Hair transplants in areas of scarring

The question came up today about whether or not hair transplants are feasible in areas of scarring. I found a number of studies addressing surgical repair of cicatricial (scarring) alopecia, in which the hair follicles are destroyed and replaced with scar tissue, so these studies should be relevant for any type of scarring on the scalp.

The older studies discuss surgical techniques including free flaps and tissue expansion. Tissue expansion involves using silicon implants to stretch skin where there is hair growth and create enough skin with naturally occurring hair follicles to use as a flap and replace the scarred scalp. It is difficult to just transplant hair/follicles into the scarred skin because of the decreased blood supply in scar tissue relative to normal scalp. This has a double-edged effect on the graft survival rate. Decreased blood supply means it is harder for the hair follicles to survive and grow, but also, the traumatized skin is more susceptible to infection and necrosis. Using flaps and skin grafts is risky because the procedure involves traumatized blood vessels for both the grafting site and the grafted skin, making it difficult for the new skin to survive.

New techniques use lasers to help with both preparation of the scarred skin and hair implantation, eliminating the need for a skin graft (which is really the riskiest part of the old procedures). A carbon dioxide laser was used to burn tiny holes into the scarred scalp, causing angiogenesis and increased blood supply to the scalp. In this case report, the success of the hair transplantation was attributed to the new vasculature. In another study, an Er:YAG laser was used to form the implantation holes for the hair follicles. Using the laser minimized trauma to the implantation site and was credited with a successful transplantation.

In summary, technology for hair transplants in scarred skin is quickly evolving into less risky and more successful procedures.

Kwon OS, Kim MH, Park SH, Chung JH, Eun HC, Oh JK. Staged hair transplantation in cicatricial alopecia after carbon dioxide laser-assisted scar tissue remodeling. Arch Dermatol. 2007 Apr;143(4):457-60.

Neidel FG, Fuchs M, Krahl D. Laser-assisted autologous hair transplantation with the Er:YAG laser. J Cutan Laser Ther. 1999 Dec;1(4):229-31.