Hair transplants are usually unsuitable for alopecia areata patients, mainly due to unpredictable flare-ups and the possibility of spontaneous regrowth. In both cases, patients are likely to get unsatisfactory results from a hair transplant, so symptom management for alopecia areata tends to focus on non-surgical treatments.
Unfortunately for alopecia areata patients, a hair transplant isn’t normally a viable treatment for this condition. Here, you’ll discover why transplants are usually unsuccessful for those with alopecia areata, and whether having stable alopecia makes a difference. Learn about proven treatments, non-surgical options, and how to assess stability, helping you make informed choices about your hair loss management.
Key takeaways
Alopecia areata is an autoimmune condition that causes round patches of hair loss across the scalp. It can also affect the eyebrows and beard; beard alopecia areata is known as alopecia barbae.
Patches often start as small round or oval-shaped areas, but can grow and expand across the scalp and/or face. Sometimes it develops into more advanced conditions, such as alopecia totalis (total loss of scalp hair) or alopecia universalis (total loss of body hair).
Early stage alopecia areata:
Late stage alopecia areata:
Around 2% of the global population are affected by alopecia areata [1]. You’re more at risk if you have other autoimmune conditions (such as vitiligo, psoriasis, lupus, or inflammatory bowel disease) and allergies (such as atopic eczema or hayfever) [2].
In most cases, hair transplants aren’t suitable for those with alopecia areata. Hair transplants involve taking healthy hair follicles from one area on the head and moving them to your balding area(s). They work for people with pattern baldness (androgenetic alopecia) because these patients normally have a band of healthy, unaffected follicles around the back of the head.
Most people with alopecia areata don’t have this invulnerable band of follicles. All hair is at risk of falling out at any time, even after transplantation. This increases the risk of hair transplant failure and unacceptable results.
Additionally, alopecia areata has a high rate of spontaneous remission (i.e. your hair can regrow at any time). So a hair transplant may not be necessary to restore your hair. If you do get a hair transplant and your hair regrows, it can create unnatural-looking patterns, especially if the transplanted grafts don’t follow your original hairline.
There are several reasons why hair transplantation isn’t normally a viable option for those with alopecia areata. Understand why surgery isn’t normally effective below.
Hair transplants rely on taking healthy hair follicles from one area of the head and moving them to the balding areas. In patients with male pattern hair loss, the band across the back and sides of the head is known as the safe hair transplant donor area. Wimpole Clinic hair transplant technician Evgeniya explains more:
Follicles in this area are unaffected by the hormones that cause male pattern baldness and female pattern hair loss, so they can be safely extracted and moved to the thinning areas.
Since alopecia areata is an autoimmune condition in which the immune system attacks hair follicles indiscriminately, patients have no safe donor area. This condition can spread quickly to other areas of your scalp, including transplanted hair. While there are no guarantees with any hair transplant, this does make alopecia areata patients especially prone to poor results.
Alopecia areata also has a high rate of spontaneous remission. In up to 80% of patients, it clears up by itself without intervention within a year [2]. That means your hair may grow back by itself without the need for surgery.
Hair transplant surgery can therefore put alopecia areata patients through unnecessary trauma and expense. That’s why only patients with highly stable alopecia are possible candidates for a hair transplant — and there’s a lack of evidence to support surgery as a treatment, even in stable cases.
Alopecia areata is a recurrent condition which can flare up at any time. 85% of patients experience at least one flare-up after their symptoms first appear (although some researchers suggest this increases to 100% when monitored long-term) [3]. So it’s very difficult to establish and maintain the stability needed to perform a hair transplant.
As well as the medical and cosmetic reasons to avoid hair transplants for alopecia areata patients, there are academic reasons, too. Very few case studies on scalp hair transplantation for alopecia areata have been published, so there’s a lack of evidence to support this as a viable treatment.
Some studies have demonstrated successful hair transplant outcomes in patients with eyebrows and beards affected by alopecia areata [4]. However, it’s worth noting that all successful follow-ups took place between 8 and 12 months post-procedure, giving only a short-term outlook.
Other case studies have less positive outcomes. One case study examining eyebrow alopecia areata found that despite positive hair transplant results, the condition caused the patient’s eyebrow hair to fall out after 8 months [5].
A long-term study (which examined the outcome of an eyebrow transplant in a patient with eyebrow alopecia areata) found that the patient experienced spontaneous remission 3 years post-procedure, leaving them with an uncanny double-eyebrow effect [6].
The patient went on to lose all their eyebrow and scalp hair (native and transplanted) 5 years after their procedure [6]. This demonstrates the unpredictable nature of alopecia areata. The authors concluded that hair transplantation was an unsuitable treatment course for those with alopecia areata, even after 2 years of condition stability.
While some experts suggest 2 years without active alopecia progression or regrowth can make a patient suitable for a hair transplant, others have found that this isn’t long enough to consider a hair transplant safe and effective [6-7].
Unfortunately, long stable periods of alopecia areata don’t necessarily indicate future stability. So in general, hair transplants aren’t suitable for alopecia areata patients, even if you haven’t seen any changes in your hair for a long time. But if your condition has been stable for 2 years or more, some surgeons may consider you as a candidate.
Certain tests can help establish whether your condition is currently active. The hair pull test is a common assessment; if more than 10% of hairs come away when the test is performed by a trained clinician, your alopecia may be in the active stage [3].
Additionally, the SALT score is often used to measure severity of alopecia areata. The score relates to the percentage of your scalp affected by hair loss. If your SALT score stays the same over several years, it may indicate some level of stability.
Because alopecia areata is highly unpredictable, doesn’t follow a specific pattern, and has a wide range of potential triggers, it’s hard to tell if your alopecia areata is stable enough to perform a successful hair transplant (and whether your results will last long-term). Close monitoring by your clinic will help them determine whether you’re a suitable surgery candidate.
Bear in mind that research shows that even 2 years of stability ended with poor outcomes after hair transplantation, so it’s highly unlikely that a reputable clinic will recommend FUE or FUT surgery to treat alopecia areata [6].
Artificial hair transplants aren’t normally available for those with alopecia areata, though some research suggests they may be a viable option, especially in cases of alopecia totalis [8-10].
Artificial hair transplants don’t use hair from your donor area, which solves the issue of transplanting follicles that may potentially be affected in future. However, they still pose several other problems:
There’s not enough evidence to establish any true success rates for hair transplants in patients with alopecia areata. As mentioned above, some research shows success in the short term, but there’s very limited evidence to show good long-term results [4-6].
If you do opt for a hair transplant to treat your alopecia areata, it’s important to temper your expectations. Know that both transplanted and native hair can shed at any time, even after long periods of stability. Lost hair can also regrow spontaneously, even in spots where you have transplanted grafts.
There’s no cure for alopecia areata, and its erratic nature makes it difficult to treat. But there are several proven ways to stop alopecia areata from spreading. These treatments for alopecia areata can help stabilise your condition.
Topical steroid creams for hair loss are an effective first-line treatment for alopecia areata. In moderate to severe cases, oral steroids or steroid injections for hair loss can be effective.
However, flare ups are common when you stop treatment, and steroids aren’t normally suitable for long-term use [13].
Both oral and topical minoxidil also have proven potential for treating alopecia areata, but must be used long-term to sustain results. Researchers suggest more evidence is needed to recommend minoxidil as a first-line alopecia areata treatment [14].
If your alopecia areata doesn’t respond to first-line treatments, you may need to use further remedies. Other proven treatments include:
In documented studies, hair transplantation tends only to be offered after several other treatments have been tried and failed [4, 6]. So there’s not much evidence to show these treatments are effective adjunctive therapies for hair transplantation.
Unfortunately, alopecia areata is a difficult condition to treat. Therapies that work initially can become ineffective, or may be unsuitable for long-term use. In these cases, some patients seek out non-medical options to address their alopecia areata. These include:
It’s not always easy to decide on the best course of action. But non-medical treatments are likely to be less financially, physically, and emotionally risky than a hair transplant if you have alopecia areata, especially if your condition is active.
Although surgery may not be a viable option, hair loss clinics like the Wimpole Clinic can still offer valuable advice and guidance. Book a consultation to discuss your symptoms and find a treatment plan that best suits you at your closest clinic location.
Male pattern baldness (androgenetic alopecia) is the most common type of hair loss in men, so it’s not uncommon for men with alopecia areata to also have male pattern baldness to some extent. Hair transplants are commonly used to restore hair lost to pattern baldness.
Unfortunately, if you have both alopecia areata, all the risks are the same, even if you also have pattern baldness as well. So it’s not usually possible to get a hair transplant if you have both androgenetic alopecia and alopecia areata.
No matter what stage you’re at in your journey to tackle alopecia areata, the Wimpole Clinic can help. Whether you want to better understand the pros and cons of hair transplantation for you, or explore other treatment options, book a free consultation with our experienced trichologists. Learn more about your condition and monitor its progress with the support and guidance of our hair loss experts.
Find out more about hair transplants for alopecia areata in these frequently asked questions.
Spontaneous regrowth is great news for your hair. It means you can get results without surgical or even medical intervention. If you tend to experience spontaneous regrowth after a flare-up, you’re unlikely to be considered eligible for a hair transplant.
Alopecia totalis and universalis have the same potential for flare-ups and partial regrowth as patchy alopecia areata, so the risks of hair transplantation are very similar. In general, hair transplants are not suitable for people with these conditions.
Hair transplant prices vary considerably depending on the clinic, location, and surgery complexity. Alopecia areata is a complicating factor, and can increase the cost compared with the average UK hair transplant cost.
If you’re on a budget, it’s even more important to do your research and find a clinic you trust. Many black market clinics will take your money and perform surgery, but this is very risky for patients with alopecia areata for the reasons outlined above.
We encourage all patients to seek multiple opinions, but it’s important to remember that most surgeons will be reluctant to take on hair transplant patients who have alopecia areata, due to the limited evidence of good long-term results. They will, however, be prepared to discuss other treatment options with you, and help you create a long-term monitoring plan to get you on the road to remission.
Wimpole Clinic Services:
Hair Transplants, Beard Transplants & Eyebrow Transplants.
Talk to a specialist
Dr. Michael May (GMC No: 1642315) is the Medical Director and Principal Surgeon of the Wimpole Clinic. He has 25 years experience in the field of hair transplant surgery has completed over 10,000 hair transplant procedures, accumulating an unmatched breadth and depth of experience that is exclusively available to Wimpole Clinic patients.
Dr. May entered private practice in 1982 when he first became involved with hair surgery, since then, he has dedicated his career exclusively to the science and practice of hair transplant surgery and hair restoration.
He qualified at St Bartholomew’s Hospital in London after which he trained and registered as a Fellow of the Royal College of Surgeons. Dr. May was instrumental in developing the revolutionary technique of follicular unit transplant (FUT), and subsequently he also presented papers and lectures in the UK and Europe to professional colleagues. He quickly became recognised by his peers and colleagues as a leader in the field of follicular unit hair transplantation. He specialises in hair restoration surgery covering; FUE, FUT lateral slit, eyebrow, eyelashes, beards, side burns, burns, repairs
As a leading authority in his field, Dr. May became a founder member and past President of the BAHRS and is the current president of the European Society of Hair Restoration Surgeons. In addition, Dr. May is a registered member of The Trichological Society and a Diplomat of Hair Restoration Surgery (ABHRS) in 2002. Dr. Michael May full list of associations are as follows:
Dr. May is available to prospective Wimpole Clinic patients during their consultation and carries out many of the hair transplant procedures at the clinic.
