The Association of Frontal Alopecia with a History of Facial and Scalp Surgical Procedures

<b><i>Introduction:</i></b> The prevalence of frontal fibrosing alopecia (FFA) is increasing worldwide, though the pathogenesis remains unknown. Anecdotal reports describe alopecia occurring in an FFA pattern following facial surgical procedures, but this potential link remains unexplored. <b><i>Objective:</i></b> The objective of this study is to determine if a significant association exists between the diagnosis of FFA and a history of facial and scalp surgical procedures. <b><i>Methods:</i></b> This retrospective study comparing data from frontal alopecia patients to controls was conducted at a tertiary medical center. Additionally, a literature review was conducted on scarring alopecias occurring from scalp procedures. <b><i>Results:</i></b> Fifty percent of frontal alopecia patients (<i>n</i> = 54) reported a history of facial surgical procedures compared to 9.8% of controls (<i>n</i> = 51) (OR: 7.8 [95% CI: 2.77–25.98, <i>p</i> &#x3c; 0.001]). Although no significant differences were observed in current daily facial sunscreen use, sunscreen use prior to alopecia onset was significantly higher in frontal alopecia (<i>p</i> = 0.295; <i>p</i> = 0.021). Sunscreen use was not a significant modifier in the association between frontal alopecia and facial surgical procedures (<i>p</i> = 0.89). <b><i>Conclusions:</i></b> A significant association exists between frontal alopecia clinically consistent with FFA and a history of facial surgery, the nature of which is unclear. The role of sunscreen use and frontal alopecia development in this setting needs to be better elucidated.