Botched Hair Transplants: Causes, Risks, and How to Avoid Them

Hair transplants are considered safe, minimally invasive, and effective outpatient procedures. But they are still a surgical procedure, and all surgeries carry some risk. If you’re considering the procedure but are worried about a botched hair transplant, you’re in the right place.

Here, we’ll cover exactly what a botched hair transplant means, what causes it, and how to lower your risk of a bad hair transplant.

The word botched is defined as something that is “unsuccessful because of being poorly done.” If you’ve done any channel surfing recently, you may have seen a show devoted entirely to botched cosmetic surgery. It can be scary to think that botched procedures are common enough to have a show dedicated to them, but it’s also important to be aware of the risk.

A botched hair transplant is typically a transplant that goes wrong due to a surgeon's error. Symptoms of a botched hair transplant include unevenly placed hair grafts, patchy areas, and excessive scarring or swelling. We’ll also touch on transplants that fail to meet patients' expectations.

Read on for common problems with and causes of botched hair transplants, plus what you can do about it.

Significant Scarring

If the hair transplant is performed well, scarring after the surgery should be barely visible, especially using the FUE method, which uses small micro-punches to move individual follicles, as opposed to follicular unit transplant (FUT), which removes a strip of skin in the donor area and can leave a linear scar.

Research shows that excess scarring after a hair transplant typically happens when the surgeon has faulty technique — including incorrectly-made incisions — or if there’s poor patient compliance.

Patchy Areas

Patchiness or thinning areas post-transplant are typically caused by overharvesting the donor site (which we’ll cover in a bit) or uneven spacing of the graft. Some shedding after a hair transplant is normal and to be expected. However, patchy areas are not the norm once hair grows in; they’re a sign of a poorly done hair transplant.

Unnatural Hairlines

If the hair grafts are placed at improper angles or the surgeon lacks attention to detail, it can result in unnatural hairlines that are asymmetrical or sit too low or too high on the head.

Necrosis (Tissue Damage)

Necrosis is the death of tissue caused by a lack of blood flow. It’s a rare but severe complication of a hair transplant. Usually, it occurs due to damage to blood vessels during surgery (usually because of an unskilled surgeon) or certain underlying medical conditions that affect blood flow. High blood sugar and diabetes are risk factors for necrosis.

Hair transplant failures are rare but possible. Below, we’ll cover some common causes of botched hair transplants.

Black Market Hair Transplant Clinics

The term “black market clinics” refers to unregulated facilities that offer hair transplants. The danger is that these procedures are performed by unqualified people (who may not even be doctors).

Medical tourism — the practice of traveling to another country to receive medical care including cosmetic procedures —  is on the rise (this makes sense since cosmetic procedures are costly in America and highly unlikely to be covered by insurance). While there are plenty of reputable clinics abroad, it’s important to be mindful of black market clinics, which may be more common abroad in countries without strict regulations.

According to 2022 census findings from the International Society of Hair Restoration Surgery (ISHRS), 5.4 percent of hair restoration patients “sought treatment to repair previous surgery from another physician/black market hair transplant,” up from 4.2 percent in 2019, suggesting this type of black market procedure is on the rise.

Inexperienced Surgeons

While not nearly as sinister as a black market clinic, sometimes surgeons are inexperienced. If your healthcare provider is new to hair transplants, there’s a chance you may not be happy with the results. It’s worth having an in depth consultation with your surgeon to not only learn more about your situation, but about their experience with similar procedures.

Lack Of Honest Communication

While the surgeon is to blame for a botched operation in many cases, hair transplant patients have an important job, too. As the patient, you should be open and honest about your medical history (including any medications you’re taking), your expectations, and whether or not you feel comfortable with the required aftercare.

On the flip side, it’s also the responsibility of the hair transplant surgeon to be upfront about their method and what they think is possible for your hair.

Using an Outdated Technique

You probably remember the bad hair plugs of the 80s and 90s that tended to be irregularly spaced and conspicuous. Thankfully, hair transplant surgery has come a long way since then.

These days, two types of hair transplants — FUE and FUT — are the most common, with other new techniques like DHI and robotic hair transplants gaining popularity. These procedures are generally quite successful and leave behind minimal scarring.

It’s unusual for any surgeon to use hair plugs anymore, as these create large holes. The procedure moves clumps of hair instead of individual follicles and looks unnatural.

You can learn more about FUT vs FUE hair transplants in our guide.

Overharvesting the Donor Area

Overharvesting the donor area in a hair transplant means that too many hair follicles from the donor site have been removed. The donor site (typically the back or sides of the scalp), is chosen because the hair there is resistant to balding.

However, if too many follicles are taken from one area,  it can result in visible thinning or bald patches in the donor site, which creates an uneven appearance and makes it evident that a transplant has occurred. Overharvesting can also make it difficult to fix a hair transplant gone wrong, as the donor area's capacity for further extraction may be reduced.

Unclear Expectations

Sometimes, a hair transplant may not be botched, per se, but may fail to meet a patient’s expectations. You may be disappointed if you expect your hair to look exactly as it did in your pre-balding life (your hair density will probably not be the same). Other factors to consider are what you expect from maintenance (typically, your doctor will recommend an additional hair loss treatment post-transfer, like minoxidil or finasteride) and how immediately you expect to see hair transplant results.

Fortunately, there are many things you can do to set yourself up for a successful hair transplant.

• Do your research. Look at before-and-after photos and compare the costs of hair transplant clinics. The average cost of a hair transplant in America (according to a 2021 study) is $13,160. If a cost seems too good to be true, it probably is.

• Choose a board-certified surgeon. You can use this physician finder tool to find a reputable hair transplant surgeon near you.

• Clearly communicate your medication and medical history. Certain medications and supplements may cause excess bleeding or suppress the immune system, making it harder to heal. If you’ve ever had a reaction to anesthesia (local or general), be sure to mention that as well.

• See a dermatologist first. A dermatologist will help you determine the root cause of your hair loss. If you’re experiencing male pattern baldness (androgenetic alopecia), then a hair transplant may be a good option. Other types of hair loss, however, like telogen effluvium, tend to resolve on their own and would not require a hair transplant. In some cases, a dermatologist will also perform the surgery.

• Be diligent about post-operative care. While a botched hair transplant is usually associated with poor surgical skills or a sketchy clinic, the patient has a responsibility, too. Your surgeon will go over what’s expected post-op for the best results.

Here’s the TL;DR on failed or botched hair transplants.

• Understand the risks: While a hair transplant procedure is generally safe, it can be botched in rare cases, resulting in visible scarring, patchy areas, unnatural hairlines, and even tissue damage. Awareness of these risks is the first step in preventing a botched outcome.

• Choose wisely: Opt for a reputable, board-certified surgeon, and avoid black market clinics. Inexperienced surgeons or outdated techniques can lead to unsatisfactory results, so be rigorous in your research and selection.

• Communication and aftercare are key: Clear communication with your surgeon about your medical history, expectations, and aftercare is essential. Be sure to do due diligence before selecting a clinic and an experienced surgeon. Proper post-operative care plays a significant role in the success of your hair transplant.

Want to learn more about hair transplantation? We have posts covering what to expect from hair transplant recovery and NeoGraft hair transplants.

Not sure if a hair transplant is right for you but want to explore other hair loss treatments? We've got you covered.

We can connect you with a licensed healthcare provider who will help you determine whether you’re experiencing pattern hair loss or another issue and determine the best treatment options available.