Scarring Alopecia: Causes, Treatment and Transplant Options
Scarring alopecia is hair loss in which the follicle is destroyed and replaced by scar tissue, so hair in that spot cannot regrow on its own. It comes in two forms that need opposite plans. In primary scarring alopecia, such as lichen planopilaris or frontal fibrosing alopecia, the immune system is still attacking follicles, so the first job is to stop the disease. In secondary scarring alopecia, a burn, injury or operation caused the scar. Once that scar is stable, a hair transplant is often the main way to bring hair back.
Is scarring alopecia permanent?
Yes, in the areas already scarred. The follicles there are gone, so creams and tablets cannot restore them. What treatment can do is protect the follicles that remain and, in the right patient, move healthy hair into the scar.
| Primary scarring alopecia | Secondary scarring alopecia | |
|---|---|---|
| Cause | Inflammation inside the scalp attacks follicles | Burn, injury or surgery damages the skin |
| Is the cause still active? | Often yes, and it can spread | No, the damage was a single event |
| First step | Medical treatment to stop the inflammation | Wait for the scar to mature and settle |
| When a transplant is considered | Only after a long period with no disease activity | Once the scar is stable and a primary cause is ruled out |
| Main risk to grafts | The disease returning and attacking grafts | Poor blood supply in scar tissue |
A scalp hair transplant in Lahore can work for both groups, but the timing and the expectations are very different, so the type of scarring has to be settled first.
Primary and secondary cicatricial alopecia explained
Cicatricial alopecia is the medical name for scarring hair loss. In the primary forms, inflammation is aimed at the follicle itself.
- Lichen planopilaris is the most common primary form. It usually affects the crown or the sides of the top of the scalp and causes permanent follicle damage.
- Frontal fibrosing alopecia usually starts as a receding band at the front or temples, often with itch, pain or loss at the outer eyebrows. It can look like ordinary recession at first, which is why our guide to a receding hairline lists it as a sign that needs a scalp examination.
Secondary forms follow outside damage: flame and scald burns, road or work injuries, and scars from earlier surgery, including old donor scars from a strip procedure. Smooth, round patches that come and go usually point to a different, non-scarring condition. Alopecia areata treatment covers that non-scarring cause, where hair usually can return.
Treating active primary scarring alopecia first
Active disease must be calmed before anything else. A European position statement on lichen planopilaris lists potent steroids applied to the scalp or injected into it as first-line treatment. Tablets that act on the immune system are added for moderate to severe or progressive disease. There is no cure, so the aim is to stop further loss.
Which medicine, and for how long, depends on how active the scalp is, and the surgeon decides this at consultation. Our non-surgical treatments cover follow-up visits while the disease is being controlled. For patients who want the look of density without surgery, scalp micropigmentation can soften the contrast between scar and hair.
When a hair transplant on scar tissue can work
Primary forms. A 2026 review of lichen planopilaris cases notes that the usual recommendation is one to two years with no disease activity and no ongoing treatment before a transplant. Even then, grafts can be lost. A systematic review of 123 patients found graft survival highest at about a year after surgery and lower in later years, and the disease came back in four patients. The surgery itself can also stir up inflammation in a scalp that looked quiet.
Secondary forms. A recent expert consensus requires two things before surgery: proof that the scar is stable, and a check that no primary scarring disease is hiding underneath. Scar tissue has a weaker blood supply and more fibrous tissue than normal scalp, so grafts take less reliably. In a study of 14 patients with scars from earlier operations, a single FUE (follicular unit extraction) session often gave low or uneven density. The authors concluded that several sessions may be needed.
A good candidate therefore has a stable scar or long-quiet disease, a healthy donor area, and the patience for a staged plan.
Burn scar hair transplant: the Pakistani context
Burns are a common cause of secondary scarring in Pakistan. The Jinnah Burns and Reconstructive Surgery Centre, Lahore admitted 883 burn patients in one year between 2021 and 2022. At Holy Family Hospital, Rawalpindi, flame burns made up 63% of burn admissions in 2022, and women died at more than twice the rate of men. In children treated at a Faisalabad burn centre, scalds were the main cause, while most flame burns needed surgery to heal.
For survivors, the order of care matters. Acute burn care and any reconstructive surgery come first. Hair restoration comes later, once the scar is confirmed stable. A published reconstruction after a severe burn used 11 FUE sessions over eight years, together with fat grafting and micropigmentation, to rebuild the eyebrows, beard and scalp. Most scalp burns are far smaller, but the principle is the same: plan in stages.
Grafts and sessions a scar repair needs
Graft numbers depend on the size of the scar and where it sits. A visible scar at the front often needs hairline-style work, and the soft front edge of a hairline alone takes 600 to 900 grafts. A larger burn may need more grafts than the scalp can safely give in one harvest. With extraction kept to 25% of the permanent donor zone, that harvest is usually 2,500 to 3,500 grafts. In those cases beard or body hair can add to the supply.
For this reason, scar repair is usually planned in stages, with each session judged before the next is added. The decision is not only how many grafts, but how many sessions you are prepared for.
What to ask before booking scar repair in Lahore
- Is my scarring primary or secondary, and how was that confirmed?
- For primary disease, how long has my scalp been quiet, and who confirmed it?
- How many sessions does the plan expect, and at what density?
- What happens to grafts if the disease returns?
- Can I see scar repair cases from your own patients?
In Lahore the per-graft rate is estimated at PKR 70 to 100. Scar work often needs more than one session, and the exact figure is given at an in-person, paid consultation. For a donor scar from an earlier strip transplant, ask about scar revision of a previous hair transplant. If earlier grafts failed, our article on failed hair transplant signs explains the warning signs.
Why choose Aneels Hair Transplant for scarring alopecia in Lahore
- Reconstructive experience on record. Dr. Aneel Riaz Batalvi’s ISHRS profile lists body hair transplantation and burned scalp reconstruction among his procedures, the two skills a large scar repair depends on.
- Incisions in scar tissue by the surgeon. Dr. Aneel makes the recipient incisions himself. In stiff scar tissue, the depth, angle and spacing of each incision decide whether grafts survive and lie naturally.
- Repair of earlier surgical scars. The clinic corrects hairlines, graft placement and donor scars left by earlier procedures, including old strip scars.
- Results you can inspect. Before and after photos and videos of the clinic’s own patients are on the results page.
Book a consultation to have your scar type confirmed, your donor area assessed, and a staged repair plan written. Call 0341-7555512 or reach the clinic on WhatsApp, or visit 32 B Masson Road, behind Ganga Ram Hospital, Lahore.
Frequently Asked Questions
How do you treat scarring alopecia?
Treatment starts by naming the type. Active inflammatory forms are treated with medicine to stop further follicle loss, and progress is checked with photos and scalp examinations. Once the scalp is quiet, or when the scar came from an injury, the options are camouflage, a staged transplant, or both.
Can lichen planopilaris start after a hair transplant?
Rarely, yes. A systematic review found 34 published cases of lichen planopilaris appearing after hair transplantation, usually at the transplant sites and on average several years later. A direct cause has not been proven, and some cases may have been present before surgery. It is a rare risk worth discussing before any procedure.
Can scalp micropigmentation hide a burn or injury scar?
Often it can make a scar much less visible. Pigment dots copy the look of short hair and reduce the contrast between pale scar and the hair around it. It suits people who keep their hair short, and one published burn reconstruction combined it with grafting.
Do I need several trips to Lahore for burn scar grafting?
Usually, yes. Scar repair is planned in stages, and each session needs time to show its growth before the next is booked. Patients from other cities should plan for repeat visits and follow-up checks in Lahore, and ask at the start how many sessions the plan expects.
What budget should I plan for grafting a scar in Lahore?
Lahore packages are estimated at PKR 90,000 to 250,000, and scar work often sits across more than one package because of staged sessions. The final cost depends on scar size, donor supply and the number of sessions. Ask for the per-session graft plan in writing.
