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.

There was an article I came across about artificial hair transplantation. The practice of artificial hair or synthetic hair transplantation to treat hair loss or androgenetic alopecia has yet to be approved by the FDA. But, in other countries, artificial hair restoration is being attempted. In addition, in the Journal of Cosmetic Dermatology, there was a study published about artificial hair transplants, but the results are to be taken with a grain of salt as there weren’t a lot of participants. Nevertheless, it’s worth mentioning.

Mentioned in the article were issues in the artificial hair implant process, which included: ineffective techniques, poor quality of hair fiber, and inexperienced surgeons. But, it’s important to note, the study’s aim is to convey the idea that artificial copolyamide fiber implantation seems to be relatively safe and a possible remedy to male pattern baldness or androgenetic alopecia.

The study consisted of 10 androgenetic alopecia adult test subjects who had tried more mainstream hair restoration techniques but to no avail; these test subjects agreed to have copolyamide fiber implanted on their scalps and were followed a minimum of three years. Initial implants included 100 fibers followed by subsequent sessions of up to 500 fibers per four to six weeks for the purpose of achieving a density of 20-40 fibers per cm2.

Throughout the study, during fiber implants and follow-up sessions, the researchers maintained an almost exact adherence to schedule. For the study as a whole, 10,000 fibers were implanted; for each test subject, an average of 1000 fibers. Overall (except for one person), researchers found that the implants resulted in pleasant-looking hair, didn’t have any notable side effects, and the subjects emotionally satisfied. At the entry point of most fibers, sebum deposition and temporary pitting were consistent throughout. In 30 percent of test subjects, there was a case of recurrent mild folliculitis.

In this study, common complications such as facial swelling, cellulitis, and severe scarring were not detected. It is important to note, each year, 15 percent to 30 percent of transplanted fibers fell away, which led to required regular maintenance. To conclude the study, factors of significant importance were the method of fiber transplant technique and consistent follow-up, leading to positive results. In the near future, hair transplants might be done with artificial hair for patients who don’t have quality donor hair and also are suffering from excessive baldness. But, much more testing is required to see whether artificial hair transplant can be an option for future hair loss patients.

In an email sent by our most recent patient he noted that his brother pointed out the “white stuff” around the transplanted hair follicles. He said that he researched other patients online but was unable to find something similar to his procedure, he stated, ” I wanted to find out what it is.”

The white portion around the follicle is a specific part of the transplanted graft. One thing that should be taken into account is that you’re not only dealing with a hair follicle but with an entire organ. A hair graft consists of the collagen band around the follicle, microscopic muscle, small portion of the epithelium (superficial layer of skin) and small supporting vessels. The white portion is simply the epithelium. The goal in hair transplantation is not to bury the hair grafts. This can help to prevent possible folliculitis, dimpling of the skin or sebaceous cysts from occurring. We make sure to keep the hair graft slightly elevated from the surface of the skin to prevent these complications.

The white portion of the hair graft will eventually dry up and fall off a few days after the surgical procedure. This little technique alone can help prevent many post-op issues and patients have no real need to worry about any further complications.