Would a hair transplant after postherpetic neuralgia due to shingles cause pain to return or worsen?

Question

I am interested in a hair transplant, but I had shingles 4.5 years ago with a rash on my neck and scalp, exactly in the donor area. This resulted in postherpetic neuralgia (PHN), causing pain and a burning sensation. Haircuts and wearing a hat were painful due to allodynia. Over the last year and a half, the pain has mostly disappeared, but occasional flashes of pain indicate the area is not fully healed. Can I consider a hair transplant, or is there a risk the pain could return or worsen?

Anna Chacon, MD, FAAD · Answer

That’s such an insightful and important question, and I completely understand why you’d be cautious given your history. Postherpetic neuralgia can be incredibly uncomfortable, and even though your symptoms have improved a lot over the last year and a half, the fact that you still experience occasional flashes of pain tells us that the nerves in that area are still a little sensitive.

A hair transplant involves a lot of tiny incisions and manipulation in the donor area, which could potentially irritate those healing nerves. While it doesn’t necessarily mean the pain will definitely come back, there is a chance that surgery could trigger or worsen discomfort in that region. Every person’s healing is unique, so it’s hard to predict with certainty how your nerves will respond.

The safest approach would be to have a very detailed conversation with both a hair restoration surgeon and possibly a neurologist or pain specialist. They can assess the degree of nerve recovery in your scalp and help weigh the risks versus benefits in your specific case.

The good news is that because your pain has improved so much over time, you may be in a better position now than before to consider options. It’s just important to be mindful and cautious so you don’t undo the progress you’ve made in healing.

Ross Kopelman, DO · Answer

A hair transplant after postherpetic neuralgia from shingles is generally safe, but there’s a slight possibility that the surgery could irritate the nerves in the affected area. Since the scalp nerves are already sensitive due to the neuralgia, the procedure might trigger temporary discomfort or aggravate symptoms. However, it’s rare for the pain to return or worsen permanently. Techniques like local anesthesia during surgery can help manage any pain, and the discomfort usually subsides as the scalp heals.

Matt Tahsini, MD · Answer

Hello, and thank you for your question. I don't think there is a big chance the pain will return, but you could try a small portion of the affected area to see. Look for a reputable doctor to do the procedure. Best of luck to you.

Dr. T

Dr. T

Jeff Donovan, MD, PhD · Answer

There’s always a risk. it’s not risk free although risk is fortunately quite low. You can always consider a small test procedure and see how that goes. It is important you appreciate the difference between “risk free” and “low risk”.

This is low risk but not risk free.

This is low risk but not risk free.

Would a hair transplant after postherpetic neuralgia due to shingles cause pain to return or worsen?

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