View Full Version : is this a Rare Complication?? Need Advice !

03-15-2010, 03:41 PM
Hey Everyone,

i got my surgery done 2 months back and on the the second day of surgery i started noticing a black mark on my scalp ! which turned out to be a necrosis of a certain recipient area !

ive uploaded two pictures which will show the last 2 months journey .. wanted to know if this is rare or someone else had experience like this one and how much more time it will take to heal ...

thanks ...

03-16-2010, 03:09 PM
It is quite rare but not unheard of. I asked Dr. Cole about this and he said that, after 10,000 procedures, he has never seen an example of this at his clinic, nor has it occurred with any of his patients. Though he has not seen it directly, he acknowledged that this is something that could potentially happen to any patient.

Dr. Cole explained that necrosis could form when large incision sites are made or in cases where the density is extremely high. He said it might also be seen in cases where a high concentration of epinephrine is combined with large incision sites and high density incision sites. Some other factors that could predispose you to necrosis would be if you are a smoker (as this decreases circulation in the skin) or if you've had a previous surgery or scalp reduction (which might reduce circulation in the scalp).

What are you taking/doing to treat it?

03-16-2010, 09:52 PM
Thanks for ur detailed reply ..

Well my surgeon is saying it is not infected so you dont need to apply anything on it .. so he has just told me to wait as it will heal with secondary wound healing process ! its been exactly 2 months and 17 days since my surgery and i received 2700 grafts !

Im not a smoker and after a week of surgery i got my all my blood tests done again but they all came normal ! but i do remember some parts of my scalp were not getting numb so i was given more anesthesia at some points but im not sure if they concentrated at this point as during surgery u cant tell much whats happening up there !

This slough only oozes out and after sometime the slough scab comes off and there is red patch appears underneath as it shows in the pic !

Do i need to apply something on it to speed the healing or something ?? By the looks of will i get a big scar here with no hair growth ? will this ever heal ?

03-17-2010, 07:17 AM
Did your surgeon confirm that the spot is necrosis? Just make sure that it really is necrosis and not some sort of infectious process that might require antibiotics or other medical therapy.

As your doctor said, if it is indeed necrosis, it is going to fill in by secondary intention and gradually resolve over time. It's possible that it could take months to heal. The necrosis will eventually be replaced with scar tissue. You won't have any hair growth from the original procedure but, once it is fully healed, a surgeon can graft the scar tissue and it should accept grafts without a problem.

Another thing you could try would be ACell treatment. If the wound is still moist, ACell can be applied in powder form. Alternatively, if the wound is too old to take ACell, you could have it injected into the spot. This may promote the regeneration of new skin tissue that can be easily grafted later on.

03-17-2010, 12:54 PM

In 30 years of following this industry, I first agree that what you have is necrosis and my premonition is that it is indeed from the incision(s). Although extremely rare, I did see it more back when the recipient incisions were made much larger in the 70's, and decades before customized blades were used. I see a combination of customized blades, scalpels, and needle instrumentation as the standard today making the sites as least invasive and cause the lowest levels of shock and trauma to the area as well as the grafts themselves.

It did not sound like your doc prescribed or had you buy any over-the-counter steroidal creams. But we lay folks are not physicians here so we cannot practice medicimne and try to tell you what eactly to use. You may want to consider seeing a good local dermatologist for an opinion and especially so if the area does not improve.

Unfortunately, most of these necrosis cases do take a long, long, time to heal and there can even be some permanent discoloration (redding and even purple). Let's hope that's not the case and remember these are only my opinions and clinical oberservations over the years. Feel free to call me if you like, it's a deep subject and I wish you the very best noms...

03-17-2010, 02:22 PM
You should see if you can have Spencer Kobren comment on this. You should try to call his show on Sunday night. This doesn't look like it would be a normal occurrence to me if the doctor was making the proper incisions and using modern day techniques. Was your hair transplant done in America? Was it with an IAHRS doctor?

03-17-2010, 08:20 PM
well this certainly sounds depressing that this use to happen back in 70`s .. i choose my surgeon because he was awarded Surgeon of the month by ISHRS few months back and im sure his techniques must be advanced !

I asked my surgeon if i need to put some steroidal cream on it or any sort of antibiotic cream but he said no .. im not sure what ACell cream i can certainly ask him about that ! i also think its a pretty good idea to consult a dermatologist too about this situation .. !

its already been 2.5 months .. how much more time do u think it will take to heal ? cuz im certainly living a very uncomfortable life .. it has certainly shaken my confidence level and my social life !

ive spent first month thinking whats happening and what caused and ... now im getting so why it is not getting healed and when will this ever heal ??!!

how can i get in touch with Spencer Kobren ? any email address i can contact him ?

03-18-2010, 04:18 PM
I think you can message him on his profile, but if I were you I would call his show on Sunday to see if you can speak directly to him. Can I ask again if the hair transplant was done in this country?

03-20-2010, 12:33 PM
i got it done from pakistan ! and my doctor is ....

Dr. Mohammad Humayun Mohmand
Member International Society of Hair Restoration Surgery (U.S.A)
Faculty Member European Society of Hair Restoration (EU)
Faculty Member Orlando Live Surgery Workshop (USA)
Cosmetic Laser Specialist (UK)
Cosmetic Hair Transplant Surgeon (USA)

03-22-2010, 11:59 AM
Audio Response:
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William Reed, MD
03-23-2010, 04:02 PM
Hey Everyone,

i got my surgery done 2 months back and on the the second day of surgery i started noticing a black mark on my scalp ! which turned out to be a necrosis of a certain recipient area !

ive uploaded two pictures which will show the last 2 months journey .. wanted to know if this is rare or someone else had experience like this one and how much more time it will take to heal ...

thanks ...

I agree with many of the remarks that Dr. Cole and Spencer Kobren make. In particular I agree that, although this is an annoying, unwanted problem, it is not a serious problem. It is a situation caused by the "wounds"/recipient incisions having outrun the blood supply. In medicine it is called "avascular necrosis". "Avascular" means lack of blood supply. The fact that it has stayed (assuming the photos are taken from approximately a standard distance) about the same size for over two months reflects its stability and reflects that it is unlikely to be an infection that is likely to spread. The pink color that you can now see in a recent photo is pink because of a type of healing tissue called "granulation tissue". This tissue is composed of young fibroblasts (scar tissue cells) and capillaries, hence the pink color from the abundant blood supply. This tissue in addition to healing the necrosis also forms a very impermeable barrier to bacteria and infection.

This issue was discussed among friends and colleagues of mine and one, a very experienced older surgeon, after hearing the more aggressive approaches recommended by the younger colleagues, interjected that in his experience we will make the healing time longer and the tissue destruction worse if we do anything but patient, watchful waiting. In his experience the healing was essentially always successful with this conservative approach and you end up with a smaller scar that can then be grafted very satisfactorily.

This has been my experience as well as I have had 3 of these outcomes in fifteen years. The tendency to densely pack grafts runs this risk of outrunning the blood supply but, fortunately, it rarely happens. More commonly there is just poor growth of the grafts but the insult of the incisions stops short of necrosis. I agree with Dr. Cole's speculations about all the factors that predispose to this as well as others such as the depth of the incisions and appropriate use of tumescence. Bottom line, however, is that we cannot know what the quality of the patient's recipient blood supply is. All we can do is to make wounds/incision sites that are as small and as shallow as will allow atraumatic insertion and successful growth of grafts. ( Curiously, the site of this necrosis is the site of the necrosis in my three cases. It has been recognized that this area is the site most predisposed to necrosis and presumably is an area that has what seems to be one of the scalps poorer blood supplies.)

I would estimate that within six to eight weeks you can probably have grafts placed into the scar. However, you may want to wait longer if the growth of your new hair covers the balded scar area: You will be pleasantly surprised that the area in which there is no growth of grafts will be smaller than you might think now. The rim of the area showing no growth will likely have some delayed growth of grafts making the final bald area of scarring be smaller than you might think at the moment, hence waiting for eight months before grafting would also be very reasonable.

I hope this helps. Of course if there are worse or new symptoms, reconsideration of the above thinking will be necessary. I assume you remain under the watchful care of your surgeon. Best of luck.

Bill Reed, MD

03-24-2010, 03:28 PM
First of all thank you so much for such a detailed reply !

i really am thinking that i shouldve joined this forum much much earlier than i did .. last 3 months have been a bit tensed and annoying but now i kinda feel better.
Dr Humayun is a member of other forum so i dont know if a formal invitation is given to doctors here cuz i really wanted his opinion and suggestions on this post .. im sure his opinion about this would be of good information too !!

its been a week since i uploaded my pictures and it has undergone some changed since then .. so im uploading a new pic !!

Once again thank you so much Mr.Spencer and Dr.Reed for taking time and giving such a detailed response.. it was really helpful .. i feel so much better now !!

03-24-2010, 04:14 PM
Hey noms,

Glad I could help!
Feel free to point your Hair Transplant surgeon to this thread and let him know that hes free to post a response as a guest member of the forum.

Hang in there!