Diagnosis: Frontal Fibrosing Alopecia

This 50-year-old male presented with a Norwood Class 3A pattern of balding, which is easily transplanted with excellent results. This man would most likely undergo a hair transplant in the hands of too many hair transplant doctors. He had a diagnosis made by an experienced surgeon with trichoscopy that showed perifollicular erythema and hyperkeratosis, both observations diagnostic for Frontal Fibrosing Alopecia.  He had a scalp biopsy to confirm the diagnosis.  This is an autoimmune disease of the scalp, and if he had a hair transplant, the surgery would most likely fail and cost him a lot of money and an unnecessary surgery. He was placed on appropriate medication to control the disease.  Still, even with this disease under control, it often comes back, and if he had a hair transplant during the remission when it came back, the hair would again be lost. A hair transplant done during remission would likely exacerbate the disease and cause a loss of most of the transplants.  Conclusion:  Always find a good doctor who knows how to diagnose your balding problem appropriately.

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