Frontal Fibrosing Alopecia – FFA

What It Means for Hair Transplant Candidates

Home » Frontal Fibrosing Alopecia – FFA

What Is Frontal Fibrosing Alopecia?

Last Updated: 26 Nov 2025

Frontal Fibrosing Alopecia (FFA) is a type of permanent, scarring hair loss that slowly destroys hair follicles along the front and sides of the scalp. It was first identified in 1994 and most commonly affects postmenopausal women — though men and younger women can also develop it.

Unlike common genetic hair loss (androgenetic alopecia), FFA isn’t just thinning—it’s irreversible damage caused by the body’s own immune system attacking hair follicles. Once the follicle is gone, it’s replaced by smooth, shiny scar tissue—and no amount of transplantation can restore hair to dead zones without careful planning.

Key Signs You Should Know

If you’re noticing any of these, FFA could be the cause—not ordinary aging or genetics:

Receding hairline that moves steadily backward (often symmetrical)
Thinning or complete loss of eyebrows (in up to 95% of cases)
Smooth, pale skin where hair used to be—no visible pores or follicles
“Lonely hairs”: a few random strands left behind in otherwise bald areas
Loss of eyelashes, sideburns, or even arm/leg hair
Tiny red bumps on the forehead or temples (inflamed vellus hairs)

💡 Important: FFA often causes no itching or pain, so people delay seeing a doctor—allowing more permanent damage to occur.

Why Misdiagnosis Is Dangerous

FFA is frequently mistaken for:

Female pattern hair loss
Traction alopecia (from tight hairstyles)
Normal aging of the hairline

But treating FFA like regular hair loss—or worse, jumping straight to a hair transplant—can backfire badly. Transplanting into active FFA can trigger more inflammation, destroy new grafts, and accelerate hair loss due to the Koebner phenomenon (where skin trauma worsens autoimmune conditions).

The Only Way to Confirm FFA: A Scalp Biopsy

Before any treatment—especially surgery—a scalp biopsy is essential.

It must be taken from the active edge of the receding hairline
Ideally includes both affected and healthy skin
Should be examined horizontally to assess follicle health

Without this step, you risk wasting time, money, and precious donor hair on a procedure that may fail—or make things worse.

Can You Get a Hair Transplant If You Have FFA?

Almost never during active disease—and only with extreme caution even when stable.

❌ Hair transplants are NOT recommended if:

Your hairline is still receding
You have redness, scaling, or inflammation at the border
It’s been less than 2 years since your last sign of progression
A recent biopsy shows ongoing immune activity

✅ Transplantation might be considered ONLY if:

The disease has been completely inactive for 2+ years
Biopsies confirm no inflammation
Serial photos prove zero progression
You continue medical therapy to keep FFA suppressed
You understand that graft survival may be lower than in typical cases

Even then, results are unpredictable. Many experts advise against surgery altogether—focusing instead on halting progression and using cosmetic solutions (like micro-pigmentation or styling techniques).

If You’re Considering a Hair Transplant…

Ask yourself:

Has a dermatologist confirmed FFA is not the cause?
Have I had a scalp biopsy?
Is my hair loss truly stable—or just slow-moving?

⚠️ Never proceed with a transplant for frontal hair loss without ruling out FFA first. Doing so could cost you your remaining hair—and your donor supply.

How Is FFA Treated? ( Hint: Not with Surgery )

The goal isn’t to regrow lost hair—it’s to stop the immune attack and save what’s left.

Common medical approaches include:

Topical steroids or calcineurin inhibitors (applied to the hairline)
Steroid injections along the active border
Oral medications like hydroxychloroquine, doxycycline, or finasteride
Regular monitoring with photos and scalp exams

Early treatment = better chance of preserving your natural hairline.

The Bottom Line

FFA is a silent, progressive condition that mimics normal hair loss—but with permanent consequences. While a hair transplant can work wonders for genetic balding, it carries serious risks in scarring alopecias like FFA.

Your best move? See a dermatologist who specializes in hair disorders before consulting a transplant surgeon. Early diagnosis and medical management offer the only real hope of stopping FFA in its tracks.

Preserve first. Transplant later—if ever.

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Medical Disclaimer

Information provided on this website is for educational purposes only and is not intended as medical advice. It should not be interpreted as promotional material or as claims of superiority over other techniques or providers.

Individual results may vary, and no outcome can be guaranteed. Always consult with a qualified healthcare professional before making any decisions about medical treatment.

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