Hair transplants are safe, simple procedures, as patients typically experience minor and temporary side effects. However, in rare cases, complications can also occur. Research shows that only 1% of patients develop hair follicle infection or inflammation, such as scalp folliculitis, after their hair transplant [1]. This usually happens when health and safety protocols are not followed or when aftercare is deficient. But when this condition does emerge, the surgeon should be informed so they can monitor and treat it, avoiding poor hair transplant results.
This article will tell you everything you need to know about how and why you may develop folliculitis after your hair transplant and what you can do to prevent this from happening. It will familiarise you with the typical signs and symptoms of this condition and provide the best recommendations for treating it at home (under close monitoring by your surgeon). Finally, it will walk you through the next steps in the highly unlikely event that you develop a severe case of post-transplant folliculitis, which can seriously impact your procedure results.
Key takeaways
Folliculitis is generally known as a common scalp problem, although it can occur in any part of your body that is covered in hair. It is usually a mild and easily treatable hair follicle infection, most often caused by microbes, such as bacteria, viruses or fungi [2][3].
When getting a hair restoration surgery, the surgeon makes small slits in your scalp, where your hair grafts are inserted. These small open wounds make it easier for microbes to get inside your hair follicles, causing infection and inflammation around the newly implanted grafts. This is why it is extremely important to maintain high standards of hygiene during surgery and diligent hair transplant aftercare once you have started your recovery.
However, post-transplant folliculitis isn’t always infectious. Some patients can develop it as a result of poor surgical technique, which damages the hair follicles and leads to inflammation around them (to be discussed) [4].
The main problem with folliculitis that occurs soon after a hair transplant is that the inflammation it produces can interfere with graft healing and survival. So while it is not normally a concerning condition, it warrants careful monitoring and treatment in patients who are at the start of their hair transplant recovery. Leaving it untreated can allow it to advance and, in rare, severe cases, it can destroy the grafted follicles, leading to hair transplant failure (although these situations are virtually unheard of with reputable UK clinics) [3].
Fortunately, post-transplant folliculitis is highly uncommon. Studies have shown it develops in approximately 1% of patients who had their hair surgically restored [1]. That is because authorised hair transplant clinics are now very strict about their surgeons’ qualifications and commitment to health and hygiene regulations.
Moreover, the aftercare required to prevent the development of this condition is not difficult or time-consuming. Following basic hygiene recommendations and respecting post-surgery restrictions, such as avoiding hot tubs for at least a month post-op are normally enough to keep your transplant area safe (to be discussed).
Oftentimes, more serious hair transplant side effects, such as folliculitis, occur as a consequence of procedures performed in illegal, unauthorised clinics abroad. These facilities are known to employ unqualified personnel to perform surgery and to cut corners regarding patient safety. The International Society of Hair Restoration Surgery (ISHRS) is vocal in warning about the risks of infection, scarring and hair transplants gone wrong when using the services of such facilities [5]. So when you see an advertisement for suspiciously low hair transplant costs in Turkey, be aware that they may not be worth the risk (find out how to recognise Turkish hair transplant clinic red flags).
While anyone can theoretically develop folliculitis after their hair transplant, some patients are more predisposed to this condition than others. So be sure to keep an extra careful eye on your transplant area if you are in one or more of the following categories [1][2][3][6]:
While infectious folliculitis is, overall, the most common, scientists [2] believe that the non-infectious kind [4], caused by poor surgical technique or ingrown hairs, may be the most widely encountered in hair transplants. Here are the main causes of post-transplant folliculitis [1][3][4]:
This type of folliculitis is not contagious and not likely to advance and cause more severe complications (unless a secondary bacterial infection is involved). It can result from mistakes made by inexperienced surgeons, such as dissecting grafts, burying them too deeply, or implanting them too densely [3][4].
Alternatively, non-infectious scalp folliculitis can be produced by ingrown hair, which triggers inflammation (especially when your new hair starts growing back after your hair transplant shedding phase).
Hair follicles can also get clogged by skin cells, dirt or debris and develop non-infectious folliculitis. However, in many cases, bacteria will overgrow in the blocked area, making the condition infectious.
Contagious or infectious folliculitis is usually caused by bacteria (especially Staphylococcus aureus) [2][3]. However, in some cases, it can also be produced by viruses or fungi. It is often the result of either the surgical team ignoring hygiene protocols or improper aftercare on the patient’s part (you can tell from the timing of the onset – if it occurs 2-3 days after surgery, it is likely connected to it).
Germs usually enter your hair follicles through improperly disinfected surgical equipment, dirty hands touching your transplant area, or poor scalp hygiene. Sharing combs, brushes or hats can also facilitate contagion. Finally, bacteria can overgrow at the site of ingrown hairs or clogged follicles, causing secondary infection.
Here are the main symptoms of scalp folliculitis that you should keep an eye out for after your hair transplant [2]:
It can sometimes be difficult to tell normal side effects, such as mild pain, itching, scabbing or scalp redness after a hair transplant, from the symptoms of scalp folliculitis. However, some key differences should raise red flags:
The only way to be able to distinguish normal hair transplant side effects from the first signs of folliculitis is to know what to expect at each stage of your hair transplant recovery timeline. This will give you an idea of what is likely normal, rather than pathological.
Here are some additional rules of thumb to consider when you are unsure whether you should be concerned about your scalp condition:
Studies [4][7] show that patients may develop folliculitis between 2 days and 6 months after surgery. Most of those who experience this condition appear to do so after approximately 45 days post-op.
Here is what you should know about the timeline and particularities of the two main types of scalp folliculitis that may occur after a hair transplant:
Typically, bacteria (e.g. Staphylococcus aureus), but sometimes viruses or fungi
The good news is that in most cases, folliculitis that occurs after hair transplant surgery is mild and has not been found to have any lasting negative impact on procedure results. Studies show no significant scarring and reveal excellent hair growth in most patients in the sample after 1 year [7].
However, in very rare cases, this condition can progress and become a threat to your grafts:
Severe cases of scalp folliculitis can cause sufficient inflammation to damage fragile, newly implanted grafts, decreasing their survival chances. Moreover, if left untreated, it can advance to cellulitis or abscesses, which can penetrate deep into your scalp tissue and destroy the hair follicles around them permanently. They can sometimes cause scarring that prevents native hair growth in your transplant area, as well as destroying your grafts. This can sometimes be resolved with a new hair transplant into the scar tissue.
While not all cases of hair transplant folliculitis can be prevented, most can be averted by following some simple advice:
Researchers believe that poor surgical technique can play a part in causing non-infectious folliculitis after a hair transplant (although further research is needed to confirm this) [4]. Choosing a well-reputed, skilled and experienced surgeon, with an impeccable record of successful hair restoration surgeries, will give you the best chance to avoid complications.
Our surgeons, at the award-winning Wimpole Clinic, take every precaution and follow every protocol to avoid preventable complications. This diligence is reflected in their high success rates, befitting of an institution with a 50-year legacy of hair restoration excellence.
After your surgery, be sure to carefully follow these recommendations (alongside any others your surgeon has provided you):
In most cases, scalp folliculitis that develops after a hair transplant is mild and will normally resolve without treatment in 7-10 days (especially if it is non-infectious). However, home care should offer symptom relief and may help speed up healing.
The most helpful thing in treating folliculitis at home is placing a clean, warm (not hot!) compress on the affected area of your scalp 2-3 times a day, for 10-15 minutes at a time [3]. Make sure you change and disinfect the cloth/hot pack between uses. However, if fewer than 10 days have passed since your procedure, ask your surgeon if it is safe to place anything on your transplant area to avoid graft dislodgement.
Keep your affected area clean and avoid touching it to prevent any infection from spreading. And resist any temptation to scratch the itchy bumps. If the itching is distressing, you can take some over-the-counter allergy medication (antihistamine) to help soothe it.
Finally, it’s important to get enough rest and eat well-balanced meals to help your body heal and recover.
If more than 3 days have passed and your scalp folliculitis is not improving or your symptoms are worsening (e.g. intense pain or developing a fever), let your surgeon know as soon as possible. They may need to prescribe a course of topical or oral antibiotics, or other appropriate treatments, such as steroid creams and/or medicated shampoos, to help you heal [3].
Call emergency services if your scalp symptoms are accompanied by any of the following occurrences (as they may indicate other, more serious conditions than scalp folliculitis):
If you want to get a natural-looking hair transplant without having to worry about complications, you have come to the right place. Our surgeon’s world-class skill, experience and dedication to patient health and safety have earned the Wimpole Clinic the title of Hair Transplant Clinic of the Year for 4 years running (2021-2024). All you need to do is book a free hair transplant consultation, and our experts will be happy to walk you through all the protocols they follow to reduce risks and achieve a 97-100% hair restoration success rate. Take a look at our before-and-after hair transplant gallery and see our results for yourself.
Find out even more about folliculitis after a hair transplant by reading the answers to these frequently asked questions:
You normally won’t get folliculitis the way you would get a cold, simply by breathing the same air as someone who has it. However, you can get it from sharing hair care tools or accessories with them. Moreover, touching a surface they came in contact with, and then your scalp, can also help spread the germs.
After your surgical hair restoration, it is best to only use your own hair care instruments. It is also recommended to sanitise your hands frequently and to avoid touching your scalp during the first week after your hair transplant.
It is normal for your grafts to have a slightly bumpy appearance immediately after surgery and for a few days afterwards. However, once their appearance has returned to normal, they should not start looking bumpy again. If more than 5 days have passed since your surgery and you still notice bumps around your hair roots, it is best to let your surgeon know. While they may be a sign of folliculitis (especially if accompanied by pus or pimples), they could also be a sign of cobbling. That is a term used to describe grafts that have been implanted too high up in your scalp, giving your transplant area a goosebumpy appearance.
No, it is never safe to pop your folliculitis (or even regular acne) pimples. This can help the infection to spread and introduce even more bacteria into the resulting wound. You should not even touch the pimples; simply apply a clean, warm compress to them and let them heal (or, if your surgeon provided different instructions, follow their advice).
No, it is not a good idea to use antibiotics that have not been prescribed for this purpose, especially if their container has been opened for a longer period (it may have gone bad). Using topical antibiotics to self-medicate can lead to imbalances in your microflora (the microorganisms that normally live on your skin). Furthermore, taking oral antibiotics can also affect your helpful gut bacteria, causing digestive problems. Finally, using antibiotics too frequently or failing to finish the course can make the harmful bacteria resistant to them in the future.
If your folliculitis does not respond to regular home care within 3-5 days and you feel you may need antibiotics, simply call your surgeon and get their recommendation. If they find that you can benefit from this medication, they will not hesitate to prescribe it to you.
Yes, you can develop scalp folliculitis anytime certain harmful germs make their way to your hair follicles, or if you experience scalp irritation, even if you had no surgery. You can get it from using hot tubs or heated pools, from sharing hair accessories or even from excessive shaving or ingrown hairs. If you haven’t had a hair transplant, this condition shouldn’t be very concerning, and in most cases, it will resolve on its own, with minimal home care. However, should it persist, you may need to see a dermatologist or a trichologist who can recommend the right treatment.
Wimpole Clinic Services:
Hair Transplants, Beard Transplants & Eyebrow Transplants.
Talk to a specialist
Dr Meena Zareie (GMC number 7722917) is the first female member of Wimpole Clinic’s Hair Transplant Surgeons team.
Dr Meena started her journey in the hair transplant industry 8 years ago, where she worked closely with leading surgeons to hone her skills, having conducted more than 1,000 FUE hair transplants.
Starting as a technician and nurse while working simultaneously for the NHS, she decided to take her passion for helping patients with hair loss further.
Her qualifications include an MD doctorate from the prestigious Medical University of Warsaw, and a Master’s degree in Drug Toxicology with the institute of cancer therapeutics. She has previously completed a bachelor’s in Biomedical Science, and is qualified in minor aesthetic and dermatological procedures for the face and body. She is a member of the British Medical Association and is a registered doctor on the General Medical Council.
Her passion for perfection and attention to detail is what drew Dr Meena to the aesthetic industry. She has completed additional FUE Hair transplant training with renowned hair transplant doctors in Georgia and Iran, and has developed a fine motor skills which serve to produce outstanding results, as each procedure is carried out with ultimate care and meticulous attention to the detail. Dr Meena’s care for her patients and work shows in her results is a real credit to the hair transplant industry.
