Hair transplantation for secondary cicatricial alopecia: A Chinese expert consensus

BACKGROUND: Secondary cicatricial alopecia (SCA) causes permanent hair loss and substantial psychosocial burden, and reconstructive options remain limited. Hair transplantation (HT) is increasingly used for selected patients, but outcomes vary because of impaired vascularity, fibrosis and heterogeneous scar characteristics, and standardized perioperative guidance is lacking. OBJECTIVES: To develop evidence-based expert consensus statements addressing diagnosis, patient selection, perioperative management and outcome assessment of HT in patients with SCA. METHODS: This consensus was developed using a modified Delphi approach. A steering committee of three senior physicians with expertise in HT and SCA designed the study and coordinated the process. A targeted literature search was conducted from database inception to October 2025 to identify key studies graded according to the Oxford levels of evidence and the GRADE framework. A panel of 27 dermatologists and plastic surgeons from across China participated in two rounds of anonymous voting and provided structured feedback. Draft statements were generated, iteratively refined and finalized based on expert feedback. Agreement was assessed using a 5-point Likert scale, with consensus defined as strong agreement (≥ 75%) and weak recommendations defined as 70%-74% agreement. RESULTS: Consensus was achieved on 11 statements. SCA was defined as irreversible hair loss secondary to external insults, requiring confirmation of disease stability and exclusion of primary cicatricial alopecia before surgery. Consensus consistently emphasized that successful HT relies on appropriate patient selection based on etiologic diagnosis and scar characteristics, combined with individualized surgical strategies and standardized postoperative care to optimize graft survival and aesthetic outcomes. Postoperative adjunctive therapies may be considered in selected cases, although evidence remains limited. CONCLUSIONS: This Delphi consensus provides a structured, evidence-informed framework for HT in SCA, a clinically challenging condition that lacks standardized perioperative management. By standardizing evaluation and management, these recommendations aim to improve clinical outcomes while identifying priorities for future research.