Types of Alopecia — What Matters for Surgery
Alopecia is a broad term covering any condition causing hair loss. The surgical approach and expected outcomes differ significantly depending on the type. The three most relevant to hair transplant surgery are androgenetic alopecia, traction alopecia and scarring alopecias.
Androgenetic Alopecia (AGA)
By far the most common form. DHT-driven miniaturisation of follicles in genetically susceptible zones. FUE and DHI transplant surgery works most reliably with AGA — donor follicles from the permanent zone are DHT-resistant and will not undergo the same miniaturisation after transplantation. The key conditions: the loss must be stable, and donor density must be adequate. Most Hairmedico patients have AGA.
Surgery does not stop AGA progression in areas that are not transplanted — native hair next to the new grafts can keep thinning from DHT over the following years. This is why Dr. Arslan designs the hairline and allocates donor reserve with a 10–20 year horizon rather than covering the maximum area possible today, and why he typically discusses concurrent medical therapy (finasteride, minoxidil) to protect the native hair a patient keeps, not only the hair they receive.
Traction Alopecia
Caused by prolonged mechanical stress on the hairline — tight braiding, extensions, ponytails. Common in women who wore high-tension styles over many years. The follicles in the affected zone are often permanently damaged rather than simply miniaturised. FUE transplant into traction alopecia-affected areas can produce excellent results, provided the underlying cause has been eliminated for at least 12 months before surgery.
Alopecia Areata
An autoimmune condition causing patchy, unpredictable hair loss. Unlike AGA, alopecia areata involves an immune attack on hair follicles — meaning transplanted follicles can potentially also be attacked after surgery. Hair transplant for active alopecia areata is generally not recommended. For patients with longstanding, stable alopecia areata (typically no new patches for 3–5 years), surgery may be considered — but only after thorough evaluation of disease activity and realistic discussion of the risk of recurrence.
The caution around timing exists because surgical trauma to the scalp can itself act as a trigger for autoimmune conditions, potentially provoking a new patch in a zone that was previously quiet — even after a long stable interval. This is why the stability period is judged on documented history rather than current appearance alone, and why Dr. Arslan asks patients with alopecia areata to coordinate with their treating dermatologist before any surgical decision is made.
Scarring Alopecias (Cicatricial)
Conditions such as frontal fibrosing alopecia (FFA), lichen planopilaris, and folliculitis decalvans cause permanent follicle destruction through inflammation. Surgery into actively scarred tissue requires extreme caution — transplanted follicles can fail due to poor vascularisation, and active disease may destroy new grafts. Surgery is only appropriate once the condition is confirmed inactive, and the recipient zone's vascularity must be assessed.
Inflammation in FFA and lichen planopilaris can be patchy, and a zone that looks quiet can still be active under the surface. For this reason, confirmation of disease inactivity comes from the patient's treating dermatologist rather than a visual check at consultation, and each affected area is assessed on its own rather than assuming uniform vascularity across the whole scalp.
Who Is a Candidate?
Surgical candidacy for alopecia patients depends on: type and activity of the alopecia, stability of the condition (confirmed inactive for minimum 12 months), adequacy of donor zone, and realistic expectations. A personal assessment with Dr. Arslan — including detailed photographic review of the affected zones — is essential before any recommendation can be made. See our packages page →
When Surgery Should Wait or Be Avoided
Surgery is not appropriate for: active alopecia areata with recent or ongoing patches; active scarring alopecias (FFA, lichen planopilaris, folliculitis decalvans) not yet confirmed inactive by a dermatologist; traction alopecia where the causative hairstyling practice has not been discontinued; and cases where the donor zone lacks the density to supply the recipient area without thinning the back and sides. In each of these situations, the underlying condition needs to be addressed before hair transplant surgery is even discussed — surgery on top of active disease will not hold.
