Unilateral Scalp Necrosis, An Unusual Complication of Hair Transplantation: A Case Report and Literature Review

Abstract

Hair transplantation is a permanent solution for hereditary baldness. However, scalp necrosis remains a very rare complication, but it is nonetheless a troublesome problem, affecting less than 1% of cases worldwide. 

Its causes are varied, including poor blood vessel function, graft density, and patient-related risk factors.

Case Presentation: We present the case of a 44-year-old Iraqi man, a heavy smoker (20 packs of cigarettes per year), who underwent a hair transplant to treat frontal temporal baldness. The patient returned to the clinic on the fourteenth post-operative day. He noticed changes in scalp color that began on day four and gradually worsened over the next ten days. Despite his attempts at self-care, the condition continued to deteriorate. On day fourteen, he developed black and yellow scales confined to the left frontal side of his scalp, clearly defined at the midline.

Management and Outcomes: The diagnosis was made clinically, supported by dermatoscopy. We began treatment with systemic antibiotics and daily topical wound care, and advised the patient to quit smoking. Over 60 days, the wound healed spontaneously, leaving a 3x2 cm atrophic scar. Notably, a year later, the patient successfully underwent a second hair transplant.

In conclusion, the significance of this case lies in its being one of the few documented cases in Iraq that highlights the role of certain risk factors in scalp necrosis, such as excessive smoking, epinephrine-loaded local anesthetics, and sensitivity of the mid-scalp as a high-risk area. Conservative treatment proved effective, supporting the idea that early diagnosis of abnormal skin changes and treatment of modifiable risk factors are just as important as the precision of the surgery itself.