Chapter 3: Why hair transplantation is not recommended for patients with alopecia areata

During the hair loss treatment process, we often receive the question, "Wouldn't it be better to have a hair transplant in this area, especially from patients suffering from sudden alopecia areata?" When you look at your empty scalp, you can completely understand the desperate feeling of wanting to fill it with hair right away. However, I firmly state that I do not recommend hair transplantation to patients with alopecia areata. This is not only because it is not effective, but because it carries the risk of worsening the condition. To understand the reason, you first need a fundamental understanding of why alopecia areata occurs.

The essence of alopecia areata: an ‘autoimmune disease’ in which the body attacks the hair follicles

While general hereditary hair loss is similar to the 'aging' process in which the hair follicles themselves gradually weaken, alopecia areata is a type of 'autoimmune disease' that occurs due to confusion in the 'immune system', our body's defense system. The immune system is essentially an ally that protects our body from bacteria or viruses that invade from the outside. However, for some reason, this immune system may malfunction, mistaking healthy parts of our body for enemies and attacking them. Alopecia areata is when the target of this attack is the ‘hair follicle’ that creates our hair.

Specifically, T-lymphocytes, a type of immune cell, flock around the growing hair follicles and begin an intensive attack, mistaking the hair follicles for foreign invaders. This attack causes inflammation around the hair follicles, and the hair follicles that were continuing their normal growth cycle receive a huge shock and suddenly enter the catagen or telogen phase. As a result, hairs that have not yet reached the end of their life fall out all at once, leaving the area looking empty and coin-shaped. In other words, alopecia areata is not a weakening or disappearance of the hair follicles themselves, but a condition in which hair temporarily cannot grow due to an excessive inflammatory reaction occurring under the scalp.

It's like planting seeds on a battlefield: Why transplantation is meaningless for alopecia areata

If you understand the nature of alopecia areata, it becomes clear why hair transplantation cannot be the solution.

• First, there is a very high chance that transplanted hair will fall out again.The area of ​​alopecia areata is like a ‘battlefield’ where immune cells are attacking the hair follicles. Even if healthy hair follicles are transplanted from the back of the head without improving the inflammatory environment, immune cells will view these new hair follicles as enemies and attack them in the same way. In the end, hair that was planted with difficulty cannot take root (failure to take root) and falls out again shortly afterwards, which inevitably leads to a futile result.
• Second, the transplant process itself can worsen alopecia areata.Hair transplant is a surgical procedure that creates numerous microscopic wounds on the scalp. If you have a healthy scalp, it will recover naturally, but in the case of alopecia areata patients with an oversensitive immune system, these wounds and irritation can actually become a fuse that further activates immune cells. There is a risk that this may worsen existing inflammation or lead to the 'Koebner phenomenon', which causes new alopecia areata in other areas that were fine. In other words, if you try to grow hair, you may end up losing hair in a larger area.

Therefore, the treatment of alopecia areata should be prioritized through a medical approach that reduces inflammation under the scalp and returns the abnormal immune response to normal, rather than a surgical approach that fills the empty space. If we transform the 'battlefield' into a 'land of peace' through treatment that stabilizes the oversensitive immune system, the hair follicles will regain the power to grow healthy hair on their own.