Once you get a smooth spot on scalp, does that mean hair follicles have died and it will never grow back?

There are actually quite a few causes of smooth bald spots. Some are associated with permanent hair loss and others are not. You may want to review this with a physician. A full review of your story together with an up close examination will help determine if you have a permanent or potentially regrowable bald spot.

Hair loss can be caused by a number of different conditions and environmental factors, so it is difficult to say whether hair loss in a specific area is permanent without first seeing pictures or preferably conducting a thorough examination. In some cases, a scalp biopsy may even be necessary in order to arrive at a definitive diagnosis. General thinning at the crown is frequently the result of genetic pattern baldness, or androgenetic alopecia, where the hair follicles gradually produce thinner and thinner hair strands with each successive hair growth cycle until they eventually stop producing hair altogether. However, a completely smooth, circular area elsewhere on the scalp may be the result of alopecia areata, less common autoimmune condition where the body’s own defenses cause excessive inflammation around hair follicles in a tightly defined area. Consulting with a doctor who has experience treating the various forms of hair loss is the best way to determine exactly what is going on and what your options may be.

In any case, there are definitely treatments that may be able to help. Medications like minoxidil and finasteride as well as non-surgical treatments like red light laser or platelet rich plasma therapy can often halt the progression of hair loss and have, in some cases, been able to stimulate follicles into re-growing some hair. Certain topical prescription medications or injections have also proven to be successful in treating cases of alopecia areata.  Just because one area has grown smooth does not necessarily mean that you should give up hope.

I think that you should see a good doctor and get a diagnosis to find out the answer to that very important question