Cobblestoning After Hair Transplant

Cobblestoning after hair transplant refers to an uneven, bumpy texture of the scalp that develops around implanted grafts. The surface may resemble cobblestone pavement, which is how the condition gets its name.

Although usually a cosmetic issue, cobblestoning can affect the perceived quality of results if severe.

What is cobblestoning?

Cobblestoning occurs when transplanted grafts protrude slightly above the surrounding scalp surface, creating a raised appearance. It is most often related to implantation depth and graft–site mismatch.

For a general understanding of hair transplantation, see:
What Is Hair Transplant?

Why cobblestoning happens

Cobblestoning results from technical and biological factors during implantation.

• Shallow recipient site creation
• Oversized grafts relative to channels
• Excessive tissue surrounding grafts
• Postoperative swelling

Role of implantation depth

Correct implantation depth allows grafts to sit flush with the scalp. Shallow placement increases the risk of raised grafts.

Depth control is explained here:
Channel Opening Depth

Graft size and recipient site mismatch

If grafts are larger than the channels prepared, surrounding tissue may bulge, producing a cobblestoned surface.

Cobblestoning vs normal postoperative swelling

Early swelling is common after surgery and usually resolves. Cobblestoning persists beyond the normal healing phase.

Timeline of cobblestoning appearance

Cobblestoning typically becomes noticeable once scabs fall off and swelling subsides, usually within 2–6 weeks.

Temporary vs persistent cobblestoning

Mild cobblestoning often improves over several months as tissue remodels. Persistent cases may remain visible long term.

Does cobblestoning affect graft survival?

Cobblestoning generally does not impair graft growth, as follicles can still receive adequate blood supply.

Cosmetic impact

Severe cobblestoning can reduce the natural appearance of the hairline or transplanted area, particularly under short hairstyles.

Areas more prone to cobblestoning

Cobblestoning is more noticeable in the frontal hairline and temple regions due to thin skin and high visibility.

Prevention strategies

Proper surgical technique significantly reduces the risk of cobblestoning.

• Accurate channel depth control
• Matching graft size to recipient sites
• Gentle graft handling

Role of implantation technique

Different implantation methods influence surface texture outcomes.

Implantation techniques are discussed here:
DHI Implantation Technique

Healing and tissue remodeling

The scalp undergoes gradual remodeling after surgery. Fibrosis and tissue adaptation can smooth minor irregularities over time.

When cobblestoning becomes a concern

Persistent or worsening cobblestoning beyond 6–12 months may require evaluation.

Corrective treatment options

Options may include minor surgical revision, steroid injections, or resurfacing techniques depending on severity.

Psychological impact on patients

Visible surface irregularities can cause dissatisfaction if not anticipated and explained before surgery.

Importance of patient counseling

Patients should be informed about possible texture changes during healing to avoid unnecessary anxiety.

Long-term outlook

Most mild cases improve naturally. Severe cases may need targeted correction but are uncommon with modern techniques.

Clinical impact of preventing cobblestoning

Avoiding cobblestoning improves surface smoothness, natural appearance, and overall aesthetic satisfaction.

References

1. Dermatologic Surgery – Recipient Site Complications
   
2. NIH – Wound Healing and Skin Remodeling
   
3. ISHRS – Recipient Area Management
   

Medical Disclaimer:
This article is provided for informational and educational purposes only and does not constitute medical advice.
It is not intended to replace a face-to-face consultation, diagnosis, or treatment by a qualified physician.
Individual treatment decisions should always be made in consultation with a licensed medical professional.