Just like a hairline frames the face and changes the Aspect Ratio, similarly eyebrows frame the eyes – the doorways to the “soul”. Mostly eyebrow transplants are done to restore eyebrows that have been damaged by trauma or disease or in cases where patients present with hypotrichia (absent or poor eyebrow growth since birth). We also do eyebrow transplants to restore hair to eyebrows that are scarred, that are overly thin or completely missing. Often, patients who present with thin or sparse eyebrows have a history of plucking their eyebrow hairs in the past.

Eyebrow transplant procedures are performed in the same way as hair transplants, by taking hair from the donor site; usually at the back of the head at the lower hair margin or the margin close behind the ear, where the hair caliber is finer.

Mostly we make use of FUT strip surgery when harvesting grafts for eyebrow transplanting. The reason is that we want the hair shaft to be approximately 1cm to 1.5cm in length after harvesting so we can clearly see the curve of the hair shaft. We place the follicle in position with the hair shaft curving towards the skin. With an FUE harvest, the hair shaft will be too short to ascertain the curvature of the hair and this could result in abnormal placement with hair growing away (outward) from the skin which will give an unacceptable result.

Each hair is placed meticulously and angled so the shaft curves towards the skin and mimics natural growth. Mostly an eyebrow transplant procedure involves between 150 to 300 follicle units transplanted per brow, so it could be up to 600 follicles in total, and depends on the individual case. The majority of the grafts used would be One-Hair Follicle units. The central areas may be transplanted with some Double Follicle units to create more density.

Before doing an eyebrow transplant, the exact cause of the hair loss needs to be established first. In some Scarring Alopecias, such as Frontal Fibrosing Alopecia (FFA), eye brow hair loss occurs in conjunction with loss of the hairline and temporal hairs and sometimes it is the only “early” sign of FFA. Other causes such as Hypo or Hyperthyroidism and other illness conditions have to be excluded also. Transplanting eyebrows when an underlying illness is unresolved or inadequately controlled will result in failure of transplanted eyebrow hair to grow.

Sources:

– Dr. A Nel hair restoration practice experience
– Eyebrow transplant lecture at ISHRS conference, Chicago, Sep 2015, Dr. G Epstein

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