Grafting into Scar Tissue and Traumatic Hair Loss

The term “cicatricial ” contains the Latin root “cicatrix,” which means “scar resulting from the formation and contraction of fibrous tissue.” (1) Historically, dermatologists have used the term cicatricial alopecia to refer to scarring alopecia caused by inflammatory disease processes such as discoid lupus erythematosus, lichen planopilaris, pseudopalade, etc. In the field of hair transplantation, the term is often used more broadly to include scarring alopecias caused by various forms of trauma (burns, accidental injury, cosmetic surgery, radiation, etc). Chapter 4 categorizes and discusses the various causes of scarring alopecia, and it is not the purpose of this chapter to repeat this information. However, at times, the hair transplant surgeon may be called upon to consider grafting into scar tissue. The purpose of this chapter is to discuss the various factors and techniques that need to be considered when contemplating hair transplantation into an area of scarring.