Lichen Planopilaris following Hair Transplantation and Face-lift Surgery.

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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 share similar histological findings with those of LPP. We report ten patients who developed LPP/FFA following cosmetic scalp surgery. Seven patient 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 post-surgery pro-inflammatory milieu inducing hair follicle immune privilege collapse and follicular damage in susceptible individuals.

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