Frontal fibrosing alopecia (FFA) is a form of scarring alopecia characterised by progressive recession of the hairline in a band-like pattern, predominantly affecting post-menopausal women but increasingly diagnosed in men and younger women. The scarring nature of the condition makes it one of the most complex situations in hair restoration medicine.
In FFA, the hair follicle is progressively destroyed by an inflammatory process that replaces it with fibrous scar tissue. Unlike androgenetic alopecia — where the follicle miniaturises but remains alive — FFA eliminates follicles permanently in the affected zone. The progressive nature of the condition means the area of loss continues to expand unless the disease is brought under control.
This has critical implications for hair transplant candidacy. Transplanting grafts into an area with active FFA will result in loss of those grafts to the same scarring process that destroyed the originals. For transplantation to be considered at all, the disease must be demonstrably stable — with no progression on serial photographs over at least two years and with dermatological confirmation that inflammation is quiescent.
Even in stable FFA, graft survival in scarred tissue is significantly lower than in normal scalp, and patients should be counselled accordingly. Surgery in this context is more likely to be one component of a management plan that includes ongoing dermatological monitoring, rather than a standalone solution.
If you have been diagnosed with FFA, management by a dermatologist with expertise in scarring alopecias is the essential first step. Hair transplant surgery can be discussed as part of a long-term plan once the disease is stable.
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