FUE (Follicular Unit Extraction) hair transplant surgery is a minimally invasive technique that has become increasingly popular due to its minimal scarring and rapid recovery time. However, despite its benefits, several complications can arise from the procedure. In this article, we will discuss the most common complications associated with FUE hair transplant surgery.
Donor-Site Depletion: Donor-site depletion is a common complication of FUE hair transplant surgery. The risk of depletion of hair from the donor region due to aggressive and nonuniform harvesting is observed, resulting in a moth-eaten or pseudo-syphilitic appearance. This complication can occur irrespective of whether scoring was performed by manual, motorized, or robotic punches.
Pinpoint Scarring: Pinpoint scarring is another common complication associated with FUE hair transplant surgery. It is a misconception that FUE is a scarproof technique. The punch used to harvest each follicular grouping may create pinpoint white atrophic macules, which can be visible on close inspection with short hair. Patients with skin color types 4–6, common in India, are more prone to hypopigmentation, which can be very apparent on shaving, negating the perceived benefit of minimal scarring by FUE.
Postoperative Effluvium: Postoperative donor hair effluvium is a possibility that can occur after FUE hair transplant surgery. The condition may appear after a few days to a few weeks of surgery and show diffuse hair loss. It is mostly temporary and resolves within 3–4 months in most cases. The most common cause can be overharvesting and/or hampered blood supply.
Buried Grafts: Buried grafts are a common complication that occurs when blunt punches are used during the FUE procedure. If the punching is performed in a hurry or proper alignment of punch along with hair follicles is not carried out, then the graft is pushed into the dermis leading to a buried graft.
Overharvesting: Overharvesting is another complication that may occur during FUE hair transplant surgery. It can lead to permanent damage to the donor area, thinning, and patchy hair loss. Before starting the extraction process, a safe donor area should be demarcated, and overharvesting should be avoided. It is preferable not to exceed the extraction of more than 1:4 follicular units.
Necrosis: Cutaneous necrosis after FUE is uncommon but has been reported in the literature. It can lead to cicatricial alopecia, which is a permanent form of hair loss.
Subdermal Cysts: Subdermal cysts present as multiple, slow-growing nodular, painless swellings in the scalp donor area. Lack of due diligence while performing FUE can lead to subluxation of the grafts into the subdermal layer of the scalp.
Keloid: Keloid or hypertrophic scar formation at the donor site following FUE is a rare complication. It is important to note that a thorough search of the literature found only two case reports of this complication.
In conclusion, FUE hair transplant surgery is a minimally invasive technique with several benefits. However, it is essential to be aware of the possible complications associated with the procedure. Patients should discuss these risks with their surgeons before undergoing the procedure to make an informed decision. With proper planning and execution, most complications can be avoided, and patients can achieve satisfactory results.
