices.
“A lot of doctors have fallen prey to that, and unfortunately, a lot of patients have been and are being harmed by that because the doctor is really not doing anything – he’s delegating to these technicians that the companies send them, or relying on a machine to make all the calculations, then push buttons and expect the machine to do everything.
“Hair transplant surgery may look simple, but it’s a very complex procedure. A lot of decisions are made in real time, in a real fast environment in terms of the angle and direction of hair growth – so you need someone with experience. We’re seeing complications now that we shouldn’t be seeing.”
The International Society of Hair Restoration Surgery (ISHRS) is the world’s leading medical authority on hair loss treatment and restoration. Dr. Barusco is a Fellow of the ISHRS. This is a distinction that is only given to those who achieve certain landmarks on teaching and leadership. Currently, fewer than 10% of the ISHRS members are Fellows. The ISHRS makes the following statement regarding this increasingly widespread practice of non-medical technicians performing hair transplant procedures:
“When a physician has taken the time to earn their medical degree, they will often spend additional time and resources to properly learn their craft so that they can offer the best medical service possible. Many hair restoration surgeons have spent numerous years learning from their peers and attending ISHRS-sanctioned surgical workshops to learn the advanced and basics of proper hair restoration surgery. This significantly reduces the chances of negative outcomes due to the time invested to learn the craft of hair restoration.
“Technicians, however, have no such training. Any training that a technician receives in a technician-driven clinic is usually from technicians learning from technicians. And that technician most likely learned from another technician, and so on. This means that there is potentially very little effort and time invested in learning the craft of hair restoration surgery, to the point that the methods necessary for achieving naturalness and high rates of growth are poorly understood.
“Moreover, the technicians never went to medical school and are not licensed to practice medicine! Most of these clinics do not understand even the most basic fundamentals of naturalness as it has taken many of the finest hair restoration physicians several years to master this aspect of their craft. All of the research into all of the meaningful areas of hair transplant surgery are performed by doctors, and this information is shared among colleagues.”
Clandestine Black Market Clinics – Why They’re No Bargain at Any Price
Clinics operated by non-physicians or technicians are becoming more common – especially in such countries as Turkey, Mexico, India and Sweden. According to the ISHRS, Turkey conducts the most aggressive marketing. Wherever the location, such clinics produce botched hair transplants much more as a rule rather than an occasional exception.
“Many of the illegal clinics have sophisticated websites ranking high with Google paid ads to attract the consumer into a clinic that appears on the surface very professional. The marketing tactics are deceptive as it appears like a team of professional doctors with excellent testimonials. However, the reality is your surgery may be done by someone with no medical training. The demand is so high, reports are that Taxi cab drivers and Syrian refugees do the surgery in some overseas countries.”
Our blog post – “Consumer Beware – The Risks of Medical Tourism for Hair Transplants” – covers this topic in depth, and features the ISHRS’s Fight the FIGHT campaign against fraudulent hair restoration clinics. Dr. Barusco participates in this consumer awareness campaign, which he covers in his video. The photo he shares of a horrific, permanently disfiguring outcome of a hair transplant performed at such a clinic can be found on the ISHRS’s Fight the FIGHT website, which is also linked above.
Knowledge is Power – Choose Your Hair Restoration Surgeon Wisely!
Some complications can be corrected by a skilled, experienced surgeon specializing in hair transplant procedures. Of course, avoiding such a situation in the first place is preferable to correcting a poor outcome later.
Ultimately, choose your surgeon based on experience, results and integrity. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice. Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device.
Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!