Frontal Fibrosing Alopecia – FUE Transplantation

  • Best Results12 months+
  • Treatment Recovery7 days
  • Procedure Time2 hours
  • Skin SpecialistDavin Lim
  • Duration of ResultsStudies still ongoing
  • AnaestheticLocal + Blocks
  • Back to Work1-2 days
  • Cost$-$$$

Frontal Fibrosing Alopecia - FUE Transplantation

Frontal fibrosing alopecia is a common form of hair loss seen in post-menopausal women. As the name suggests it affects the frontal hairline & eyebrows. Management is medical. FUE or follicular unit extraction hair transplantation can be considered if FFA is not progressive. A two-year cooling off period is recommended.

FactsFacts On FUE Hair Transplants for FFA

  • FUE hair transplantation can replace hair loss in frontal fibrosing alopecia
  • Your condition should be dormant for at least two years before consideration of FUE
  • The frontal & temporal scalp can be treated as can the eyebrows
  • FUE for frontal hair loss has a higher success rate compared to eyebrow transplantation
  • The use of pulsed anti-inflammatory creams can be useful
  • Medical follow up is essential for best results

What are the guidelines for hair transplantation in FFA?

The current consensus by dermatologists is that patients should be in remission for at least 2 years before considering FUE or eyebrow transplantation. Refer to the para below for a guideline.

How do I know if FFA is in remission?

There are five ways dermatologists ascertain FFA remission.

Firstly, clinical examination of classically involved areas of the brow & frontal scalp. FFA can be classed as quiescent if there is an absence of redness & perifollicular scale (scaling around the hair follicle).

Secondly dermatoscopic examination can aid in diagnosing scarring, with further magnification to exclude activity around remaining hair follicles.

Thirdly symptoms are absent in cases of remission; namely no itch or burning.

Fourth, serial photography with magnification or a trichogram can confirm the static density of remaining follicles

Fifth, histological analysis (biopsy) – rarely required, but useful in cases of doubt.

What happens if you undertake FUE if FFA is still active?

Chances are you will waste your time, effort and money. Transferring good, healthy hair follicles in a potentially hostile recipient area will most likely result in death of the hair follicle. As one has a limited number of hair follicles, this is not a sensible option.

This is why every patient should have at least a 2-year remission prior to FUE. The flipside is that having a longer remission period (e.g 10 years), does not equate to improved outcomes. More studies in the next decade will provide a clearer picture.

What are test spot FUEs & why do I encourage them?

Test spots can give an indication of probable graft survival. This involves transplanting a limited number of grafts (usually between 50 to 100) to the margins of the temples & frontal scalp. Eyebrow hair can also be transplanted. It can take up to 12 months for full growth. 

Test spots are only a guide as to the probable survival rate of grafts. Viability at one year means you have a higher chance of success compared to complete failure. The flipside is that if FFA reactivates, transplanted hair follicle survival may be compromised. This is why I always work closely with a medical dermatologist to ensure you have the best chances of graft survival.

Davin’s Viewpoint on FUE transplants for Frontal Fibrosing Alopecia

FFA is more common than what the papers state. For the most part, this condition is progressive up to the point of hair loss confined to the eyebrows, frontal & temporal scalp areas. Interestingly complete loss of follicular units also occur on the face (Sun T, Lim DS, 2021).

Medical intervention early is the best treatment – this goes for all forms of hair loss. Your dermatologist can prescribe lotions, injections & tablets. Early management reduces inflammation that kills the follicle.

FUE for FFA is relatively new (just over a decade old). The studies show good to excellent results (50 to 80+% uptake) at 1 year. Eyebrow transplants have excellent results initially, however permanence is questionable. My advice to patients is that transplants should NOT be undertaken if there are any signs or symptoms of inflammation. For the highest chances of graft survival, medical follow up by a dermatologist is mandatory.

Another caveat is that the typical age group of FFA  patients (postmenopausal women) will have incidental female patten baldness, realistically one in five. Early medical management will decrease hair fall in this group. This is why follow up by a hair expert is so important.

Disclaimer: I do not get involved in medical management of any hair loss conditions. My work is strictly procedural. Cutis has two hair experts who are dermatologists.

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