2200 grafts in Scarring Alopecia (LPP) with Dr. Sethi and Dr. Bansal, 1 year

[Dr. Sethi & Dr. Bansal]

Presenting a successful hair restoration story in a Scarring Alopecia (Lichen Plano Pilaris, LPP). The lady patient of 26 years old presented to us with a childhood history of Scarring Alopecia which was non progressive for more than last 10 years. She was socially conscious and regressive. As expected, she always wanted hair on her head and was hiding her big hairless patch of scar with regular use of a cap. When we saw her, took a detailed history and wanted to be 100% sure of the non progressiveness of the condition before taking her up for the procedure. So, we did a test patching of 200 grafts to see any remnant of activities of the disease. After near to 6 months, most of the 200 grafts grew. This gave us the confidence to go ahead and do the bigger chunk of the scarring patch. We did 2000 grafts (the patient allowed us to do a complete trimming of the donor area as she was expecting the best possible result to her by us). We kept on following her. She came after four months with some visible growth and by the end of 1 year, most of her hair had grown and she could cover most of her bald patch and is extremely happy. We are following her since then and till today her hair is doing well and there is no sign of disease activity. 

Note: Lichen Plano Pilaris (LPP) is a very rare and unpredictable disease condition which causes Scarring Alopecia in patches in the central scalp and occasionally on the occipital scalp, more often in ladies than males. Usually LPP does not affect the hairline. Also very rarely affects the beard in males. But in many cases, after doing the procedure, the disease which seems silent, gets activated and damages the planted roots. So it is difficult clinically to ascertain the timing of a hair transplantation in LPP. Many physicians consider a silent period of more than 2 years is adequate to do a procedure upon the scarring. But many are proven wrong by the disease reactivation! Also, scarred tissue has altered vasculature and is not the same as the normal skin for transplanting hair. The thickness of the different layers of the skin are also altered so an experienced surgeon only should attempt to do a procedure in a Scarring Alopecia.

So there are two unpredictabilities in LPP: 

1. Uncertainty of the disease activity, &

2. Unfavourable dermal tissue. 

Other than doing a biopsy, trusting the history by the patient about the disease activity, a test grafting is essential to predict the future course after transplantation. 

 

 

 

 

Edited November 23, 2018 by Dr. Sethi & Dr. Bansal

[BjornBorg]

I can see how happy she is even through the blurring. Brought a tear to my eye.

Is she considering filling it in even further?

[JohnCasper]

Great work....doctors.  So glad the test patch worked and you were able to make such a dramatic change for your patient.  I’m sure she is absolutely thrilled.  Congrats to everyone involved.

[Dr. Sethi & Dr. Bansal]

2 hours ago, BjornBorg said:

I can see how happy she is even through the blurring. Brought a tear to my eye.

Is she considering filling it in even further?

@BjornBorg It has definitely also made us feel very fortunate that she gave us the opportunity to perform the procedure for her. She has been a great source of encouragement for us.

She has been happy with her results and she is not looking to go for another procedure.

[Dr. Sethi & Dr. Bansal]

3 minutes ago, JohnCasper said:

Great work....doctors.  So glad the test patch worked and you were able to make such a dramatic change for your patient.  I’m sure she is absolutely thrilled.  Congrats to everyone involved.

@JohnCasper Thank you for your kind words. The patient gained confidence and has a very liberated attitude towards life itself.

[PlzRespond]

Very interesting case. I’m happy it has worked out for this young woman.

 

for LPP you stated it is best to see a 2 year remission. What about alopecia areata? How long should one wait before getting a transplant following the last instance ?

[Dr. Sethi & Dr. Bansal]

5 hours ago, PlzRespond said:

Very interesting case. I’m happy it has worked out for this young woman.

 

for LPP you stated it is best to see a 2 year remission. What about alopecia areata? How long should one wait before getting a transplant following the last instance ?

@PlzRespond

It is always better if the remission period is very long. I mean if it is more than 5 years then it is very good. If it is 2 years then it might be unpredictable in terms of disease reactivation.