Multimodal Reconstructive Treatment of the Face and Scalp Following Catastrophic Burn Injury: An Eight-Year Experience with Structural Fat Grafting, Follicular Unit Excision Hair Transplantation, and Scalp Micropigmentation

Background: Severe burn injuries involving the face and scalp have profound physical and psychosocial consequences, and represent the greatest reconstructive challenge in plastic surgery. One comprehensive solution involves the sequential application of autologous fat grafting, follicular unit excision (FUE) hair transplantation, and scalp micropigmentation (SMP); however, the long-term outcomes of this approach have rarely been documented. Methods: A male patient sustained catastrophic methane explosion burns at age 27, involving 79% total body surface area (TBSA) with full-thickness involvement of the face and scalp (Revised Baux Score 123; estimated mortality risk 50–80%). Following 65 reconstructive procedures at external institutions over six years, he was referred to our center at age 30. He presented with extensive facial and scalp scarring, complete absence of eyebrow, beard, and mustache hair, and widespread scalp alopecia. Over an eight-year period, the patient received 11 sessions of autologous FUE hair transplantation (7180 follicular units to the eyebrows, beard, and scalp), four sessions of structural fat grafting using the Coleman technique, and five sessions of SMP. Results: The patient achieved complete reconstruction of facial hair, a natural scalp hairline, and significant scar quality improvement. Conclusions: Our findings demonstrate that systematic, long-term multimodal reconstruction, i.e., combining fat grafting, FUE transplantation, and SMP, can yield clinically meaningful esthetic and psychosocial outcomes, even after the most catastrophic burn injuries.