Pitting and Uneven Skin Texture After Hair Transplant

Pitting and uneven skin texture after hair transplant describe a condition where the scalp surface appears dimpled, sunken, or irregular around transplanted grafts. Unlike raised irregularities, pitting creates a depressed appearance of the skin.

Although primarily a cosmetic concern, pitting can affect the perceived naturalness of results.

What is pitting after hair transplant?

Pitting occurs when recipient sites heal with slight depressions rather than a smooth surface. This typically results from excessive tissue removal, deep channel creation, or localized tissue loss during implantation.

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

Difference between pitting and cobblestoning

Pitting and cobblestoning are opposite surface irregularities. Cobblestoning produces raised grafts, while pitting creates depressed areas around follicles.

Cobblestoning is discussed here:
Cobblestoning After Hair Transplant

Why pitting occurs

Pitting results from a combination of surgical and biological factors.

• Excessive channel depth
• Removal of too much dermal tissue
• Aggressive instrumentation
• Compromised wound healing

Role of channel depth

Creating channels deeper than necessary can remove supportive tissue, leading to surface collapse during healing.

Depth control is explained here:
Channel Opening Depth

Tissue response and healing

After implantation, the scalp undergoes remodeling. In areas with tissue loss, contraction during healing can create depressions.

Timeline of pitting development

Pitting often becomes noticeable once scabs fall off and initial swelling resolves, usually within 3–8 weeks postoperatively.

Temporary vs persistent pitting

Mild pitting may improve over several months as collagen remodeling occurs. Deeper pits may persist long term.

Does pitting affect graft survival?

In most cases, pitting does not directly affect follicle survival, as grafts may still receive adequate blood supply.

Areas more susceptible to pitting

Pitting is more noticeable in areas with thinner skin, such as the frontal hairline and temples.

Cosmetic impact

Uneven skin texture can reduce the illusion of natural density, especially under short hairstyles or direct lighting.

Prevention strategies

Preventing pitting relies on precise surgical technique.

• Controlled channel depth
• Minimal tissue trauma
• Appropriate instrumentation

Relation to implantation technique

Different implantation methods affect tissue handling and depth control.

Implantation techniques are discussed here:
Slit Technique Explained

Assessment during follow-up

Texture irregularities should be assessed after full healing, usually at 6–12 months.

Corrective treatment options

Persistent pitting may be managed with minor surgical revision, resurfacing, or injectable treatments depending on severity.

Psychological impact

Visible texture changes can cause concern if patients are not informed about possible healing variations.

Importance of patient counseling

Clear explanation of potential surface changes reduces anxiety and improves satisfaction.

Long-term outlook

Most mild cases improve naturally, while severe cases are uncommon with modern techniques.

Clinical importance of preventing pitting

Maintaining smooth scalp texture enhances natural appearance and overall aesthetic quality.

References

1. Dermatologic Surgery – Recipient Site Complications
   
2. NIH – Wound Healing and Dermal 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.