DHI carries risks similar to any hair transplant procedure: infection, poor graft survival, scarring, and temporary numbness. The technique introduces one additional risk specific to the Choi Implanter Pen: graft damage during the loading step. When performed by an experienced surgeon and trained team, serious complications are rare, and the overall safety profile matches traditional FUE.
This article is for informational purposes only and does not constitute medical advice.
Common Risks and Their Likelihood
| Risk | Likelihood | Severity | Preventable |
|---|---|---|---|
| Temporary numbness | Very common (50-70%) | Mild | Resolves naturally in 2-8 weeks |
| Shock loss of native hair | Common (20-30%) | Moderate | Temporary, regrows in 3-6 months |
| Folliculitis | Moderate (10-20%) | Mild | Treatable with antibiotics |
| Minor infection | Low (1-2%) | Moderate | Preventable with proper aftercare |
| Poor graft survival | Low (5-10% below expected) | Significant | Dependent on surgeon and aftercare |
| Graft damage from pen loading | Low (varies by team) | Significant | Dependent on technician skill |
| Visible donor scarring | Low | Mild | Proper extraction technique |
| Cysts or ingrown hairs | Low (2-5%) | Mild | Treatable |
| Serious infection | Very low (<0.5%) | Severe | Proper sterile technique |
DHI-Specific Risk: Graft Damage During Loading
How It Happens
The loading step is unique to DHI. Each extracted follicular unit must be inserted into the hollow needle of the Choi Implanter Pen by a technician. The graft is picked up with forceps and carefully placed inside the needle with the hair shaft entering first and the follicle bulb positioned at the needle tip.
Damage can occur if:
- The forceps crush the follicle during pickup
- The graft is bent or folded during insertion into the needle
- The graft dries out while being handled
- The technician rushes and forces the graft into the needle
How to Minimize This Risk
- Choose a clinic with experienced DHI technicians: Ask how many DHI procedures the loading team has performed
- Ask about the relay system: Clinics using 6-8 pens in rotation with dedicated technicians minimize loading time per graft
- Hydration protocols: Grafts should remain in chilled saline or Hypothermosol until the moment of loading
- Team size: A team of 4-6 technicians loading in rotation reduces rush and fatigue-related errors
Infection
Risk Level and Causes
Infection occurs in approximately 1-2% of DHI procedures. The recipient area has hundreds or thousands of tiny implantation sites, each representing a potential entry point for bacteria. The donor area has extraction wounds that, while small, also carry infection risk.
Signs of Infection
- Increasing redness, swelling, or warmth beyond day 5 (when these should be decreasing)
- Pus or yellow/green discharge from implantation sites or the donor area
- Fever above 38C (100.4F)
- Worsening pain after the first few days rather than improving
Prevention and Treatment
Following the prescribed antibiotic course, keeping the scalp clean according to the washing protocol, and avoiding touching the transplant area with unwashed hands are the primary prevention measures. If infection occurs, it is typically treated with oral antibiotics and, in rare cases, topical antibiotic ointments.
Poor Graft Survival
Expected vs. Suboptimal Results
DHI graft survival rates should fall between 90 and 95% with an experienced surgeon. When survival drops below this range, the result shows thinner coverage or patchier growth than planned.
Causes of Poor Survival
- Surgeon error: Incorrect implantation depth (too shallow or too deep), poor angle, or trauma during placement
- Graft dehydration: Grafts left outside the body too long or not kept in chilled solution
- Loading damage: Follicles crushed or bent during Choi pen loading
- Patient non-compliance: Touching, scratching, or dislodging grafts during the first 7-10 days
- Smoking: Nicotine constricts blood vessels, reducing blood flow to newly implanted grafts
- Infection: Bacterial infection can kill surrounding grafts
Shock Loss
Shock loss affects both transplanted and native hair. The transplanted hairs shed at weeks 2-4 (normal and expected). However, 20-30% of patients also experience temporary shedding of existing native hair near the transplant zone.
Native hair shock loss occurs because the implantation process creates micro-trauma in the surrounding tissue, temporarily disrupting nearby follicles. In the vast majority of cases, this native hair regrows within 3-6 months. Permanent native hair loss from a transplant procedure is extremely rare.
Scarring
Donor Area Scars
DHI extraction leaves tiny circular scars (0.6-1.0mm each) in the donor zone, identical to FUE scarring. These are virtually invisible when hair is 3mm or longer. Over-harvesting from the donor area can lead to a thinned or patchy appearance, which is why responsible surgeons limit extraction density.
Recipient Area Scarring
The Choi pen creates very small implantation sites that heal without visible scarring in the vast majority of cases. The implantation channels are smaller than traditional FUE slit incisions, which may contribute to less surface disruption.
Numbness and Nerve Damage
Temporary numbness in the donor and/or recipient areas is the most common side effect, affecting 50-70% of patients. It results from minor nerve irritation during extraction and implantation. Sensation typically returns within 2-8 weeks.
Permanent nerve damage is extremely rare and almost exclusively associated with FUT strip surgery rather than DHI or FUE, since the latter methods do not involve deep tissue incisions.
Reducing Your Overall Risk
The most effective way to reduce DHI risks is choosing the right surgeon and clinic. Key factors include:
- Surgeon's specific experience with DHI (not just FUE)
- Quality and training of the technician team
- Sterile clinical environment
- Realistic graft count planning (not over-promising results)
- Comprehensive aftercare protocols
For a full understanding of the DHI technique, see the DHI overview. To learn how to evaluate surgeons, visit our guide on choosing a hair transplant surgeon.
FAQ
What are the risks of DHI hair transplant?
DHI risks include infection (1-2% of cases), poor graft survival (below the expected 90-95% rate), graft damage during Choi pen loading, temporary numbness in the donor or recipient area, shock loss of native hair, folliculitis (inflamed hair follicles), and scarring in the donor zone. Most complications are minor and treatable. Serious adverse events are rare when DHI is performed by an experienced surgeon in a sterile clinical setting.
Can grafts be damaged during DHI loading?
Yes, graft damage during loading into the Choi Implanter Pen is a DHI-specific risk. The follicular unit must be precisely inserted into the hollow needle without crushing, bending, or drying out the graft. Inexperienced technicians may damage grafts during this step, reducing survival rates. This risk is minimized by using well-trained technician teams who handle grafts quickly and keep them hydrated throughout the loading process.
Is DHI safer than FUE or FUT?
DHI has a similar safety profile to traditional FUE. Both avoid the linear scar associated with FUT and have comparable infection and complication rates. DHI may offer a slight advantage in reduced graft handling time, but it introduces the additional step of pen loading which carries its own damage risk. FUT carries the additional risk of a linear donor scar and longer recovery. No hair transplant method is risk-free, and surgeon experience is the most important factor in minimizing complications.
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