Infection after a hair transplant: how to spot it and when to act

How common is infection after a hair transplant?

Published rates vary from one series to the next, mainly because not every team files the same lesions under the word “infection”. The review by Romera de Blas et al. (2026), which covers the literature on the FUE technique up to September 2025, attributes the rarity of infection to the scalp’s generous blood supply and the minimally invasive nature of the technique. When an infection does occur, it is usually a superficial folliculitis or cellulitis, an infection of the skin and the tissue just beneath it.

The series by Garg and Garg (2021) shows the gap between inflammation and infection: of the 2896 patients treated, 203 developed sterile folliculitis, meaning no organism was identified, whereas only two developed an infection. The multicentre study by Zhou et al. (2024), which covered 1317 patients, found folliculitis in 12.11% of them, all forms included.

Each figure applies to the population and the definition used in its own series. Taken together, they show that a confirmed infection remains the exception, whereas small inflamed spots are a common part of recovery from a transplant. To place this risk among the other possible complications, our article on whether a hair transplant in Turkey is safe reviews them one by one.

Which signs should worry you, and when?

Romera de Blas et al. (2026) describe the typical signs of infection as pustules or honey-coloured crusts, increasing pain, swelling, redness, pus draining from the wound, and tender or enlarged lymph nodes nearby. Each of these signs has to be judged against the normal after-effects of surgery, which peak early and then subside; our article on a red scalp after a hair transplant sets out how long they usually last. Fever, shivering or feeling generally unwell point to a more serious infection.

A node behind the ear or at the nape of the neck is interpreted alongside the rest of the picture, and our article on a swollen lymph node after a hair transplant covers its possible causes. The table below brings together the most useful differences to look for, so that you can describe the situation precisely to the medical team.

Normal healing	Possible infection
Redness gradually fading	Redness spreading and warm
Discomfort easing	Pain getting worse
Dry, dark scabs	Honey-coloured crusts or pus
Forehead swelling going down	Swelling increasing
Normal temperature	Fever, shivering, feeling unwell

What the date of onset tells you

According to the same review, infection and folliculitis most often appear within the first month, while the skin is completing its healing. Folliculitis can still arise later: in the series by Bunagan et al. (2010), the first lesions appeared anywhere between the second day and the sixth month after surgery. Spots that crop up around the tenth week are more often pseudofolliculitis, a mechanical irritation caused by transplanted hairs that are starting to emerge and sometimes curve back towards the skin.

More rarely, painful lumps that ooze several weeks after the procedure and do not respond to standard antibiotics point towards an atypical mycobacterium. Chow et al. (2023) describe a patient treated in Central America whose lumps appeared on day 19: three successive courses of antibiotics failed, and it took five weeks of culture to identify Mycobacterium abscessus. Romera de Blas et al. note that such opportunistic infections have mostly been reported after procedures carried out outside a medical setting or in poorly regulated facilities.

A simple spot, folliculitis or infection: what sets them apart?

Folliculitis means inflammation of one or more hair follicles. On a transplanted scalp, it takes the form of red bumps or pustules arranged around the follicular units, sometimes with mild pain or itching (Romera de Blas et al., 2026). In the study by Zhou et al. (2024), carried out in four centres among patients followed for nine months, the risk was higher when the first aftercare session took place more than three days after surgery, when implantation density exceeded 45 grafts per cm², for sessions of 4000 grafts or more and for operations performed in summer. These factors mostly come down to how the session is planned and when the first aftercare takes place.

The same authors separate folliculitis into two broad forms. The infectious form, usually caused by Staphylococcus aureus, generally appears in the first few weeks, whereas the sterile form, inflammation around the follicle with no detectable organism, tends to develop later and includes pseudofolliculitis linked to regrowth. Only an examination, sometimes with a swab, can tell them apart, and the choice of treatment follows from it.

Not every infection is bacterial. The same review mentions reactivation of the herpes simplex virus, which causes small painful blisters and needs antiviral treatment, and, in exceptional cases, a widespread herpetic rash known as eczema herpeticum (Kaposi’s varicelliform eruption). For spots unrelated to the procedure, or that keep coming back months later, our article on folliculitis of the scalp covers the other causes and their treatment.

What should you do if your transplant seems infected?

Contact the medical team that carried out your procedure on the day the doubt arises, without waiting for your next scheduled check. Send two or three sharp photos taken in natural light, including a close-up of the area that worries you, then give the date of surgery, your temperature taken with a thermometer, how things have changed since the day before and any product applied recently. This information helps distinguish folliculitis that can be watched from a situation that needs an examination.

The NHS describes cellulitis, one of the two forms such an infection usually takes, as skin that is painful, hot and swollen, and in that case advises asking for an urgent GP appointment or contacting NHS 111. If you are already home, see a doctor locally alongside your exchanges with the team, and bring the operation report and your discharge prescription. The NHS recommends calling 999 or going to A&E if cellulitis comes with a very high temperature or shivering, a fast heartbeat or fast breathing, dizziness, confusion, or cold, clammy or pale skin.

Tell the doctor that you have had a hair transplant, when and in which country. This helps them interpret unusual lesions and, if standard antibiotics have no effect, consider a mycobacterium: Chow et al. (2023) then recommend taking samples to identify the organism and its sensitivity to antibiotics.

Until a doctor has seen the area, avoid treating it yourself. Squeezing a pustule or picking off a scab reopens a wound that is closing, and an antibiotic ointment applied without medical advice may distort the sample the doctor could need. Do, however, carry on with the gentle washes set out in your aftercare plan, unless the team tells you otherwise.

How is an infection diagnosed and treated?

An examination of the scalp often distinguishes localised folliculitis from a spreading infection, and the date of onset guides the doctor, since the same lesion is read differently in the first week and in the third month. When a bacterial infection is suspected, Romera de Blas et al. recommend taking a sample before the first dose of antibiotic, for culture with sensitivity testing that identifies the organism and the drugs that work against it. Treatment starts without waiting for that result and is adjusted once it is known. Atypical mycobacteria are hard to pick up on routine tests (Chow et al., 2023), which is why a course of treatment that fails to work should be reported.

Treatment then depends on how extensive the lesions are and which organism is involved, as the table below summarises.

Situation	Usual management
Limited folliculitis	Gentle care, topical antibiotic
Widespread or painful lesions	Antibiotic tablets
Persistent sterile folliculitis	Anti-inflammatory cream or tablets
Abscess	Incision and drainage
Atypical mycobacterium	Drainage, prolonged treatment

For limited folliculitis, the 2026 review describes gentle cleansing and warm compresses, which help crusts lift and superficial pustules drain, with a topical antibiotic such as mupirocin or clindamycin as first-line treatment. Oral antibiotics are kept for widespread or painful forms, or for infections causing general symptoms. Persistent sterile folliculitis may call for a short course of a topical steroid or a tetracycline prescribed for its anti-inflammatory effect. The NHS advises keeping on with antibiotics until the course is finished, even once you feel better, and contacting your GP if you have not started to improve two to three days after starting them.

An abscess, a pocket of pus under the skin, is drained through a small incision made by a doctor. Atypical mycobacterial infections call for more demanding treatment: in the patient described by Chow et al. (2023), recovery required surgical drainage, a month on a combination of two antibiotics, then five further months on one of them.

Does an infection affect the result of the transplant?

Folliculitis that stays limited generally leaves regrowth unaffected. Bunagan et al. (2010) compared 27 patients with folliculitis following a transplant with 28 who had none: the pustules, few to moderate in number, cleared up on their own, without scarring or any effect on the growth of the transplanted hair, whatever management was used. The 2026 review adds two caveats: extensive or recurrent folliculitis can delay regrowth and reduce graft survival, and a severe infection, though rare, can compromise both the grafts and the cosmetic result.

The review also stresses that early, appropriate treatment protects the grafts, which is why any sign that is heading the wrong way should be reported promptly. If regrowth seems poor once healing is complete, our article asking whether a hair transplant can fail explains how the result is assessed and when.

Why can a hair transplant become infected?

An FUE or DHI transplant leaves two kinds of small wounds: the openings left where grafts were taken from the donor area, and the incisions where those grafts are then placed. They remain exposed to germs until the outer layer of skin has covered them. Staphylococcus aureus often lives in the nasal vestibule, just inside the nostrils, in patients and staff alike, and transmission during close-contact procedures has been documented (Romera de Blas et al., 2026). Our hair transplant guide explains extraction and implantation step by step.

Romera de Blas et al. (2026) list four factors that favour infection: poor scalp hygiene, excessive crusting, diabetes and a weakened immune system. Long-term steroids or an immunosuppressant fall into that last category. In the series by Garg and Garg, both infections occurred in patients with diabetes.

Patient advice matters too, according to the review: gentle care and not scratching prevent grafts from being dislodged and a secondary infection from setting in. The opposite behaviour causes problems too, since delaying or skipping washes for fear of damaging the grafts lets fluid and thick crusts build up. The authors link scabs that are slow to come away with a higher risk of inflammation around the follicles and of folliculitis.

Can the donor area become infected?

It is exposed in the same way as the grafted area. In the study by Zhou et al. cited in the 2026 review, folliculitis affected the donor area in 46.7% of cases, the recipient area in 40.3% and both areas in about 13%. It should therefore be watched for the same changes: redness that keeps spreading, pain that increases or any discharge. As you cannot see it directly, ask someone close to you to photograph it or use a second mirror.

The same review also describes inclusion cysts, small firm lumps that appear a few weeks to a few months after surgery, in the donor area or, more often, in the grafted area. Most cause no symptoms, but some become inflamed or infected and turn red, tender or start to discharge. A lump that grows or turns painful should be shown to the medical team, without any attempt to squeeze or drain it yourself; if it is infected, a doctor will open and drain it.

How can you reduce the risk of infection before and after surgery?

The assessment before the transplant is also the moment to identify patients at higher risk. The NHS notes that a weakened immune system, for example because of diabetes, makes cellulitis more likely, so report these conditions and any current treatment before a date is set. Smoking, which the 2026 review lists among the risk factors for necrosis of the grafted area alongside diabetes and vascular disease, is also best stopped around the time of surgery.

For these higher-risk patients, the review mentions two targeted measures. Decolonisation, using mupirocin ointment in the nose or an antiseptic shampoo before surgery, may be considered in selected high-risk cases. As for preventive antibiotics, many surgeons prescribe them routinely although current evidence does not support this practice, and the authors recommend reserving them, in most cases, for patients at higher risk of infection. If you are given an antibiotic, take it exactly as instructed.

In theatre, prevention rests, according to the same authors, on strict asepsis and, for folliculitis, on controlled implantation density and careful graft handling. After surgery, the review lists a first gentle cleanse within 48 to 72 hours among the measures that prevent folliculitis, which matches the three-day threshold found by Zhou et al. Then let the scabs fall away on their own: softening them without pulling them off is covered in our article on hair transplant scabs.

The timing of washes and of a return to exercise, swimming or saunas can be found in our hair transplant aftercare advice. Wash your hands before each care session and, until the skin has healed, do not put anything on your scalp that the team has not cleared.

Who should you contact after a transplant with Body Expert?

On the day after surgery, the team at our partner clinic in Istanbul checks the treated area, removes the dressing and carries out the first wash with you, so that you leave knowing how to do it. Once you are home, your 12-month post-operative follow-up continues remotely, and your dedicated English-speaking patient coordinator forwards your photos and questions to the medical team.

If you suspect an infection, message your coordinator as soon as a sign starts to progress. The medical team reviews your photos and tells you whether local care is enough or whether you need to be examined near home, by your GP or, if the warning signs described above are present, at A&E.

For a hair transplant in Istanbul, our team sends you a free quote within 24 hours, with no obligation, setting out your stay and how this follow-up is organised once you are home.

Sources

Bunagan, K. M. J. S., Pathomvanich, D., & Laorwong, K. (2010). Recipient area folliculitis after follicular-unit transplantation: Characterization of clinical features and analysis of associated factors. Dermatologic Surgery, 36(7), 1161-1165. https://doi.org/10.1111/j.1524-4725.2010.01601.x

Chow, I., Chan, S., Lin, M., & Peters, L. (2023). Mycobacterium abscessus scalp infection after hair transplantation in Central America. CMAJ, 195(42), E1440-E1442. https://doi.org/10.1503/cmaj.230794

Garg, A. K., & Garg, S. (2021). Complications of hair transplant procedures: Causes and management. Indian Journal of Plastic Surgery, 54(4), 477-482. https://doi.org/10.1055/s-0041-1739255

NHS. (2024, April 18). Cellulitis. https://www.nhs.uk/conditions/cellulitis/

Romera de Blas, C., Vega Díez, D., Ricart Vayá, J. M., & Gómez Zubiaur, A. (2026). Complications in follicular unit excision hair transplantation: Current evidence and practical approaches. Frontiers in Medicine, 13, 1750989. https://doi.org/10.3389/fmed.2026.1750989

Zhou, Y., Zhang, J., Yi, Y., Xie, X., Lei, R., Fan, Z., Sun, P., Hu, Z., Qu, Q., & Miao, Y. (2024). Characterization and risk factors of folliculitis after hair transplantation: A multicenter retrospective study. Plastic and Reconstructive Surgery, 154(6), 1115e-1122e. https://doi.org/10.1097/PRS.0000000000011175