Can an FUE Hair Transplant Be Performed on an Afro-Caribbean Man With Central Centrifugal Cicatricial Alopecia (CCCA) ?

Dear Leeanne:

Thank you for your letter and question. The diagnosis of a scarring alopecia, such as CCCA, will require that there is evidence that the process is not active before surgical intervention may be considered. There is no correct answer as to when surgery may be performed but there should probably be a minimum of one year during which there is no active inflammation. The dermatologist that is following your friend should be able to assist in this determination. There is also a risk that the condition can be reactivated by surgery in the involved areas. Occasionally a “test session” can be performed to see if this is a possibility. CCCA, also called “hot comb” alopecia, has been linked to physical and chemical trauma of the scalp by certain hair-care practices. I will assume that if this is the cause of your friend’s hair loss, these practices have been discontinued.

The presence of acne keloidalis in the potential donor area may pose a challenge to the successful treatment of your friend. There is some evidence that acne keloidalis is itself a scarring alopecia and therefore the condition may be exacerbated by performing follicular unit extraction in the area. A suggestion, similar to the one made for the recipient area, is that the condition should be under control and a test session may be helpful to determine if the procedure will cause any problems.

FUE using the proper instrumentation can be performed in some African American patients, but the success depends on the degree of curvature of the follicles. In the last year I have required a test session to see if the procedure is feasible in a particular patient. You should check with the hair restoration surgeon, who should also have extensive experience in FUE, to see if they are comfortable with an FUE procedure in an African American patient.

To summarize, active inflammation in the donor and recipient area should have been treated and the condition quiet for at least one year prior to the consideration of surgery. A test session to assess the feasibility of FUE and to ascertain the impact on the donor and recipient area of FUE should be conducted. The test areas should be observed for at least 3-4 months before a large scale hair restoration session is scheduled.

I hope that this discussion answered some of your questions and shed some light on the issues involved.