Non-Surgical Treatments for Scarring Alopecia

In the case of patients who are not suited for surgery, we have a variety of non-surgical treatments that have been proven to help with scarring alopecia.

Scarring alopecia is a category of hair loss disorders that may comprise up to 3% of hair loss patients. Also known as cicatricial alopecia, it occurs in otherwise healthy men and women regardless of age. There are many forms of scarring alopecia, their shared feature is a potentially permanent and irreversible destruction of hair follicles, which is replaced with scar tissue (hence the name). Thankfully, due to the Ziering Medical team’s expertise, a diagnosis of scarring alopecia does not close the door on hair restoration. In the case of patients who are not suited for surgery, we have a variety of non-surgical treatments that have been proven to help with scarring alopecia. These include a custom combination of Scalp Micropigmentation to camouflage thinning or balding patches and Z-Factors to stimulate scalp and follicle regeneration.

What is Scarring Alopecia?

As a category of hair loss disorders, scarring alopecia encompasses a variety of specific diagnoses that are individually rare but as a whole comprise up to 3% of hair loss patients. The category includes conditions such as: 

  • Dissecting cellulitis
  • Eosinophilic pustular folliculitis
  • Follicular degeneration syndrome (known previously as “hot comb” alopecia)
  • Folliculitis decalvans
  • Lichen planopilaris
  • Pseudopelade of Brocq

Scarring alopecia may also be a component of larger conditions like chronic lupus erythematosus that affect the rest of the body. The shared feature of these conditions is their potential to permanently destroy hair follicles and leave scar tissue behind. Most of these conditions start out as small patches of hair loss that might expand in time. For some cases, the hair loss is gradual with no noticeable symptoms, allowing it to go unnoticed for a while. In other cases, the hair loss is accompanied by itching, burning pain, and progresses rapidly. Unlike alopecia areata the edges of scarring alopecia patches look ragged. As the destruction of hair follicles occurs below the surface of the skin, the scalp skin surface may not look that different aside from patchy hair loss. They can appear smooth and clean, or show redness and scaling, or even have blisters filled with fluids or pus. 

Diagnosis requires skin biopsies to determine the specific type of scarring alopecia. After this, specific treatments can be selected to best suit the particular condition. Lymphocyte inflammation of hair follicles require corticosteroids in topical creams or injections. For inflammations of neutrophils or other cell mixtures, treatment entails antibiotics and isotretinoin. After the condition has subsided, hair restoration treatment can then restore patients’ appearances. 

Scalp Micropigmentation for

Scarring Alopecia

One of the non-surgical methods we employ for patients with scarring alopecia, Scalp Micropigmentation is a tattooing technique using minute, metabolically inert pigment granules that we implant beneath the epidermis with artistic strokes. SMP mimics the short hair appearance of a closely shaved scalp. Scalp micropigmentation uses include:

  • Enhancing hair transplants
  • Aiding hair transplant repair procedures
  • Camouflaging linear scars
  • As alternative to hair transplant surgery

As it is used to create the look of thicker or denser hair, it is an excellent way to blend scars, hypogonadism or partial alopecia, or blending thinning areas into a patient’s natural hair.

All permanent cosmetic procedures will initially appear larger, brighter, or darker than what is expected for the desired final outcome. It will take time for this transition, based on how quickly the outer layer of the skin exfoliates. Ultimately, the procedure results will last 20 – 36 months varying on skin type and chemical products used daily on the scalp.

Scalp Micropigmentation is bio-absorbable by the immune system through phagocytosis in approximately 2 years.

Augmenting Treatment with Z-Factors

Z-Factors is a service at Ziering Medical that includes the administration of a protein-based injection into a patient’s balding and thinning areas to stimulate hair regrowth. It works as a stand-alone non-surgical hair restoration treatment option and also in combination with hair transplant surgery. We have also employed it for scarring alopecia patients. 

Z-Factors include rich biologically active growth factors with amniotic origin known to enhance tissue regeneration and speed wound healing. The two primary cell lines in the amnion are:

  • Human mesenchymal stromal cells (hMSC)
  • Human amnion epithelial cells (hAEC). 

Both of these cells are pluripotent stem cells or master cells that can potentially produce any cell or tissue the body needs to repair itself. The Z-Factor shot does not require any anesthesia and is typically a series of three (3) injections unless the extent of a patient’s hair loss and the size of the treatment zone does not warrant or require the full series. In this instance, one or two injections may suffice. Routine Z-Factor treatments may be required to maintain results.


For scarring alopecia patients, we can design customized treatment plans that include Scalp Micropigmentation and Z-Factors. This scarring alopecia treatment will cover thinning or bald patches as well as promote hair growth, resulting in 3-dimensional looking results with a more natural appearance. 

Interested to learn more about hair loss treatments at Ziering Medical? Reach out to Ziering Medical. We have clinics in Beverly Hills, California; Greenwich, Connecticut; and New York City, New York.