Fractional CO₂ Laser Before Follicular Unit Extraction Hair Transplantation With Platelet-Rich Plasma for Secondary Cicatricial Alopecia

Secondary cicatricial alopecia is characterized by permanent hair loss due to destruction of hair follicles following trauma, burns, infection, or other causes. Hair transplantation using follicular unit extraction (FUE) is an established treatment; however, graft survival may be limited by poor vascularity and fibrosis within scar tissue. Fractional carbon dioxide (CO₂) laser has been proposed to improve the recipient site by enhancing tissue remodeling and vascularization before transplantation. This prospective comparative clinical study evaluated the effect of three preoperative sessions of fractional CO₂ laser followed by FUE hair transplantation with intraoperative platelet-rich plasma (PRP) injection compared with FUE hair transplantation combined with intraoperative PRP alone in patients with stable secondary cicatricial alopecia. Twenty participants were allocated into two groups of 10 patients each and were followed for 9 months after hair transplantation. The primary objective was to determine whether preoperative fractional CO₂ laser improves the clinical outcome of FUE hair transplantation in secondary cicatricial alopecia. Outcomes included clinical improvement, dermoscopic assessment of hair growth, patient satisfaction, and scar assessment.

Inclusion Criteria: * Patients with stable secondary cicatricial alopecia. Male or female participants. Participants with realistic expectations regarding treatment outcomes. All hair types (silky, curly, or normal hair). Presence of an adequate donor site for follicular unit extraction (FUE). Ability and willingness to provide written informed consent. Exclusion Criteria: * Extremes of age. Chronic systemic diseases, including hepatic or renal disease. Receiving chemotherapy or systemic corticosteroid therapy. Platelet disorders or other blood disorders. Pregnancy or lactation. History of keloid formation. Scar duration less than 1 year. Absence of a suitable donor site for hair transplantation