Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the eyebrow hair transplant procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.
Alternatives for improving the appearance of the eyebrows include temporary(pencil) or permanent eyeliner. (micropigmentation/tattooing)
The goal of eyebrow hair transplantation is to create greater hair density in the eyebrow. This fuller density strives to achieve a more natural eyebrow look that does not require the application of pigmented liners to create the shape and outline of the eyebrows.
The limitations of eyebrow hair transplants, like all hair transplants, is how many hairs can be inserted at the time of the procedure and how many hairs will survive and grow afterwards.
Expected recipient site outcomes include the following: temporary swelling and bruising of the eyebrows, temporary clots or crusts of the eyebrows, initial long transplants in which the hair shaft will shed two to three weeks after the procedure, and four to six months after surgery to see the full transplanted hair growth. Expected donor site outcomes include suture lines in the scalp above the ears from the harvest and very mild temporary harvest site discomfort.
Significant complications from eyebrow hair transplants do not occur. More likely risks include infection, inadequate take/density of the transplanted hair, undesired angulation of the transplanted hair, and the possible need for additional hair transplantation sessions. Any of these risks may require revisional surgery for improvement.
Should additional surgery be required for additional hair transplants to be placed, this will generate additional costs
Eyebrows are the one piece of hirsuitic artistry that adorns the forehead. They separate the forehead from the eyelids and produce a partial frame for the entire orbital area. The desired shape and size of the eyebrows has changed over the years. Pencil-thin eyebrows were once the way to go, requiring considerable maintenance with waxing and tweezing. While waxing and maintenance is still needed, fuller more bushy eyebrows are now in.
But for the woman who has naturally thin eyebrows or has lost a lot of eyebrows due to years of plucking, what is she to do? Applying topical Rogaine or Latisse is one option but that will only be effective if there are enough hair follicles to stimulate. It may make existing hairs longer and thicker which can help but will not repair lost follicles.
This is where hair transplantation comes in. Transplanting hairs to the eyebrows has the obvious goal of adding follicular density but eyebrow restoration is so much more than just throwing hairs into the skin on top of the brow bone. The eyebrows are a unique patch of hair, small as it may be. The direction and angulation of the hairs must be precisely done to look natural and to grow in harmony with the eyebrow hairs that already exist. The shape of the eyebrow is gender-specific with women having an arch to the outer aspect of the eyebrow while in men the eyebrow is flat with little to no arch.
Like the scalp, eyebrows use hairs harvested from the scalp. Up to 500 hairs may be needed for both eyebrows and this requires a scalp donor strip of at least 1 x 4 cms if not longer. Such smaller donor strips has the luxury of trying to find a patch of hair that is not gray (or likely to go gray), has a curl to it that matches as close as possible the existing angulation of the eyebrow hair growth and is not thicker than an eyebrow hair. (thinner is better)
When placing grafts into the eyebrows, the most important aspect is their placement. The eyebrow have a fanning effect from the inner aspect of the brow out to the tail. In the most inner aspect, the hairs point directly upward but then start to turn quickly into a more horizontal orientation. At the tail of the brow, the hairs may actually be less than horizontal and turn downward. Besides the angulation, eyebrow hairs lay almost flat against the surface of the skin and don’t stick up like those on the scalp.
While hair transplantation to the eyebrows seems like one is transplanting hairs, the reality is that follicles (hair bulbs) are being transplanted. The attached hair (which is dead) is just the handle to carry and insert the follicles. This is why it is important after the procedure to not touch or manipulate the eyebrows. Let the eyebrows dry out and form a crust, that will help stabilize the follicles so they take better. The crust will come off after a week and the visible hairs will fall out weeks later. This does not matter as what counts is the implanted follicles. It is expected to lose all the transplanted hair shafts which naturally shed from the trauma of the procedure. It will take up to six months to see regrowth and the results of the procedure.
The success of eyebrow transplants, as defined by graft survival, is somewhere between 50% to 75%. This is why a second touch-up may be needed within the first year of the procedure. Scalp hairs will grow much faster than natural eyebrow hairs so regular trimming will be needed. While this involves a little time, that is more than made up by avoiding the much greater time needed in applying eyebrow liner.
Eyebrows occupy a very visible location on one’s face and are critical to the appearance of the eye area. They frame the eye and serve as an important aesthetic landmark between the eye and the frontal scalp hairline. Significant loss or changes in eyebrow hair density are usually very noticeable and can be quite troubling. While eyebrow shapes and styles change over the years, thin or sparse eyebrows are not usually aesthetically desireable.
Hair transplants to the eyebrows can be done for both men and women. While most commonly done for eyebrows lost due to injury (lacerations, avulsions, burns), disease (alopecia areata, trichilomania), or age (thinningof the hair) it may also be done for cosmetic enhancement (thickening of the eyebrow and/or extension of the tail) as well. Thin eyebrows in women occur from a congenital thinness and limited ability for the eyebrows to grow or loss of eyebrow hairs due to excessive plucking.
Tattooing of the lost or thin eyebrow is a very common technique that is simple and relatively quick to do with an immediate result. Unfortunately, eyebrow tattoos if not done professionally with good technique can look very unnatural with less than ideal color matches. Over time the tattoo will have some fading, which will require some touchups or long-term maintenance. Eyebrow tattoos essentially can not be removed. If unhappy with an eyebrow tattoo result, hair transplants can be done right into the tattooed skin.
Hair transplantation to the eyebrow is a more refined technique of that used in scalp hair grafting. It is based on two important principles; individual follicular grafts and precise placement into the unique shape and orientation of eyebrow hairs. While the eyebrow area is not big (compared to the scalp), the harvesting and placement of individual follicles into the eyebrow is a meticulous procedure that can take almost as long as scalp hair transplant sessions.
Placement and proper angulation of the hairs is the key to a good, natural-looking eyebrow transplant. The eyebrow has hairs that have unique orientations in different parts of the eyebrow. The hair in the upper part of the middle of the eyebrow points upward to the hairline, while the hair on the tail will usually point towards the ears. The eyebrow hairs are also oriented much like a feather with the upper part of the eyebrow pointed slightly downward and the lower portion slightly upward forming a slight ridge.
Eyebrow hair transplantation may require more than one session of grafting to get the best results. Not all follicles completely survive each grafting session and optimal density of the eyebrow may require a second set of grafts. My goal is to get the best result in one session, not two, but hair transplant growth and density is not completely predictable. Second graft sessions are not done for six months after the first to give optimal time for the hair to grow and for the patient to adjust to the changes in the appearance of the eyebrow.
The hair used for eyebrow transplants comes from the scalp. Because most scalp hairs are more coarse than fine eyebrow hairs, the donor site is usually taken from the scalp hair right abobe or behind the ear. Scalp hair in this area is thinner and a better match for the eyebrows. Each eyebrow usually requires about 50 to 75 hair transplants, sometimes up to more than 100 per eyebrow depending upon the goals of the patient. These hair transplants, like the rest of the scalp,will continue to grow for the rest of your life and will need to be trimmed regularly. Over time, the transplanted scalp hairs will take on some of the characteristics of eyebrow hairs and growth will slow down. (eyebrow hair grow is about half that of scalp hairs)
Be aware that although the eyebrow hair transplants will be seen immediately after the procedure, the hair shaft attached to the follicle will fall out. In essence, follicle transplants are being done and the hair shaft is a good handle to place them. The hair shaft will quickly shed leaving the eyebrow looking like it did before the procedure. Hair growth from the follicle will require at least 3 months to become visible again and up to 6 to 9 months to grow in and see the final results.
There is no significant recovery from the procedure other than some crusting of the eyebrows and occasionally some slight upper eyelid swelling or bruising. There are no dressings used on the eyebrows other than ointment to keep them moist for the first few days. One can usually return to work within a few days.
As one can see, eyebrow hair transplants require much greater commitment and patience than eyebrow tattooing methods. But if one is looking for the most natural eyebrow result, particularly in a young person, eyebrow hair transplants may be a good long-term solution.
Hair Restoration for the Thinned or Absent Eyebrow
I used to see one or two patients a year who had lost their eyebrows due to an accident such a burn injury or an avulsion from a motor vehicle accident. While these still do occur, I am now seeing more patients that have very thin eyebrows due to original underdeveloped thin eyebrows, over-tweezing, or loss of eyebrow hairs due to age. In some elderly patients due to decreased vision, I have had a few requests for eyebrow management as they could no longer see well enough to ‘paint on their eyebrows’. In the past, all of these eyebrow problems were treated with tattooing or medically speaking, micropigmentation. While placing permanent tattoo colors in the skin was effective, it was not the most natural as it was not real hair or even looked like hair. It was just a painted on eyebrow so to speak.
It is now becoming more popular to consider hair transplants as an option in these cases. Eyebrow hair transplantation has been done for decades but only more recently is it now being performed regularly. Its emergence as an alternative to tattooing is the general hair transplantation concept of follicular unit grafting. Hair transplants in the scalp have gone from the old-fashioned ‘corn row’ look to single hair follicle transplants. This has produced more natural hair restoration in the scalp and is perfectly suited for the eyebrow. Given that the eyebrow is a small area, the number of transplants needed is less than 200 per brow. Since this requires only a small donor area from the scalp, almost any patient is a candidate for the procedure. Eyebrow hair transplants are done in the office, under local anesthesia, and both brows can be completed in a few hours. Other than some potential for upper eyelid swelling and bruising, there is very minimal discomfort after the procedure.
Several important concepts for patients to know are: 1) The transplanted eyebrow hairs will grow like the scalp so they will have to be trimmed and shaped regularly (more so than your normal eyebrow hairs), 2) After transplantation, the new hairs will fall out in a few weeks (remember hair is dead, it is the follicle that is alive). The follicles must grow new hair which will take several months to be seen again, 3) Not all transplanted hairs will survive, although 90% or greater take is the norm. Touch-up grafting may be needed, and 4) Like scalp hairs, eyebrow transplanted hair can be dyed as well.
Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.