CCCA (Central Centrifugal Cicatricial Alopecia) and hair transplant: what CCCA is, when surgery is possible, and how Dr.
What is CCCA?
Central Centrifugal Cicatricial Alopecia (CCCA) is a progressive scarring hair loss condition that begins at the crown of the scalp and spreads outward in a centrifugal (radiating outward) pattern. It almost exclusively affects Black women, with estimates suggesting it affects up to 17% of Black women in the United States.
CCCA causes permanent hair loss because the inflammatory process destroys the hair follicle and replaces it with scar tissue (fibrosis). Unlike androgenetic alopecia — where the follicle miniaturises but survives — in CCCA the follicle is permanently eliminated. Once an area has fully scarred, no medical treatment can restore follicle function.
The condition is associated with: tight hairstyling practices (particularly chemical relaxers combined with heat and tension), possible genetic predisposition, and certain hair care products. Its exact aetiology remains under active research.
When is hair transplant possible for CCCA?
Hair transplant for CCCA is possible — but only under very specific conditions:
The disease must be inactive. Active CCCA involves ongoing follicular inflammation that will destroy newly transplanted grafts just as it has destroyed the native follicles. A minimum of 12–24 months of confirmed disease inactivity is required before surgery is considered. Inactivity is confirmed by scalp biopsy or trichoscopy examination showing no active inflammation.
The donor area must be unaffected. CCCA primarily affects the crown and vertex. In most patients, the donor zone at the back and sides of the scalp remains fully intact and available for harvest.
Realistic expectations are essential. Transplanting into scarred scalp tissue produces lower graft survival rates (typically 70–85%) than transplanting into healthy tissue. Patients must understand that the result may require a second session to achieve adequate density.
Medical treatment before surgery consideration
Before any surgical consultation for CCCA, dermatological management is required to halt disease progression. Current treatment options for active CCCA include: topical and intralesional corticosteroids, oral tetracycline antibiotics (doxycycline), topical calcineurin inhibitors, and low-dose oral minoxidil to protect non-scarred hair.
Dr. Arslan coordinates with the patient's dermatologist or trichologist before planning any CCCA case. The surgical and medical teams must confirm disease inactivity before a consultation for transplant surgery is scheduled.
Dr. Arslan's CCCA protocol at Hairmedico
Hairmedico accepts CCCA consultations from Black women who have achieved documented disease remission. Dr. Arslan's protocol for CCCA cases includes: review of biopsy results or trichoscopy documentation of inactivity; a test session of 100–150 grafts with 3-month observation before a full procedure; DHI technique for placement into the scarred recipient zone; and extended 12-month follow-up with monthly photograph review to detect any recurrence of inflammation that would threaten the transplanted grafts.
