Alopecia is a condition that affects many people around the world. Most types of hair loss are reversible and can be managed with the right treatments. However, some forms of alopecia, especially those characterized by scarring, often cause irreversible damage.
A specific type of scarring alopecia, called Central Centrifugal Cicatricial Alopecia (CCCA), leads to permanent hair loss by causing inflammation and scar formation in the hair follicles.
In this post, we’ll discuss everything you need to know about hair transplants for scarring alopecia, including whether it’s a viable option, what results to expect, and what other treatments could help restore hair growth.
What Is Scarring Alopecia?
Scarring alopecia refers to a group of conditions that result in permanent hair loss due to damage to the hair follicles. It is also called cicatricial alopecia. [1]
Unlike other forms of hair loss, where the hair follicles remain intact and can regenerate hair, scarring alopecia involves the destruction of the hair follicles, leading to the development of scar tissue. [2]
Once scarring occurs, the affected area is generally unable to regrow hair on its own.
The condition is often linked to an autoimmune response, where the body’s immune system mistakenly attacks the hair follicles, this inflammatory process destroys the follicles, preventing them from producing new hair. However, the exact cause of scarring alopecia is not known.
The pathogenesis of scarring alopecia is also linked to genetic factors and excessive hairstyling, such as tight hairstyles. CCCA, a common form of scarring alopecia, particularly affects women with type 4 hair, most of whom are African American, suggesting the role of genetics in the development of this condition. [3]
In CCCA, hair loss typically begins at the crown of the scalp and spreads outward in a circular pattern. The hair loss is often accompanied by pain, itching, and a burning sensation.
The diagnosis of scarring alopecia usually involves a combination of physical examination, medical history, and sometimes scalp biopsy.
During the physical examination, the healthcare provider will look for signs of permanent hair loss, thinning, or shiny scalp areas with no visible hair follicles. Your doctor may also ask questions about your medical history to determine the possible cause, such as autoimmunity.
A scalp biopsy involves removing a small sample of tissue from the affected area and testing it in a laboratory. It is the most accurate method for diagnosing scarring alopecia. The biopsy can help confirm if there is inflammation or scar tissue in the scalp, which indicates the presence of scarring alopecia. [4]
Does Scarring Alopecia Go Away?
Unfortunately, scarring alopecia does not go away on its own.
Once the hair follicles have been replaced with scar tissue, the ability of the scalp to regenerate new hair is lost. Some treatments may help slow the progression or manage inflammation, but hair regrowth in the affected areas is unlikely without medical intervention.
Early diagnosis and treatment can often help prevent further scarring in these cases. Also, some forms of scarring alopecia can be managed effectively with proper care and hair restoration treatments, such as PRP (Platelet-rich plasma) hair therapy and hair transplants.
Does Hair Transplant Work for Scarring Alopecia?
Yes, hair transplants can be an effective option for the management of scarring alopecia. However, there are several important factors to consider when making the decision to choose a hair transplant, as the success of the procedure depends on the extent of the scarring and the overall health of the scalp. [5]
In cases where the scarring is active or severe, common hair transplant techniques such as Follicular Unit Extraction (FUE) may be less effective compared to their use in non-scarring/traditional types of hair loss. Scar tissue often has reduced blood supply, which can affect graft survival and healing.
Also, in some cases, hair follicles in the affected area may be completely destroyed, leaving thin viable donor follicles for a transplant. Hence, it is important to talk to your hair loss expert to determine whether you could undergo the procedure.
Can You Get a Hair Transplant with Scarring Alopecia?
Yes, but not everyone with scarring alopecia is a good candidate for hair transplantation. At Heva Clinic in Turkey, we offer hair transplants for patients with scarring alopecia after a detailed consultation to assess the condition and ensure the best possible outcome.
So Who Is a Good Candidate for a Hair Transplant with CCCA?
Here are three main factors for scarring alopecia hair transplant eligibility:
1- Amount of Healthy Donor Hair
The amount of healthy donor hair is one of the most crucial factors that determines the success of a hair transplant.
Hair transplants typically rely on follicles from the donor area, which are usually located at the back or sides of the head. If only a small part of the scalp has been affected by scarring alopecia, there is a higher chance of enough healthy donor hair being available. A transplant may be a viable option in this case.
2- Extent of Scarring
The extent of scarring can proportionally lower the chances of successful outcomes of a hair transplant.
If the scarring is widespread, the effectiveness of the transplant is likely to be limited because, in such cases, it can become challenging to find healthy areas with viable hair follicles to harvest for the procedure.
3- Timing
Timing also plays a key role. If scarring alopecia has been untreated for an extended period and the scarring is severe, the likelihood of a successful hair transplant decreases.
This is because the longer the condition goes untreated, the more damage occurs to the hair follicles, making it harder to achieve desired results. Early treatment and intervention are, hence, essential for optimizing the chances of success in hair restoration procedures.
Which Technique Is Better for Scarring (Cicatricial) Alopecia Hair Transplant?
There are two primary techniques used for hair transplants: FUE (Follicular Unit Extraction) and FUT (Follicular Unit Transplantation). After the introduction of FUE method, FUT option become obsolate since FUE is a minimally invasive procedure which does not cause further scarring.
In FUE method, individual hair grafts are extracted from the donor area and transplanted into the bald or thinning recipient areas.
What Result Can Be Achieved for Patients with Scarring Alopecia?
Hair transplants for scarring alopecia generally produce positive outcomes in patients who are suitable candidates. The main goal of the transplant is to restore hair density and improve the overall appearance of the affected area.
The results can vary based on the extent and duration of the scarring. For example, in patients with mild scarring, a hair transplant can create a natural-looking result with fuller, thicker hair in the previously bald or thinning areas.
For those with extensive scarring, the results may not be as dramatic, as hair may only grow in areas with some remaining viable follicles. Additionally, patients with significant scar tissue may require multiple hair transplants or additional treatments to enhance the final result, such as PRP therapy, microneedling, or topical growth treatments.
Hence, although hair transplants can improve the aesthetic outcome, it’s important to have realistic expectations.
How Much Does Hair Transplant for Scarring (Cicatricial) Alopecia Cost?
The cost of a hair transplant varies depending on the country, clinic, surgeon and the technique used. The hair transplant prices in Turkey are significantly affordable, ranging between $2800 and $3600 for scarring (cicatricial) alopecia at Heva Clinic.
This pricing includes personalized treatment planning, experienced surgeons skilled in scarring alopecia transplant, and modern techniques such as FUE or DHI. Due to the complexity of cicatricial alopecia, it’s important to choose a clinic with a proven track record in such cases to ensure optimal graft survival and natural-looking results.
What Are the Limitations of Hair Transplants in Scarring Alopecia?
Hair transplants are not a one-size-fits-all solution, and they do have some limitations in the case of scarring alopecia. Some of these include:
Limited Donor Hair
The quality and quantity of the donor hair play a major role in the success of the procedure. If a large portion of the scalp is affected by scarring, there may not be enough healthy donor hair to perform a successful transplant.
Permanent Scar Tissue
The biggest challenge with scarring alopecia is that the hair follicles are permanently damaged, and the underlying scar tissue may not support new hair growth. This can make it difficult to restore a natural look, especially in cases of severe scarring, which can lead to failed hair transplants.
Post-Transplant Care
Scarring alopecia may require ongoing treatment even after the transplant. Medications, like minoxidil or finasteride, may be needed to prevent further hair loss and improve the overall result. [6]
High Costs
The cost of hair transplant can be expensive, especially when multiple sessions are required to achieve optimal results. Also, additional treatments like PRP therapy may be needed to enhance the transplant’s effectiveness, increasing the total costs.
What Is the Best Treatment for CCCA?
Early intervention is key to managing CCCA or other forms of scarring alopecia. Depending on the extent and duration of scarring and the desired outcomes, your doctor will recommend the best treatment suitable for you.
Some options for the treatment of CCCA include:
Medications like corticosteroids and minoxidil can be used to manage inflammation and slow down hair loss in the early stages of CCCA. [7]
Oral or intralesional corticosteroids may be prescribed to control inflammation. In some cases, immunosuppressants are used to modulate the immune system response. [8]
PRP therapy is an emerging treatment for CCCA, as it helps promote hair growth by using your body’s own growth factors. It involves injecting your own platelet-rich plasma into the scalp to stimulate hair follicles and encourage hair growth. [9]
For patients with mild or stabilized CCCA, a hair transplant can be an effective way to restore hair density, especially if there is some remaining healthy hair and viable donor follicles.
Conclusion
While scarring alopecia presents challenges, hair transplants can offer hope for those seeking to restore hair in affected areas. With a clear understanding of what scarring alopecia is, when to consider a hair transplant, and what other treatments are available, you can make an informed decision about your hair restoration journey.
By working closely with a qualified provider, you can explore a range of treatments designed to combat hair loss and enhance scalp health.
If you’re dealing with scarring alopecia and wondering if a hair transplant or other treatments are right for you, contact our medical team for a free medical consultation.
References:
- https://pubmed.ncbi.nlm.nih.gov/22097988/
- https://www.ncbi.nlm.nih.gov/books/NBK559187/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3659809/
- https://pubmed.ncbi.nlm.nih.gov/27574457/
- https://pubmed.ncbi.nlm.nih.gov/25207763/
- https://pubmed.ncbi.nlm.nih.gov/34984092/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8719951/
- https://pubmed.ncbi.nlm.nih.gov/33376285/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7367994/
