Color Doppler Ultrasound in Hair Transplant Planning for Cicatricial Alopecia

Hair transplantation (HT) has become an important reconstructive option for selected patients with stable cicatricial alopecia. However, objective methods for assessing recipient-site suitability before surgery remain limited. The objective of the study is to describe the structural and vascular ultrasound findings in patients with cicatricial alopecia undergoing preoperative evaluation for HT. This retrospective observational study included 22 patients with cicatricial alopecia evaluated with high-frequency ultrasound (HFUS) and color Doppler between 2014 and 2025. Structural variables included dermal and subcutaneous thickness, follicular characteristics, and follicular diameter, while vascular assessment included Doppler patterns and peak systolic velocity. HFUS consistently demonstrated dermal thinning, reduced or absent subcutaneous adipose tissue, and decreased or absent follicular structures. Eleven patients underwent HT, of whom 4 required recipient-site optimization with autologous fat grafting before follicular unit excision. All 4 demonstrated preoperative dermal thickness <3 mm and reduced or absent subcutaneous adipose tissue on ultrasound. At 12 months, graft survival exceeded 90% in 8 patients and was approximately 80% in 3 patients. Limitations: Retrospective design, limited sample size, and clinical heterogeneity. In conclusion, HFUS and color Doppler provide objective assessment of recipient-site characteristics and may support preoperative planning by identifying patients who could benefit from recipient-site optimization before HT.