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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

Indianapolis, Indiana

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