What causes scar hair loss? Can hair be transplanted at the scar site

Scar induced hair loss is usually caused by permanent damage to hair follicles due to trauma, infection, or skin diseases. The feasibility of hair transplantation at the scar site needs to be evaluated based on local blood supply and skin conditions. Scar induced hair loss may be caused by factors such as burns, surgical trauma, folliculitis, lichen planus, discoid lupus erythematosus, etc. Before hair transplantation, professional testing is required to determine the survival status of the hair follicles.

1. Traumatic factors

Severe burns or mechanical injuries can directly damage the structure of hair follicles, forming fibrotic scar tissue. This type of scar is usually accompanied by local blood circulation disorders and requires assessment of residual hair follicle openings through dermatoscopy. For smooth scars with a stable period of more than one year, it may be considered to extract healthy hair follicles from the posterior occipital region for transplantation.

II. Infectious factors

Recurrent bacterial folliculitis or fungal infections may lead to permanent necrosis of hair follicles, commonly seen as secondary infections in seborrheic dermatitis. This type of scar is often accompanied by excessive keratinization, and infection control and softening of the stratum corneum are necessary before hair transplantation. After partial deep fungal infection is cured, dormant spores may still remain, and pathogen testing is needed to rule out the risk of recurrence.

III. Skin Disease Factors

Hair loss scars caused by discoid lupus erythematosus appear as porcelain white atrophic spots, with active skin lesions often present in the surrounding area. Patients of this type need to ensure that their condition is stable for more than six months before hair transplantation, and avoid stimulating and inducing homomorphic reactions during surgery. Scars caused by lichen planus are often accompanied by severe itching. Before hair transplantation, pathological biopsy should be performed to confirm whether the lesion is completely quiescent.

Fourth, iatrogenic factors

Radiation therapy or improper cosmetic procedures may cause irreversible hair follicle damage. The microvascular network of the skin is severely damaged after radiation, and special high-density hair transplantation techniques are needed to compensate for the insufficient blood supply. Spot scars caused by laser freckle removal and other procedures can be precisely repaired through single hair follicle transplantation.

Fifth, congenital factors

Scar prone individuals can form hypertrophic scars with minor trauma, and hair transplantation for this group of people requires extra caution. Scar stimulation test evaluation is required before surgery, and tension-free suture technique is used during surgery. The bald areas associated with partial congenital skin hypoplasia may require the use of tissue expanders to create conditions for hair transplantation. After hair transplantation in the scar area, special attention should be paid to postoperative care, keeping the transplantation area moderately moist to avoid scabbing and compressing hair follicles, and using medical silicone dressings to prevent scar hyperplasia. Daily exposure to sunlight and mechanical stimulation should be avoided, and regular red light therapy should be performed to promote hair follicle survival. Within six months of hair transplantation, continuous use of drugs such as minoxidil is necessary to maintain hair follicle activity, while supplementing with foods containing zinc, iron, and vitamin B can help improve hair shaft strength and toughness. If there are rejection reactions such as redness, swelling, and exudation around the transplanted hair follicles, immediate medical attention should be sought for anti-inflammatory treatment.