Scarring hair loss, or cicatricial alopecia, is a form of permanent hair loss whereby hair follicles are destroyed and replaced with scar tissue1,2. Once the disease has been stable for at least two years, there are several treatment options which can be considered3. These include hair transplant, excision of the hairless region, and flap procedures (an intact blood supply is extracted from the donor site)4,5. When choosing the best option for you, there are a few important individual characteristics to investigate. For example, when choosing a hair transplant, here are the top 5 considerations:
Availability of Donor Hair
Very simply, how much donor hair is available? How large is the recipient area?
Properly assessing donor and recipient regions is especially important in younger individuals as pattern hair loss may develop over time. This could lead to gradual loss of the transplanted hair or “islands” of hair in a balding region. An experienced hair surgeon should be able to anticipate this possibility and operate accordingly.
Scalp laxity refers to the looseness of the affected area of the scalp. Greater laxity allows for a low-tension wound closure. Strip or follicular unit extraction (FUE) hair transplants may be the better option for those with less laxity while excision may be preferable in cases with greater laxity or smaller affected areas.
Patient’s Healing Characteristics
Some people are better at healing than others. Those with a history of producing highly visible scars or who have experienced greater than average postoperative bleeding may benefit from hair transplant over the alternative surgical options. Another option is FUE hair transplants.
Scar tissue in the areas of hair loss can lead to reduced blood flow. Your hair transplant surgeon should be able to test for a sufficient supply to nourish the newly transplanted follicles. Larger scarred areas are most at risk for low blood flow.
Area of Involvement
If the affected area is highly visible, such as the hairline, a hair transplant is most likely the way to go. Alternatively, hair transplantation can be used as an additional procedure to hide scars in visible areas.
Overall, there are multiple treatments available for scarring hair loss. However as they mainly consist of surgical options, there are many considerations, making individual assessments by an experienced surgeon important.
Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.
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- Harries MJ, Sinclair RD, Macdonald-Hull S, Whiting DA, Griffiths CEM, Paus R. Management of primary cicatricial alopecias: options for treatment. Br J Dermatol. 2008 Jul;159(1):1–22.
- Saxena K, Saxena DK, Savant SS. Successful Hair Transplant Outcome in Cicatricial Lichen Planus of the Scalp by Combining Scalp and Beard Hair Along With Platelet Rich Plasma. J Cutan Aesthetic Surg. 2016 Mar;9(1):51–5.
- Unger W, Unger R, Wesley C. The surgical treatment of cicatricial alopecia. Dermatol Ther. 2008 Jul;21(4):295–311.
- Fan J-C, Wang J-P. [Plastic surgical management of large cicatricial scalp alopecia]. Zhonghua Yi Xue Za Zhi. 2009 Apr 28;89(16):1098–101.