A Rare Post–Hair Transplant Complication with Complete Recovery: A Case Report and Review of the Literature

Abstract

Postoperative complications following hair transplantation are generally mild and self-limited; however, severe infectious or inflammatory reactions involving the periorbital or cervicofacial regions are exceedingly rare yet potentially vision- or life-threatening. Early recognition and prompt multidisciplinary management are essential, as delayed intervention may result in rapid soft-tissue progression, necrosis, and systemic instability. A 34-year-old man developed rapidly progressive cervicofacial edema 48 h after an uncomplicated hair transplantation procedure. The patient had no history of prior cranial surgery, trauma, or implanted prosthetic material. The swelling originated in the recipient area and rapidly extended to the forehead and bilateral periorbital regions, accompanied by severe pain, fever, hypotension, and hemodynamic instability. Laboratory evaluation demonstrated markedly elevated inflammatory markers (C-reactive protein 193 mg/L (reference < 5 mg/L), procalcitonin 51.43 ng/mL (reference < 0.05 ng/mL), lactate 9.68 mmol/L (reference 0.5–2.2 mmol/L)) with progressive leukopenia. Despite empirical broad-spectrum antibiotics, intensive care support, and multidisciplinary management, the patient’s condition deteriorated, with worsening edema, hemorrhagic–purulent bullae, bilateral pleural effusions, and atrial fibrillation with rapid ventricular response. Subsequent periorbital skin necrosis required surgical debridement. Later during hospitalization, neck soft-tissue involvement with multiple small fluid collections emerged. Gradual improvement followed escalation of antimicrobial therapy and corticosteroid administration; however, residual frontal muscle akinesia and right facial nerve paresis persisted. The patient eventually stabilized on long-term azathioprine therapy and achieved full clinical recovery. This case underscores that rapidly progressive cervicofacial edema, periorbital involvement, frontal muscle akinesia, and right facial nerve paresis after hair transplantation, although rare, may indicate a fulminant infectious or inflammatory process requiring urgent, multidisciplinary management. Early recognition, timely therapeutic escalation, and close monitoring are critical to preventing irreversible tissue damage and systemic complications. Increased awareness of such severe postoperative reactions can enhance clinical vigilance and improve patient outcomes.