Hair Transplant for Patients with Scarring Alopecia?

Hair Transplants do work for scarring alopecia and I have had great success with this. This is a somewhat controversial topic in the hair transplant literature. It has been suggested that more studies be done on patients with Lupus and other autoimmune disorders due to poor results that have been observed. The best that we can say is that follicular unit hair transplantation has very little risk and does work for many patients with scarring alopecia.

Hair transplant is not generally recommended for scarring type of alopecia. Some doctors depending on history and exam may consider a small "test" transplant to see if the surgery may work.  This does not guarantee success but it may help make a decision with the risks in mind.  SMP may also be an option for those who cannot have a hair transplant surgery.

It depends on the cause of the scarring. If it is an active disease, a hair transplant is not advised since the hair would be lost. Sometimes an active disease can become inactive or burnt out. If a disease has remained dormant for a number of years, this can be the case. In that case, test implants are first done to test viability before a full-blown surgery is committed.

There are a variety of scarring alopecias, some that are in fact very appropriately treated with hair transplants. Discoid Lupus can often be successfully treated with a hair transplant.

Your best choice for scarring alopecia is excision of the scar with or without a tissue expander, or a scalp flap to reconstruct the area where the scar was removed. For large areas we use the Fleming-Mayer Flap, but this is not usually needed for small areas. Also, excision is much cheaper than transplants.

Hair grafts do not generally do well in scarred recipient beds. Successful take of transplanted hair grafts is possible but it truly depends on the extent and depth of the scars.

A hair transplant can be a good option for scarring alopecia provided THREE criteria are met:1. the patient's scarring condition is completely quiet now (meaning there is no ongoing itching, burning or pain)2. the scarring condition has been quiet for at least 1 year (meaning the area hasn't enlarged in size)3. the patient has enough hair to move from another area into the scarring area.Some scarring hair conditions are challenging to get to become 'quiet' and require years of treatment by a dermatologist before transplantation can be considered. Some scarring hair loss conditions never become quiet despite the best of medications. It's important to find a dermatologist who treats hundreds and hundreds of patients with scarring hair loss conditions (like lupus) in order to get on the right treatment and figure out when you can come off them again and figure out when ultimately you're ready for a transplant. If you get a transplant when your condition isn't truly quiet (inactive), the hairs either won't grow, or only grow partially. In some cases, the condition can worsen if the transplant is done prematurely. 

There are many methods of hair transplantation.  Wanted them RFUE and another can be a surgical flap.  Grafts can be taken with as few as one hair follicle or multiple follicles.  The quality of the hair, the number of follicles per unit and the location in which the hair is to be placed are all important determinants in the final result.  While it is a common misconception that hair can and should be taken from any location, taking appropriate hair from an appropriate location is key to success.  For instance, one cannot always use hair from a beard to replace a frontal hairline.  The orientation in which Harris placed is also important.  If the frontal hairline is being created then it is important to make sure that hairs are aligned in the correct orientation.  The way the hair is also laid down, for example a staggered pattern versus a straight line will also change the quality of the result.  You should certainly visit with a surgeon who does many of these types of transplantations as well as offers multiple options for hair restoration.  The cost can vary by geographic locale.  In general they can arrange from $7000-$25,000.  When you go over consultation ask for before and after photographs.

In order for a hair transplant to be successful for scarring alopecia, the disease needs to be inactive and there must be adequate donor hair.  I have good results putting hair into scar tissue as long as the primary disease is stable. 

If you have active scarring alopecia from diseases like lupus, a hair transplant will fail as long as the disease is active