Frontal fibrosing alopecia (FFA)

Frontal fibrosing alopecia (FFA) is a scarring form of hair loss that slowly pulls the hairline back in an even band around the forehead and temples. It mainly affects women after menopause, but can occur earlier and in men too. A typical early sign is that the eyebrows thin out or disappear, sometimes before the hairline is noticeably affected.

FFA is considered a variant of lichen planopilaris, an inflammatory process where the immune system attacks the hair follicles and gradually replaces them with scar tissue. Unlike hereditary hair loss, the loss is therefore permanent in the affected areas, because the follicle itself is destroyed. The skin in the band often becomes pale and smooth, and redness or flaking can sometimes be seen around the remaining follicles at the edge.

This is a condition where the right order is absolutely crucial, and where we are clear about what we can and cannot do. FFA must be investigated and treated by a dermatologist. The goal of the medical treatment, anti-inflammatory medication, and often 5-alpha-reductase inhibitors, is to slow or stop the ongoing inflammation. The earlier that happens, the more hair can be preserved.

A hair transplant is normally not relevant while the disease is active: transplanting into an inflamed, still-attacked scalp does not work, and even transplanted follicles can be attacked. In selected cases, when the disease has been judged burnt out and inactive for a longer period, a transplant can be discussed, but the results are more uncertain than with a regular hair transplant, and it requires careful collaboration with your dermatologist. If you suspect FFA, we primarily recommend a dermatologist assessment. You are welcome to us for a free consultation where we help you understand what you are seeing and guide you on.