Background: One of the most successful treatments for secondary cicatricial alopecia worldwide is hair transplantation, which restores irreversible hair loss and profoundly changes the patient's life. This study aimed to evaluate the role of nanofat injection before hair transplant and in Improving the survival rate of hair grafts after transplantation with follicular unit extraction technique in restoration of hair in secondary cicatricial alopecia. Methods: Randomized clinical study was conducted on 18 patients with cicatricial alopecia in the scalp, beard or moustache. Fat was harvested from abdomen and transformed into nano fat then injected at the scar. Follow-up for 6 months using trichoscope to visualize the number of hair grafts in one cubic centimeter. Results: The median number of hair follicles among our studied cases 525(325–962.5) with range (70-1600), the mean transplanted area was 30 (±17.72SD) with range (5-60), the mean inserted grafts was 19.47 (±4.41SD) with range (11-24) and the mean survived grafts was 16.22(±4.29SD) with range (8-24). According to donor area after 3 days all our patients were completely healed, after 10 days there were 1(5.6%) with folliculitis all over donor area come and go, 1(5.6%) with severely inflamed, 2(11.1%) with slightly inflamed, 1(5.6%) with steal phenomena and 13(72.2%) with hair starts to get taller and hide the site of punch and after 6 months all patients were totally normal and no abnormality detected. Conclusion: The nanofat is rich in stem cells so it will promote the quality of the skin and its blood supply.