Lichen Planopilaris Hair Transplant: Can You Restore Hair After Scarring Alopecia?

Can You Get a Hair Transplant with Lichen Planopilaris?

The answer is yes, you can get a hair transplant with LPP, but with caution and only under strict conditions.

Is Hair Transplant Possible in Lichen Planopilaris?

Yes, but several key factors determine the feasibility of a lichen planopilaris hair transplant:

 

• • Disease Inactivity: As previously noted, transplantation is only attempted in patients with no active inflammation.

• • Scalp Condition: Severely scarred areas may have reduced blood supply, which affects graft survival. Surgeons must carefully assess the vascularity and elasticity of the recipient site.

• • Donor Area Evaluation: The occipital scalp (safe donor area) must be healthy, with adequate density and no signs of subclinical LPP involvement.

Transplants in LPP-affected scalps are typically performed with reduced density to minimize trauma and reduce the risk of disease reactivation. Some patients may require a staged procedure with multiple hair transplant sessions.

Medical Treatments Before Considering Lichen Planopilaris Hair Transplant

Even though a hair transplant may be the end goal, managing active disease with medical treatment is the first step. Common therapies include:

 

• • Topical corticosteroids

• • Intralesional steroid injections

• • Hydroxychloroquine (an antimalarial with anti-inflammatory effects)

• • Systemic retinoids

• • Immunomodulatory agents under specialist supervision

These treatments won’t bring back lost hair, but are essential to stabilize the disease and prevent further scarring.

Lichen Planopilaris Hair Transplant: When Is It Safe to Proceed?

A lichen planopilaris hair transplant is only considered safe when the disease is in a clinically and histologically inactive phase.

Attempting transplantation during active disease may result in graft failure, reactivation of inflammation, and worsening of scarring.

In cases where LPP has remained stable and inactive for an extended period, surgical intervention may offer cosmetic improvement and psychological benefit. Still, patients must understand that the procedure carries higher risks and uncertainties than standard hair transplants.

How Do I Know If My LPP Is Inactive for a Hair Transplant?

LPP is a relapsing-remitting disease, which means periods of stability can be followed by flare-ups. Determining inactivity requires a multi-modal approach:

Clinical signs of remission:

 

• • No progression of hair loss for at least 12 to 24 months

• • Absence of scalp symptoms such as itching, burning, or tenderness

• • No new areas of alopecia

Trichoscopy (dermoscopy):

 

• • Lack of perifollicular erythema and scale

• • Stabilized pattern of hair loss

Histological confirmation (The gold standard):

 

• • A scalp biopsy taken from the periphery of a lesion should show no active lymphocytic infiltrate and signs of quiescent fibrosis

Many clinicians advocate for a minimum of 1–2 years of disease inactivity before considering a lichen planopilaris hair transplant. In some cases, a test hair transplant session with a small number of grafts can help determine if the recipient site can support transplanted follicles.

Hair Transplant Technique Considerations in LPP

Hair restoration in the setting of scarring alopecia, such as LPP, requires an adapted surgical approach:

 

• • FUE (Follicular Unit Extraction) is preferred due to its minimally invasive nature and lower risk of additional scarring.

• • Reduced graft density helps optimize survival in compromised tissue.

• • Pre-operative assessment may include blood supply evaluation.

• • Special graft holding solutions may be used to maximize graft viability during surgery.

• • Post-operative care often includes anti-inflammatory measures and scalp care tailored to reduce the risk of disease reactivation.

What’s the Success Rate of Hair Transplants for LPP?

When performed in the inactive phase and under expert care, many LPP hair transplant patients achieve natural-looking, long-term results, although graft survival rates may be slightly lower than in non-scarring alopecias.

Success is defined not only by graft survival but also by maintenance of the result over time without disease reactivation. Outcomes may vary, but are improving with refined techniques.

 

• • Graft survival: Around 60–80%, depending on scarring severity, extent, and vascularization

• • Cosmetic improvement: Moderate to significant in well-selected cases

• • Long-term success: Higher if the disease remains inactive and the patient adheres to follow-up care

LPP hair transplant success rates also depend on the hair transplant surgeon’s experience with scarring alopecia and meticulous surgical technique.

Will Transplanted Hair Fall Out If LPP Reactivates?

Yes. If the disease reactivates post-hair transplant, it can affect both the native and newly implanted follicles, leading to the recurrence of hair loss. This underscores the importance of:

 

• • Thorough pre-operative screening

• • Potential use of maintenance immunosuppressive therapy post-operatively

• • Ongoing dermatological monitoring

Lichen Planopilaris patients should be fully informed that disease recurrence is a possibility even after years of remission. Early detection of an LPP flare-up can allow for immediate intervention to minimize damage.

Hair Transplant Risks for LPP Patients

Under ideal conditions, hair transplantation is safe, but for LPP patients, there are additional considerations:

 

• • Graft survival may be reduced in scarred areas

• • There’s a risk of disease reactivation post-transplant

• • The results may be less dense than in patients with non-scarring alopecia

• • Poor planning may lead to donor area depletion

It’s essential to manage patient expectations and choose a hair transplant clinic experienced in treating scarring alopecia, such as Civas&Akpınar Hair Restoration Center.

What Results Can You Expect After Lichen Planopilaris Hair Transplantation?

In well-selected patients, a lichen planopilaris hair transplant can deliver natural-looking, long-lasting results, though it might not be as dense as in patients with androgenetic alopecia (AGA).

Patients should expect:

 

• • Improved scalp coverage in previously bald patches

• • Graft survival rate might be lower in scarred areas

• • Possibly lower hair density compared to traditional hair transplants

• • Multiple sessions may be needed to achieve satisfactory density

• • Long-term follow-up with a dermatologist is necessary to monitor for reactivation

Choosing the Right Clinic for Lichen Planopilaris Hair Transplant

Because of the complexities involved, not every clinic is equipped to treat scarring alopecia patients. Make sure the hair transplant clinic you choose:

 

• • Is led by experienced board-certified dermatologists or accredited hair transplant surgeons

• • Uses FUE (Follicular Unit Extraction) or DHI (Direct Hair Implantation) techniques that minimize trauma

• • Has a proven track record of success with cases of LPP or Hair Transplant in Cicatricial Alopecia

• • Employs special organ-holding solutions to preserve graft viability

• • Offers long-term monitoring and aftercare

At Civas&Akpınar Hair Transplant Clinic, located in Ankara, Turkey, our team has extensive experience managing Lichen Planopilaris. Procedures are performed by accredited dermatologists with expertise in both FUE and DHI techniques, ensuring each patient receives an approach tailored to their condition.

Our Experience Treating Scarring Alopecia with Proven Results

At Civas Hair Transplant Clinic, our commitment to treating scarring alopecia, such as Lichen Planopilaris, is backed by extensive clinical experience and academic research.

Dr. Ekrem Civas and Dr. Ümit Akpınar have co-authored several pivotal studies that have advanced the understanding and surgical management of cicatricial alopecia.

Dr. Civas’ publication, “Surgical Correction of Primary Cicatricial Alopecia: Experience with Nine Patients,” details the outcomes of FUE hair transplantation in patients with stable scarring alopecia, including LPP, demonstrating promising long-term results.

Additionally, Dr. Civas and Dr Akpınar’s works “Approach to Scalp Scars” and “Innovations in Cicatricial Alopecia” provide comprehensive insights into surgical interventions and emerging techniques for managing scalp scars and cicatricial alopecia.

These contributions reflect our dedication to combining evidence-based practices with personalized care, ensuring optimal results for patients dealing with complex hair loss conditions.

If you’ve been diagnosed with LPP or another type of scarring alopecia, reach out to our team to schedule a personalized consultation and explore your hair restoration options.