Safety Considerations in Hair Restoration Procedures: A Comprehensive Review

Hair loss is a common, multifactorial condition caused by traumatic, autoimmune, hormonal, and iatrogenic factors. Despite its prevalence, it is associated with significant psychological distress. Hair transplantation is an increasingly utilized treatment; however, postoperative complications remain an important consideration.

A scoping review was conducted using PubMed, Embase, and Scopus from database inception through February 2026. Studies published in English reporting complications following hair transplantation were included, while those focused solely on medical management were excluded. Complications were categorized by timing (early <30 d; late >30 d) and severity (minor: self-resolving/minimally impactful; major: requiring surgical intervention). The review began with 3119 identified records; duplicates were removed, and title/abstract screening yielded 253 studies for full-text review. After full-text screening, 117 studies met the inclusion criteria.

Of the included studies, 47 reported late complications, 42 early complications, and 28 both. Fifty-nine studies reported minor complications, 39 major, and 19 both minor and major. Common adverse events included pain, infection, folliculitis, and edema. Minor infection rates ranged from 1.4% to 2.0%, and folliculitis from 1.1% to 12.1%. Necrosis was rare (0.03% in 1 study). Serious complications most frequently included arteriovenous fistula (n=16), necrosis (n=6), and graft failure (n=6). Interpretation was limited by heterogeneity in definitions and reporting, necessitating qualitative synthesis. Identified risk factors included smoking, chronic sun damage, diabetes, dense graft packing, epinephrine use, vascular injury, and excessive graft depth.

Hair transplantation carries the risk of both minor and major complications. While common complications are generally self-limited, they may negatively impact outcomes. Rare but serious complications can occur. Emphasis on patient optimization, surgical technique, and early recognition is essential, and standardized reporting is needed to better define incidence and risk factors.