Scar without hair
A well-defined area after a burn, injury, or surgery; the skin is smooth, firm, sometimes lighter or darker than the surrounding skin.
CONDITION / HAIR
Scarring alopecia.
Cicatricial alopecia is hair loss in which hair follicles are destroyed and replaced with scar tissue, so hair no longer grows in this area. The cause can be an inflammatory scalp disease, trauma, burn, or surgery.
CONCEPTUAL VISUALIZATION- What it is
- Hair loss in which follicles are destroyed and replaced by a scar.
- Primary
- Inflammatory scalp disease; treated by a dermatologist.
- Secondary
- The result of a burn, trauma, or surgery.
- Which helps
- Hair transplant, expander, flaps — when the scar is stable.
01 / WHAT IS ITWhat is
What is
cicatricial alopecia.
In regular baldness, the follicle (hair root) is alive, it just works weaker. In scarring alopecia, the follicle is destroyed, and in its place — scar tissue. Therefore, an examination shows smooth skin without hair openings, and hair will no longer grow there. European guidelines explicitly warn: in areas where a scar has already formed, hair regrowth should not be expected.
Doctors distinguish two types. Primary Scarring alopecia — when inflammation attacks the follicles themselves: for example, lichen planopilaris or frontal fibrosing alopecia. This is a disease treated by a dermatologist, and the main goal is to stop the inflammation. Secondary — when follicles have died due to an external cause: burn, injury, surgery, radiation therapy.
The type determines all treatment. In secondary, when the scar has matured and is stable, hair can be restored surgically. In primary, the disease must first be suppressed; transplantation is discussed only when it has been inactive for a long time.
Hair loss noticeably affects well-being. A review by German dermatologists recommends offering psychological support and masking methods — this is part of treatment, not a trivial matter.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow it
How it
looks
Primary and secondary scarring alopecia look and behave differently.
An area that grows slowly
Hair loss gradually expands, hair thins at the edges. This happens in the primary form.
Itching and burning
The scalp itches, burns, or hurts, with redness and flaking around the hairs — signs of active inflammation.
Hairline above the forehead
The edge of the hair above the forehead gradually recedes backward — this can manifest as frontal fibrosing alopecia.
After a hair transplant
Scars in the donor area or unnatural hairline after a previous transplant.
Complications after hair transplantationLarge skin defect
After the removal of a tumor or a severe injury, not only hair is missing, but also the skin itself.
Scalp skin defects03 / REASONSWhy it disappears
Why it disappears
hair.
The cause is determined first: it depends on it whether surgery is possible.
Inflammatory diseases (primary)
The body's own immunity attacks the follicles. According to the classification of the North American Hair Research Society, primary forms are divided into four groups by type of inflammation. The disease can start unnoticed, so the diagnosis is often made late.
Frontal fibrosing alopecia
The international consensus of experts notes that it is becoming more common.
Burns
After a deep burn of the head, hair does not grow at the site of the scar.
Scars after facial burnsInjuries and surgeries
A scar after a wound or incision remains without hair; incisions can be deeper than burn scars.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
An old hairless scar is a planned situation and does not require urgent care. However, fresh hair loss with itching or pain should be shown to a dermatologist without delay, and after a head surgery, some signs require immediate assistance.
103 immediately if:
- bleeding from a wound that cannot be stopped;
- the blood is gushing, bright red;
- person breathes very frequently;
- confusion, unclear speech, the person says nonsensical things;
- the skin has become bluish, pale or mottled;
- a rash that does not fade if you press on it;
- very high or very low temperature, the body feels hot or cold to the touch, or the person is shivering.
Do not delay a visit to the doctor:
Immediately - to the surgeon who operated: after surgery or the placement of an expander, the pain or swelling increases, the wound over the expander has opened, the skin over it has darkened or thinned; if it is not possible to contact the surgeon — go to the emergency department. On the same day: the wound has turned red, pus is coming from it, you feel unwell or have a fever, but there are no signs from the 103 list. In the next few days — see a dermatologist: Hair falls out in patches, and the skin there itches, burns, hurts, becomes red or flakes, or the hairline on the forehead noticeably recedes: in the primary form, early diagnosis helps preserve hair. Planned: A stable scar without hair after a burn, injury, or surgery.
05 / DIAGNOSTICSHow to determine
How to determine
Type of alopecia.
- Questioning
When the patch appeared, whether it is growing, itching, or hurting; what burns, injuries, surgeries, hair transplants there have been.
- Examination and trichoscopy
The scalp is examined under magnification: whether there are follicle openings, signs of inflammation, what the border of the patch is.
- Biopsy
If the picture is unclear, a small piece of skin is taken for examination. Before transplantation, it is important to rule out the primary form.
- Scar and donor area assessment
Scar size and thickness, blood supply, hair density on the occiput — the method depends on this.
06 / TREATMENTHow they restore it
How they restore it
hair.
The first step in the primary form is to stop the inflammation; in the secondary form, wait until the scar matures. Then, the method is chosen based on the patch size, scar condition, and the stock of own hair.
01
Primary: first stop the disease
Treatment is conducted by a dermatologist.
- The goal
- Stop or slow down hair loss and scarring, relieve itching and pain. Due to the rarity of the disease, there is little evidence for various drugs.
- Medicines
- Often start with strong hormonal ointments or injections into the scalp; if necessary, the dermatologist prescribes medication orally.
- Will it grow back
- The literature describes isolated cases of regrowth after treatment — 71 for all species; therefore, the goal of treatment is to preserve what is.
02
Hair transplantation
Their own follicles are transferred to the rumen.
- With secondary form
- The consensus of experts requires that before the operation, confirm that the scar is stable and exclude the primary form. The result depends on the cause and characteristics of the scar.
- How it takes root
- In a scar, blood circulation is worse and the tissue is denser. In a series of 25 scar transplants monitored for over six months, 18 were observed; among them, the result was rated as excellent in 44.4% and good in 38.9%; after incisions — worse than after burns. Often several sessions are required.
- After the burn
- In a series of 41 patients, after a year, 31 were very satisfied, 7 — satisfied, 3 — not very satisfied; three had complications.
- Children
- In a series of 13 children aged 4–12 years, on average 85.3% of the hairs survived.
03
Transplant in the primary form
Only when the disease has been inactive for a long time.
- What to expect
- In a review of 8 studies (123 patients), on average, 82.7% of grafts survived after 7–12 months, but 39.6% after 4–6 years: the fraction decreases over time. In 4 patients, the disease flared up again.
- FFA and lichen planus planus
- According to the review of data from 42 patients, a positive transplant result was observed in 2 out of 7 with frontal fibrosing alopecia and 5 out of 8 with lichen planus; remission before surgery lasted on average 2.69 years.
04
Expander and flaps
For large areas.
- Expander
- Under healthy skin with hair, a balloon is placed and gradually filled, then the scar is excised and covered with stretched skin. In a series of 30 patients after burns, mild complications were as follows: infection — in 8, fluid accumulation — in 4, wound dehiscence — in 2.
- Flaps and excisions
- A small area is excised, a medium area is covered with hair-bearing skin from a neighboring area.
- What is combined
- The expander restores the area, the transplant — the natural growth line. The review notes that the expander has limitations, including residual scars and prolonged treatment.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Cicatricial alopecia at the Valikhnovskyi Institute of Surgery is treated in the direction of 'Robotic Hair Transplantation.' The clinic is responsible for surgical hair restoration. The primary inflammatory form is treated by a dermatologist; transplant is discussed only when the disease is stable.
CLINIC SERVICE
Robotic hair transplantation
Own hair in baldness — with the ARTAS robot and manually, as well as after burns, injuries, and surgeries.
View service
What we do for this condition
- Hair transplant into a scar — follicles from the back of the head are transplanted into scarred tissue using the ARTAS robot (FUE), manually (FUE), or with the strip method (FUT); graft survival in a scar is usually lower, and multiple sessions are often needed.
- Fabric dermotension (expander) — the main method for large areas: the skin with hair next to the scar is stretched with a balloon over weeks or months, and then used to cover the defect.
- Rotational and transposition flaps — for a medium-sized area, the skin with hair is moved from an adjacent area of the scalp.
- Excision of small scars — a small bald area is excised and stitched.
- Transplant after reconstruction — hair is transplanted even in a flap, once the tissue has stabilized.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of the head from several angles and, if available, a dermatologist's conclusion or biopsy.
- ConsultationExamination of the scar and donor area, determination of the cause; if necessary — referral to a dermatologist.
- PlanTransplant, expander or flap, how many stages and when to start.
- TreatmentSurgery — when the scar has matured or the disease has been inactive for a long time.
- RecoveryFollow-up examinations after surgery; for the primary form — continued dermatological supervision.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Will hair grow on the scar itself?
No, in the area where a scar has already formed, the follicles are destroyed. Hair can be restored by transplantation, an expander, or a flap.
Is it possible to transplant hair in the inflammatory form?
Only when the disease has been inactive for a long time. Even then, some grafts may be lost over the years, and the disease may flare up. The decision is made together with a dermatologist.
Is it possible to transplant hair onto a scar after a burn?
Yes, but in a scar, graft survival is usually lower than in healthy skin, and multiple sessions are often required. Large areas are initially covered with skin with hair using an expander.
When is it possible to operate after an injury or burn?
When the scar has matured and the tissues have stabilized. The exact timing will be determined by the doctor during the examination.
Do they do this on children?
Yes, there are described series of transplants and expanders in children. What and when is suitable for a child is decided individually.
What should be done if surgery is currently impossible?
Masking methods help: hairstyle, wig, micropigmentation. If hair loss is depressing, it is worth asking for psychological support.
Sources
16 sources · European guidelines, consensuses, systematic reviews, case series, and NHSshowCollapse
- Cicatricial alopeciaJournal der Deutschen Dermatologischen Gesellschaft, 2018doi:10.1111/ddg.13498 ↗
- Management of classic lichen planopilaris: The EADV task force on hair diseases position statementJournal of the European Academy of Dermatology and Venereology, 2026doi:10.1111/jdv.70379 ↗
- Statement from the frontal fibrosing alopecia international expert alliance: SOFFIA 2024Journal of the European Academy of Dermatology and Venereology, 2025doi:10.1111/jdv.20833 ↗
- Hair transplantation for secondary cicatricial alopecia: A Chinese expert consensusJournal of the European Academy of Dermatology and Venereology, 2026doi:10.1111/jdv.70644 ↗
- Hair Transplantation in Frontal Fibrosing Alopecia and Lichen Planopilaris: A Systematic ReviewThe Laryngoscope, 2020doi:10.1002/lary.28551 ↗
- A Systematic Review of Follicular Unit Graft Survival Rates After Hair Transplantation in Primary Cicatricial AlopeciaDermatologic Surgery, 2025doi:10.1097/DSS.0000000000004707 ↗
- Hair regrowth in cicatricial alopecia: A literature reviewThe Journal of Dermatology, 2021doi:10.1111/1346-8138.15902 ↗
- Hair transplantation in scar reconstructionJournal of Plastic, Reconstructive & Aesthetic Surgery, 2026doi:10.1016/j.bjps.2026.08.040 ↗
- Hair Follicle Transplantation on Scar TissueJournal of Craniofacial Surgery, 2013doi:10.1097/SCS.0b013e31828a78ad ↗
- Autologous follicular unit extraction transplant for postburn cicatricial alopecia: A single-center's retrospective case seriesJournal of Cosmetic Dermatology, 2024doi:10.1111/jocd.16237 ↗
- Application of Autologous Hair Transplantation Technique in Children with Cicatricial AlopeciaAdvances in Therapy, 2023doi:10.1007/s12325-023-02581-3 ↗
- Tissue Expanders for Hair Restoration in the Scalp: Overexpansion Does MatterPlastic and Reconstructive Surgery - Global Open, 2024doi:10.1097/GOX.0000000000006222 ↗
- Reconstruction of post burn scalp alopecia by using expanded hair-bearing scalp flapsPakistan Journal of Medical Sciences, 2015doi:10.12669/pjms.316.7927 ↗
- Hair lossNHS, 2024nhs.uk/symptoms/hair-loss ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
The figures on the page are from these sources.
Scar without hair
Or the area of baldness?
Send photos of your head from several angles. The doctor will tell you if it is possible to restore the hair and where to start.