Lichen planopilaris is a scarring type of hair loss, which means the follicle itself gets destroyed and replaced with scar tissue, so the hair that is gone is gone permanently. Frontal fibrosing alopecia is one of its subtypes. Because the loss does not come back on its own, hair transplantation keeps coming up as a cosmetic option, and two dermatologists in Spain went looking for what the published evidence actually says about whether transplanted hair survives in scarred scalp. They searched four research databases from their beginnings through October 2025 and found thirteen studies covering 113 patients. Eight of those were case series and five were single case reports. Roughly eighty percent of the patients were women, the average age was 48.9, and about two thirds had frontal fibrosing alopecia while the rest had the classic form. The short term results looked good. In the studies that followed patients six to twelve months out, 92 of 94 patients had favorable growth, with graft survival running between 80 and 100 percent. Out to two years, survival was still between 71 and 100 percent. Past the two year mark is where the picture changed. Among the 62 patients followed beyond twenty four months, only two held survival rates in the 80 to 85 percent range. The other 55, just under 89 percent of that group, were at 41 percent or lower. In one case the growth was described as excellent at fifteen months and had disappeared entirely by four years.

The authors are blunt about how thin the evidence underneath those numbers is. Their search turned up no clinical trials and no prospective studies at all, only case reports and case series, which they rated as level 4 evidence on the Oxford scale. The individual studies did not measure graft survival the same way as each other, follow-up lengths were inconsistent, and because transplantation is a cosmetic procedure the authors say reporting bias cannot be ruled out. Only studies written in English or Spanish were included. They also point out how slippery the idea of stable disease is here. In ten of the thirteen studies the transplants were done on patients whose disease looked clinically inactive, and yet the length of that quiet period ranged anywhere from zero months to sixty. There is no biomarker that confirms this condition is truly in remission, so that call comes down to a clinician's judgment, and in one patient a biopsy of a surviving follicular unit came back with findings consistent with frontal fibrosing alopecia, which the authors say may point to inflammation still running under a scalp that looks calm. The waiting period commonly recommended before transplanting, one to two years off treatment, has by their own account no robust statistical evidence behind it. Their conclusion is that transplantation may be considered a cosmetic alternative in this condition, and that prospective studies with larger groups and standardized follow-up are needed before anyone can say much more than that.

Here's the study: Palacios-Diaz RD, Lasheras-Pérez MA. Systematic review of efficacy of hair transplantation in patients with classic lichen planopilaris and frontal fibrosing alopecia: revisiting the current evidence. Anais Brasileiros de Dermatologia, 2026;101(5):501426. doi:10.1016/j.abd.2026.501426. Indexed on PubMed (PMID 42586001). Read the full text here.

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