is this a Rare Complication?? Need Advice !

[William Reed, MD]

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

[noms]

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 !!

[SpencerKobren]

Hey noms,

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

Hang in there!