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INTRODUCTION

Hair transplantation has been performed since the 1960s for the treatment of androgenetic alopecia. The technique of follicular unit transplantation (FUT) provides consistently natural appearing cosmetic outcomes for patients with this condition, and the majority of patients who seek consultation for hair restoration are seeking treatment for thinning hair as a result of female or male pattern hair loss. However, there is a subset of patients who require special consideration for hair restoration. In this chapter, we describe hair restoration surgery for scarring alopecia and corrective hair surgery.

The general public often perceives androgenetic alopecia as a normal variant of aging, but hair loss due to scarring alopecia is often more cosmetically disfiguring. Moreover, patients who seek corrective hair surgery typically do so because their previous surgery appears unnatural and they feel as though they must do something to correct their unnatural appearing, “pluggy” transplants. These patients need special consideration not only because they may be more troubled or devastated by the cosmetic appearance of the involved bald areas, but also because they will need special considerations regarding the techniques to be used for their corrective surgery to be successful.

HAIR RESTORATION SURGERY FOR CICATRICIAL (SCARRING) ALOPECIA

The term “cicatricial alopecia” will be used interchangeably with scarring alopecia in this section. Cicatricial or scarring denotes that the follicular epithelium has been replaced with fibrous connective tissue. Hair surgeons often use the term more broadly than dermatologists, with any cicatricial alopecia generally being defined as any form of inflammation or trauma that leads to a scarring process. This can, therefore, include scarring hair loss from cosmetic surgery, burns, or radiation. Cicatricial alopecia can be divided into primary and secondary cicatricial alopecias.1 In primary cicatricial alopecia, the hair follicle is the target of the inflammation and disease activity.2 In secondary cicatricial alopecia, the hair follicle just happens to be present in the area of disease activity, as in radiation dermatitis or burns. In this chapter, the various types of cicatricial alopecia will be discussed, as well as special considerations for transplanting patients with scarring alopecia.

INITIAL EVALUATION

Overall, hair transplantation into areas of scarring alopecia can be more challenging as the patient not only needs a suitable donor area, but the inflammatory stage of the scarring alopecia must also be inactive. It is, therefore, important that patients with scarring alopecias secondary to inflammatory scalp dermatoses be treated medically before considering surgery. Some patients respond to medical therapy within months, others over years. For some patients, reactivation of the inflammatory stage may occur post transplant and lead to loss of the transplanted hairs. Patients with primary scarring alopecia seeking hair transplant surgery should be aware of the impact that reactivation of inflammation would have on transplanted hair, as well as the need for regular follow-up with their dermatologist following surgery. In addition, scalp fibrosis and diminished ...

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