The Laryngoscope

© 2020 The American Laryngological,

Rhinological and Otological Society, Inc.

Hair Transplantation in Frontal Fibrosing Alopecia and Lichen

Planopilaris: A Systematic Review

Joshua A. Lee, BA ; Dylan A. Levy, BS; Krishna G. Patel, MD, PhD; Emily Brennan, MLIS;
Samuel L. Oyer, MD

Objective: Evolving hair transplantation (HT) techniques have offered new possibilities for hair restoration. However, the role
of HT in patients with frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) remains unclear. This study aims to evalu-
ate the outcomes and temporal relationship of HT in this population.
Methods: A literature search of three databases was conducted. We reviewed 1) literature reporting outcomes of patients
with LPP or FFA who received HT, and 2) studies reporting the development of LPP or FFA resulting from HT.
Results: Thirteen articles included 42 patients that provided data for evaluation. Fifteen patients had previously been
diagnosed with FFA or LPP, and the remaining 27 patients developed disease after undergoing HT. Seven patients with FFA
and eight patients with LPP received HT, with a mean sustained disease remission of 2.69 years prior to HT. In total, two of
seven (29%) patients with FFA and five of eight (75%) patients with LPP experienced positive HT results over a follow-up
period of 8–72 months. Interestingly, 27 patients without evidence of previous disease developed FFA or LPP following HT
after a median duration of 16 months.
Conclusions: HT for LPP and FFA is feasible but results may be less favorable compared to HT for other causes. Out-
comes may be more favorable for LPP than FFA but this was not statistically significant and evidence is very limited. FFA and
LPP can also develop following HT in patients without previous evidence of disease.
Level of Evidence: NA
Key Words: Hair transplantation, scarring alopecia, frontal fibrosing alopecia, lichen planopilaris..
Laryngoscope, 00:1–8, 2020

INTRODUCTION pattern (Fig. 2). Additionally, FFA displays a unique pre-

In 1994, Kossard et al. provided the first description of
frontal fibrosing alopecia (FFA) in six postmenopausal
women.1 Since then, it has been recognized as one of the
most common causes of primary scarring alopecia.2 FFA is
considered a variant of lichen planopilaris (LPP) given the
overlap of histologic features. Both entities demonstrate a
lichenoid reaction characterized by perifollicular fibrosis
and a T-cell–predominant lymphocytic inflammation.1
Dermoscopic findings in FFA and LPP include perifollicular
scales, reduced follicular ostia, and perifollicular erythema
(Fig. 1).3,4 The two diagnoses are distinguished by their
divergent clinical presentations: FFA commonly begins
with concurrent recession of the frontal hairline and eye-
brows, whereas LPP typically produces a multifocal alopecic
From the Division of Facial Plastic & Reconstructive Surgery,
Department of Otolaryngology–Head and Neck Surgery (J.A.L., D.A.L., K.G.P.,
S.L.O.), Medical University of South Carolina, Charleston, South Carolina,
U.S.A.; Frank N. Netter MD School of Medicine (D.A.L.), Quinnipiac
University, North Haven, Connecticut, U.S.A.; and theMedical University
of South Carolina Library (E.B.), Charleston, South Carolina, U.S.A.
Additional supporting information may be found in the online
version of this article.
The authors have no other funding, financial relationships, or con-
flicts of interest to disclose.
Editor’s Note: This Manuscript was accepted for publication on
January 17, 2019.
Send correspondence to Joshua A. Lee, BA, Facial Plastic & Recon-
structive Surgery, Department of Otolaryngology–Head and Neck Sur-
gery, Medical University of South Carolina, 135 Rutledge Avenue, MSC
550, Charleston, SC 29425. E-mail: leejosh@musc.edu
DOI: 10.1002/lary.28551
dominance in postmenopausal women.5
Various hormonal hypotheses have been proposed for
the etiological underpinnings of FFA. An immunomodula-
tory role of dehydroepiandrosterone (DHEA) in fibrotic dis-
eases has been proposed.6 However, contradictory evidence
from hormonal studies in premenopausal women with FFA7
and the presence of disease in men also raise questions
about this hormonal theory.8 Alternatively, the progressive
nature of FFA along with reports of familial cases suggest a
possible genetic component.9 Despite these theories, a defin-
itive cause of FFA and LPP has yet to be discovered.
Standards for the medical treatment of FFA and LPP
are not currently well established. A recent systematic
review showed that intralesional corticosteroids and
5-alpha-reductase inhibitors can achieve success rates in
FFA as high as 88%.10 Encouraging results have also been
reported with hydroxycholoroquine. Topical corticosteroids
are largely ineffective for FFA11 but are considered first-line
treatment for LPP. Other beneficial therapies for LPP
include cyclosporine and systemic corticosteroids.11 Despite
these findings, medical therapy only slows the progression
of disease, leaving affected patients with areas of noticeable
hair loss that can be emotionally and socially debilitating.12
Hair transplantation (HT) offers an enticing solution
to patients and treating physicians to address areas of
scarring alopecia. Since its first description in 1959,13
techniques in autografting have evolved substantially
from mini/micrografts,14 to single follicular unit trans-
plantation harvest via strip excision, also called follicular

Laryngoscope 00: 2020 Lee et al.: Hair Transplantation in FFA and LPP
1

Fig. 1. Dermoscopic images of patients with LPP and FFA. Top:
Active inflammation seen in a patient with LPP demonstrating peri-
follicular erythema and scaling. Bottom: Quiescent disease seen in
a patient with FFA demonstrating single hair follicular units with
intervening scarring, loss of follicular ostia and scalp atrophy.
FFA = frontal fibrosing alopecia; LPP = lichen planopilaris. [Color
figure can be viewed in the online issue, which is available at www.
laryngoscope.com.]
unit transplantation (FUT),15 and follicular unit extrac-
tion (FUE).16 Single follicular unit transfer has become
the gold standard technique and has shown favorable
results in patients with androgenetic alopecia.17,18 Hair
transplantation has also shown success in patients with
cicatricial alopecia secondary to burns and trauma.19,20
Despite this promising therapeutic avenue, HT for pri-
mary scarring alopecia remains controversial given its mixed
results.21 The relapsing and remitting nature of unstable cic-
atricial diseases such as FFA and LPP often complicates sur-
gical planning and management.22 Herein, we perform a
systematic review of HT in patients with FFA and LPP. The
goals of this review are to 1) evaluate success rates of HT for
FFA and LPP, and 2) examine the temporal relationship of
disease and treatment by evaluating reports of HT as the
inciting event resulting in new-onset FFA or LPP disease.
METHODS
Data Collection and Selection
This study was conducted according to PRISMA guide-
lines.23 To identify studies for inclusion in this review, a research
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2
Fig. 2. Top: Patient the LPP demonstrating patterned scarring alo-
pecia of the vertex with quiescent disease centrally and active dis-
ease peripherally. Bottom: Patient with FFA demonstrating
progressive scarring alopecia confined to the frontal and temporal
hair line with thinning of the eyebrows. FFA = frontal fibrosing alo-
pecia; LPP = lichen planopilaris. [Color figure can be viewed in the
online issue, which is available at www.laryngoscope.com.]
informationist with expertise in conducting systematic reviews
developed detailed search strategies in the following three data-
bases: PubMed (NLM NIH), Scopus (Elsevier), and Cochrane
Library (Wiley). The search strategies used a combination of sub-
ject headings (eg, MeSH in PubMed) and keywords for the follow-
ing three concepts: lichen planopilaris, frontal fibrosing alopecia,
and hair transplantation/grafting. The PubMed search strategy
was modified for the other two databases, maintaining similar
keywords. The search strategies for each database are detailed
in Appendix S1. The databases were searched from inception
through May 2, 2019. To identify additional articles, the refer-
ence lists of relevant articles were hand searched, as well as cit-
ing articles. References were uploaded to EndNote (Clarivate
Analytics, Philadelphia, PA, USA) and screened for relevance.
Selection Criteria
Only studies with the primary objective of examining our
intervention of interest—HT—were included. Inclusion criteria
were: 1) double- or single-blinded randomized controlled trials; 2)
double- or single-blinded randomized comparison trials; 3) pro-
spective or retrospective observational studies; and 4) case series
or reports that report the outcomes of single follicular unit HT in
patients with FFA or LPP. We also included studies reporting
HT either preceding or succeeding the diagnosis of FFA and LPP
to examine the temporal relationship between treatment and
Lee et al.: Hair Transplantation in FFA and LPP
disease. Abstracts were first independently reviewed by two
reviewers (JAL and DAL) to identify all articles satisfying the
inclusion criteria. Non-English studies and nonhuman studies
were excluded. Articles were critically appraised to assess level
of evidence using the Oxford Center for Evidence-Based Medicine
criteria.24 Risk of bias was assessed using the Cochrane
ROBINS-I tool for assessing risk of bias in non-randomized stud-
ies of interventions due to the following constraints: confounding,
participant selection, classification of intervention, missing data,
outcome measurement, and selection of reported results.25
Data extracted from studies included: author, publication
year, study design, study characteristics, and patient demo-
graphics. For patients who received HT for known FFA/LPP the
following data were collected: medications given for disease control,
HT technique, dichotomous result (positive or negative as defined
by the investigators), last follow-up time, outcome (including dura-
tion and percentage of graft survival), and measured hair density.
For subjects who developed FFA/LPP subsequent to HT, we also
collected the original indication for HT, time from HT to disease
onset, method of disease diagnosis and relevant surgical data.
When data was not available, two attempts were made to contact
the article’s corresponding author to request the data.
Statistical Analyses
All analyses were performed using SPSS version 25.0 (IBM
Corporation, Armonk, NY, USA). Categorical variables were
summarized by frequency and percentage. Continuous variables
Fig. 3. PRISMA diagram
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were summarized by mean  standard deviation (SD) or median
and interquartile range (IQR: 75th and 25th) where appropriate.
All continuous variables were assessed for normality using the
Shapiro–Wilk test. Comparisons of dichotomous outcomes were
performed using a Fisher’s exact test. A P value of <.05 was con-
sidered to indicate a significant difference for all statistical tests.
RESULTS
Search Results
The initial literature review of the three databases
yielded a total of 76 abstracts. After removing duplicates,
51 remained. A review of potential abstracts identified
21 articles that described HT in patients with FFA or
LPP. Of those, only 10 articles met inclusion and exclu-
sion criteria. An additional three references were
included following review of relevant article references.
Figure 3 illustrates our search results.
Ultimately, 13 articles were included representing
data from 42 different subjects. The earliest included arti-
cle was published in 2010. According to the Oxford Centre
for Evidence-Based Medicine grading system, the meth-
odological quality of all included studies was assessed as
level 4/5, since they were all either case reports or case
series. Bias was assessed for all included studies and is
available in Table S1 with high likelihood of bias due to
Lee et al.: Hair Transplantation in FFA and LPP
3
4
TABLE I.
Hair Transplantation in Patients with Known Disease.
Disease-Free
Quality Patient Period Prior HT Grafts (Density Time to Last
Article Rating Number Age Sex Treatment to HT Technique and/or Size) Follow-up Result Study Outcomes

Frontal Fibrosing Alopecia

Nusbaum et al.27 5 1 44 M TS, ILS, HS, CI 10 m FUT 82 2-hair and 3-hair FU 4 yr Negative Hair growth sustained at 15 mo.
Returned after 4 yr no longer on

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medications, had six hairs
remaining with advanced alopecia
Liu et al.49 5 1 44 F HQ, TS, CI, ILS 2 yr FUE 360 FU (630 hairs) 4y Positive Hair density 56 hair/cm2 at 13 mo;
stable at 4 yr without medications
Jimenez et al.28 4 1 82 F TS, CI NR NR 50 FU 6 yr Negative 90% growth at 14mo, 20FU remained
at 2.5y, 16FU remained at 6y
2 70 F TS, ILS, 5aRI, MIN NR NR 80 FU into 1 × 2 cm area 4y Negative Full growth at 10mo, 68FU at 8mo
with signs of perifollicular
hyperkeratosis, dec thickness of
hair shaft, dec hairs/unit), 21 FU at
3y, 6FU at 4y
3 58 F TS, ILS, 5aRI, MIN NR NR 20 FU (35 hairs) 4 yr Negative 100% at 1y, 8FUs, 11 hairs at 4 yr
Rogers et al.29 5 1 65 F NR 5 yr NR 800 grafts 1 yr Negative poor growth at 1 yr
Scribel et al.30 5 1 57 F ILS, CI AD FUE NR 2 yr Positive Active inflammation at FFA sites
(perifollicular erythema and
casts),TP sites were not inflamed
Lichen Planopilaris
Liu et al.49 5 1 61 F TS, ILS 3 yr FUE 551 FU (938 hairs); 3.3 yr Positive Best results at 10 mo, still stable at
Density 58/cm2 3 yr + 4 mo w/o medical therapy;
126 hairs/cm2 post op
Podda et al.45 5 1 NR NR NR 3+y LA 50 test mini (3–5 hairs) and 8–20 mo Positive 95% graft survival
micro (1–2 hairs) grafts +200
subsequent grafts for
2–5 sessions
2 NR NR NR 3+y LA 50 test mini (3–5 hairs) 8–20 mo Positive 95% graft survival
and micro
(1–2 hairs) grafts
+200 subsequent
grafts for 2–5 sessions
Cevasco et al.46 4 1 NR NR NR NR NR NR NR Negative Fair response (minimal regrowth,
minimal symptom reduction)
2 NR NR NR NR NR NR NR Positive Good response (stabilization, greater
than minimal regrowth)
3 NR NR NR NR n/a NR NR Negative Worse
Saxena et al.47 5 1 24 M MIN 2 yr FUE 50 grafts with multiple follicles 10 m Positive 80% graft survival at 10 mo
Tyagi et al.48 5 1 15–30 n/a MIN NR FUE 10–250 cm2 NR Positive 70% graft uptake

5aRI = 5-alpha-reductase inhibitor; AD = active disease; AH = artificial hair; CI = calcineurin inhibitor; F = female; FA = folic acid; FU = follicular units; FUE = follicular unit excision; FUT = follicular unit trans-
plantation; HQ = hydroxychloroquine; HT = hair transplantation; ILS = intralesional steroids; LA = laser-assisted, multi-stage; M = male; MIN = minoxidil; MTX = methotrexate; Nap = Naproxen; NR = not reportable;
RA = rheumatoid arthritis; TS = topical steroids.

Lee et al.: Hair Transplantation in FFA and LPP

confounding and selection of participants across all stud- TABLE III.
ies. Of the included articles, five studies reported on HT Outcomes of Hair Transplantation in 15 Patients with FFA or LPP.
in patients with FFA and five studies documented HT in
Positive Negative
patients with LPP. Four additional studies reported on Outcome n (%) Outcome n (%)
patients who developed FFA or LPP following HT. There
was variability in the technique of HT used in surgery. Total 7 (47%) 8 (53%)
Techniques reported include autologous FUE and FUT, Frontal Fibrosing Alopecia 2 (29%) 5 (71%) P = .132
and laser-assisted HT. See Table I for a summary of Lichen Planopilaris 5 (63%) 3 (38%)
study characteristics in patients with known disease and
Table II for a summary of study characteristics in
patients who developed disease following HT.
FUE and one by FUT. Two patients received Er:YAG laser-
assisted transplantation wherein recipient site creation was
Hair Transplantation in Patients with LPP performed using the laser. Unfortunately, the technique
or FFA was not specified for the remaining seven patients. No
Five studies reported on a total of seven patients authors responded to our requests for missing information.
undergoing HT with FFA. The mean age of this group was Range of follow-up for all HT patients was 8–72 months,
60.0 years (SD = 13.75). Five studies documented eight with reactivation of disease reported between 8 and
patients with LPP who underwent HT. The mean age of the 48 months. Only two out of seven (29%) with FFA had suc-
LPP group was 42.5 years (SD = 26.16). Six of the seven cessful outcomes at their last reported follow-up, while six out
patients with FFA were female, while the majority of LPP of eight (75%) with LPP experienced positive results
patients did not report on gender. Five patients had HT by (Table III). The difference of outcomes between LPP and FFA

TABLE II.
Frontal Fibrosing Alopecia or Lichen Planopilaris Developing After Hair Transplantation.
Quality Patient Indication Subsequent Disease Biopsy
Article Rating Number Age Sex HT Type for HT Disease Onset Reported Confirmation

Crisóstomo et al.26 4 1 50 M FUT NR 6 yr LPP No

2 46 M FUT NR 2 yr LPP Yes
Chiang et al.32 4 1 50 M mHT AA 6 yr* LPP Yes†
2 62 M mHT AA 3 yr* LPP Yes†
3 52 M HT AA 6 mo LPP Yes†
4 34 M HT AA 3 mo LPP Yes†
5 63 F HT AA 2 yr LPP Yes†
6 59 F HT AA 6 mo LPP Yes†
7 37 F HT AA 9 yr* LPP Yes†
33
Kossard et al. 5 1 75 M mHT AA 5 yr FFA Yes
Donovan et al.34 4 1 46 M HT AA <12 mo LPP Yes
2 30 M HT AA 24 mo LPP Yes
3 48 M HT AA 8 mo LPP Yes
4 33 M HT AA 4 mo LPP Yes
5 43 M HT AA <12 mo LPP Yes
6 36 M HT AA 12 mo LPP Yes
7 67 F HT AA 36 mo LPP Yes
8 34 M HT AA 4 mo LPP Yes
9 38 M HT AA 36 mo LPP Yes
10 68 M HT AA 4 mo LPP Yes
11 44 M HT AA <23 mo LPP Yes
12 35 M HT AA 24 mo LPP Yes
13 55 M HT AA <16 mo LPP Yes
14 51 M HT AA 12 mo LPP Yes
15 57 F HT AA 7 mo LPP Yes
16 31 M HT TA <13 mo LPP Yes
17 44 M HT AA <17 mo LPP Yes

(m)HT = (multiple) hair transplant; F = female; FFA = frontal fibrosing alopecia; LPP = lichen planopilaris; M = male; NR = not reported.
*Unclear onset, progressive loss since time indicated.
†
All patients but one had biopsy confirmation, specific patient not reported.

Laryngoscope 00: 2020 Lee et al.: Hair Transplantation in FFA and LPP
5

Fig. 4. Disease onset following hair transplantation in previously
healthy patients [Color figure can be viewed in the online issue,
which is available at www.laryngoscope.com.]
was not significant (P = .132). Among patients with
≥12 months of follow-up, three of eight (38%) had positive out-
comes. Four patients with positive outcomes (all LPP) pro-
vided data on graft survival rate, ranging between 70% and
95%. Two patients with successful HT had stable disease with-
out requiring medication, but the majority of studies did not
detail medical management following HT. Data from seven
patients showed an average disease-free period before HT of
2.69 years (SD = 1.29 years; range = 10–60 months). Common
medical treatments included intralesional and topical steroids,
calcineurin inhibitors, and finasteride. Not included in this cal-
culation was a report by Scribel documenting the success of
FUE in a patient with active inflammation from FFA.30
Patients with negative outcomes experienced progressive
decrease in the density of transplanted follicular units or signs
of relapsing disease. See Table I for a summary of our findings
and patient-specific data.
LPP or FFA Developing from Hair
Transplantation
Four studies reported on 27 previously healthy patients
who developed FFA or LPP after HT (Table II). The mean age
of this group was 47.7 years (SD = 12.43). Twenty-two
patients were male (82%) and give were female (19%).
Twenty-four (89%) patients had prior HT for presumed andro-
genetic alopecia without evidence of scarring alopecia. Biopsy
confirmation of FFA or LPP occurring after HT was obtained
in at least 25 (93%) patients. The specific technique of HT was
not specified for the majority of patients. The median onset of
disease following surgery was 16 months (IQR = 29). The
timing of disease onset is depicted in Figure 4. Follow-up was
documented in only one patient whose perifollicular erythema
responded well to intralesional triamcinolone.26
DISCUSSION
HT has evolved into one of the most innovative and
powerful tools to address hair restoration. Although
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6
favorable cosmetic results in patients with androgenic
alopecia have reached success rates as high as 94%,18 its
efficacy has not been formally studied in individuals with
FFA and LPP. In this review, we identified multiple cases
in which HT failed secondary to disease recurrence.
Among patients with LPP, there was an approximate
75% rate of favorable outcome. Conversely, patients with
FFA had a lower success rate of only 29%. While this dif-
ference was not statistically significant largely owing to
the small sample size, it is possible that patients with
LPP may fare better following HT surgery. These studies
also highlight the fact that early positive results are not
necessarily durable as some patients maintain adequate
graft survival for 1 year after transplantation, but experi-
ence failure by their fourth year of follow-up.27,28
Most practitioners agree that transplantation should
not be conducted until sustained remission of disease for
1–2 years,22 though robust investigation to support this
suggestion is lacking. This review revealed an impressive
degree of outcome heterogeneity when adhering to this
suggestion. Despite an average time in remission of
2.69 years and many reports of successful transplantation
performed during this period, one study reported negative
outcomes after waiting 5 or more years before operative
intervention.29 Further challenging this maxim was a
case from Scribel et al. in which a patient experienced
favorable results with FUE despite evidence of active
inflammation at the time of operation.30 In that report,
follow-up dermoscopic evaluation revealed regions of
active FFA but transplanted follicular units displayed no
inflammation. No biopsy confirmation was performed in
this patient, however.
The Koebnerization phenomenon is a well-known
dermatologic entity wherein cutaneous trauma or injury
causes a variety of skin conditions such as psoriasis, viti-
ligo, and lichen planus.31 This review identified four
recent studies of 27 previously healthy patients in which
FFA or LPP developed after HT surgery.26,32–34 Chiang
et al. reported an additional three cases of FFA, but these
patients developed disease after facelift and were thus
excluded from our study.32 Of note, there was a prepon-
derance of male patients (82%) in this cohort, which likely
reflects the patient population who sought treatment for
androgenetic alopecia. Kossard and Crisostomo report
that the late-onset and progressive nature of hair loss in
their case studies distinguishes posttransplantation
Koebnerization from androgenic alopecia, characterized
by immediate or gradual follicular loss.26,33 However,
between Donovan and Chiang et al., 12 patients experi-
enced graft failure within the first year, and all but one
had biopsy-proven FFA or LPP in the latter study.32,34
This calls into question the chronology of developing FFA
and LPP after cutaneous trauma. Fortunately,
Koebnerization appeared to arise in only 5.9% of patients
following HT according to Chiang et al.32
A proposed pathophysiology of Koebner phenomenon
includes a non-specific inflammatory reaction after
trauma, and subsequent disease-specific inflammation
related to T-cells, B-cells, or autoantibody infiltration.35
This is reasonable given that follicles are normally protec-
ted from cell-mediated immune attack36 and that collapse
Lee et al.: Hair Transplantation in FFA and LPP
of immune privilege can progress to LPP.37 Although
early accounts of HT introduced the concept of donor-site
dominance,13 discoveries of recipient bed morphologic
changes have expanded this discussion. Alterations to
growth rate, thickness, graying, and graft survival have
been observed in transplanted follicles compared to their
donor equivalents.38–40 Histological examination of donor
follicular units also points to ongoing molecular crosstalk
between donor and recipient tissues.41
Methods to promote survival of transplanted hair
include using recipient tumescent solution and respecting
the scalp neurovasculature.42 Transplanting a proper
density of follicular units is of tantamount importance.
One study of four patients determined that 20 to 30 one-
hair follicular units per cm2 showed improved survival
compared to grafts containing 40 to 50 equivalent follicu-
lar units.43 The effect of preservation solution on graft
viability has also been studied.44 Prudent harvesting has
consequential implications in graft survival, as tran-
section of the follicular unit may lead to poor wound
healing.42 Scribel et al. hypothesized that injury to the
donor unit may promote apoptotic damage repair or
expose a novel antigen thus stimulating a lichenoid tissue
reaction.30 Ultimately, many factors intrinsic to trans-
plantation technique contribute to graft survival and may
be particularly important in preventing occurrence or
recurrence of FFA and LPP.
This systematic review is the first to evaluate the
interplay between HT and FFA and LPP, specifically. The
reviewed studies document both patients with FFA and
LPP who received HT, as well as those who developed dis-
ease subsequent to surgical intervention. Because HT can
incite an auto-inflammatory reaction in previously healthy
patients, it is possible that surgical trauma also contributes
to recurrence in those with a history of inflammatory dis-
ease. This interaction between disease and transplantation
further challenges the utility of proving remission prior to
surgical intervention. For the practicing surgeon, this has
important implications for counseling both healthy and
susceptible patients as well as for ensuring disease stabili-
zation after transplantation.
Limitations
This review was limited by the scarcity of literature
pertaining to the topic of interest as well as by inconsistent
reporting of measurable techniques and outcomes. This
may be due in part to the fact that FFA and LPP are only
recently gaining attention in the hair restoration commu-
nity as techniques and graft survival improve and are
applied to more challenging causes of hair loss. Future pro-
spective studies are warranted to optimize the medical and
surgical management of FFA and LPP, including the time
interval needed prior to considering hair transplantation.
CONCLUSION
Overall, our findings suggest that HT for LPP and
FFA is feasible but results may be less favorable com-
pared to HT for other causes. Outcomes might be more
favorable for LPP than FFA, but this difference did not
Laryngoscope 00: 2020
reach statistical significance and evidence is very limited.
FFA and LPP can also develop following HT in patients
without previous evidence of disease.
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