Is scalp reduction surgery suitable for a patient with Folliculitis Decalvans? (Photo)

Question

Hi, I tried test hair transplant in 2017 (60 grafts). Only 5% grew back. I've been on & off antibiotics from dermatologist. Symptoms much improved. Current symptoms include mild itching and crusting. No inflammation. Been on vegan diet for 10 months and removed all inflammatory food/drink. Symptoms further improved. Since HT failed, I was wondering if any type of scalp surgery is possible to reduce the bald area? Perhaps excising part of the scarred area & resuturing. Thanks in advance

Glenn Charles, DO · Answer

It is possible to to do a scalp reduction on patients that have a bald area from Folliculitis Decalvans. However, you would likely need an expander placed under the skin first to stretch the skin out and making it possible to remove the bald part of your scalp and be able to close the wound. This can take several months and would be 2-3 procedures.

Jeff Donovan, MD, PhD · Answer

It can be an option but really only when the disease activity is zero. Your disease activity is not yet at zero. I would encourage you to connect with a dermatologist in your area who specializes in scarring hair loss. The goal needs to be to get the disease activity to zero to increase the chances of a procedure like thus being successful. The fact that your 2017 transplant did not work well does not have much significance as I suspect the transplant would likely have been performed when your disease was still slightly active. Transplants don’t work when FD is slightly active: Please consult with an expert as your situation is challenging. There may be a few option but step 1 is to fully shut off the disease (if possible).

David Perez-Meza, MD, FISHRS · Answer

Excellent question of permanent scarring alopecia (FD). I reviewed the photos and I see a big alopecic scar in the occipital area and thinning at the top of the head. Obviously the possibility of inflammation-infection is always to keep in mind. If the folliculitis is severe then may cause a permanent hair damage. Serial scar removals can take a long time and may be not successful. If your scalp and the alopecic area are stable of folliculitis and no hair regrowth then you may be a candidate for tissue expansion (insert a ballon in your scalp). Do you also have Male Pattern of Hair Loss? I will recommend to look for a 2nd opinion with a plastic and reconstructive surgeon with experience in scalp cases and tissue expansion. Good luck.

Is scalp reduction surgery suitable for a patient with Folliculitis Decalvans? (Photo)

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Is scalp reduction surgery suitable for a patient with Folliculitis Decalvans? (Photo)

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Everything you need to know about Hair Transplant

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