Lichen planopilaris following hair transplantation and face-lift surgery

Abstract

Cosmetic surgical procedures, including hair transplantation and face-lift surgery, are becoming increasingly popular. However, there is very little information regarding the associated development of dermatological conditions following these procedures. Lichen planopilaris (LPP) is an uncommon inflammatory hair disorder of unknown aetiology that results in permanent alopecia and replacement of hair follicles with scar-like fibrous tissue. Frontal fibrosing alopecia (FFA), a variant of LPP, involves the frontal hairline and shares similar histological findings with those of LPP. We report 10 patients who developed LPP/FFA following cosmetic scalp surgery. Seven patients developed LPP following hair transplantation, and three patients developed FFA following face-lift surgery. In all cases there was no previous history of LPP or FFA. There is currently a lack of evidence to link the procedures of hair transplantation and cosmetic face-lift surgery to LPP and FFA, respectively. This is the first case series to describe this connection and to postulate the possible pathological processes underlying the clinical observation. Explanations include Koebner phenomenon induced by surgical trauma, an autoimmune process targeting an (as yet, unknown) hair follicle antigen liberated during surgery or perhaps a postsurgery proinflammatory milieu inducing hair follicle immune privilege collapse and follicular damage in susceptible individuals.

Frontal fibrosing alopecia: A retrospective review of 19 patients seen at Duke University

“…30 FFA has also been J AM ACAD DERMATOL VOLUME 68, NUMBER 5 described in patients following cosmetic procedures (eg, hair transplantation and face-lift surgery). 16,34 One of our patients had previous face-lift surgery and another had rhinoplasty surgery, although a temporal relationship is unclear.…”

Lichen Planopilaris in the Androgenetic Alopecia Area: A Pitfall for Hair Transplantation

“…Cases may also accidentally be discovered as new onset of LPP after hair transplantation was performed without scalp biopsies prior to the procedure. Cases of LPP after hair transplant surgery have been reported recently [4][5][6] , and although it has been suggested that LPP occurs due to the loss of immune privilege after surgery [6] , it is possible that LPP in at least some of the reported patients did not occur de novo but rather had coexisted with the MPHL prior to the surgery. In fact, if our 14 male patients who requested hair transplantation for their MPHL had not been biopsied prior to the transplantation they could have developed classic LPP afterwards.…”

Evaluation of perifollicular inflammation of donor area during hair transplantation in androgenetic alopecia and its comparison with controls

“…[6] Lichen planuspilaris (LPP) like changes has been reported to occur after hair transplantation. [78] LPP is basically a histopathologic diagnosis characterized by perifollicular lymphocytic inflammation and fibrosis around the infundibular and isthmus. [910] These changes were presumed to be due to factors including koebnerization, loss of hair follicle immunoprivilege, autoimmunity, coincidence or misdiagnosis.…”