Scarring hair loss (cicatricial alopecia)

Scarring hair loss, or cicatricial alopecia, means the follicles have been destroyed and replaced by scar tissue. Unlike hereditary hair loss, the loss is permanent — there are no dormant follicles that can be revived, because the follicle itself is gone. The cause can be external: an injury, a burn, a surgical scar (for example after a facelift or other surgery) or an accident. It can also be due to inflammatory skin diseases such as lichen planopilaris or frontal fibrosing alopecia, where ongoing inflammation gradually destroys the follicles. Here the order matters. If the hair loss is due to an active skin disease, it must first be investigated and calmed medically by a dermatologist — transplanting into an inflamed scalp does not work. If the scar is stable and "mature" (after an injury or surgery), however, hair can often be transplanted directly into the scar tissue. Transplantation into scars requires special technique. Scar tissue has poorer blood supply than healthy skin, so we place the follicles more sparsely and sometimes in two rounds to give them the best possible chance of surviving. An initial PRP treatment can improve the quality of the tissue before the procedure. At a consultation we assess the scar and whether the conditions are right.