23 & permanent traction alopecia, which hair restoration is best? (Photos)

Question

Hi! I’m 23 yrs old and for the last 3+ yrs, I’ve had two identical small hair lost spots on either side of my hairline, just above where my sideburn hairs begin. I believe it’s due to permanent traction alopecia, I’ve tried oils and all that sort of thing. Will a micro hair transplant be good for someone like me?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your situation. Traction alopecia, especially from chronic tension (tight hairstyles, extensions, braids), can result in permanent follicle damage over time. At your age, with small, localized, stable areas of loss persisting for over 3 years, it does sound like scarring or permanent traction alopecia rather than temporary shedding.

✅ Why Micro Hair Transplant Can Be a Good Option:

For small, well-defined patches like yours, follicular unit extraction (FUE) or a micrograft transplant is often the most effective permanent solution.

Oils, minoxidil, and other topical treatments generally do not regrow hair in areas where follicles have been destroyed.

Transplanted hairs are taken from resistant areas (usually the back of the scalp) and will continue to grow normally in the new location.

Small areas require fewer grafts, making recovery quicker and outcomes more predictable.

✅ Other Options to Consider:

Camouflage approaches: Scalp micropigmentation can help if you prefer a non-surgical option.

Platelet-Rich Plasma (PRP): May improve overall hair health but unlikely to regrow in areas of scarring.

Continued traction avoidance: Essential to prevent further loss or weakening of adjacent hair.

✅ Summary Recommendation:
A micro hair transplant is generally considered the most definitive and reliable solution for permanent traction alopecia, especially if the area is stable and you are in good health. You’d be an excellent candidate for evaluation by a hair restoration surgeon who can assess donor density and plan the precise graft placement.

If you have any other questions about techniques (FUE vs. FUT) or recovery expectations, feel free to ask.

Marco Barusco, MD · Answer

Hello,

A micro hair transplant can be an excellent solution for small, localized areas of hair loss like the ones you described, especially if the cause is permanent traction alopecia. This approach allows for precise placement of grafts to restore density and achieve a natural appearance. Since your hair loss is stable and localized, you’re likely a great candidate.

I recommend consulting with a skilled surgeon to confirm the diagnosis and discuss a tailored plan to meet your goals.

Best regards,
Dr. Marco Barusco

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. For someone who is 23 years old and dealing with permanent traction alopecia, hair restoration treatments like PRP (Platelet-Rich Plasma) and exosome injections can be quite beneficial. PRP involves drawing a small amount of your blood, processing it to concentrate the platelets, and then injecting it into the scalp. This procedure can stimulate hair follicles and promote hair growth by increasing blood supply and delivering growth factors directly to the affected areas. On the other hand, exosome injections are a more advanced option, utilizing exosomes—tiny vesicles that carry proteins and genetic material—to facilitate cellular regeneration and repair. These injections can enhance the regenerative process and potentially improve hair density and health more efficiently. Both treatments can complement each other and are often used in combination to maximize results, especially in cases where traction alopecia has led to significant hair loss. I love both treatments and highly recommend them. I hope this helps and best of luck!

Sujeev Bains, MD · Answer

Hello,
With long standing traction alopecia, the hair follicles can become dormant and need a restorative hair transplant procedure while any non-dormant miniaturized hair follicles may respond to known preventative hair treatments. Prior to a procedure, it requires a full review of one's hair loss history and examination to confirm this is the etiology of the hair loss. This also assists in surgical mapping the area to determine the amount of grafts needed to cover the area. Our clinic has had many successful hair transplant procedures performed on traction alopecia.

Ilhan Serdaroglu, MD · Answer

FUE hair transplant can be an option for restoration  of  small  bald  spots due to permanent traction alopecia. I advice you have a FUE with 1800-2000 grafts; you would achieve the desired hairline in just one session of dense packing hair transplant. exosomes , PRP and  other  supportive  treatnent  will  not  work  for  you  ..  you  need  an HT and must  stop  pulling  your  hair .

Jeff Donovan, MD, PhD · Answer

A combination of oral minoxidil, topical minoxidil and steroid injections are probably the best of the non surgical treatments. For many patients, these may be worth trying ahead of any planned surgery as sometimes they help a great deal. surgery can be a wonderful option provided a very skilled and experienced surgeon is doing the procedure. Other medical treatments have little evidence at all.

Ross Kopelman, DO · Answer

At 23, experiencing traction alopecia can be frustrating, but the good news is that there are effective solutions. Based on the location of your hair loss&mdash;small areas near the hairline&mdash;micro hair transplants or even an FUE (Follicular Unit Extraction) procedure could be a great option for you. This approach is minimally invasive and allows for precise placement of grafts in smaller areas, which seems ideal for the spots you’re describing.
Since you’ve already tried oils and other treatments without success, it's likely that your traction alopecia is permanent. A transplant would offer a more permanent solution, helping to restore those areas and create a natural, fuller appearance.
You’re also young, which means your body is in a good position for healing and achieving optimal results. A well-executed hair restoration can deliver long-lasting effects for years to come.
If you opt for this route, it’s crucial to avoid any hairstyles or habits that caused the traction alopecia in the first place to prevent recurrence. Hair transplants, particularly for small areas like yours, can yield excellent results, allowing you to regain confidence in your hairline.

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