Lichen planopilaris following hair transplantation and face-lift surgery.

Cosmetic surgical procedures, including hair transplantation and face-lift surgery, are becoming increasingly popular. However, there is very little information regarding the associated development of dermatological conditions following these procedures. Lichen planopilaris (LPP) is an uncommon inflammatory hair disorder of unknown aetiology that results in permanent alopecia and replacement of hair follicles with scar-like fibrous tissue. Frontal fibrosing alopecia (FFA), a variant of LPP, involves the frontal hairline and shares similar histological findings with those of LPP. We report 10 patients who developed LPP/FFA following cosmetic scalp surgery. Seven patients developed LPP following hair transplantation, and three patients developed FFA following face-lift surgery. In all cases there was no previous history of LPP or FFA. There is currently a lack of evidence to link the procedures of hair transplantation and cosmetic face-lift surgery to LPP and FFA, respectively. This is the first case series to describe this connection and to postulate the possible pathological processes underlying the clinical observation. Explanations include Koebner phenomenon induced by surgical trauma, an autoimmune process targeting an (as yet, unknown) hair follicle antigen liberated during surgery or perhaps a postsurgery proinflammatory milieu inducing hair follicle immune privilege collapse and follicular damage in susceptible individuals.

Eyebrow reconstruction in dormant keratosis pilaris atrophicans.

A novel and successful case of eyebrow reconstruction, in dormant keratosis pilaris atrophicans, is presented. Keratosis pilaris atrophicans is a benign hereditary disorder of unknown aetiology. Grouped keratotic follicular papules and perifollicular erythema affect the cheeks and eyebrows, with a subsequent atrophic stage that results in scarring and alopecia. It often presents during early infancy with remission during adulthood. A 33 year old man presented with scarring and alopecia of the eyebrows and was followed over a total 4 year period during which reconstruction was achieved using individual hair follicle micrografts. Composite scalp grafts and flaps, more often than hair follicle micrografting techniques, are described in the literature for reconstruction of the eyebrows in a range of conditions. This case provides an encouraging example of successful micrografting in dormant inflammatory cutaneous disease.