Surgery / Radiation Alopecia
Overview
Scarring hair loss can occur following surgery, radiation, or burns. Common scenarios include the following: skin cancer being removed from the scalp, brain tumors being removed with subsequent alopecia on the remaining scalp, radiation to the head for either primary or adjuvant treatment of a malignancy, or a burn. Regardless of the cause, there is a patch of scar tissue with loss of hair follicles and absence of follicular ostia (openings of hair follicles). There is no way for medical therapy (whether minoxidil, PRP, or other medical treatments) to restore hair into a completely scarred scalp. Surgical hair transplantation or hair systems are the only options to restore hair into scarred scalp.
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Treatment options:
Hair transplantation can be performed into scar, however, it is critical to select a surgeon with considerable experience transplanting into scar tissue. Ask them about their credentials, training, and number of cases transplanting into scar tissue. When transplanting into scar tissue it is recommended to wait a year or more to let the scar soften prior to transplantation. Additionally, when transplanting the density of grafts is roughly half a typical hair transplant density. Because the blood supply to scar is not as robust as a normal scalp, a lower graft density is required for optimal graft survival. Over time as these new grafts survive, neovascularization will occur within the scarred tissue and allow for more grafts to be placed 6 months to a year after the initial transplant. A minimum of 2 transplant surgeries is typically necessary to achieve cosmetically acceptable results, however, transplants can continue to be repeated as necessary to achieve the desired density.
Hair systems / hair pieces / scalp prosthetics / wigs are another good option to camouflage scar following surgery or radiation. Often a custom system can be made that clips into adjacent hair concealing the patch of alopecia.