Hair Restoration and the Scarred Scalp

Baldness (alopecia) secondary to certain dermatologic diseases or scalp injury and subsequent scarring is called cicatricial or scarring alopecia. In medical terminology a scar is called a cicatrix. The common causes of cicatricial alopecia are injury to the scalp caused by trauma, thermal burns, chemical burns, electrical burns, and diseases that destroy hair follicles and scalp tissue. Cicatricial alopecia may involve the complete scalp or portions of the scalp. The extent of scarring and the patient’s wishes guide the selection of hair restoration procedure.

Nonsurgical Hair Restoration

Hair pieces, hair weaves and hair extensions are the only effective nonsurgical treatments for cicatricial alopecia. Hair restoration drugs are ineffective or minimally effective in scarred scalp tissue.

Surgical Hair Restoration

If cicatricial alopecia is partial, a hair-bearing portion of scalp, the occipital donor area, may be available as a donor site. Procedures that may be considered include free or pedicled scalp flaps, scalp reduction with or without tissue expansion, and transplantation of micrografts or single hairs. Multiple surgical sessions may be required if cicatricial alopecia is extensive and/or scarring is severe. Dermatologic diseases causing scarring alopecia should be evaluated carefully by an expert. During the active stages of these diseases treatment with surgery is not indicated, as the transplanted hair will be affected by the same process that caused the original hair loss. Patients with these conditions can be candidates for surgery after the disease is “burned out” or no longer active.