Frontal Fibrosing Alopecia in a Man: Results of Follicular Unit Test Grafting

The document reports on a rare case of Frontal Fibrosing Alopecia (FFA) in a 44-year-old man, which is a condition typically seen in postmenopausal women and characterized by scarring alopecia of the frontotemporal hairline. The patient underwent a test grafting procedure after 10 months of treatment with no disease activity, where 82 two-hair and three-hair follicular units were transplanted. Initially, the grafts showed excellent hair growth at 15 months post-operation. However, after being lost to follow-up for 4 years and discontinuing all therapy, the patient returned with marked loss of transplanted hair and further progression of the disease. This single case suggests that hair transplantation may not be an effective treatment for FFA, as the transplanted follicles were almost totally destroyed upon disease recurrence. The authors recommend that if test grafting is considered, it should be restricted to patients with long-term disease stability of at least 5 years and that prolonged observation and adherence to medical therapy are necessary to definitively assess results.