LICHEN planopilaris may develop years after hair transplantation or facial surgery, a new systematic review suggests.
Lichen Planopilaris After Surgery
Surgical procedures involving the scalp or face could trigger lichen planopilaris in predisposed individuals, according to a systematic review of published cases. However, the researchers emphasized that a causal relationship has not been established and that undetected disease may have been present before surgery in some individuals.
Lichen planopilaris is a rare form of cicatricial, or scarring, alopecia characterized by inflammation surrounding the hair follicles and progressive, permanent hair loss. Previous case reports have suggested that hair transplantation and facial surgical procedures may precede the condition, but the available evidence has remained fragmented.
Researchers therefore reviewed reports of newly developed lichen planopilaris, including frontal fibrosing alopecia, following procedures involving the scalp or face.
Cases Developed Several Years After Procedures
The systematic review included seven studies involving 66 individuals. Of these, 34 developed lichen planopilaris after hair transplantation, while 32 developed the condition following facial procedures.
The mean age at diagnosis was 55.7 years, which was younger than the age generally observed among people with lichen planopilaris. The average period between the procedure and disease onset was 4.88 years, indicating that symptoms may not appear until several years after surgical intervention.
Among cases with available information on disease location, lichen planopilaris occurred at the hair transplant site in every individual. However, 44% also experienced involvement in areas distant from the transplant site.
Surgical Trauma May Act as a Trigger
The concentration of disease at treated sites supports the possibility that surgical trauma may contribute to the development of lichen planopilaris in susceptible individuals. Nevertheless, the evidence was derived from a small number of heterogeneous observational reports and cannot demonstrate that the procedures caused the disease.
Subclinical lichen planopilaris may also have existed before transplantation or facial surgery but remained unrecognized at the time of treatment.
The findings suggest that clinicians performing hair transplantation and facial surgical procedures may consider discussing this rare potential complication with appropriate candidates. Careful assessment before surgery could also help identify signs of existing inflammatory or scarring hair loss.
Reference
Escudero JL et al. Lichen planopilaris after hair transplantation and facial surgical procedures: a systematic review. Dermatol Surg. 2026. doi:10.1097/DSS.0000000000005244.
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