Hair Restoration For Burn Survivors With Scarring Alopecia

Whilst many conditions which cause hair loss can be treated using non-invasive medications, there are some where surgery is the only option. One of these is burn alopecia - the hair loss caused when the scalp or face is injured by burns as a result of fire, chemicals, boiling water, steam, cooking oils or even electricity.

It generally leads to permanent baldness in the areas where the scalp has been burned and scarred, as the affected hair follicles are destroyed or rendered incapable of producing hairs, as with other cases of secondary scarring hairloss which falls under the umbrella term of cicatricial alopecia.

Although any treatments which involve stimulating the follicles are ineffective for burn survivors, in some cases a hair transplant may be possible. Surgical hair restoration in burn patients is an extremely challenging and lengthy process but there are some specialists working in this area who recognise the importance of dealing with this issue.

Hair transplants for burn alopecia

An article published by highly-respected surgeons at the UK's Farjo Hair Institute, who Belgravia refer clients to when hair loss treatment is not their best option, has outlined current medical techniques for burns patients, and the psychological benefits of dealing with this type of alopecia.

Writing in researchgate, they state: 'Although hair loss from previously hair-bearing areas of the head and neck is hard to hide with clothing specifically the scalp, eyebrows, eyelashes and beard region it is often seen by clinicians as less important than scar management per se. However, hair loss can have an equal or greater impact on the self-esteem and quality of life of patients than the scars themselves and act as a constant reminder of the causative traumatic incident.'

The authors note that this type of hair restoration is often arduous for both the patients and the surgeon, and the work may be spread over a number of years. This is not only to achieve the best results possible but also because, as the piece explains, 'graft take is not as reliable as in healthy non-scarred skin and may need repeating to achieve adequate density. Also, different areas of hair loss may need to be addressed in separate procedures'.

If the head itself has sustained significant injury, reconstructive surgery may be required before any type of hair restoration is considered. The Farjo Institute also notes that due to the lack of infrastructure, highly specialist skills and general inexperience in this area within the public health service, the majority of this type of work is carried out privately.

However, a hair transplant is not appropriate for everyone in this situation; factors including the extent of the area affected and the amount and quality of donor hair can determine suitability. According to the article, 'The authors’ anecdotal experience in over 100 cases is that hair follicle graft survival in scar tissue can be in the range of 090%. Prior to embarking on transplantation, the scars should be fully mature, i.e. as pale, soft, flat and as supple as they are likely to become.'

Hair restoration techniques

When a hair transplant procedure is carried out to address cases of Male Pattern Baldness, donor hair is typically harvested from the sides and/or back of the scalp as this hereditary condition only affects the follicles along the top of the scalp from crown to hairline. These are then grafted into the areas where the hair is thinning, such as around a receding hairline, for example. In cases of burn survivors, locating the necessary amounts of healthy hair follicles undamaged by their injuries, is key.

There are two common hair transplant techniques - follicular unit extraction (FUE) and follicular unit transplant (FUT) - both of which can be used when dealing with burn alopecia. The key difference between the two methods revolves around how donor hair follicles - the 'follicular units' - are harvested. The graft implantation methods are the same for each.

FUT involves surgically removing a strip of skin from the donor area which generally contains between one and four individual hair follicles, as well as sebaceous glands, nerves, a small muscle, and sometimes vellus hairs. The units are then trimmed down by hand before being grafted into the scalp, allowing for more hairs to be transplanted at a time.

FUE, on the other hand, uses a punch device to cleanly harvest each hair follicle individually from the back or sides of the scalp. It is less likely to leave scarring in the donor area and can mean the visual effects of hair transplant surgery - often an inflamed scalp with bloodied dots in donor and graft areas - will resolve themselves quicker, generally in less than two weeks from the op.

Other methods which can be employed include flap surgery, though not all of the hair loss solutions available or best-suited to burns survivors are surgical.

The research authors note there are various cosmetic options worth considering, either as standalone remedies or in conjunction with, or whilst waiting for surgery. These include concealer sprays, hair microfibres used to give the appearance of thicker hair, micropigmentation (a form of incredibly fine tattooing which mimics individual hairs anywhere on the head), hair replacement systems or wigs, or prosthetics with built-in hair.

For more information on dealing with severe hair loss from burns - whether to the scalp, eyebrows or facial hair - we highly recommend reading the full report, here: Hair transplantation in burn scar alopecia.