Facial Cosmetic Surgery Presents an 8 Fold Increased Risk of FFA

Several studies in the past have highlighted a possible assoication between surgical trauma in the frontal scalp to the development of frontal fibrosing alopecia.

In 2005, Kossard and Shiell reported a case of frontal fibrosing alopecia developing after hair transplantation for androgenetic alopecia. In 2012, Chiang et al reported 7 patients who developed LPP following hair transplantation, and three patients developed FFA following face-lift surgery.

Pham et al 2022

A new study addresses this risk in a case control study. A total of 54 frontal alopecia (52 female and 2 male) and 51 matched controls (49 female and 2 male) patients were included in the study. The average age of patients with frontal alopecia was 64.6 years and 61.8 for controls (no significant differences)

Prior Scalp Surgery More Common in FFA

A significant number of frontal alopecia patients (n = 27, 50%) reported a history of surgical scalp or facial procedures in contrast to controls (n = 5, 9.8%, p < 0.001). The most commonfacial surgical procedures performed on frontal alopecia patients included:

a) facelift [n = 14, 51.9% control: n = 3, 60%, p = 0.012]

b) blepharoplasty (n = 6, 22.2%, control: n = 1, 20%, p = 0.101)

c) brow lifts (n = 5, 18.5%, control: n =0, 0%, p = 0.077).

The association between facial surgical procedures and frontal alopecia was statistically significant with age and race adjustments (OR 7.8 [95% CI 2.77–25.98, p < 0.001]).

Comments

This is a really important study that highlights the possible role of surgical trauma in inducing FFA. More studies are needed to better understand this phenomenon. It’s also an important reminder that extra caution is needed to ensure FFA is quiet before doing surgery on the frontal hairline (facelift, hair transplants) before proceeding to surgery.

MAIN REFERENCE

Pham et al. The Association of Frontal Alopecia with a History of Facial and Scalp Surgical ProceduresSkin Appendage Disord. 2022 Jan;8(1):13-19.

ADDITIONAL REFERENCES

Kossard and Shiell. Frontal fibrosing alopecia developing after hair transplantation for androgenetic alopecia. Int J Dermatol . 2005 Apr;44(4):321-3.

Chiang YZ et al.  Lichen planopilaris following hair transplantation and face-lift surgery Br J Dermatol . 2012 Mar;166(3):666-370.