Follicular unit extraction for secondary cicatricial alopecia: A case-based perspective on technique optimization and surgical considerations

Cicatricial alopecia (CA) is often challenging to treat due to limited response to medical treatments. However, with recent advancements in hair restoration surgery, it has emerged as a viable option for patients with burnt-out, inactive disease. Despite concerns regarding lower graft survival rates (~50%) compared to non-scarring alopecia (>90%), promising outcomes have been observed, particularly in post-traumatic cases. This case series presents five patients with CA treated by follicular unit extraction (FUE) technique using grafts harvested from the beard or occipital scalp. FUE was preferred in these cases due to recipient site fibrosis. The surgical technique was tailored to the recipient site’s characteristics – larger slits for fibrotic skin and smaller ones when dermal support is limited. In this case series, the average graft survival rate was 64.2%, and the transection rates were within an acceptable limit. All cases were given supportive therapy with oral minoxidil and platelet-rich plasma therapy to improve surgical outcomes.