Complications Following Hair Transplantation: A Systematic Literature Review and Meta-Analysis

Abstract

Background: Hair transplant surgery is often tended to as a last resort for different types of alopecia. It involves importing hair from a donor site to recipient site using different surgical tools. Surgical interventions hold the risk of causing complications, due to the penetration of skin and exposure of internal tissue to tools and outer environment.

Aim: This work systematically investigates reported complications of hair transplantation surgery in the literature.

Methods: An electronic search was performed on databases: PubMed, Scopus, MedRxiv, and Google Scholar. Recovered articles were systematically filtered through titles and abstracts, and then through full-text review. After filtration, included articles were subjected to data extraction through a specialized data extraction form. Data were then analyzed qualitatively and quantitatively.

Results: This review included 45 articles that were divided under two categories: 24 case reports describing 27 cases and 21 observational studies. Mean age of included patients was 40.46 ± 13.5 years in cases and 40.31 years for non-case studies. In cases, 20 (74%) patients reported donor-site complications early after surgery, and 25 (92.6%) late complications. At the recipient site, 6 (22.2%) patients reported complication early, and 8 (29.6%) patients reported delayed complications. In observational studies, 442 patients reported complications out of 2353 included in reviewed studies. Pain and discomfort were the most reported complications. In cases, 6 (22.2%, p = 0.32) patients reported pain at the donor area and observational studies included 281 (63.57%) pain-complaining patients. Arteriovenous fistulas (AVFs) were reported in 11 patients (40.7%, p = 0.073) and were associated with the use of punch graft technique for FUE.

Conclusion: Hair transplant surgery is generally safe. Pain, swelling, and edema at the donor site were the most often reported complications. At the recipient site, scarring was reported most. A few cases of donor-site AVF were reported in the literature and were often associated with FUE with punch graft technique.

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Keywords: Complications; Follicular unit extraction; Follicular unit transplant; Hair transplantation surgery; Safety.