Q: What is the most common cause of necrosis (death of tissue) in the recipient area? — A.Q., Los Altos Hills, C.A.

A: Recipient site necrosis is one of the worst complications of a hair transplant and results in skin ulceration and scarring. Usually it is caused by a combination of a few or many of the factors listed below. Each by itself should not present a risk.

Pre-existing conditions in the patient such as:

1. smoking (the big one)
2. diabetes (juvenile more than adult onset)
3. photo-damage (alters the collagen and vasculature)
4. long-standing baldness (less blood supply when there are no follicles)

Poor surgical techniques:

1. recipient sites that are too large
2. recipient sites that are placed too closely (too dense)
3. too many grafts placed at one time
4. too much epinephrine used in the procedure
5. multiple procedures in one session — i.e. FUE and FUE in same session, or large FUT and Graft excision, scalp reduction, etc.