Scarring alopecia presents a significant challenge in reconstructive hair transplantation due to the irreversible loss of hair follicles and the compromised quality of scar tissue. This chapter explores the classification, causes, and clinical manifestations of primary and secondary scarring alopecias, emphasizing the need for a multidisciplinary and regenerative approach to treatment. This chapter introduces guided SEFFI Stem & Vol, an advanced pre-transplantation technique that enhances the recipient area by utilizing adipose-derived stem cells (ADSCs) and stromal vascular fraction (SVF). These regenerative components play a crucial role in improving vascularization, trophism, and tissue flexibility, creating a more suitable environment for hair transplantation. The methodology is particularly beneficial in cases where scalp injuries result from trauma, burns, autoimmune conditions, radiotherapy, or surgical interventions.