Objective To analyze the effect of recombinant collagen spray on wound healing after follicular unit extraction (FUE) technique in patients with cicatricial alopecia. Methods A total of 50 patients with cicatricial alopecia who underwent FUE and admitted to Xiangyang Hospital of Traditional Chinese Medicine from May 1st to July 31st, 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 25 patients in each group. The control group received the conventional treatment plan after surgery, and the observation group received the recombinant collagen spray on the basis of the control group. The wound healing time, postoperative recovery, hair coverage rate in the alopecia area, follicular unit density, patient satisfaction and adverse reaction rate were compared between the two groups. Results The wound healing time in the observation group was shorter than that in the control group (P <0.05). The recovery of wound edema and scab healing at 72 hours after treatment in the two groups were better than those at 12 hours after treatment, and those in the observation group were better than those in the control group (P <0.05). After treatment, the hair coverage rate in the alopecia area and the follicular unit density in the two groups were higher than those before treatment, and those in the observation group were higher than those in the control group (P <0.05). The patient satisfaction in the observation group (96.00%) was higher than that in the control group (76.00%) (P <0.05). The incidence of adverse reactions in the observation group (4.00%) was lower than that in the control group (8.00%), but the difference was not statistically significant (P >0.05). Conclusion The application of recombinant collagen spray for patients with cicatricial alopecia who underwent FUE can effectively improve the wound healing speed, improve the hair coverage rate in the alopecia area and the follicular unit density, enhance the patient satisfaction, and does not increase the incidence of adverse reactions, which is worthy of clinical application.