Introduction Hair transplant surgery is one of the commonest procedures in Male Cosmetic Surgery and is also becoming common in Females. A number of patients are worried about the complications of hair transplant and particularly the scar in the strip procedure. There are simple procedures to avoid the complications in such cases

Possible situations

1. Prolonged pain in the back of the head and headaches This situation is easily avoidable. It occurs commonly in procedures that are done by untrained surgeons and other surgeons who perform hair transplant, assuming that it is a simple procedure. The reason for this is that these surgeons raise the hair bearing strip in the sub galeal plane, since it is faster and blood less. What they forget is that this plane also damages the nerves and the vessels permanently. A nerve that is avulsed, never recovers, and develops a swollen end known as neuroma that is responsible for the jarring pain and irritable sensation that occurs chronically. It is advised that the strip be raised in the plane above galea, just 1 mm deep to the follicle roots. This clearly prevents damage to the nerves, and if done patiently, does not cause any bleeding and is reasonably fast. The surgeon only needs to be patient and know tissue handling.

2. Scar on the back of the head Usually the scar on the back of the head should be a pencil line thickness and well settled, and not red in colour. In some individuals there is a naturally tight scalp. Slight scar spreading does occur in them. But this should not be common. In most of the clients, the scar should be imperceptible. The trick is simply to do a 2 layered closure and the 2 edges should not be in tension. It is advisable to dissect the layers a bit so that they come closer to each other Monocryl may be preferred to Vicryl for better tension control and less reaction

3. Bleeding This should never be a problem. It is essential to use a tumescent anesthesia for infiltation. Inject Adrenaline in a concentration of 1:200,000, and wait for at least 7 minutes. Apply pressure on both sides of the strip and raise the strip in the proper plane. It hardly bleeds at all.

4. Infection This should be the rarest of clinical situations. If it does occur, it is prudent to question the sterilisation techniques used.

5. No hair growth or poor density This situation is something that needs better surgical technique. The viability of hair follicles has to be maintained, cold saline should be used to maintain the hair follicles. The assistants should be carefully taught the procedures so that inadvertent hair root damage does not occur. It is important to not keep the hair roots exposed for too long outside the body. Use of fine instruments to make slits allows better density.