Hair Transplant in Primary Cicatricial Alopecia: Challenges and Innovative Solutions

       Learn how hair transplant for Primary Cicatricial Alopecia can be successful at Civas&Akpınar Hair Transplant Clinic, with cutting-edge techniques for optimal results.

Hair loss is an issue faced by many, but when the loss is caused by cicatricial (scarring) alopecia, the situation becomes more complex. Primary cicatricial alopecia  (PCA) refers to a group of conditions where hair follicles are permanently destroyed and replaced with scar tissue.

This condition leads to irreversible hair loss, and many patients with scarring alopecia seek hair transplant solutions. However, given the complexity of primary cicatricial alopecia, the possibility of performing a hair transplant depends on several factors.

In this article, we will explore what primary cicatricial alopecia is, how it affects hair transplant outcomes, and how Civas&Akpınar Hair Transplant Turkey is addressing these challenges with cutting-edge research and expertise. 

What is Primary Cicatricial Alopecia?

Primary Cicatricial Alopecia (PCA), also known as scarring alopecia, is a group of rare hair loss disorders characterized by the permanent destruction of hair follicles, leading to irreversible hair loss

The condition occurs when inflammation targets and damages the stem cells in the hair follicle, causing scarring and permanent hair loss. Unlike non-scarring alopecia, PCA leaves behind a smooth, shiny scalp surface where follicles are completely absent.

PCA can significantly impact a patient’s quality of life due to its permanent nature and visible hair loss patterns. Understanding its causes, diagnosis, and effective treatment options is essential for managing the condition.

Moreover, the psychological and social effects of PCA can be profound, often leading to feelings of self-consciousness and social withdrawal. Raising awareness about available treatment options, including hair transplantation, can help patients regain confidence and improve their quality of life. 

Causes and Symptoms of Primary Cicatricial Alopecia 

Primary Cicatricial Alopecia can arise from a range of underlying causes, including autoimmune disorders and infections.

Some autoimmune conditions, such as Lichen Planopilaris (LPP) and Frontal Fibrosing Alopecia (FFA), are among the most common culprits. Infections like Folliculitis Decalvans and Dissecting Cellulitis can also damage the follicles and result in scarring.

Common symptoms of PCA include: 

• Persistent itching and burning sensations in affected areas.  Pain or tenderness on the scalp. 
• Gradual hair thinning, followed by irreversible hair loss. 
• Smooth, shiny scalp areas where follicles are permanently destroyed. 

Early diagnosis is crucial, as inflammation can continue to progress, worsening hair loss and scarring

Timely intervention with anti-inflammatory medications and other therapies can help stabilize the condition before considering hair restoration

Diagnosis and Importance Before Hair Transplantation 

Accurate diagnosis of Primary Scarring Alopecia is vital to avoid misdiagnosis and inappropriate treatment, as hair transplantation in the active phase of the disease can lead to poor outcomes. Diagnosing the specific type of cicatricial alopecia helps determine the most suitable treatment and ensures that inflammation is under control before proceeding with hair restoration.

At Civas&Akpınar Hair Transplant Turkey, our team of expert dermatologists, Dr. Ekrem Civas and Dr. Ümit Akpınar, have conducted extensive research on scarring alopecia, contributing valuable insights to the field

We employ advanced diagnostic methods to accurately identify the condition and assess eligibility for hair transplantation.

Why Hair Transplants Are Effective for Primary Cicatricial Alopecia?

Hair transplantation offers a viable solution to restore hair in areas affected by PCA, especially when the disease is inactive and well-managed. By transplanting healthy hair follicles from unaffected areas into scarred regions, natural hair growth can be reestablished

The success of the procedure depends heavily on the stability of the disease and the skill of the hair transplant surgeon.  Our clinic specializes in tailoring hair transplant procedures for patients with scarring alopecia, leveraging advanced FUE techniques to maximize success rates and minimize scarring.

Furthermore, meticulous planning and comprehensive patient consultations help optimize results. During these consultations, we assess scalp condition, donor hair availability, and patient expectations to develop a customized treatment plan that aligns with their needs. 

Key Factors Affecting Success in Hair Transplants for Primary Cicatricial Alopecia

When considering a hair transplant for Primary Cicatricial Alopecia (PCA), it’s crucial to evaluate several key factors that can influence the success of the procedure:

• Stability of the Condition: The most important factor is whether the condition is still active. If PCA is active, hair transplantation cannot be performed, as further hair loss and scarring may occur after the procedure, compromising the results. Successful outcomes are more likely if the condition is stable.
• Donor Area Suitability: Adequate hair density and quality in the donor area are essential for a successful hair transplant. The health and condition of the donor follicles directly affect the viability and longevity of transplanted grafts.
• Extent of Scarring: Severe scarring caused by PCA may limit the area from which hair follicles can be extracted. If the scarring is extensive, it may reduce the effectiveness of the transplant and lead to lower graft survival rates.
• Scalp Laxity: Scalp laxity refers to the flexibility of the skin on the scalp. Insufficient laxity may reduce the number of grafts that can be safely harvested, making it a critical consideration during the planning phase of the procedure.
• Blood Supply to Recipient Area: For grafts to survive and grow successfully, the recipient area must have an adequate blood supply. Poor blood circulation in the transplant area can lead to graft failure and poor results.
• Post-Transplant Care: Proper aftercare following the hair transplant procedure is crucial to enhance graft survival and minimize complications. Adhering to post-operative instructions, including avoiding physical strain and protecting the scalp from infection, ensures the best hair transplant results.

FUE: The Best Technique for Primary Cicatricial Alopecia 

Follicular Unit Extraction (FUE) is considered the gold standard for hair transplantation in PCA patients. It involves extracting individual follicular units from the donor area and implanting them in the scarred region.

FUE’s precision helps minimize additional scarring and ensures better survival rates of transplanted grafts.  Our clinic’s experience with FUE hair transplant for cicatricial alopecia has yielded promising results, allowing patients to regain their confidence and restore their natural hair appearance.

The advanced techniques we employ reduce the risk of complications, making FUE a reliable choice for complex cases of scarring alopecia. 

How Does Hair Transplant For Primary Scarring Alopecia Work?

1. Diagnosis and Stabilization

Before embarking on a hair transplant journey for PCA, the first and most vital step is diagnosis. Determining the precise type of scarring alopecia is essential, as each subtype presents unique challenges. Additionally, it is crucial to assess whether the condition is active or if there is any ongoing inflammation.

Hair transplant specialists, like those at Civas&Akpınar Hair Transplant in Turkey, emphasize the need for a stable, inflammation-free scalp as the foundation for a successful transplant. 

2. Donor Area Assessment and Expectation Management

Following the stabilization of cicatricial alopecia, the focus shifts to evaluating the donor area and the bald spots. This involves a thorough analysis of the quality and availability of donor hair. It is essential to manage patient expectations, ensuring they understand that while the objective is to achieve the best possible results, the procedure may not completely cover the entire affected area. This transparent communication sets realistic expectations

3. Test Hair Transplant Session 

In certain cases, especially when dealing with complex primary cicatricial alopecia, a test hair transplant session may be required. This session involves the transplant of a smaller number of grafts, typically ranging from 100 to 200.

The purpose is to evaluate how well the grafts survive in the recipient area. This mini-session serves as a valuable indicator of the patient’s suitability for a full hair transplant and helps determine the hair grafts’ viability. 

4. Ongoing Medical Treatment 

For patients whose grafts do not survive the hair transplant test session or for those whose cicatricial alopecia cannot be fully stabilized, ongoing medical treatment is the primary course of action. This treatment aims to manage the condition and minimize its impact. 

5. Full Hair Transplant 

Assuming the test session is successful and PCA is stable, a full hair transplant can be performed. Using the most appropriate method, such as FUE, DHI, or Sapphire, hair surgeons can extract more grafts and transplant them into the recipient area.

Hair Transplant Treatment For Cicatricial Lichen Planopilaris 

Cicatricial Lichen Planopilaris (LPP), also known as lichen planus, is a skin condition that affects regions of the skin with hair and hair follicles. It results in the destruction of hair follicles, leaving behind scar tissue in its place. This results in both hair loss and the development of scar tissue.

LPP is more prevalent in patients between the ages of 40 and 60 and is seen 2 to 5 times more frequently in women than in men. LPP is characterized by itching, burning, occasional pain, and sensitivity. It leads to a burning sensation or sensitivity in the scalp.

The upper part of the scalp, especially the crown, is most commonly affected. Hair loss or areas with scar tissue can be noticeable. Additionally, lichen planus can affect the skin, mouth, genital areas, and nails.

Hair transplantation for scarring alopecia presents unique challenges, primarily stemming from the degenerative changes and reduced blood supply to scarred tissues.

Complications can also arise when scarring extends into the safe donor area of the patient, leading to an insufficient supply of grafts necessary for achieving complete coverage.

In cases of primary cicatricial alopecia such as Lichen Planopilaris, it is crucial to confirm that the disease is inactive before performing a hair transplant procedure. As mentioned by Dr .Civas in a published research paper titled: Surgical correction of primary cicatricial alopecia: Experience with nine patients, a waiting period of a minimum of one year should be observed.

The disease activity can be assessed through dermatoscopic examination performed by a dermatologist, and if necessary, confirmed through pathology. 

In some cases, especially for complex LPP, a test hair transplant session may be recommended. During this session, a smaller number of grafts (typically 100-200) are transplanted to evaluate how well the grafts survive. This test session provides insight into the patient’s suitability for a full transplant.

When extensive scarring patches on the scalp result in a shortage of suitable donor hair, body hair extracted from beard areas or other parts of the body can be used to perform hair transplants. 

Body Hair Transplant In Primary Scarring Alopecia

In the world of hair restoration, innovative techniques are revolutionizing the treatment of primary cicatricial alopecia, a condition marked by permanent hair loss due to scarring of the hair follicles.

One such groundbreaking approach is body hair transplant (BHT), which not only offers hope to patients suffering from this condition but also expands the horizons of hair transplant procedures.

Traditional hair transplants primarily use hair from the scalp as donor follicles, but in cases where there’s limited donor hair available, body hair transplant (BHT) has become a viable alternative.

BHT involves the extraction of healthy hair follicles from areas like the chest, back, or beard, and transplanting them into the affected scalp regions. This innovative technique can significantly improve the appearance and confidence of individuals dealing with scarring alopecia.

Challenges and Limitations of Hair Transplants in PCA

While hair transplantation can offer a solution for some primary scarring alopecia patients, several challenges and limitations must be considered: 

• Severity of Scarring: The presence of dense scarring in the donor or recipient area can make it difficult to extract hair follicles or implant them in a way that guarantees survival and growth.
• Limited Donor Hair: Due to scarring and damage to hair follicles, PCA patients may have less available donor hair compared to those with non-scarring alopecias, potentially limiting the number of grafts that can be extracted.
• Risk of Graft Failure: Since the inflammation that causes PCA can damage the skin and hair follicles, there is an increased risk that the transplanted grafts may not survive in the recipient area.
• Need for Ongoing Medical Treatment: To ensure the success of the hair transplant, patients may require medical treatment to control inflammation and prevent the recurrence of PCA in the transplanted areas. This ongoing treatment is essential for maintaining the health of both the transplanted hair and the scalp.

Success Rate of Hair Transplant in Primary Cicatricial Alopecia (PCA)

The success rate of hair transplant in Primary Cicatricial Alopecia can vary significantly depending on several factors, including the severity of the scarring, the stability of the condition, and the quality of the donor hair.

In general, Primary Cicatricial Alopecia patients may experience lower success rates compared to those with non-scarring forms of hair loss due to damaged hair follicles and limited donor hair.

However, when PCA is in a stable, inactive phase, and adequate donor hair is available, hair transplants can still yield satisfactory results. Success rates can also improve with proper medical management to control inflammation and prevent further scarring.

Dr. Civas Case Studies on Hair Transplant in Primary Cicatricial Alopecia 

Dr. Ekrem Civas stands out as one of the best hair transplant surgeons in Turkey, recognized not only for his surgical expertise but also as a distinguished academician.

Driven by his natural curiosity, he continually seeks ways to enhance the techniques employed during hair transplant procedures, aiming for better results and greater patient satisfaction.

Dr. Ekrem Civas’ extensive studies and research on scarring alopecia have played a pivotal role in shedding light on the intricacies of this challenging hair disorder.  In 2018, Dr. Civas joined forces with colleagues to conduct a comprehensive study involving nine patients diagnosed with primary cicatricial alopecia.

Prior to commencing the study, they ensured that the patients’ conditions had stabilized, and that the disease was in an inactive state. Their primary objective was to evaluate the effectiveness of Follicular Unit Extraction (FUE) Hair Transplant in treating primary cicatricial alopecia.

Read more here. 

In 2022, Dr. Civas and Dr. Akpınar published two significant articles, ‘Approach to Scalp Scars’ and ‘Innovations in Cicatricial Alopecia,’ exploring surgical interventions and innovative treatments.

Learn more here and here.

Hair transplantation for primary cicatricial alopecia is a complex but achievable solution when performed by skilled experts. Accurate diagnosis and selecting the right technique are essential for successful outcomes.

At Civas&Akpınar Hair Transplant Clinic in Turkey, our dedication to innovation and research ensures that we remain at the forefront of PCA hair restoration.

Contact us today to schedule a consultation and learn more about your options..