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Histological Analysis for the Cause of Kinky Hair after Hair Transplantation

Introduction: Studies on kinky hair after hair transplantation are rare although kinky hair happens frequently. Commonly referred to in the literature as “post-transplant kinkiness,” we decided to investigate what causes kinky hair using a histologic approach. Method: A patient, who had a hair transplant at another clinic three years previously, came to our clinic with a complaint of low density of transplanted area. Reduction foreheadplasty was done to reduce the height of her forehead as well as to get rid of low-density parts. We collected some of the severe kinky hairs upon the removal of transplanted areas and observed them at the microscopic level. Results: We noted fibrotic tissues alongside the kinky hair’s follicle. In addition, distortion of the bulb was observed with the presence of fibrotic tissue at the subcutaneous layer. Discussion: We usually mention scarring in terms of kinky hair after transplantation. Scars in the subcutaneous layer probably cause kinky hair rather than scars in the dermis. Fibrotic tissue that forms in the subcutaneous layer presses on transplanted hair follicles and causes deformity of follicles. Growing follicles after the telogen phase are likely to be deformed by encountering scar tissue when they grow downward to enter the anagen phase. The resulting deformed bulb causes the kinky hair. Therefore, reducing tissue damage during transplantation is very important. Inflammation aggravates scar formation, so it might be helpful to lessen the factors that lead to inflammation such as infection and bleeding. Conclusion: Perifollicular scarring after hair transplantation causes hair follicle deformity and results in the hairs growing as kinky hair. Therefore, reducing scarring in the transplant recipient area is essential for the prevention of kinky hair.