Cosmetic Outcomes and Safety of Hair Transplantation and Topical Minoxidil for Temporal Triangular Alopecia: A Systematic Review
Abdulaziz AlRoujayeeABSTRACT
Background
Temporal triangular alopecia (TTA) is a non‐scarring alopecia affecting the frontotemporal region, with estimated prevalence of 0.11%. Despite recognized aesthetic and psychological impact, particularly among children and adolescents, no systematic evaluation has synthesized available evidence on its treatment.
Aims
This systematic review synthesizes and evaluates surgical and medical management of TTA, with emphasis on cosmetic outcomes, durability, and safety.
Methods
Following PRISMA 2020, a systematic search was conducted from inception to December 30, 2025 using PubMed, Web of Science, and Cochrane CENTRAL. Eligible studies reported cosmetic outcomes, adverse events, or patient satisfaction with hair transplantation or topical minoxidil for TTA.
Results
Nine studies met inclusion criteria ( n = 23 patients): three case reports of topical minoxidil and five case reports and one case series of hair transplantation (follicular unit transplantation or excision). Hair transplantation was associated with cosmetic improvement (20 patients, six studies), maintained up to 6 years in one case. Topical minoxidil (three cases) was associated with cosmetic improvement; relapse after discontinuation was reported in one case, with outcomes after discontinuation not assessed in the other two. Both interventions were associated with favorable safety profiles, with no serious adverse events across the included studies.
Conclusions
Topical minoxidil may be a non‐invasive option for pediatric patients or those preferring non‐surgical management, and hair transplantation for adults seeking durable cosmetic correction. These findings reflect low‐level evidence from case reports and a case series (Level IV, Oxford Centre for Evidence‐Based Medicine) and should be considered descriptive observations from a small evidence base. Given the scarce published evidence, higher‐quality prospective studies with longer follow‐up are needed, particularly in pediatric populations.