Itching, redness and pimples after a hair transplant: What is normal?

Are itching, redness and pimples normal?

Most of the time, yes. In the days and weeks after a hair transplant, mild itching, redness in the recipient area and small, pimple-like bumps are common. They are usually part of the skin’s healing process and go away over time. How noticeable they are and how long they last varies from person to person.

What matters most is how a symptom changes over time. Normal symptoms ease over days and weeks. If the pain is getting worse, the redness is spreading, the recipient area feels warm to the touch, there is discharge or you have a fever, this may be a sign of infection, and a doctor needs to take a look. Infection after a hair transplant is uncommon; the scalp’s rich blood supply is thought to contribute to this. Even so, it is important to spot it early.

Why does itching happen, and what can you do?

Itching is a common reaction of healing skin. As the channels in which the grafts (small pieces of tissue carrying one or more hairs) were placed heal over, small scabs form on top. As the scabs dry and the skin underneath renews itself, you may feel itchy. The same feeling can occur in the donor area (the area the grafts are taken from); months later, the itching may come back as new hair grows.

Itching usually lessens as the scabs come off. During this period, keep the following in mind:

• Do not scratch or rub the recipient area or the donor area. Scratching can pull scabs off too early and damage the grafts.
• Wash your hair gently with your fingertips, as described in your instructions; this helps the scabs soften.
• Keeping your nails short can limit the damage if you scratch in your sleep without realizing it.
• Do not use any cream, oil or medicine on your own. If the itching bothers you, tell us; your doctor will assess what is right for you.

Itching, burning or a rash that gets worse after you start using a new product may be a skin reaction; let us know before you continue using the product.

Why does redness happen, and how long does it last?

In the area where the channels were opened, the skin repairs many small wounds at the same time. During this process, more blood flows to the area; redness is the visible sign of this healing response. It is most noticeable in the first few days and usually stays limited to the areas that were treated.

After the scabs have come off, a slight pinkness may remain for a while. Even if the skin looks closed on the surface, the repair underneath continues, and blood flow to the area only returns to its usual level over time. In most people, the pinkness fades with time; on fair skin, it may be more noticeable and last longer.

Sun exposure can also make the redness last longer. In the first few weeks, protect the recipient area from direct sun; ask us before applying sunscreen.

Why do pimples appear, and what should you do?

Small, pimple-like bumps may appear in the recipient area, and sometimes in the donor area. These are usually called folliculitis (inflammation of the hair follicle). Inflammation does not always mean germs are involved; for the reasons we describe below, these bumps can also appear as a reaction of the healing skin. Sometimes, however, a bacterial infection develops, which is why it is important to keep an eye on how the pimples change.

In the first few weeks

During this period, small pimples may appear in the recipient area. Possible causes include the opening of the hair follicle at the skin’s surface becoming blocked by scabs or flakes of skin, and a reaction to a short piece of hair left under the skin. These pimples are usually small and scattered; mild ones mostly go away on their own.

As new hair grows

Months later, as new hairs push through the skin to the surface, small, pimple-like bumps may form around them. A hair that cannot break through the skin and curls up underneath it (an ingrown hair) can look the same. We explain the timeline of this period in our article on when transplanted hair grows.

Do not squeeze pimples

Do not squeeze, pop or scratch pimples, and do not pick off the scab on top. Squeezing can push the inflammation deeper, make it easier for germs to get in and damage the hair follicle. Do not use products such as acne treatments or antibiotic ointments on your own either. If the pimples are multiplying, getting bigger or becoming painful, or if the redness around them is spreading, contact us; your doctor will decide after an examination whether treatment is needed.

Which signs mean you should seek help without waiting?

Below, we show the usual course of each symptom side by side with the changes that need attention.

If you notice any of the following, contact us without waiting for your follow-up appointment:

• Pain that gets worse instead of easing
• Redness or swelling that is spreading or keeps increasing
• Warmth in the recipient area or the donor area
• Discharge, pus or a bad smell
• Fever, chills or feeling unwell
• Painful or growing pimple-like bumps in the recipient area

In an emergency, or if you cannot reach us outside our opening hours, go to the nearest healthcare facility without delay. If an infection is suspected, the doctor decides on treatment after an examination; do not use leftover antibiotics or any other medicine you have at home without asking a doctor.

What varies from person to person?

These symptoms can follow a different course even in two people who had the procedure with the same method. The main factors are:

• Your skin and your scalp history: Redness is more noticeable on fair skin. If you have had frequent pimples, marked oiliness or seborrheic dermatitis (a skin condition that causes greasy scaling and redness) on your scalp in the past, tell us during the examination.
• Your general health and smoking: Smoking and some conditions, such as uncontrolled diabetes, can delay wound healing and increase the likelihood of infection. We cover this topic in our article on chronic conditions and hair transplants.
• Your surroundings: Sweat, dust, pool water and seawater can irritate healing skin; we explain the details in our article on exercise, pools and Turkish baths after a hair transplant.

How do we follow your healing together?

During the examination, we also look at your scalp; if there is an active pimple, rash or infection, we plan the timing of the procedure around it. Whether you are suitable for a hair transplant is determined during the examination.

After the procedure, we give you written aftercare instructions; if you notice a difference between this article and your instructions, follow your instructions. Also take any medicines you have been given as instructed. We describe the general framework of aftercare on the hair transplant aftercare page.

We review your healing together at follow-up appointments. If you notice a change that worries you, contact us without waiting for your appointment. The healing process and results vary from person to person.