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Hair Transplant Risks in Scarring Alopecia
A rare, serious form of permanent scarring hair loss caused by the immune system attacking hair follicles.
Scarring: Destroyed follicles are replaced by scar tissue. Hair cannot regrow.
Progressive: Without treatment, it slowly expands.
Inflammatory: Active disease causes redness, scaling, and itching.
Commonly Misdiagnosed: Often mistaken for regular thinning early on, delaying crucial treatment.
Sara’s CommentCan you get a hair transplant if you have Lichen Planopilaris (LPP)?
Almost never. LPP is an inflammatory, scarring alopecia where surgery can trigger more loss. Transplanting into active disease destroys grafts and worsens scarring.
Look for these signs, different from genetic hair loss:
Itching, burning, or pain on the scalp.
Redness, scaling, or bumps around hair follicles.
Patchy bald spots with a smooth, shiny appearance (no pores).
“Lonely hair” sign: Isolated thick hairs within a bald patch.
Often starts at the crown or sides of the scalp.
Because LPP is permanent and progressive, an accurate diagnosis is critical before any treatment discussion.
Proper diagnosis requires:
Scalp Biopsy: Essential. A small sample from the active edge of hair loss must be examined to confirm scarring and inflammation.
Trichoscopy: Magnification to see perifollicular scaling and loss of follicles.
Medical History: Checking for related conditions like oral or skin lichen planus.
Warning: Considering a hair transplant without ruling out LPP first risks catastrophic, irreversible damage to your donor area and recipient site.
Our fundamental ethic is to “first, do no harm.” For LPP, this means surgery is almost always contraindicated.
Hair transplant is strongly contraindicated if:
There is any active inflammation (redness, itching, scaling).
The bald patches are still expanding.
A biopsy shows active disease.
You’ve had new hair loss within the last 2 years.
Why? Surgery can trigger the Koebner phenomenon—trauma from graft insertion can cause new LPP lesions, destroying both native and transplanted hair.
Transplantation might be discussed only after all these conditions are met:
Disease Inactivity: Proven 24 months (2 years) of zero progression, no symptoms, and a clean follow-up biopsy showing no inflammation.
Stable Medical Therapy: You are on a consistent treatment plan to suppress the immune activity.
Realistic Expectations: Understanding that graft survival may be lower than average and the disease could reactivate.
Even then, it is considered a high-risk procedure.
The primary goal is to halt the immune attack and preserve your existing hair.
Treatment focuses on controlling inflammation:
First-Line: Topical steroids, steroid injections, and oral medications like Hydroxychloroquine.
Symptom Control: Managing itch and pain.
Long-Term Monitoring: Using photos and tracking symptoms to prove stability.
Lichen Planopilaris is permanent, scarring hair loss. Destroyed follicles cannot regrow hair.
Hair transplant during active LPP is strongly contraindicated. Surgery can worsen the disease and destroy grafts via the Koebner phenomenon.
The only path to surgery requires 2+ years of proven inactivity, confirmed by biopsy and a specialist, and carries significant risk.
The primary treatment is medical, not surgical. The goal is to stop inflammation and preserve remaining hair.
🔍 Do you have patchy hair loss with itching or redness?
LPP must be ruled out before any surgical discussion. Send your details and photos for a free preliminary medical review. Your doctor should advise if you need a specialist dermatologist for diagnosis before any transplant can be considered.
Images & Information shown are for reference only
Information on this website is provided for general educational purposes only and does not constitute personalized medical advice. It is not intended to promote our service or imply superiority over another.
Individual results in hair restoration vary significantly and no outcome can be guaranteed. The before-and-after images shown represent possible results — not promises. We recommend seeking independent medical advice to discuss your options … Read More
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At Dr. Bertram Hair Transplant, we only offer what aligns with natural results, minimal risk, and realistic expectations. Since 2009, our FUE protocols are in strict accordance with evidence-based guidelines from ISHRS and WFI. Every procedure is internally audited against ABHRS surgical benchmarks,
International Society of Hair Restoration Surgery is the leading global medical association that establishes international practice standards and patient safety protocols.
The American Board of Hair restoration Surgery represents the highest standard. To maintain rigorous certification requirements the physician must demonstrate surgical expertise.
Worls FUE InstituteI serves as the premier educational body focused exclusively on Follicular Unit Extraction methodology. The institute ensures consistent application of safe FUE.
