Early-onset recipient-site necrosis after FUE hair transplantation complicated by Pseudomonas aeruginosa infection: a case report.

Follicular unit excision (FUE) is a widely used hair transplantation technique with a favorable safety profile; however, rare but severe complications such as recipient-site scalp necrosis can occur. We report a 46-year-old male with androgenetic alopecia who developed early-onset recipient-site necrosis following FUE hair transplantation. Dusky discoloration appeared on postoperative day two and progressed to extensive necrosis with yellowish crusting by day ten. Wound culture revealed secondary Pseudomonas aeruginosa infection. The patient had a history of heavy smoking and underwent a prolonged nine-hour procedure. Management with conservative wound care and culture-guided systemic antibiotics led to resolution of infection, with healing resulting in residual atrophic cicatricial scarring at 12 weeks. This case highlights that recipient-site necrosis, although rare, may arise from the synergistic effects of patient-related risk factors, prolonged operative duration, dense graft placement, and secondary infection. Early recognition and prompt intervention are critical to minimizing tissue loss and optimizing outcomes.