Folliculitis following hair transplantation are skin lesions that appear pimple-like and are seen when (for any reason) hair follicles become inflamed.  Folliculitis can be seen anywhere throughout the skin.  The follicle and its surrounding tissues may become infected with different bacterias called Streptococcus aureus.

There are also certain variations of folliculitis which are known as “hot tub folliculitis” and “barber’s itch”. Permanent damage to the hair follicles and local hair loss on the area of infection can occur in severe cases of folliculitis.

After Hair Transplant Folliculitis

One of the most common complications of hair transplant surgery is folliculitis. Folliculitis occurs when there is blockage of hair or its corresponding sebaceous gland when newly transplanted hair is growing.  Folliculitis typically appears as small, red or white-headed pimples around one or more follicular units following hair transplantation.  It may present with itching, mild pain and discharge in addition to the typical redness and swelling of pimples. Most cases of folliculitis (especially those occurring after hair restoration surgery) clear spontaneously within a few days, however more extensive types of folliculitis may need medical or surgical treatment by your physician.

Folliculitis is typically seen a few days or even months after hair transplant surgery. They are generally difficult to be differentiated from common pimples or acne and are recommended to be left alone to clear naturally. Presence of simple folliculitis usually does not affect the growth of transplanted hair. Those instances of folliculitis that do not clear naturally within a few days of forming are considered to be more aggressive and patients are recommended to contact their hair transplant physician at that point.

Treatment

Simple folliculitis generally does not need any treatment and lesions tend to clear up on their own within a few days. Occasionally, when small instances of folliculitis become infected and are seen with spreading of redness and inflammation around the originally inflamed follicles, your physician should be notified.  A physician’s evaluation is the best way to 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 alternatively decide to drain them. Draining the folliculitis is a simple procedure and can be easily done in your doctors’ office.

Q:

I am a previous hair transplant patient who has class VI hair loss. I had previous procedures done to get some thin hair in the front and top.  I am keeping my hair very short on the back and my primary goal was to camouflage the scar in the back of my head from previous hair transplants. So far, I have achieved this by simply growing my hair longer, and covered the rest of my scalp with Toppik-like products.

Cosmetically, the hair restoration was successful, but constant usage of this kind of product is a bit messy and annoying. Because of this, I have completely shaved my head and decided to try a different route. With the help of tattooing, I was going to go for a shaved head look. Unfortunately though, the scar is a show-stopper and I need to consider all of my options.

What I would consider to be a successful result is: short hair completely covering my head (even if only relatively light density) combined with tattooing and a self-tanner to reduce contrast. I am not “greedy” about the sides at the front, and will accept a 3 or 3A pattern. Is this possible in my case, though?

A:

It is good to hear that you are not striving for high density and that you are realistic about the final appearance of your hair.  Being a class VI with limited donor hair, should leave options open to create light density in your large balding area, but obtaining more density would be extremely difficult if not impossible due to your insufficient donor hair. You should know your priorities and how many surgeries you are committed to have in order to achieve your desired look.

• If you only need to revise the scar and have trichophytic closure done to minimize the visibility of your scar, one surgery is adequate.  Double edged trichophytic closure is a new technique that can improve the appearance of the scar tremendosly.
• If you are attempting to achieve higher density as well as scar revision, you may need several hair transplant procedures (depending on your donor amount available).

Your donor hair can be easily evaluated and options can be given to you for about what to be expected through attending a consultation with an experienced hair transplant doctor.

Hair Restoration surgery is evolving rapidly and we are consistently refining our approach on a regular basis to improve the quality of transplanted hair while at the same time minimizing the possibility of complications. Double edged trichophytic closure is a new approach to donor wound closure that has been put into practice by Dr. Mohebi and US Hair Restoration.

Double edged or two sided trichotomy can help to minimize 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). This practice of double edged closure helps us to minimize the width of the top skin layer (epithelium) that is removed from each edge of the donor wound. By making these changes, double edged trichophytic closure allows hair to grow into the wound from both edges and thus minimize the contrast between a patient’s scar (with no hair) and surrounding scalp (with 100% hair density).

By employing the double edged trichophytic closure in our pratice, we constantly have results of less detectable donor scars. In addition to less detectable scarring, we are also able to minimize the risk of folliculitis or ingrown hairs in the donor area, which are the two of the most common complications of traditional trichotomy.

We have a patient who is very physically active. He had a hair transplant procedure and was concerned if he could continue competitive mixed martial arts in the next 3 weeks. “Do you think my head will be okay if I’m doing that? Is it high risk for new transplant hair or donor scars?”

By the time the patient has his mixed martial arts competition it will be over 3 weeks after his hair transplant procedure. At this point hair grafts have already settled and healed and the donor area is closed. The only real concern is putting too much tension on the edges of the healing donor wound. This may cause the wound to widen or stretch.

Most physical activities are fine and should not pose an issue to the donor scar but we do suggest avoiding any sports that may add tension or possibility of stretching until after 1 month from your surgery. The donor scar should be stronger and able to handle any additional stress as you would have normally. However, we do suggest a period of at least 3 months for all aggressive sports just to be safe but that is definitely up to your own personal discretion.

For previous hair transplant patients, scar revision is the process of correcting or minimizing the scar appearance left after a hair transplant procedure. In the case of a patient email we received, his scar seems to be a bit wider on one side compared to the other. His transplant was performed in a different clinic and the result of the wide scar was of natural effect. He asks, “Is it better to do only half and not touch the good side so to speak?”

There are a couple of techniques that can be used to correct this issue. The most common is a simple excision and closure of the scar which may reduce the scar’s width. Considering the scar is behind the neck area, BOTOX can be applied to prevent future stretching. Some patients may require what is known as trichophytic closure which allows hair to grow into the scar further minimizing the appearance of the scar. Finally, the most effective way of eliminating scar visibility is by means of an FUE (follicular unit extraction) procedure to fill in the scar left behind by the strip procedure.

The maturation or completely healing of a scar is a timely occurrence. Scars can sometimes take as long as 6 months to fully develop and can continue to evolve even after that time but at a slower rate. Because of how long scars can take to fully develop, we avoid during any type of scar revision surgery until at least 6 months after wound closure. We offer free donor scar revision consultation at our Orange County hair restoration office.