Frontal fibrosing alopecia (FFA) is a type of scarring hair loss that leads to thinning around the temples and forehead. Hair transplants can be an option to improve appearance once the disease is stable. However, the long-term results of the procedure are not well understood.
This study reviewed the outcomes of hair transplants in 51 patients (48 women, 3 men) with FFA who were followed for at least two years after their procedure. The study included patients aged 34 to 79 years, with an average age of 54. Hair transplants were done after the disease had been stable for an average of 15 months (ranging from 0 to 60 months), whether or not the patient was on treatment. ‘Stability’ was confirmed through a doctor’s evaluation—meaning no further hair loss at the hairline for at least a year—and scalp imaging (trichoscopy), which showed no signs of ongoing inflammation around the hair follicles.
Authors assessed hair transplant outcomes using photo evaluation, trichoscopy, and patient satisfaction surveys.
The strip technique was used in most patients (86%), while 14% had follicular unit extraction. On average, about 1,300 hair grafts were transplanted per procedure. The most common treatment areas were the temples (59%), followed by the front hairline (44%) and eyebrows (29%). Patients were followed for an average of 3.2 years (ranging from 2 to 10 years), and all continued medical treatment for frontal fibrosing alopecia (FFA) after the transplant.
Hair graft survival rates declined over time:
The location of the transplant and the use of medical therapy after surgery did not affect graft survival. Additionally, waiting longer after FFA stabilization before surgery did not lead to better graft survival. There were no cases where the disease worsened or became active again after the procedure. Of the 51 patients, 42 (82%) reported being satisfied with their hair transplant results, and none of them experienced worsening or reactivation of their disease after the transplant.
This study shows that while hair transplants can improve the appearance of FFA, the transplanted hairs often thin over time. Interestingly, even though the long-term survival of the grafts wasn’t ideal, most patients reported being satisfied with the results. The likely reason is that the overall cosmetic improvement—even if temporary for a few years—was meaningful for them. For some individuals with FFA, a hair transplant may be a reasonable option, but it’s important to understand the expected long-term outcomes. Discussing goals and expectations with your doctor beforehand can help ensure the best experience and satisfaction with the results.
Article Summary By Andrea Quartey, MD Candidate at Lewis Katz School of Medicine at Temple University, 2025
References
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