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Can FUE be performed on patients with alopecia totalis?

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Can FUE Be Performed on Patients with Alopecia Totalis?


Follicular Unit Excision (FUE) is generally not suitable for patients with alopecia totalis because this condition involves the complete loss of hair on the scalp, leaving no viable donor hair for transplantation. Alternative treatments, such as immunotherapy, topical medications, and support from a dermatologist or specialist, are more appropriate for managing alopecia totalis.

Expanded Information

Alopecia totalis is a form of alopecia areata characterized by the complete loss of hair on the scalp. This condition presents unique challenges for hair restoration due to the lack of available donor hair. Here’s a detailed explanation of why FUE may not be suitable and what alternatives are available:

Understanding Alopecia Totalis

  • Autoimmune Condition: Alopecia totalis is an autoimmune disorder where the immune system attacks hair follicles, leading to total scalp hair loss.
  • Progressive Nature: The condition can develop suddenly and progress rapidly, often affecting other body hair as well.
  • Lack of Donor Hair: With complete scalp hair loss, there are no viable donor follicles available for transplantation, which is critical for FUE.

Why FUE Is Not Suitable

FUE relies on the extraction of healthy hair follicles from a donor area, usually the back and sides of the scalp. For patients with alopecia totalis, the absence of hair in these areas makes the procedure unfeasible:

  • No Donor Hair: FUE requires a sufficient supply of healthy donor hair to transplant into balding areas. Without donor hair, the procedure cannot be performed.
  • Autoimmune Attack: Even if some donor hair were available, the autoimmune nature of alopecia totalis means that newly transplanted follicles might be attacked and lost.

Alternative Treatments

For patients with alopecia totalis, other treatment options should be considered to manage the condition and potentially stimulate hair regrowth:

  • Topical Immunotherapy: Treatments like diphencyprone (DPCP) or squaric acid dibutylester (SADBE) can help stimulate hair growth by inducing a mild allergic reaction that distracts the immune system from attacking hair follicles.
  • Topical Corticosteroids: Strong topical steroids can reduce inflammation and immune response, potentially promoting hair regrowth.
  • Systemic Medications: Oral or injectable corticosteroids, immunosuppressants, or biologic drugs can help control the autoimmune response and support hair regrowth.
  • JAK Inhibitors: Janus kinase inhibitors, such as tofacitinib and ruxolitinib, have shown promise in treating alopecia areata, including alopecia totalis, by targeting specific pathways in the immune system.
  • Light Therapy: Phototherapy using UV light can help reduce immune activity in the scalp and stimulate hair growth.
  • Supportive Care: Psychological support and counseling can help manage the emotional impact of alopecia totalis, improving overall quality of life.

Consulting a Specialist

It’s essential for patients with alopecia totalis to consult with a dermatologist or a specialist in hair loss disorders. These professionals can provide a comprehensive evaluation and recommend the most appropriate treatment options based on the individual’s specific condition and health status.


FUE is generally not suitable for patients with alopecia totalis due to the lack of viable donor hair and the autoimmune nature of the condition. Alternative treatments such as immunotherapy, corticosteroids, JAK inhibitors, and light therapy are more appropriate for managing alopecia totalis. Consulting with a dermatologist or hair loss specialist is crucial for developing an effective treatment plan. For more information on hair restoration and to explore other treatment options, visit our FUE Surgeons Directory.

For more detailed information about hair restoration procedures, please visit our articles on FUE Surgery and FUT Surgery.

If you have further questions or need assistance in choosing the right specialist, our support team is here to help you find the perfect match from our vetted directory of professionals.

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