What is Hair Transplant Necrosis
Necrosis is the death of skin tissue. In terms of hair restoration, this typically means the death of the scalp tissue in particular. There is no area of the scalp that is more susceptible to tissue death than any other area of the scalp. There is no regular size of the area affected by tissue death. The area in general can be the size of a small coin or smaller or it can involve half of the entire recipient scalp.
What are Some Common Causes of Necrosis?
Necrosis of the scalp usually occurs due to one of two reasons:
- Over-packing – Like any other surgery, an overly ambitious doctor can attempt too much change at once and cause damage as a result. In many cases, a doctor overly packs the recipient area with too many hair follicle grafts in an attempt for high-density results, which creates far too much trauma to the recipient scalp which can lead to tissue death.
- Over-packing an area can disrupt the blood flow to an isolated region of the scalp.
- This region is starved of the blood’s nourishing nutrients long enough to completely die off and become necrotic.
- Infection – If an infection over the course of a hair transplant surgery, it can be quickly treated with antibiotics. If left untreated, however, an infection can reach deep into the recipient scalp, become necrotic, and spread to a larger area.
- An unskilled surgeon can make incisions that are unnecessarily deep, which can cause infection.
- Similarly, too many incisions can cause excessive bruising, and the tissue can become necrotic as the blood pools beneath the skin.
- Once necrosis sets in, the affected scalp area must be removed via a process called debridement so it cannot spread.
- This lengthy process leaves scarring and takes months of recovery to fully heal.
What Does Necrosis Look Like?
After hair transplant surgery, the recipient’s scalp will be reddish or pinkish in hue. This is normal. Necrosis, on the other hand, will start out as a dark bruise. This bruise is actually blood pooling under the skin and clotting, which prevents new blood from reaching the tissue. Eventually, the tissue will die from a lack of oxygen and become infectious.
What are some Risk Factors for Scalp Necrosis?
The following characteristics increase the likelihood of developing death of scalp tissue:
- Long-term cigarette use
- Diabetes
- Cardiovascular disease
- Prior scalp surgeries
- Previous scalp necrosis
Necrosis and Epinephrine
Epinephrine is routinely administered during a hair transplant to restrict or reduce blood flow to the scalp and minimize bleeding. An exceptionally high dose of epinephrine may starve the tissue of oxygen long enough to cause tissue death. New science, however, suggests that epinephrine has absolutely no link to tissue death. A 2006 study closely examines accidental high-epinephrine injections into the finger during hand surgeries. Of all 59 reported cases where too much epinephrine was used, not one instance resulted in tissue necrosis. For this reason, the connection between high levels of epinephrine and tissue necrosis remains unclear, and in need of further study.
How to Prevent Scalp Necrosis
The best way to prevent scalp necrosis is by selecting a highly trained doctor to perform your hair transplant. Be sure to ascertain the credentials of any potential candidates, and conduct at least one preliminary interview before making a final selection. Your likelihood of developing scalp necrosis is very low as long as you select a highly competent medical practitioner to perform your procedure. Be sure to ask how many hair transplants the doctor has performed in the past, and request to speak with one of their previous patients, if available.