Surgical Restoration

Eyebrows are a very significant aspect of our appearance. They are one of the most distinctive features that make up our faces, and we pay a lot of attention to them.Eyebrows are also one of our most expressive facial features by virtue of being located in the center of the face and framing the eyes. Eyebrows obviously serve a lot of functions in our culture today — beauty, nonverbal communication, distinctive appearance. However eyebrows do not have only cosmetic value. We know that eyebrows help keep moisture out of our eyes when we sweat or walk around in the rain. The arch shape diverts the rain or sweat around to the sides of our face, keeping our eyes relatively dry. The most obvious advantage of this is that it lets us see clearly when we’re sweating a lot or out in the rain. Without eyebrows, getting around in these conditions is a little more difficult.

Unlike the loss of scalp hair, the loss of one’s eyebrows is not viewed as a natural process and is, therefore, not cosmetically acceptable.

Eyebrows may be lost due to injury or disease or over enthusiastic plucking ( hypothyroidism, alopecia areata, burns, congenital absence to grow eyebrows and aging)

Eyebrow restorations are similar to hair transplant procedures performed on the scalp in that, for appropriate candidates, the transplanted hair is permanent. However, because eyebrows have their own unique attributes,

eyebrow transplants differ from hair transplants in a number of important ways

Eyebrow Anatomy and Physiology

The direction of eyebrow hair changes dramatically in different parts of the brow. In the region of the eyebrow nearest the nose, the hair points upward. The hair across the top of the eyebrow points outward and downward. The hair in the lower part of the brow grows outward and upward. This crisscross growth pattern causes the hairs in the middle of the eyebrows to converge and form a subtle natural elevation running horizontally through the middle of each eyebrow. The second distinctive characteristic of eyebrow hair is that the hairs emerge from the follicle at a very acute angle so that the hair grows flat to the skin’s surface. This is in contrast to scalp hair where the angle between the hair and scalp can be 45 degrees. The third important feature of the eyebrows is that the hairs grow as individual strands, rather than in the 1- to 4-hair follicular unit grouping that are characteristic of scalp hair. The fourth distinctive element of eyebrow hair is that the hair growth cycle is very short. This means that eyebrow hair will grow (in anagen) only for about 4 months before it enters the resting (telogen) phase and falls out. In contrast, scalp hair has a growth phase that last 3 to 7 years, enabling the scalp hair to grow much longer.

The Procedure:

Extraction method (FUE)

Follicular Unit Extraction (FUE) is a method of obtaining donor hair for Follicular Unit Transplantation (FUT), where individual follicular units are harvested directly from the donor area, without the need for a linear incision. In this hair restoration procedure, a 1-mm or smaller punch is used to make a small circular incision in the skin around the upper part of the follicular unit, which is then extracted directly from the scalp.

The benefits of Follicular Unit Extraction include; the lack of a linear scar for those who want to wear their hair very short, the ability to resume strenuous activity almost immediately after the procedure, its use in corrective procedures, and for graft harvesting in body hair transplants.

Donor Harvest with single strip technique

Hair transplantation is a surgical procedure by which permanent hair from regions of the scalp that normally never go bald, such as the sides and lower back of the head, is transferred or redistributed into areas of permanent hair loss or thinning. Sedation is very rarely used and you will be fully aware and can converse with the surgical team during your operation. We do recommend that you eat and drink before the operation which will make you feel more comfortable. Careful planning is first utilized to design the eyebrow according to your wishes, and following generally accepted guidelines. The recipient bald or thinning area is carefully evaluated and marked. Under local anesthesia, a strip of scalp containing healthy hair is removed from donor areas on the back and sides, generally in a long horizontal row. This donor area is then closed with sutures (stitches). This should leave a fine pale scar easily covered by your own hair as long as it isn’t too short! The hair grafts are carefully prepared, trimmed, and then placed into the recipient sites made in the bald or thinning scalp. In most cases, grafts of various sizes are artistically placed in zones, in order to achieve the desired final appearance.

Eyebrow Transplant Technique

The most important aspect of transplanting eyebrows is to follow the natural hair direction very closely. This entails very subtle angle changes to recreate the fan-like splay of hair at the medial end of the brow and the converging hair direction as one moves laterally along the brow. Most importantly, the recipient sites for the hairs should be made with a very fine-gauge needle that literally slides along the surface of the skin as the sites are being made, as this will insure that the hair will lie as flat as possible on the surface of the skin as it grows.

Single hair micrografts, placed into recipient sites that have been created at very acute angles to the skin surface, require a considerable about of skill and experience. In addition, when the patient’s hair is waved or curly, it is particularly important to rotate the hair so that curve of the hair shaft follows the natural curve of the eyebrow.

Cosmetic Results of an Eyebrow Hair Transplant

Although eyebrow hair transplantation is a safe and cosmetically elegant procedure, there are a number of things to consider before undergoing this type of hair restoration. As with hair transplants to the scalp, the hair transplanted to eyebrows will continue to grow and must therefore be periodically cut. Besides being a minor nuisance, trimming the hair leaves a cut-end that is not as delicate as the fine-tipped end of an untouched hair. In the process of healing, all wounds contract. As the recipient sites contract, they may slightly change their flat orientation and sometimes result in eyebrow hair that is slightly more elevated than one would like. Typically about 70% of all transplanted hairs grow, and of these hairs that grow 10-15% of them will grow in an aberrant direction (either too vertical or not flat enough to the skin) despite being implanted in an aesthetic direction. These hairs can be either cut short or plucked out .In contrast to hair transplants, where the donor hair is taken from another part of the scalp and matches perfectly, with eyebrow transplants the hair is taken from a part of the body other than the eyebrows and will thus have slightly different characteristics with regard to both growth rate and appearance. If they are different, then over time, the transplanted scalp hair will slowly begin to approximate the growth pattern and characteristics of the existing eyebrow hair – but it may never totally match it. The appearance of eyebrow hair transplants will mature over the course of a year. At that time an additional eyebrow hair transplant procedure may be considered. During this interval, the eyebrow can be tweezed and shaped as needed. When the local anesthetic has worn off, usually after 3 – 4 hours, the scalp will feel a bit tight and sore but this soon goes. Simple painkillers such as Combiflam, Diclomol etc. will help. You may also get some forehead swelling and bruising which lasts a few days and is perfectly normal. Some crusting will occur around the grafts. These must not be scratched as the grafts may be pulled out. These crusts will quickly dissolve once you start getting your hair wet on day 2 after the operation. The grafted area of scalp will appear slightly pinker than usual for a few days but this soon passes. The tiny hair that is transplanted in the graft normally falls out within the first few weeks. This is normal. The hair will then grow normally from the hair root and will be noticeable by approximately 3 months and carry on growing as fast and as long as your normal hair, usually about 1cm a month.

Commonly seen after eyebrow transplant

  • There will be tiny crusts where each graft was placed which will fall off at 3 to 4 days. Gently rub off any remaining crusts at 7 days – if there is any discomfort or bleeding, stop and begin to rub again 2 days later. There will also likely be a mild amount of pinkness to the area for a few days after the crusts fall off.
  • Some of the transplanted hairs will fall off over the following 2 weeks. This is normal, as the hairs will start to grow back 2 to 3 months later. Once the hairs start to grow back, you will need to trim them once or twice monthly, and occasionally apply some hair gel to “train” some of the hairs to grow flat to the forehead in the ideal direction.
  • For most patients, at 7-10 days they are presentable without any obvious signs of having had a procedure other than they will have new hairs, and possibly some mild flaking.
  • For the first 3 days after the procedure, wash your face very gently with soap and water if desired. After the 3rd day, normal face washing, showering, and exercise is permitted. Normal hair shampooing is permitted the day after your procedure.
  • Avoid excessive sun exposure for the first week after your procedure.

Risks, side effects, and possible complications:

In the overwhelming majority of hair transplantation procedures there are no complications. However, a number of side effects, risks, and complications can occasionally occur. For the purpose of putting these things in perspective, we will divide them into two categories: those that occur occasionally and those that occur very rarely and are included here for the sake of completeness:

Side effects that occur occasionally:

  1. Swelling in the forehead,
  2. Folloiculitis
  3. Temporary numbness of part of the head
  4. Post-op pain or headache
  5. Itching in the area of the new grafts or along the donor scar may occur occasionally.

Side effects or complications that occur only rarely:

  1. Irregular or uneven or delayed hair growth: Most transplanted hairs are shed after each session, over a period of 2-8 weeks. Generally within 3-4 months, new hair growth begins. This may occur at irregular rates, with some hairs coarser, finer, darker, or lighter in color, or different in textures than the characteristics of the original hair. In most instances, this eventually normalizes. However it may take 15 months or more from the starting point before cosmetically satisfactory results are seen.
  2. Discoloration of grafts
  3. Elevation or depression of grafts
  4. Bleeding
  5. Scarring
  6. Dizziness or fainting
  7. Allergy or reaction to anesthetics or medications used: Medications are kept at hand to immediately treat any allergic reactions.
  8. Failure to improve “quality of life”: Interruption of work or job routine, or interruption of home, family or social life, or failure to live up to a patient’s goals or expectations from the procedure.
  9. Infections: Very rare because of rich blood supply.
  10. There is also the possibility that other effects or complications not presently known, recognized, or understood, may develop, now or in the future.