Hair Restoration Blog

Q:

I had a hair transplant back on October 31, 2009. I started getting red boils along my transplanted area (suspected to be folliculitis) in January and I have been taking Accutane for the last complete month.

My question to you is, why did it happen? Was it due to infected surgical equipment used in the surgery? I was advised to get such a heavy drug which has effected the overall tone of my face somewhat like getting severe dryness. Lastly, sir what do u think there are few patches in the infected area who are now like bald patches. Do you have any suggestions or medicine for the future?

A:

Pimple-like scalp lesions that develop after hair transplant surgery are typically folliculitis.

Folliculitis can typically be seen after hair transplant surgery in both the implanted and donor wound areas in the few weeks to month after hair transplant.

The development mechanism of folliculitis is similar to acnea.  It is usually due to blockage in the exit pores of the sebaceous gland (skin oil glands).  Following obstruction of those pores that can occur after hair transplant surgery, sebum (skin oil) cannot be emptied to the skin surface and instead begins accumulating underneath the skin surface.  The result is red or white head-like pimples.

Recovery is generally spontaneous. Although, if too many of these lesions develop, or if there was any sign of secondary infection (i.e.- redness or swelling around the area), the lesions may need to be drained by your physician and the patient may occasionally be recommended to use antibiotics.

Thanks to the generous vascular supply of scalp skin, the infection of scalp skin after hair transplant surgery is extremely rare.

Folliculitis is a pimple -like skin lesion that is seen when hair follicles become inflamed for any reason.  Folliculitis could be seen anywhere in the skin.  Follicle and their surrounding tissues may become infected with different bacteria often Streptococcus aureus.

Certain variations of folliculitis are also known as hot tub folliculitis and barber’s itch. Sever cases of infected folliculitis can cause permanent damage to the hair follicles and lead to local hair loss on the area of infection.

Folliculitis After Hair Transplantation

Folliculitis is one of the common complications of a hair transplant surgery due to blockage of hair or its sebaceous gland when a newly transplanted hair is growing.  Folliculitis after hair transplantation usually appears as small, red or white-headed pimples around one of more follicular units.  Folliculitis may present with itching, mild pain and discharge. Most cases of folliculitis (especially the ones occurring after hair restoration surgery) clear spontaneously in a few days, however more extensive types may need medical or surgical treatment.

Folliculitis may be seen a few days or even months after a hair transplant surgery. They are generally difficult to be differentiated from common pimples or acne. Presence of simple folliculitis usually does not affect the growth of transplanted hair.

Treatment

Simple folliculitis generally does not need any treatment and the lesions tend to clear up on their own within a few days.  Occasionally, they may become infected and that is seen with the spread of redness and inflammation of skin around the original inflamed follicles.  A physicians evaluation can best determine whether or not you need antibiotics for the treatment of your folliculitis.  Occasionally, as a way to avoid use of medication or continuing infection, your doctor may decide to drain them.  Draining the folliculitis collections is a simple procedure and can be easily done in your doctors’ office.

Double edged trichophytic closure is a new approach to donor wound closure.  Double edged or two sided trichotomy can help to minimize the complications of trichophytic closure based on the width of epithelium that is being removed and inability of some the hair follicles or oil glands to find their way out to the skin surface.

Hair Restoration Surgery is evolving rapidly and we are consistantly refining our approach on a regular basis to improve the quality of transplanted hair while at the same time minimize the possibility complications.

Double edged trichophytic closure helps us to minimize the width of the top skin layer (epithelium) that is being removed from each edge of the donor wound.  This approach allows hair to grow into the wound from both edges and thus minimize the contrast between scar (with no hair) and surrounding scalp (with 100% hair density).

By employing double edged trichophytic closure we constantly have results of less detectable donor scars and are able to minimize the risk of folliculitis or ingrown hairs in the donor area, which are the two common complications of trichotomy with the traditional methods.