2026 中国专家共识：继发性瘢痕性脱发的植发治疗 Hair transplantation for secondary cicatricial alopecia A Chinese expert consensus

Accepted:8July2026

Received:14February2026

DOI:10.111/jdv.70644

CONSENSUSSTATEMENT

JEADV

Hairtransplantationforsecondarycicatricialalopecia:AChineseexpertconsensus

YingjieZhao||JiaxianZhang²|JuanChen³|XueChen⁴|ZhexiangFan¹|

ZhenyuGong⁵ZhenheGuo⁶|ChaofeiHan’|WenjieJiang⁸|MeiLi⁹|

XinfengLi¹⁰|YufeiLil¹|PeihuaLiu¹²|ZhenxingWang³|JipingWang¹⁴1WeiWu¹⁵HuaXian¹⁶|XiangXie¹⁷|PingXue⁸|DingquanYang¹⁹|

WeiqiYang²⁰|DongyiZhang²¹|JufangZhang²²YujinZhang²³|GangZhou²⁴

WeiZhou²⁵|ZhiqiHu¹D|WenyuWu²⁶D|YongMiao¹D

Correspondence

YongMiao,DepartmentofPlasticand

AestheticSurgery,NanfangHospital,

SouthernMedicalUniversity,Guangzhou510515,China.

Email:miaoyong123@

WenyuWu,DepartmentofDermatology,

HuashanHospital,FudanUniversity,

ShanghaiInstituteofDermatology,Shanghai,200040,China.

Email:wenyu_wu@

ZhiqiHu,DepartmentofPlasticandAestheticSurgery,NanfangHospital,SouthernMedicalUniversity,Guangzhou510515,China.

Email:huzhiqidr163@

Fundinginformation

theNationalNaturalScienceFoundationofChina,Grant/AwardNumber:82372538

Abstract

Background:Secondarycicatricialalopecia(SCA)causespermanenthairlossandsubstantialpsychosocialburden,andreconstructiveoptionsremainlimited.Hairtransplantation(HT)isincreasinglyusedforselectedpatients,butoutcomesvarybecauseofimpairedvascularity,fibrosisandheterogeneousscarcharacteristics,andstandardizedperioperativeguidanceislacking.

Objectives:Todevelopevidence-basedexpertconsensusstatementsaddressingdi-agnosis,patientselection,perioperativemanagementandoutcomeassessmentofHTinpatientswithSCA.

Methods:ThisconsensuswasdevelopedusingamodifiedDelphiapproach.Asteer-ingcommitteeofthreeseniorphysicianswithexpertiseinHTandSCAdesignedthestudyandcoordinatedtheprocess.AtargetedliteraturesearchwasconductedfromdatabaseinceptiontoOctober2025toidentifykeystudiesgradedaccordingtotheOxfordlevelsofevidenceandtheGRADEframework.Apanelof27dermatologistsandplasticsurgeonsfromacrossChinaparticipatedintworoundsofanonymousvotingandprovidedstructuredfeedback.Draftstatementsweregenerated,itera-tivelyrefinedandfinalizedbasedonexpertfeedback.Agreementwasassessedusinga5-pointLikertscale,withconsensusdefinedasstrongagreement(≥75%)andweakrecommendationsdefinedas70%-74%agreement.

Results:Consensuswasachievedon1lstatements.SCAwasdefinedasirreversiblehairlosssecondarytoexternalinsults,requiringconfirmationofdiseasestabilityandexclusionofprimarycicatricialalopeciabeforesurgery.ConsensusconsistentlyemphasizedthatsuccessfulHTreliesonappropriatepatientselectionbasedonetio-logicdiagnosisandscarcharacteristics,combinedwithindividualizedsurgicalstrat-egiesandstandardizedpostoperativecaretooptimizegraftsurvivalandaestheticoutcomes.Postoperativeadjunctivetherapiesmaybeconsideredinselectedcases,althoughevidenceremainslimited.

Conclusions:ThisDelphiconsensusprovidesastructured,evidence-informedframeworkforHTinSCA,aclinicallychallengingconditionthatlacksstandardized

YingjieZhaoandJiaxianZhangcontributeequallytothiswork.

Foraffiliationsrefertopage8.

◎2026EuropeanAcademyofDermatologyandVenereology.

Allrightsreserved,includingrightsfortextanddataminingandtrainingofartificialintelligencetechnologiesorsimilartechnologies.

JEurAcadDermatolVenereol.2026;00:1-10./journal/jdv

HTEORSECONDARYCICATRICIAL.ALOPECIA

perioperativemanagement.Bystandardizingevaluationandmanagement,theserecommendationsaimtoimproveclinicaloutcomeswhileidentifyingprioritiesforfutureresearch.

KEYWORDS

follicularunitexcision,hairloss,hairtransplantation,perioperativemanagement,scarringalopecia,secondarycicatricialalopecia

INTRODUCTION

Cicatricialalopeciaencompassesagroupofdisorderscharacterizedbyirreversibledestructionofhairfolliclesandreplacementwithfibrotictissue.Basedonaetiology,itisclassifiedasprimarycicatricialalopecia(PCA)orsecondarycicatricialalopecia(SCA).Inprimaryforms,immune-mediatedinflammationtargetsthefollicu-larunit,whereasSCAresultsfromexternalinsultssuchasburns,trauma,radiation,infectionorsurgicalinjury,leadingtopermanentfollicularlossandscarring.,2

SCAcausesvisibledisfigurementandisfrequentlyasso-ciatedwithsubstantialpsychosocialburden.Asfolliculardestructionisirreversible,medicaltherapyofferslimitedbenefit.Traditionalreconstructiveapproaches,includingscarexcision,tissueexpansionandlocalflaptransfer,maypartiallyrestorecoveragebutoftenyieldsuboptimalcos-meticoutcomes,includingunnaturalhairdirectionanddensitymismatch.³

Advancesinhairtransplantation(HT),includingrefinedmicrosurgicaltechniques,instrumentationandperiopera-tivecare,havesubstantiallyimprovedgraftsurvivalinthenon-scarredscalp.⁴However,transplantationinscartissueremainstechnicallydemanding.Fibrosis,reducedvascular-ityandalteredtissueelasticityrequirecomprehensivepre-operativeassessment,meticuloussurgicalplanning,tailoredimplantationstrategiesandstructuredpostoperativeman-agementtooptimizeoutcomes.-

High-qualityevidencetoguideclinicalpracticeinSCAislimitedbydiseaseheterogeneity,ethicalandpracticalconstraintsonrandomizedtrials,andtherelativerar-ityofeligiblepatients.Inthiscontext,arigorouslycon-ductedDelphiconsensususingtransparentmethodologyrepresentsapragmaticapproachtosynthesizingavailableevidencewithclinicalexperience.Thisexpertconsensusaimstoprovidestructured,evidence-informedrecommen-dationsforthediagnosis,perioperativemanagementandoutcomeassessmentofhairtransplantationinsecondarycicatricialalopecia.

MATERIALSANDMETHODS

Expertrecruitment,panelstructureandroles

Toensuremethodologicaltransparency,theconsensuspro-cesswascoordinatedbyasteeringcommittee.Allinvitedexperts,exceptthewritinggroup,participatedinvoting

WhyWasThisStudyUndertaken?

Hairtransplantationforsecondarycicatricialalo-peciaremainstechnicallydemanding,withincon-sistentoutcomesandnostandardizedperioperativeframeworktoguideclinicaldecision-making.

WhatDoesThisStudyAdd?

UsingastructuredDelphiprocess,thisstudyde-velopedconsensus-based,clinicallyactionablerec-ommendationslinkingscarassessmenttosurgicalstrategy,includingtechniquemodificationsandstagedinterventions.

WhatAretheImplicationsforClinicalPractice?

Thisframeworktranslatesheterogeneousexperi-enceintoreproduciblepractice,enablingmorereli-ablepatientselection,improvinggraftsurvivalandsupportingsafer,morepredictableoutcomesinahigh-riskreconstructivesetting.

anditerativefeedback.Specifically,thesteeringcommitteewasresponsiblefordefiningthestudydomainandclini-calquestions,developingthemethodologicalframework,supervisingevidencesynthesis,selectingtheinitialstate-ments,coordinatingtheDelphiprocessandadjudicatingdisagreements.Theinitialsetofstatementswaspredefinedbasedonclinicalquestionsidentifiedbythesteeringcom-mittee,ratherthangenerateddenovoduringtheDelphiprocess.Allpanellists,exceptthewritinggroup,contrib-utedtoanonymousvotingandstatementrevisionacrossrounds.Panellistswereselectedbasedonpredefinedcri-teria,including≥10yearsofclinicalexperienceinhairtransplantation,authorshipofpeer-reviewedpublicationsandrepresentationfrombothdermatologyandplasticsur-gery.ExpertsfrommultipleregionsofChinawereincludedtoenhancethediversityofclinicalperspectives.Awritinggroupconductedthetargetedliteraturereview,supportedthesteeringcommitteeandrevisedthemanuscriptac-cordingtofeedback.Thesteeringcommitteeparticipatedinvotingunderthesameanonymousconditionsasotherpanellistsanddidnothavedisproportionateinfluenceontheconsensusoutcomes.Allpanellistscontributedtotheevaluationandrevisionofthestatements,andauthorship

ZHAOETAI.3

wasassignedbasedonactiveparticipationintheconsensusprocess.

Evidencecriteria

AtargetedliteraturereviewwasperformedusingPubMedandWebofSciencefromdatabaseinceptiontoOctober2025.SearchtermsareprovidedinTableS1.Amanualsearchwasalsoperformedtoidentifyadditionalrelevantreferences.Titlesandabstractswerescreenedindepen-dentlybythewritinggrouptoidentifypotentiallyrelevantstudies.Full-textarticleswerethenassessedforeligibil-itybythesteeringcommitteebasedonclinicalrelevance(FigureS1).Prioritywasgiventohigherlevelsofevidence,includingsystematicreviews,randomizedcontrolledtri-alsandprospectivecohortstudies.EvidencequalitywascomprehensivelyassessedusingtheOxfordCentreforEvidence-BasedMedicinecriteria,andrecommendationstrengthwasgradedaccordingtotheGRADEframework(TablesS2andS3).8-10

Giventhelimitedavailabilityofhigh-levelevidenceinthisfield,well-designedcaseseriesandtechnicalreportswerealsoincludedwhendirectlyinformingclinicalprac-tice.Discrepanciesbetweenscreenerswereresolvedthroughdiscussionwiththesteeringcommittee.Asthiswasatar-getedliteraturereviewdesignedtosupportconsensusdevel-opment,evidencewasappraisedbasedonstudydesignandclinicalapplicabilityratherthanexhaustiveincorporationofallstudieseligibleforaspecificsearchterm.

RESULTS

All29invitedexpertsparticipatedintheconsensusde-velopmentprocess.Excludingthewritinggroup,27pan-ellistsparticipatedinformalvoting,yieldingaresponserateof100%inbothDelphirounds.Thepanelcomprisedmultidisciplinaryspecialistsinhairtransplantationandcicatricialalopeciafrom26centres,includingbothplas-ticsurgeonsanddermatologists.Atotalof11predefinedclinicalquestionswereconvertedinto11consensusstate-mentsbasedonthetargetedliteraturereview(TableS4).AllstatementswereevaluatedandrefinedovertwoDelphirounds.Tenstatementsachievedstrongconsensus(≥75%agreement)andwereretainedasformalrecommendations.Onestatementreachednear-consensus(73%)andwasclas-sifiedasaconditionalrecommendation.Thehighestagree-mentacrosstheDelphiroundswasobservedforstatementsrelatedtopreoperativediagnosisandevaluation,patientselection,intraoperativestrategy,postoperativecareandoutcomeassessment.Incontrast,postoperativeadjunc-tivetherapiesshowedcomparativelyloweragreement.Revisionsbetweenroundsprimarilyinvolvedclarificationofwording,refinementofclinicalscopeandalignmentwithavailableevidence.Nostatementswereremoveddur-ingtheprocess,asallwereconsideredclinicallyrelevant.AdetailedsummaryoftheDelphivotingprocessispresentedinTableS5.

DISCUSSION

VotingprocedureandDelphirounds

TheconsensusprocessfollowedamodifiedDelphiapproachandwasconductedbetweenDecember2024andSeptember2025inaccordancewithACCORDrecommendations.Atotalof11preliminaryclinicalstatementsweredevelopedbythesteeringcommitteebeforevoting.Inthefirstround,panellistsindependentlyreviewedthedraftstatements,votedandprovidedstructuredfeedback.Avirtualmeetingwassubsequentlyconvenedtodiscusseachitemindetail,focusingonareasofdisagreement,clarificationofwordingandrefinementofclinicalscope.Basedonthesediscussions,statementsthatdidnotachieveconsensusinRound1wererevisedandcirculatedforasecondroundofvotingusingastructuredquestionnaire.Thosefailingtoreachconsensusafterrevisionwereexcluded.

Votingwasconductedanonymouslyusinga5-pointLikertscale(rangingfromstronglydisagreetostronglyagree).Consensuswaspredefinedas≥75%agreementordisagree-ment.Statementsreachingthisthresholdwereconsideredformalconsensusrecommendations.Statementsthatdidnotreachthepredefinedthresholdbutachievednear-consensus(70%-74%agreementordisagreement)wereretainedasweakrecommendationsduetotheirclinicalrelevanceandlow-riskprofile,withwordingadjustedtoreflectuncertainty.

Thisconsensusstatementaddresses11clinicallyrelevantquestionscoveringkeyaspectsofHTforSCA,includingpa-tientselection,perioperativeplanning,surgicaltechniqueandpostoperativemanagement.Ratherthanprovidinganexhaustivenarrativereviewoftheliterature,thefollowingsectionspresentthefinalizedconsensusstatementstogetherwiththekeyevidenceandclinicalconsiderationsthatin-formedpanelagreement(Table1).Moreover,adiagnosisandmanagementalgorithmissummarizedinFigure1.

Preoperativediagnosis

Threecaseseries,-¹³togetherwithcollectiveclinicalexpe-rience,consistentlysupportedthevalueofclinicopathologiccorrelationinestablishingthediagnosis.Buildingontheavailableevidence,thepaneldefinedastepwisediagnosticapproach.Incaseswithaclearhistoryofexternalinsultandaconcordantphysicalexamination,thediagnosiscanbees-tablishedclinically,withdermoscopyservingasasupportivetool.Dermoscopyisrecommendedasafirst-linetoolwhentheaetiologyisuncertain,whentheconditionmaycoexistwithotherhairlossdisorders,orwhendifferentiationfromPCAisrequired.TypicaldermoscopicfeaturesofSCAin-cludeabsentfollicularopenings,whitescarringareasandreducedvascularization.

HTFORSECONDARYCICATRICIALALOPECIA

TABLE1Expertconsensusrecommendationsforhairtransplantationinsecondarycicatricialalopecia.

Diagnosis

1.SCAisidentifiedbyaclearhistoryofextemalinsult.TypicaldermoscopicfeaturesofSCAincludeabsentopeningsofhairfolices,whitescaringareas,andreducedvascularization.

2.Clinicaldiagnosiscansuficewhenaclearextemalcauseandphysicalexaminationarepresent,withdermoscopyusedasasupportivetool.Dermoscopyisrecommendedasafirst-linetoolwhentheetiologyisuncertain,whendifferentiationfromPCAisrequired,orwhenSCAmaybeconcomitantwithotherhairlossdisorders.Foruncertaindermoscopyindings,histopathologyisrecommendedasasecond-linetoolfordiagnosticallyuncertaincases.

Preoperativeevaluation

1.AcomprehensiveassessmentofSCAduration,site,size,thickness,elasticity,vascularity,andconcomitantdiseasesshouldbeperfomed.

2.Thesizeofthedonorareaandthenumberofhairfolliclesavailableshouldbeevaluated.

3.Individualizedsurgicalplanning(proceduralsessions,graftnumber,implantationtechnique,anddensity)isessential.

Indications

HTisindicatedforSCA(e.g,scalp,eyebrows,beard,eyelashes,andbodyregions)withnocontracture,hyperplasia,redness,sweling,orruptureof

scarsintheprevious6months,andintheabsenceofrecurrentcausativefactors.

Absolutecontraindications

Activeorunhealedscars;inflammatory,infectious,ulcerative,neoplastic,orautoimmunediseaseswithinthescaringarea;severesystemicilnes,includinginfection,diabetes,unstablecardiovascularandcerebrovasculardiseases,coagulationdysfunction,andimmunedeficiency;pregnantorlactatingwomen;adherentbonescarsorkeloids.

Relativecontraindications

Excessivelythick,hard,thin,orpoorlymobilescars;animplant(cranialrepairmaterial)underthescarcarriesagreaterrisk;inadequatedonorarea

andgraft;patientswithpsychologicaldisorders,mentalillness,orhigh/unrealistic/unreasonableexpectations;ifhypertrophicscarringoccursatthe

SCAsite,HTshouldbeconsideredafter2yearsofstability;patientswhoaretoooldortooyoungtotolerateorcooperatewithsurgeryandpostopera-tivecare.

Preoperativeadjunctivetherapy

Preoperativeadjunctivetherapyisrecommendedforpoorlyvascularized,rigid,oratrophicscars;fatgrafting,scarexccision,scalpexpansion,flaptrans-fer,orfractionallasertherapymaybeperformed3-6monthsbeforeHTtooptimizetissueconditions.

Anesthesiamanagement

Localinfiltrationandnerveblockanesthesiaarepreferred,whileintravenousanesthesiaisadministeredaccordingtothespecificclinicalsituation.ifbleedinginthesurgicalareaisminimal,epinephrinemaybeomittedfromthetumescentsolution;ifepinephrineneedstobeadded,theconcentrationshouldnotexceed1:400,000.

Donorharvesting‘

1.ChooseFUEorFUTbasedonscarcharacteristics,donoravailability,andpatientaestheticneeds.

2.Duringgraftharvesting,thetissuearoundthehairfolicleshouldbepreservedasmuchaspossible,andgraftsshouldbekeptatalowtemperatureandamoiststatethroughouttheprocess.

Recipientsitecreation

1.Forfirmthickscars,premadeincisionsusingbladesareprefered;forsof/thinscars,stick-and-placeorimplanterpentechniquesaresuitable.

2.Recommendeddensity:35-45FU/cm²forgoodelasticityandwell-vascularizedareas,and20-35FU/cm²forpoorareas.

Postoperativecare

1.Beginsalinecleansingwithin1-2days;gentleshampooafterday3withoutrubbingtherecipientarea;scabremovalwithin7-10days.

2.Avoidtouch/frictionintherecipientarea,strenuousexercise/labor,combinghair,tighthats,alcohol,smoking,orspicyfoodfor1week.Complicationprevention

Monitotherecipientareafoischemia,folicuitis,erythema,orinfecion.managepromplywithwound-healingagents,vasoactivedrugs,anibiotics,orsymptomatictreatmentasappropriate.

Outcomeevaluation

1.Assessgraftsurvivalrateat12months.

adjustmentofthesurgicalplan;ifacceptable,buttheimplantationdensityislow,secondaryorevenfurtherHTprocedurescanalsobe

2.Iflowerthanexpected,thescarbloodsupplyshouldbere-evaluated,andsecondaryHTshouldbeconsideredafteradjuvanttherapyor

considered.

Postoperativeadjunctivedrugtherapy

Topicalminoxidil,PRP,orgrowthfactors(e.g.,FGF)mayenhancegraftsurvivalandhairgrowth,thoughevidenceremainslimited

Abbreviations:FGF,Fibroblastgrowthfactor;FU,Follicularunit;FUE,Follicularunitexcision;FUT,Follicularunittransplanation;HT,Hairtransplantation;PRP,Platelet-richplasma;SCA,Secondarycicatricialalopecia.

Thetechnicalrecommendationssummarizedinthistableareprimarilybasedonthescalparea.Keyproceduralparametersmayrequireadjustmentwhenapliedtonon-scalpareas.

Thisstatementreachedborderlineagreement(73%)andisthereforeconideredaconditionalrecommendation.

Specifically,SCAistypicallyidentifiedbyaclearhistoryofexternalinsult,includingtrauma,burns,infection,radiation,medicationexposureorcongenitalandgeneticconditions.4Incontrast,PCAischaracterizedbyimmune-mediatedfol-liculardestruction,whereasAGApresentswithprogressiveminiaturizationorhairlossaffectingtheforeheadand/orcrown,accompaniedbyapositivefamilyhistory.

Histopathologicalexaminationshouldbereservedfordiagnosticallyuncertaincasesondermoscopy,particularly

whenPCAcannotbeexcluded.Typicalhistopathologicalfea-turesofSCAincludeextensivefibrotictissue,accompaniedbytheabsenceofskinappendagesandreducedvascularity.

Preoperativeevaluation

Consensuswasreachedthatcomprehensivepreoperativeevaluationshouldextendbeyondscarmorphologytoinclude

ZHAOETAL.

Patientwith

alopecia

Diagnosis

·Medicalhistory(causeofdisease)

·Physicalexamination(localizedscar,alopecia)

ConfirmedNoDermoscopyand/or

SCA?histopathology

Yes

Scarexcisionorexpanded

flapreconstruction

Insufficient

donorarea

Preoperativeevaluation

·Recipient-areasize,vasculaity,elasticity,thickness

·Donor-areasite,graftnumberandquality

·Individualizedsurgicalplanning

Poorblood

supplyFatgraftingand/or

lasertherapy

Recipient

areareduction

Bloodsupplyimprovement

Premadeincision

Implantationforfirmorthickscars

Hairtransplantation

·Localanesthesia(ifadded,epinephrneconcentrationnotexceeding1:400,000)

·Graftharvesting(FUTorFUEselection

basedondonorarearesourcesandpatientrequirements)

·Graftdissection(moisturizesthroughout)

·Implantation(adjustdensityaccordingtobloodsupply)

Implantationforsoftandthinscars

Stick-and-placeorimplanter

Postoperativecareandcomplicationprevention

·Routinecareafterhairtransplantation

·Symptomatictreatmentofcomplicationssuchasfolliculitis/ischemia

beconsidered(minoxidil,

Adjuvantdrugtherapymay

PRP,growthfactor,etc.)

Efficacyevaluation

(12monthspostoperatively)

·Folliclesurvivalrate(dermatology)

·Patientsatisfaction(FACE-Q/GAIS)

Yesbutinsufficientdensity

Highsurvival rate?

No

Longtermfollow-up

FIGURE1AdiagnosisandmanagementalgorithmforHTinSCA.

assessmentofvascularity,elasticity,thicknessandbalanceofthedonor-recipientarea.Fiverelevantstudies¹5-19informedthisdomain,includingscarassessmentscales,systematicre-viewsandclinicalseriesfocusingonSCA-relatedHT.

CommonlyusedtoolssuchastheVancouverScarScaleandthePatientandObserverScarAssessmentScalepri-marilyassesssurfacecharacteristics,vascularity,pig-mentation,thickness,surfacearea,surfacetextureand

6HTFORSECONDARYCICATRICIALALOPECIA

subjectivesymptomsofthepatient.15,16However,thepanelagreedthatthesetoolsaloneareinsufficientforsurgicalplanninginSCA.Evaluationshouldalsoincludeexam-inationofthesurroundingscalpforsignsofresidualin-flammationorinstability,suchasperifollicularscale,perifollicularerythema,pustules,crusting,telangiectasia,hairtufting,hypopigmentation,isolatedhairandepithelialabnormalities.

Recipient-sitevascularity,thicknessandflexibilitywereidentifiedascriticaldeterminantsofgraftsurvival.Scarsresemblingnormalskincolour,demonstratingmobilityandlackingfirmadherencetotheunderlyingsubcuta-neoustissue,wereconsideredmoresuitableforHT.Theneedle-pricktestwasalsoendorsedasanobjectivemethodtoassessperfusionbyobservingcapillarybleeding.⁷A20Gneedlewasinsertedatrandompoints1-2mmfromthecentreofthescartowardsthesurroundingareatoas-sesslocalbleeding.

Inaddition,donor-recipientareabalanceshouldbeas-sessedtoguidegraftnumberanddensity.8,19Thepanelagreedthatconservativedensityplanningandstagedpro-ceduresshouldbeconsideredwhendonorsupplyislimitedorrecipient-areaconditionsaresuboptimal,particularlyinpatientswithconcomitantAGA.

Indicationsandcontraindicationsforhairtransplantation

Basedonreviewoftheavailableevidenceandconsensusvoting,thepanelagreedthatstrictpatientselectionisfun-damentaltoachievingfavourableoutcomesinHTforSCA.Twelverelevantpublications,includingcaseseries,techni-calreports,proceduralstandardsandclinicalguidelines,informedthisdomain.19,22-32Consensusemphasizedscarstability,adequatelocalvascularityandacceptablesystemichealthascoreeligibilitycriteria.

ClinicalevidencesupportstheeffectivenessofHTinim-

provingcosmeticoutcomesacrossmultipleSCAsite9,i,c,-

ingthescalp,eyebrows,eyelashesandbeardregions.

However,giventhatthemajorityofavailableevidencerelatestoscalptransplantation,detailedtechnicalrecommendationsinthisconsensusareprimarilybasedonscalpprocedures,whereasotherrecipientsitesrequireindividualizedadapta-tionduetodifferencesinanatomicalstructure,vascularity,tissuecharacteristicsandaestheticrequirements.Moreover,thepanelsagreedthatHTshouldbedeferreduntilthescarhasremainedclinicallystableandinactiveformorethan6months,asprematureinterventionmaycompromisegraftsurvivalandincreasecomplicationrisk.³

Absolutecontraindicationswerederivedfromestab-lishedsafetyconsiderationsinHT,whereasrelativecon-traindicationsreflectedpatient-andsite-specificriskfactors(Table1fordetails).22-32Forpatientswithexten-siveSCAandinsufficientdonorsupply,alternativerecon-structivestrategiesorstagedandcombinedapproaches

shouldbediscussed,withpreoperativecounsellingtoalignexpectationswithachievableoutcomes.Inpaediatricpa-tients,reportedagerangesintheliteraturespanfrom4to17years.30-32ThepanelagreedthatHTshouldbeconsid-eredonlywhenthechildcansafelytoleratelocalorgeneralanaesthesiaandwhenpostoperativecareandl