Hair transplant into scar tissue: suitability, blood supply and number of sessions

Why doesn’t hair grow back on a scar?

When an injury reaches the deeper layer of the skin, the dermis, healing replaces the original skin with fibrous tissue rich in collagen. Destroyed follicles do not regenerate, so the area stays bald, and the collagen fibres, thicker, more tightly packed and running in a single direction, make the tissue stiffer than normal skin. The dermis of a mature scar also holds fewer cells and fewer blood vessels than healthy skin (Plotczyk et al., 2023).

A transplant gets round this by bringing in follicles that are already formed. Follicular units are harvested from the back and sides of the scalp, then implanted one by one into the scar. These hairs keep the characteristics of the area they came from, a principle described in 1959 as donor dominance, so they carry on growing after the move (Farjo et al., 2015). The area you can cover therefore depends on the supply in your donor area, which is finite.

The difficulty lies in the recipient site. A graft survives only if the surrounding tissue supplies it with blood quickly, and stiff scar tissue with few vessels accepts grafts less readily than a scalp thinned by pattern baldness (Yoo et al., 2019). Much of the assessment of your scar comes back to this question.

Which scars can take a hair transplant?

Doctors separate scarring alopecias into two groups. Secondary forms follow an external injury such as a burn, trauma, surgery or radiation, and leave a scar that no longer changes. Primary forms are caused by an inflammatory disease that destroys the follicles itself and can flare again years later (Madura et al., 2020). This distinction weighs more in the decision than the appearance of the scar.

Burn scars

A deep burn destroys the follicles throughout the depth it reaches and often leaves a large, sometimes contracted scar. Beyond roughly 80 to 100 cm² of bald skin, a UK hair restoration team considers it usually better to reduce the area first with serial excision, tissue expansion or flaps, keeping the transplant for finishing work such as the hairline, small residual patches and the scars left by those operations (Farjo et al., 2015). A skin graft stuck directly to the skull cannot take hair grafts, because there is no tissue beneath the surface to hold them.

Scars from accidents or surgery

Linear scars from neurosurgery, mole removal, forehead implants or brow lifts form another common group. In a Korean series of 15 patients treated in a single session, mean graft survival reached 80.7% at 12 months, with individual values between 70% and 90% (Yoo et al., 2019). The three neurosurgery scars in that series had the lowest average, at around 73%.

Stabilised scarring alopecia

Lichen planopilaris, frontal fibrosing alopecia and discoid lupus are grafted only once the disease is inactive, because a flare can destroy the implanted hairs. The required period varies between authors: at least one year without signs of activity for the Indian team, whose patients had in practice been stable for 3.6 years on average, and two to five years of stable disease for several others (Madura et al., 2020; Tan et al., 2024). According to a 2025 systematic review, graft survival of about 83% at 7 to 12 months then declines, falling below 40% between four and six years, with four disease reactivations among 123 patients (Yii et al., 2025).

The diagnosis and medical treatment of these conditions are covered in our article on scarring alopecia. Long-standing traction alopecia calls for the same reasoning once the follicles have gone.

Radiotherapy, a previous transplant and keloids: three special cases

Persistent hair loss after radiotherapy to the head needs an assessment coordinated with the oncology team, as explained in our article on hair transplant after cancer. Marks left by an earlier procedure, whether the line of an FUT strip or FUE extraction points, are discussed separately in our article on hair transplant scars.

A raised scar that spreads beyond the original wound may be a keloid. Making new wounds in this tissue can trigger a further scarring reaction, and this situation follows its own logic, set out in our page on keloids and hair transplant surgery.

Cause of the scar	Key point to assess
Extensive burn	Reduce the area first
Skin graft over bone	Enough tissue thickness
Surgery or accident	Maturity and suppleness
Scarring alopecia	Confirmed inactive disease
Radiotherapy to the head	Review with the oncologist
Keloid	Dermatology opinion first

A mature, stable scar comes first

A recent scar often stays red or pink for months, and repaired skin carries on remodelling for up to about two years after the injury (Plotczyk et al., 2023). Grafting a scar that is still pink exposes the incisions to bleeding that pushes the grafts out of their sites, whereas a mature scar, once pale, flat and supple, bleeds far less (Farjo et al., 2015). The UK team therefore advises waiting until the scar is as pale and soft as it is likely to become, even when the patient is keen to move quickly.

Published intervals give a sense of scale. The Korean team operated at least six months after the surgery that caused the scar, and the Indian team applied the same interval to secondary scars, on top of the period of inactivity required for primary forms (Yoo et al., 2019; Madura et al., 2020). In the Indian series, secondary scars were on average more than two years old at the time of grafting, which shows that these thresholds are minimums.

To document stability, dated photos taken in the same light a few months apart show whether colour, texture or size are still changing. Operation notes, letters from your burns service or from your dermatologist complete the file, particularly when the scar results from a disease.

Blood supply: what decides whether grafts take

A follicular unit is a tiny piece of skin with modest metabolic needs, which allows it to settle into a scar. The blood supply of a mature scar still varies widely from one patient to another and needs assessing before the procedure (Farjo et al., 2015; Yoo et al., 2019). That supply sets how much hair a single session can add.

Packing too many grafts closely into a scar can reduce blood flow further and cause skin necrosis (Farjo et al., 2015). Published densities are therefore adapted to the tissue: around 35 follicular units per cm² for surgical scars treated more than six months after the original operation, and 20 to 25 per cm² in a series dominated by traumatic scars (Yoo et al., 2019; Madura et al., 2020).

The thickness of the tissue matters as much as its blood supply. A thin atrophic scar offers only a shallow bed, where grafts have to sit at a very acute angle, while a thick fibrous scar needs wider and deeper incisions, otherwise a graft placed too superficially is pushed out (Yoo et al., 2019; Madura et al., 2020). The Indian team also avoided adrenaline in the local anaesthetic for the scarred area, so as not to narrow the vessels further.

Preparing the scar before transplant

A thick, stiff or depressed scar can be prepared in advance. In the Indian series, 38% of patients first had sessions of fractional laser, sometimes combined with steroid injections into the scar, to soften it and reduce its thickness (Madura et al., 2020). Injections of the patient’s own fat are also being tried to build up some tissue beneath a very thin scar, with variable results so far (Farjo et al., 2015). These steps lengthen the timeline and are decided case by case.

Which technique works in scar tissue?

Harvesting by FUE, which extracts each follicular unit individually using a small punch, is the usual choice. It suits scattered scars and scalps left tight by burns, where removing an FUT strip would limit the number of grafts and could widen the donor scar, or even make it hypertrophic, because of the tension needed to close it (Farjo et al., 2015; Madura et al., 2020). Each stage of the method is described in our FUE hair transplant guide.

At implantation, grafts are placed into incisions made in advance or inserted with an implanter that creates the incision at the same moment, as in DHI. The final appearance owes far more to the angle, direction and density chosen for each graft than to the harvesting method (Farjo et al., 2015). On a scar, the surgeon continues the direction of the neighbouring hair, which the injury interrupted, to help the treated area blend with the rest.

The procedure is carried out under local anaesthetic, preceded at Body Expert by needle-free pre-anaesthesia for comfort. Its length depends mainly on the number of grafts: from 30 minutes to five and a half hours in the Korean series, with an average of just under two hours (Yoo et al., 2019).

Test grafting: what does a small first session show?

When it is unclear how a scar will respond, a test graft on a small area lets the team observe regrowth before committing a large part of the donor supply. The Indian team used one in every patient with primary scarring alopecia, to check that the disease stayed quiet, and in doubtful secondary scars, to judge graft take (Madura et al., 2020).

The test shows whether the scar can nourish a small number of grafts and whether any local reactivation appears in the following months. It only partly reproduces a full session, which is denser and covers more ground, and a good result over a few square centimetres leaves some uncertainty for the rest of the scar.

Reading the result takes several months, while the implanted hairs shed and then regrow. For a patient having surgery abroad, a test therefore means two trips separated by a good part of the year. If your scar falls into this category, that timing constraint is worth raising with our team as soon as you request a quote.

One, two or three sessions: how is coverage planned?

On a scar surrounded by dense hair, the contrast is more visible than in pattern baldness, where density fades gradually. Hiding the area completely therefore often takes several passes: for large burned areas, the UK team estimates that at least three procedures are needed to imitate normal density, and that a full programme can extend over five years or more (Farjo et al., 2015).

Small scars are more often treated in one go. In the Indian series, where the moustache accounted for more than half of the cases and the average was 131 grafts, 84% of patients had a single session, 14% had two and one patient had three; an additional session could be scheduled 8 to 12 months after the first (Madura et al., 2020). The 15 Korean patients, whose surgical scars measured from 1.2 to 130 cm², were all treated in one session (Yoo et al., 2019).

The Body Expert package does not cap the number of grafts, but on a scar the amount implanted at once depends on what the tissue can supply with blood, and each further session means a new stay. Between procedures, hair fibres or micropigmentation can reduce the contrast between the pale scar and the surrounding hair (Farjo et al., 2015).

What results can you expect from a scar hair transplant?

Published figures describe selected patients and very different scars. On surgical scars, mean survival of 80.7% at one year remains below the roughly 90% the same team sees on healthy scalp, while the UK team reports survival ranging from 0 to 90% from its experience of more than 100 burn cases (Yoo et al., 2019; Farjo et al., 2015). The gap between these figures reflects how unpredictable scar tissue is, which is why no percentage can be promised for a particular scar.

Regrowth follows the usual pattern of a transplant, with shedding of the implanted hairs in the first weeks and then gradual growth, stages set out in our hair transplant timeline. On a burn scar, transplanted hairs can take up to 18 months to mature, so the result is judged late (Farjo et al., 2015). In primary scarring alopecia, it also needs long-term monitoring, since graft survival tends to fall over the years.

Complications are mainly cosmetic, the most common being density judged insufficient, while infection and skin necrosis are rare (Farjo et al., 2015). Two patients out of 50 saw their scar thicken after the transplant in the Indian series (Madura et al., 2020). Spreading redness, increasing pain, pus or a fever are reasons to contact the medical team promptly.

Can a transplant change the scar itself?

A pilot study at Imperial College London implanted growing follicles into the FUT donor scars of three men, all at least four years old, then followed these scars with biopsies for six months. The outer layer of skin thickened, cells and blood vessels in the dermis became more numerous, and collagen reorganised into less dense, less aligned fibres (Plotczyk et al., 2023). In a fourth patient, whose scar came from a skin graft with no surrounding follicles, the effect was only temporary. These observations open a line of research into scar remodelling, which needs confirming in larger groups before any benefit can be expected for a given scar.

Frequently asked questions

Is a bald patch always a scar?

A bald patch does not always correspond to an old scar, and an inflammatory scalp disease can go unnoticed in its early stages. When the appearance of the area, persistent itching or the history of the hair loss leaves any doubt, a dermatologist’s opinion and sometimes a biopsy establish the diagnosis before any decision is made (Tan et al., 2024). This step matters because surgery can trigger a flare of alopecia areata or lichen planopilaris, even when the condition seemed well controlled.

Can scars in the beard or eyebrows be grafted?

Yes, the same principles apply to the face. Burn scars in the beard, moustache or eyebrows can receive grafts, and for the beard, beard hairs harvested by FUE give the closest match, although scalp hair can also be used (Farjo et al., 2015). In the Indian series, the moustache was in fact the most frequent site (Madura et al., 2020). Our page on beard transplant in Turkey describes this procedure.

What if a transplant isn’t possible?

Too small a donor supply, a disease that is still active or skin that is too thin can rule out a transplant. Large scars are then first a matter for reconstructive surgery, with excision, tissue expansion or flaps, and several non-surgical options remain: coloured powders and fibres, scalp micropigmentation, hairpieces or hair systems (Farjo et al., 2015). These options can also help during the wait before a transplant.

Planning your scar hair transplant with Body Expert

For a first opinion, send clear photos of the scar, close up and from a distance, as well as of your donor area, with the cause of the injury, its date and any treatment already received. If the scar comes from a scalp disease, include the diagnosis and the latest letter from your dermatologist. These details allow the medical team at our partner clinic to say whether a transplant can be considered now, whether it is better to wait or prepare the scar, and how many sessions seem realistic.

In the UK, as in other publicly funded health systems, hair transplantation for burn scars is often unavailable, and patients who can afford it are usually treated privately (Farjo et al., 2015). With Body Expert, the review of your file leads to a free quote within 24 hours, with no obligation. Your hair transplant in Istanbul includes a 5-star hotel, VIP transfers between the airport, hotel and clinic, a dedicated English-speaking patient coordinator and a 12-month post-operative follow-up, carried out remotely, which helps you track regrowth in the scar and decide with the team on any further session.

Sources

Farjo, B., Farjo, N., & Williams, G. (2015). Hair transplantation in burn scar alopecia. Scars, Burns & Healing, 1, 2059513115607764. https://doi.org/10.1177/2059513115607764

Madura, C., Vinay, N., Kusuma, M. R., Harsha, S., & Chandrashekar, B. S. (2020). The assessment of hair transplantation outcomes in cicatricial alopecia. International Journal of Trichology, 12(4), 164-167. https://doi.org/10.4103/ijt.ijt_52_19

Plotczyk, M., Jiménez, F., Limbu, S., Boyle, C. J., Ovia, J., Almquist, B. D., & Higgins, C. A. (2023). Anagen hair follicles transplanted into mature human scars remodel fibrotic tissue. npj Regenerative Medicine, 8(1), 1. https://doi.org/10.1038/s41536-022-00270-3

Tan, M., Yong, A. A., & Wang, E. C. E. (2024). Hair restoration surgery: Pre-surgical considerations and pitfalls. Plastic and Aesthetic Research, 11, 30. https://doi.org/10.20517/2347-9264.2023.138

Yii, V., Moussa, A., Triwongwaranat, D., Smith, B. R. C., & Bhoyrul, B. (2025). A systematic review of follicular unit graft survival rates after hair transplantation in primary cicatricial alopecia. Dermatologic Surgery, 51(11), 1052-1057. https://doi.org/10.1097/DSS.0000000000004707

Yoo, H., Moh, J., & Park, J.-U. (2019). Treatment of postsurgical scalp scar deformity using follicular unit hair transplantation. BioMed Research International, 2019, 3423657. https://doi.org/10.1155/2019/3423657