Hair Transplant Surgery - Scientific Papers

Tobacco Related Complications in Hair Restoration Surgery and Its Treatments
Author: Antonio Ruston M.D.

Introduction: Some complications have been observed in hair transplantation surgery, mainly related to diabetes and cigarette smoking. Smoking affects the microcirculation responsible for the nutrition of hair grafts, through lowering the caliber of arteries and arterioles.

Objective: In this paper, we describe complications believed to be related to smoking, in patients submitted to hair transplantation surgery and how we treat them.

Materials and Methods: We have selected 02 cases of patients submitted to a single session of hair transplantation, who presented partial tissue necrosis in the grafted area and development of baldness above the donor site scar in one of them during the post operative period. Both patients were smokers of an average of 40 to 60 cigaretttes a day for the past 15 years; had no previous diseases and were about the same age. The procedure was performed under local anesthesia with infiltration of a 2% Lydocaine saline solution with an epinephrine ratio of 1: 500000. The front area was grafted with follicular units and mini and micro grafts were used in the other areas. The recipient sites were made with beaver blades and 18G nokor needles . At the end of surgery the scalp was rewied and looked normal. Signs of necrosis apeared 48 to 72 hours after surgery and no specific treatment was done. . For the initial treatment of the developed baldness near the donor site we prescribed only massage with 2% minoxidil twice a day.

Results and Discussion: Both surgeries were performed following the regular technique we use, with the same instruments as usual and by the same team. The anesthetic solution had the vasoconstrictor fairly diluted and there was no dense packing in the recipient area. In spite of the orientation given to quit smoking two weeks before surgery one of the patients didn´t quit till 4 days before surgery . In the necrotic areas there was no hair growing and we observed a significant lowering in density in the grafted area, giving the idea of exiguous blood suply probably related to tobacco. The necrotic areas were removed and sutured six months after surgery with a satisfactory end result. The donor site treated with minoxidil took about three months till hair started growing back again, looking normal after six months.
Conclusion: Considering the large number of surgeries performed by the same team and the fact that both of the mentioned procedures followed the protocol we concluded that the complications above were related to cigarette smokin.