The Surgical Treatment of Cicatricial Alopecia

The 2008 document outlines the surgical treatment options for cicatricial alopecia, distinguishing between stable cicatricial alopecia (SCA) and unstable cicatricial alopecia (UCA). Surgical excision is generally preferred for both types, particularly for UCA due to its progressive nature. The choice between hair transplantation and excision depends on factors such as donor hair availability, scalp laxity, and potential for future hair loss in surrounding areas. Techniques discussed include the use of tissue expanders to facilitate larger excisions, hair transplantation with careful donor selection and recipient site creation, and the importance of low-tension wound closure and adequate blood supply for successful outcomes. The document also notes the potential need for multiple sessions, the possibility of complications, and the importance of individualized treatment plans. If surgery is not viable, alternatives like scalp coloring, tattooing, or hairpieces are suggested. The authors stress the importance of conservative approaches, patient-specific preparations, and postoperative care to minimize complications and improve graft survival.