Cobblestoning After a Hair Transplant
Written by Michael Seutin,
founder — former nurse, researching transplant pricing.
Published · every medical statement links to its source.
Cobblestoning is skin around transplanted grafts that heals raised or pitted, leaving a bumpy, uneven surface in the recipient area[1]. A 2018 review puts it down to grafts placed at the wrong depth or into slits that are too small, and says it mostly improves with time; scars that don't may need to be cut out[1].
What it looks like
The 2018 review describes elevations and indentations of scar tissue around the grafts, causing an unsightly uneven surface[1]. A 2014 study lists cobblestoning among the scar changes reported after hair transplants, alongside raised skin in the transplanted area, fibrosis and keloids[2].
It is not the same as the crusts that form on each graft early on, which the NHS calls temporary[3]. Cobblestoning is about how the skin heals around each graft once those are gone.
Why it happens
Two technical causes: grafts set at the wrong depth, or pushed into slits too small for them. The 2018 review says grafts should not sit more than 1 to 2 mm above the surrounding surface[1]. The ISHRS says the recipient incisions must be the correct depth to receive the graft and keep its blood supply, and sized so they are neither too small nor too large for the graft[4].
So it comes down to who cuts the slits and who places the grafts. A 2013 review says recipient-site problems can come from surgeon or assistant error, and that assistants contribute to the success or failure of the surgery through graft dissection and placement[5]. The ISHRS says only the surgeon should make the recipient incisions, and that technicians may place grafts with forceps or blunt implanters only after the surgeon has made all the incisions[6]. It adds that each country has its own laws on technicians pulling and placing grafts[6].
Cobblestoning or something else?
- Cysts are small skin-coloured swellings around transplanted grafts that can turn red and painful. The 2018 review says they come from small grafts slipping under the skin, or one graft piggybacking on another[1].
- Folliculitis is inflamed, pimple-like bumps around the grafts, usually a reaction to damaged hairs rather than an infection[1]. Our infection page covers the signs that it isn't.
- White dots at the back of the head are FUE donor scars, not cobblestoning. The 2018 review says they may be visible on close inspection with short hair[1].
Does it go away, and what can be done?
The 2018 review says cobblestoning mostly improves with time, or the scars may need to be excised[1]. We found no published figure for how often it happens with today's follicular-unit grafts, so we give none. If you think you have it, the NHS says to speak with the surgeon who treated you if you are not happy with the results or think the procedure was not carried out properly[3].
Before you book, ask who will make the recipient slits and who will place the grafts. The clinics below answer part of that on their own websites.
What these clinics' own sites say about who operates
Each of these clinics states on its own website who does the work, or how many patients the team takes in a day: the two facts that decide what your hours in the chair are spent on. In their words, as recorded in our directory:
TurHair
Istanbul, Turkey · Dr. M. Sıraç Demir
Istanbul clinic built around Dr. M. Sıraç Demir, whose ISHRS membership we confirmed in the society's own member directory — a Full Member since 2017, not merely a badge on his website. The clinic's stated distinguishing feature is that Dr. Demir opens the recipient channels himself rather than delegating to technicians, which is the single step patients most often discover was handed to someone else. Prices are quoted per case after a photo consultation and are not published.
Checked against the clinic's own site, July 2026.
Vera Clinic
Istanbul, Turkey · Dr. Salim Öz Aysu, Dr. Emin Gül, Dr. Aidin Chadordouz Jeddi, Dr. Tolga Varol, Dr. Ahmet Azak
Istanbul clinic operating since 2013, founded as EsteVera Clinic and renamed Vera Clinic in 2016. Its site names five hair transplant doctors (Dr. Salim Öz Aysu, Dr. Emin Gül, Dr. Aidin Chadordouz Jeddi, Dr. Tolga Varol and Dr. Ahmet Azak) and says they perform extraction and implantation themselves. Publishes packages from €3,200 (Sapphire FUE) to €5,190 (DHI Max). Türkiye's Ministry of Health lists two Vera facilities among those authorized for international health tourism: Özel Vera Clinic Polikliniği in Kartal (authorization ST-5175) and Özel Veraclinic Tıp Merkezi in Ataşehir (ST-0704). The clinic states ISO 9001 and ISO 10002 certification, which the medical centre's HealthTürkiye listing also gives. With five doctors on the team, confirm in writing which doctor is assigned to your case.
Checked against the clinic's own site, October 2026.
Ulusan Clinic
Izmir, Turkey · Dr. Sibel Ulusan, Dr. Zafer Ulusan
Izmir clinic in Alsancak run by Dr. Sibel Ulusan and Dr. Zafer Ulusan, both qualified in the 1980s, with roughly 15 years focused specifically on hair restoration and patients from 45 countries. FUE, DHI and Sapphire FUE. Unusually, the clinic's own pricing tool separates doctor-performed from technician-performed FUE — the distinction most Turkish clinics blur. Prices quoted per case and not published.
Checked against the clinic's own site, July 2026.
Sources
Primary sources only: the NHS, the FCDO, the ISHRS and peer-reviewed papers on PubMed and PubMed Central. Each was opened and read on the date shown.
- Complications in Hair Transplantation (Kerure & Patwardhan, J Cutan Aesthet Surg, 2018) — PubMed Central. Read 2026-10-23.
- Complications of hair restoration surgery: a retrospective analysis (Loganathan et al., Int J Trichology, 2014) — PubMed Central. Read 2026-10-23.
- Hair transplant — NHS. Read 2026-10-23.
- Hair Graft Placement: The Final Step in Hair Transplantation — ISHRS. Read 2026-10-23.
- Complications in hair restoration (Lam, Facial Plast Surg Clin North Am, 2013) — PubMed. Read 2026-10-23.
- World Hair Transplant Repair Day Shines Light on Proliferation, Dangers of Black-Market Hair Transplant Clinics Worldwide (29 October 2025) — ISHRS. Read 2026-10-23.
Read next
← The full hair transplant recovery timeline, day by day to month 12
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Questions, answered
Grafts placed at the wrong depth, or pushed into slits that are too small, according to a 2018 review, which says grafts should not sit more than 1 to 2 mm above the surrounding skin.
Often it improves. The same review says cobblestoning mostly improves with time, and that scars which don't may need to be excised. Start with the surgeon who treated you.
No. Cysts are small skin-coloured swellings around grafts that slipped under the skin, and they can turn red and painful. Cobblestoning is healed skin around the grafts that sits raised or pitted.