Does Hair Grow Back After Aplasia Cutis Congenita?

While hair will not naturally grow back over the bald spot caused by aplasia cutis congenita (ACC), the area will heal into a smooth, permanent scar. We know this is a common long-term cosmetic concern for parents, but there are many simple ways to manage it right now, as well as effective options to camouflage or treat the area if your child chooses to do so when they are older.

Why Hair Doesn’t Grow Back

Aplasia cutis congenita means a congenital (present at birth) absence of skin ^[1]. In babies with ACC, one or more layers of the skin fail to form properly during pregnancy ^[2].

This missing tissue usually includes the deep layers of the skin that house hair follicles — the tiny, tube-like structures that produce and grow hair ^[3]. Because these follicles never developed in the affected area, the skin is physically unable to produce hair ^[4]. Even after the skin heals and closes over, it forms a type of scar tissue (cicatricial tissue) that remains permanently hairless ^[5].

Caring for the Spot Right Now

Once your baby’s pediatrician or dermatologist has confirmed the spot has fully healed over into a scar (usually through conservative management during infancy ^[6]), it becomes a stable but fragile area of skin.

Daily care is straightforward:

• Sun Protection: Because the scar does not have the same protective pigment or hair coverage as the rest of the scalp, it is highly sensitive to the sun. Always use a hat or apply baby-safe sunscreen to the spot when outdoors.
• Gentle Washing: You can wash the scalp and surrounding hair normally, using a gentle baby shampoo.
• Routine Checks: Simply keep an eye on the scar as your child grows, just as you would with any other birthmark.

Future Options for Camouflage and Treatment

It is important to know that treating the bald spot is entirely elective. ACC scars are primarily a cosmetic issue once healed. If you choose not to put your child through surgery, they will be perfectly healthy ^[7]. Many families simply use creative hairstyles, headbands, or hats to cover the spot during childhood. Later on, teenagers might explore non-surgical options like specialized hairpieces or scalp micropigmentation (a cosmetic tattoo that mimics hair follicles).

If your family does want to pursue medical treatment, doctors generally recommend waiting until the child is older (often around school age, 4 to 7 years old, or later in adolescence) so their scalp has grown and matured ^[8][9].

Surgical and cosmetic options include:

• Surgical Excision: For smaller bald spots, a surgeon can completely remove the scarred area and stitch the edges of the normal, hair-bearing scalp together, leaving only a thin, hidden line ^[2][10].
• Tissue Expansion: If the bald spot is large, doctors can use a technique called tissue expansion ^[11]. Small medical balloons (expanders) are placed under the healthy, hair-bearing scalp next to the scar. Over a period of weeks, these are slowly filled with saline to stretch the skin ^[12]. Once enough extra skin is created, the surgeon removes the bald scar and stretches the new hair-bearing skin over the gap to achieve a seamless result ^[11].
• Hair Transplantation: A surgeon can take individual hair follicles from healthy parts of the scalp and transplant them directly into the scar ^[13]. Because scar tissue does not have the best blood supply, doctors sometimes combine this with fat grafting — injecting a small amount of the patient’s own fat into the scar to improve skin quality and help the new hair follicles survive and thrive ^[14][15].