Although the risks are very minimal and serious or long term side effects are exceedingly rare , for the consumers knowledge I have tried to collect extensive list as under:
A: Easily avoidable by a good doctor and patient:
- Infection of the donor and transplant sites: I have never seen any serious infections as the scalp has a wonderful blood supply which prevents and protects against these infections. This occurs if the sterile techniques are not used ( e.g. disposable needles, sterilized instrumentations etc.) if poor post operative hygiene is kept.
- Swelling in the operated site: The head may look swollen at the end of the procedure due to the anesthetic fluid in the tissue for a few hours. This gets alright by the next morning. The swelling due to the surgery is a natural reaction after 24 hours but this is usually minimal and lasts for 2-5 days. Mild Swelling after surgery is common. The swelling may work its way down to the eyes three or four days after the surgery this may frightening although it eventually goes away. Sleeping with the face down for first 3-4 days could swell your face by dependent edema- so avoid that position for 3-4 days. Sit with the head bent backwards to bypass the swelling to the back side of head instead of coming to the front. Sleeping on side would make your side swell up due due dependent edema your ear may change the position for a day or two until the swelling subsides. but the use of post-operative steroids may be helpful at reducing or eliminating swelling. Rarely delayed swelling could be due to allergic reaction to the Minoxidil application started post operatively.
- Itching if the operated site: Seen usually during healing phase so in a way good indicator of healing. This could be due to dryness or allergy to Minoxidil application. This is also temporary symptom for a few days but can easily be taken care of by proper scalp cleaning and supplementing with hair oil or other skin emollient e.g. conditioner for the dry hair, for few days.
- Flaking: If you do not wash your hair vigorously after 10 days of hair transplant, you will have crusting that may last for a month or more. Dry skin that may follow a hair transplant requires good skin care in terms of shampooing not just hair but also the skin underneath. For people with dry skin and hair may supplement some hair conditioner or hair oil.
- Reaction.s to the local anesthetic: This occurs if you are sensitive/ allergic to it or if you are given over dose. Even this is exceedingly rare because the medications used like Lignocaine and Sensorcaine are intensively studied local anesthetic agents and have very high safety margin and their safe dosage are well defined. Local anesthetic toxicity can result in seizures, respiratory depression or arrest, hypotension, cardiovascular collapse or cardiac arrest. Paracetamol, aspirin, vitamins, alcohol and other such substances should be absolutely safe, but on very rare occasions, each of these can kill. When used in ‘overdose’ and untreated, these medications (including Lidocaine) can be lethal. This can although very rarely occur esp. in patients who had pre existing conditions, such as gross obesity, known cardiac disease, epilepsy, chronic obstructive pulmonary disease, and liver disease that can significantly affect anesthesia dosage and care. In all such cases most of the adverse events can be avoidable with skilled medical care
- Mild pitting or tenting around the transplanted hair: this can be avoided by making appropriate size holes and making the appropriate size grafts. Easily avoidable by a good hair transplant surgeon.
- Wide scar: Scarring always happens when the skin is cut, but newer techniques of wound closure usually prevent that from occurring at socially detectable levels. With each successive procedure there is possibility of slightly wider scar 5% after 1st 10% after 2nd surgery and more after 3rd. More chances in dark or black people. Rarely do these scars become cosmetically significant unless one shaved his head and in that case, all such scars will be seen no matter how perfect the healing is. Wide scars can best be corrected by planting some FUE hair in the cosmetically visible area and some times hair colored tattoo in the scar helps. People with keloidal tendencies should avoid this surgery.
- Bleeding: spotting of blood on the pillow the next morning due to some oozing from the stitch area is not uncommon for 2-4 days and is event less and one should keep the stitched area clean by twice daily shampooing for period of 10 days . Some oozing from the recipient site is usual and that requires twice daily gentle shampooing with spray bottle if possible to prevent crusting. Sudden late bleeding from the donor up to 2 weeks could be due to some strenuous activity or that from recipient area could be due to dislodged graft. This may require immediate pressure at the site of bleeding with the clean finger tip for 7 minutes by watch and once it stops you may consult your doctor.
- Numbness or hypersensitivity above the donor area (This can happen only in strip method due to cut superficial nerves FUE does not have such a problem) or recipient site (usually temporary for 3-6 months – till the new nerve growth takes over). Massage or tapping of the hypersensitive scar help to retain the sensitivity.
- Redness in recipient area: Generally, the redness goes away after about a week or two. This is due to what is known as "Histamine positive skin". It is the way how your body reacts to irritation with resultant vasodilitation (more blood flows through your skin). This is more common in white or fair skin and very rare in dark or black skin. The good thing is; redness will slowly fade away in few weeks. Use of steroids ointment for a few weeks will expedite this fading. Copper Peptide shampoo may help. A disguising light makeup (Couvre, Toppik or Nenogen) is also useful at times. avoid sun irritation.
- Failure of the hair to survive the procedure or Poor hair Growth - this happens if there is improper technique or wrong case selection of Hair Transplant (alopecia areata or scarred area. Poor hair growth may be attributed to the smoking during the post operative period because out of those who had poor growth were smokers.
- Shock loss occurs in the recipient area especially in young( below 30years and females) in first 3 months following surgery. The best way to reduce the risks for shock loss in males is the use of Finasteride 1mg to be taken orally 2-4 weeks prior to the surgery and for the subsequent few months and in females Minoxidil and Low Level Laser Therapy may help beside reassurance. Usually the miniaturized hairs of the recipient area shed and some may be lost permanently.
- Pimples or Folliculitis or cysts: It is not uncommon to have a few pimples in the first few months as the new hairs grow in. Folliculitis or cysts in the scalp are most often caused by (1) remnants of the previous hairs that were not shed but put below the skin or (2) pieces of the sebaceous glands that are putting out sebum below the skin and collecting below the skin, or (3) grafts that were placed too deeply or piggybacked one on top of the other (4)Ingrown hairs. This is cared for by just keeping the scalp clean. Sometimes popping these pimples yourself works, or doctor can drain the cyst. Wet warm compresses will help. Steroid application may work in initial period of pimple. Sometimes these ingrown hairs have infectious which might require an antibiotic.
- Wavy or rough transplanted hair: This although rare to see could be due to 1. poor support of sparse transplant 2. bent ir partly folded roots while transplant or 3. microscopic scars in graft is influencing the direction of hair growth and the character of the hair.This usually corrects after one hair cycle (about 3 years). As a temporary solution use of gels, mousses, and good conditioners will help to solve this problem.
- Difference in color of transplanted hair and the native hair: Donor hair has thicker shaft and have heavier pigments due to lower exposure to sun compared to the hair on the top . As a result sometimes the native hairs may look lighter in color compared to the transplanted hair. This difference usually fade over a period due to bleaching effect of sun on the transplanted hair.
- Delayed hair growth: On occasional cases the hairs started growing after 8 to even 12 months post operatively. The reasons for that are not accurately known. Minoxidil to increase the scalp blood supply and Laser comb may be of some help at least theoretically