Necrosis Following FUE (Follicular Unit Extraction)
FUE hair transplantation, the most popular, low-risk and modern hair restoration technique, carries a small risk of necrosis – tissue death. In this blog post, we will discuss the causes, risks, and management of necrosis after follicular unit extraction. Necrosis after hair transplantation usually occurs in the 1st month. You can find detailed information about this process in our article on the 1st month after hair transplantation. The risk of necrosis in FUE hair transplantation is usually less than 0.5% and if it occurs, it can be partially compensated by a hair transplant under appropriate conditions after the damaged area has healed. However, with early intervention, it is also possible to solve the problem without the need for hair implantation again. And here are the details…
What Exactly Is Scalp Necrosis?
The death of scalp tissue due to poor blood flow is a rare but serious complication of Giant Cell Arteritis (GCA). This is a condition that causes inflammation in blood vessels. In turn, this leads to the death of tissue in a localised area. In cases like this, patients will have pain in their scalp and long-term red skin lesion in the area where the ophthalmic branch of the trigeminal nerve is. This nerve sends sensations to the forehead and upper part of the face.
Most of the time, you can see signs of dead tissue in the donor or recipient area within the first 1 to 3 weeks. These signs include ongoing redness, dark colouring, or crusting that doesn’t follow the usual healing timeline.
What causes necrosis to form following FUE?
The main problem is that there is not enough blood. Here are the most common causes of scalp necrosis following FUE hair loss surgery: Excessive trauma due to over-harvesting grafts, tight closure and suturing, dense packing of grafts, and anesthesia complications. Necrosis commonly occurs due to the old type of hair transplantation, FUT. This is because FUT involves making strip incisions, which sometimes leads to vascular strangulation and collapse around the edge of the wound.
Who is more likely to experience necrosis following FUE?
Though necrosis can affect any patient, certain factors increase the likelihood.
- Heavy smoking and nicotine use can cause reduced scalp perfusion.
- Microvascular compromise in diabetic patients (diabetes mellitus) raises the risk of necrosis.
- Previously compromised tissue, which may be the result of scalp scarring or previous procedures, is more susceptible to ischaemia.
- Localised infections can disrupt healthy wound healing and result in tissue death.
- Epinephrine constricts blood vessels, and excessive use can prolong ischaemia.
Signs to watch out for: How to spot scalp necrosis early
Early detection of scalp necrosis can improve patient outcomes. Below are the symptoms that warrant immediate medical care:
- Severe pain, regardless of the size of the wound.
- A wound accompanied by a fever (higher than 38°C) and a rapid heartbeat (more than 100 beats per minute).
- Persistent dark red or black lesions.
- Delayed healing: Wounds that fail to epithelialise within the expected timeframe.
- Greyish foul odour or discharge.
- Skin blisters
- A small sore or pus-filled bump that is unusually painful to the touch.
Is it possible to stop it? Yes — here is how.
Following good clinical practices can reduce the risk of this. Doctors should:
- Check that patients are suitable for surgery before the op. This is especially important for people with uncontrolled diabetes or who smoke a lot.
- Use blunt needles and handle grafts carefully to protect the tiny blood vessels.
- Don’t graft too densely, as this can block blood flow.
- Make all substances weaker by diluting them properly, and be careful when you apply them.
- Hydration and nutrition are really important for the skin to heal well.
What can patients do?
- Make sure you drink enough water and eat well after the op.
- Try not to smoke or drink alcohol, as these can affect the duration of healing.
- Follow all the instructions you are given after your operation. This includes how to care for your wound and which medicines you must take.
Treatment options for dead skin on the scalp?
Doctors use special products like antiseptic solutions & creams to gently remove dead skin cells and help the area heal. If there’s a risk of infection, they might give you antibiotics. On the other hand, for bigger wounds, a medical device can help. However, in serious cases, doctors remove the damaged tissue and cover the area with healthy skin from another part of the body.
What should you do if you notice necrosis after your surgery?
Don’t wait in vain. Let your clinic know as soon as you spot any symptoms, like black skin or delayed healing. Don’t remove the scabs or apply random creams. It’s not OK to treat yourself when you’re in such a serious condition. These actions can make the condition worse.
Healing from scalp necrosis after FUE
It can take a long time to heal and how long it takes depends on how badly the tissue has been damaged:
- Little black spots on the skin should get better over the next 3 to 6 weeks with gentle treatment.
- Larger areas might take months and you might need more operations.
- Hair may not grow back in areas of necrosis. Treatments like SMP (scalp micropigmentation) or secondary hair transplants might be an option.
- One of the causes of necrosis is the use of regular shampoo. Intense chemicals irritate the skin and prepare the ground for infection. After your doctor has started necrosis treatment, you can safely use Perseus Post-Hair Transplant Shampoo with his approval.
FAQs about Necrosis Following FUE
Is it normal to have dead skin after a hair transplant?
Yes, it is normal to see some dead skin / scabbing / crusting after a hair transplant, particularly in the initial week. These small crusts form around the bald and donor areas as part of healing process. In fact, scabs are a good sign. They show that your body is making clots to protect the small cuts from getting infected. As the skin on the scalp heals, the scabs will gradually fall off. However, noticing necrosis with pain that not go away, that’s a sign something’s wrong.
What does early stage necrosis look like?
At first, it looks like a normal skin infection, like cellulitis. The affected area may look pale, then quickly turn red or maybe bronze. The skin feels warm, swollen, and very tender or hurts. As it gets worse, the skin may go a dark purple colour and get big blisters full of fluid.
How do I know if I damaged my hair transplant?
There are a few signs that something might be damaged:
- Some people have experienced things like grafts falling out or bleeding in the first few days.
- Swelling, redness or pain that is more than normal.
- Don’t pick scabs too soon.
- You won’t have to worry about shedding or regrowth after a few months.
- Signs that there is an infection include pus, a bad smell or a fever.
If you notice any of these, contact your surgeon straight away.
Will necrosis heal on its own?
No, necrosis won’t heal on its own. If you have dead tissue, you need to get a medical professional to treat and remove it. This stops the infection and helps the healing.
How long after surgery does necrosis start?
Necrosis can begin within the first few days after an operation, normally between 2 to 5 days, as blood flow becomes blocked in the affected area. Changes in texture, such as it being firmer or having a leathery feel, often show that there is necrotic tissue beneath the surface. Necrosis can occur within 2 days after surgery or at any time during the first one to one and a half months.
How quickly can necrosis spread?
Necrosis can spread quickly — sometimes within hours — especially if there is an infection. These bacteria reproduce quickly, so the infected area can get bigger very quickly. While this can vary from patient to patient, a large open wound can form within just two days of the onset of symptoms.
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