Systematic review of efficacy of hair transplantation in patients with classic lichen planopilaris and frontal fibrosing alopecia: revisiting the current evidence.

BACKGROUND: Lichen planopilaris (LPP) is the most common form of primary cicatricial alopecia. Areas of alopecia are permanent; thus, hair transplantation becomes a potential cosmetic alternative. OBJECTIVE: To review the evidence of the efficacy of hair transplantation in patients with LPP. METHODS: The authors conducted a systematic review across four databases: Web of Science, PubMed, SciELO, and Cochrane. The authors analyzed studies describing the use of hair transplantation in patients with LPP, in any of its subtypes. Articles published from the inception of each database through October 2025 were included. Data from each study were summarized in tables. When possible, quantitative variables were grouped and expressed as frequencies or means. RESULTS: The authors included thirteen studies (113 patients): eight were case series (61.5%) and five articles were individual case reports (38.5%). 64.8% patients had frontal fibrosing alopecia, while 35.2% had the classic subtype. Hair transplantation was performed in patients with no clinically active disease in ten studies (101 patients). Nevertheless, the duration of quiescence prior to transplantation varied widely, ranging from 0 to 60 months. In most cases, survival rates were between from 80%‒100% at 6‒12 months, 71%‒100% up to 24-months, and below 41% after the second year. STUDY LIMITATIONS: No prospective studies or clinical trials were identified. There was a marked heterogeneity in the reported data, and follow-up times were inconsistent. CONCLUSIONS: Hair transplantation may be considered as a cosmetic alternative for patients with LPP. However, a clear decline in graft survival rate was noted after the second year.