Does smoking affect your hair transplant?

Smoking has long been considered detrimental to hair growth due to the nature of the chemicals found in cigarettes, vapes and other nicotine-containing items (such as cigars, pipes and patches)¹. The delicate blood vessels of the scalp can be affected by smoking and nicotine-containing products, and thus blood flow to the area is affected. This has the knock on effect of slowing post-operative wound healing, reducing oxygen supply to the tissues and increasing the risk of infection by lowering the body’s immunity. In rare cases, smoking can even cause tissue “necrosis”, or death of the tissues. 

In this article, we will explore the effect smoking has on our scalps, as well as ways to prevent this damage. We will cover what smoking does to the scalp after surgery, how it impacts your result and ways to prevent poor growth. 

How Do Wounds Heal?

Normal wound healing involves four crucial steps.

1. Haemostasis
2. Inflammation
3. Growth and Rebuilding
4. Strengthening

We can observe these four steps during the process of hair transplant surgery, for context. 

1. Haemostasis: At the incision and extraction sites of hair grafts during surgery, cuts to the area cause immediate bleeding and irritation. The body then responds by clotting the site of injury, to prevent further bleeding. Over a period of a few days our body’s immune cells and platelets turn these clots into healing scabs which eventually fall away. 
2. Inflammation: To prevent infection at the sites of injury, white blood cells rush to the area. White blood cells are important for helping the body fight off germs and infection, and oversee the body’s repair process. 
3. Growth and Rebuilding: Collagen is secreted, a key component in wound healing which helps cells build new, strong tissue. This can be seen on the scalp as reddish brown scabbing as healing progresses, and can become dull and dry like a protective barrier as the wound continues to mend. 
4. Strengthening: As the new tissue heals, the scabs become tighter and puckered in preparation for falling off to reveal fresh skin underneath. In surgery, incisions can heal rapidly in the first four to six weeks, with further healing occuring in the months following the injury. As the wounds heal, skin loses its redness and inflammation settles. 

How Does Hair Grow?

Deep in the skin sits the hair root and bulb. At the base of the hair bulb lies small blood vessels that supply the hair shaft and bulb with rich, nutritional blood. This rich supply of blood allows the regeneration of hair cells and for each hair follicle to actively undergo its own cycle through growth, maintenance and resting phases.

The active growth phase of hair is known as the Anagen Phase, with approximately 85% of our hair in this phase at any given time². During this phase, the hair follicle draws extensively on rich, nutritional blood to thrive; after hair transplant surgery this supply of highly oxygenated and rich blood is especially important to aid the healing process.

The Effects of Smoking After Surgery

Hair transplant surgery involves taking hair from the back and the sides of the head, where hair is less susceptible to being lost, and placing them into areas in the hairline or crown where hair loss and balding has occurred. The incisions made when taking out the hair, and putting them back in create sites for possible complications. The risks of surgery and how smoking can affect wound healing can be grouped into two areas:

1. Post-Operative Infection and Immunity
2. Necrosis and lack of blood supply

Post-Operative Infection and Immunity

Infection occurs when microbes enter an open wound and thrive, creating inflammation and damaging surrounding tissues. As the scalp is richly supplied in blood by a large network of blood vessels, immune cells are quickly able to bind together at sites of infection to quickly target these microbes^3,4.

Smoking affects the immune system in diverse ways. It hinders the regulation of immune cells, which prevents them from performing their actions effectively to target inflammation and clear away debris. It additionally reduces the ability of immune cells to fight infection, which impairs healing and prevents healthy regeneration of cells such as hair follicles⁵.

Symptoms of infection include pain, redness, itching or burning sensations, swelling and oozing pus or abscess formation. These symptoms can be addressed with good hygiene habits, keeping the scalp clean and dry, as well as medical treatments such as oral and topical antibiotics. It is important to note that even with treatment, due to how deeply smoking can impair the immune system, antibiotics may sometimes not be sufficiently strong enough to fight wound infections.  

Blood Supply and Necrosis

The active ingredient in smoking devices, Nicotine, is a potent vasoconstrictor. This means that this chemical causes narrowing and constriction of blood vessels all over the body. In hair, nicotine is absorbed directly by cells in the bulb, which is the centre of hair cell growth. When the blood vessels surrounding the bulb constrict, it narrows the quantity of essential nutrients getting through to the bulb for hair growth and regeneration. This can cause impaired healing and poor growth of new hairs after surgery⁶. 

A further ingredient found in cigarettes, Carbon Monoxide, binds to red blood cells and reduces the amount of oxygen supplied to the skin.

Necrosis

In rare cases, “necrosis” or death of the tissue can occur. Necrosis happens when blood supply to the wound site is limited or interrupted. When this happens, new hair grafts can die due to lack of oxygenated and rich blood supply. 

Luckily, necrosis is considered a rare potential complication of hair transplant surgery, and with timely treatment, can be confined to small, localised areas which can heal in 2-3 weeks. That being said, this complication is painful and disappointing to see, as the grafts affected do not thrive⁷.

If the quality and quantity of healthy blood required for normal healing is reduced, post-operative recovery can be drastically hindered. For a more in-depth analysis into how smoking can cause and effect hair loss, please see our article here. 

Achieving A Good Hair Transplant Result 

To achieve a good hair transplant result, patients must seriously consider quitting smoking to protect both their health and follicles. It can be a challenge to quit smoking, but with the right advice and support, it is definitely achievable.

Some effective methods to quit include creating plans to avoid triggers (e.g certain social smoking situations or stressors that create the urge to smoke as relief) and therapies to step down and reduce withdrawal symptoms, such as nicotine replacement therapy (NRT).

NRT comes in various forms, such as patches, gums, lozenges and prescription medications.
Psychological and behavioural counselling in-person, over the phone and online are all additional helpful methods of helping stick to a step down plan. Lifestyle changes such as exercise, diet improvements and mindfulness are all ways to alleviate stressors and ease the want to smoke.

To start your journey towards quitting smoking, national quitlines such as NHS Smokefree Helpline, or the American Cancer Society’s Quitline, are both resources that provide expert advice and support.
Every effort to reduce and quit smoking clears the path towards healthy hair growth, and a good hair transplant result. By allowing rich and adequate blood supply to tissues, maintaining healthy blood vessels and keeping your immune system in tip top shape, you have a much better chance of being satisfied with the resulting growth following surgery. 

Conclusion

While smoking has become a social norm and is tough to work around, it is important to understand the impact this practice has on our hair and overall health.

At The Treatment Rooms London, we endeavour to provide quality guidance through your hair journey, and are always happy to address questions about hair growth beyond your transplant. The path towards healthy hair can be a very personal journey, with the highs and lows of adjusting lifestyle choices in order to produce the best results. With the right motivation and the right advice, you can achieve the hair transplant result that you envision. 

References

1. Kavadya, Yatra; Mysore, Venkataram1,. Role of Smoking in Androgenetic Alopecia: A Systematic Review. International Journal of Trichology 14(2):p 41-48, Mar–Apr 2022. | DOI: 10.4103/ijt.ijt_59_21 
2. Gail Audrey Ann Cooper, Chapter 1 – Anatomy and Physiology of Hair, and Principles for its Collection, Hair Analysis in Clinical and Forensic Toxicology, Academic Press, 2015, https://doi.org/10.1016/B978-0-12-801700-5.00001-7.
3.  Daniel Yetman Identifying and Treating an Infection Following a Hair Transplant, Healthline.com, August 12, 2021. Medically reviewed by Susan Bard, MD.
4. Loganathan E, Sarvajnamurthy S, Gorur D, Suresh DH, Siddaraju MN, Narasimhan RT. Complications of hair restoration surgery: a retrospective analysis. Int J Trichology. 2014 Oct;6(4):168-72. doi: 10.4103/0974-7753.142861. PMID: 25368473; PMCID: PMC4212293.
5. Effects of tobacco smoke on immunity, inflammation and autoimmunity, Yoav Arnson a,b c a,b, , Yehuda Shoenfeld , Howard Amital * Journal of Autoimmunity 34 (2010) J258 – J265.
6. Dardour JC, Pugash E, Aziza R. The one-stage preauricular flap for male pattern baldness: long-term results and risk factors. Plast Reconstr Surg. 1988 Jun;81(6):907-12. doi: 10.1097/00006534-198806000-00013. PMID: 3375352.
7. Chen J, Qu Q, Guo Y, Hu Z, Li X, Fan Z, Yang J, Tang Q, Miao Y. Recipient site scalp necrosis: A rare postoperative complication of hair transplantation. J Cosmet Dermatol. 2024 Feb;23(2):622-629. doi: 10.1111/jocd.16017. Epub 2023 Oct 9. PMID: 37814471.