Surgical Restoration

Eyelashes have an anatomical function of shielding the eye from injury, from dust and grit.

Eyelashes frame the eyes, and together with eyebrows, hairline, cheek bones, nose, lips and chin create the facial appearance that is unique to every individual.

A person without eyelashes has a strange appearance because they lack one of the important anatomical landmarks of facial normality.

There are a number of reasons people may have no eyelashes.

Facial injury and scarring due to automobile accidents, industrial accidents, chemical burns, eyelid tattoos, and long-term use of false eyelashes;

Surgical treatment, injury or tumors that results in the removal of eyelash follicles and tissue scarring;

Medical treatment of radiotherapy or chemotherapy for cancer that results in hair loss;

Trichotillomania, which is compulsive hair plucking of scalp hair, eyebrows and eyelashes;

Congenital atrichia, which is a birth defect causing a lack of body hair

Today, people receive eyelash transplantation to correct many of these issues, and also for esthetic purposes.

Medical Treatment for Eyelash Enhancement.

Topical ocular prostaglandin analogues and prostamides can cause changes in eyelashes by inducing the growth phase in resting follicles and hypertrophic changes. Thin or short eyelashes can be treated with this group of drugs. Bimatoprost 0.03 % has been on the market since the FDA approved it in December 2008 for eyelash thinning but it was originally approved since 2001 for treatment of glaucoma.

According to studies, Bimatoprost lengthens, thickens and darkens eyelashes via a process that isn’t fully understood. Like the hair on your head, eyelashes sprout, grow for a while and eventually fall out. Bimatoprost both extends the growth phase and increases the number of hairs that sprout.

During clinical studies, full results appeared after 12 to 16 weeks of daily use. You apply Bimatoprost by dabbing it on the upper lash line each night with the sterile applicators supplied. The drug spreads to your lower lash line automatically as you blink. According to the manufacturer, you should never apply it in your eye or onto your lower lid. Before you apply, your face must be clean and your makeup and contact lenses removed. Always discard each applicator after one use. Re-using applicators, even just once the next evening, can cause serious problems, such as an eye infection or allergic reaction. And apply it carefully, since Bimatoprost may promote hair growth on other skin areas.

After two months of nightly use, you may begin to see results. After three or four months, your doctor may recommend a treatment schedule of every two days. If you stop using Bimatoprost, your eyelashes will gradually return to their former state.

According to clinical studies conducted before FDA approval, Bimatoprost eyelash lengthener is safe for most people. Side effects of Bimatoprosteyedrops include eye irritation, intraocular inflammation as well as overgrowth of eyelashes and pigmentation of the iris and skin.

However, you may not be a candidate for it if you have certain eye problems (such as uveitis and conjunctivitis), risk for macular edema, severe allergies or skin infections of the upper eyelids. Pregnant women shouldn’t use it, and nursing women may want to wait as well.

Because the active ingredient in Bimatoprost lowers intraocular pressure, if you are already using IOP-lowering medications for ocular hypertension and/or glaucoma, you must tell your eye doctor before you try Bimatoprost so he or she can monitor your eye pressure closely.

Most study participants had no problems if Bimatoprost accidentally got into their eyes. But a few did experience side effects that included dry eyes and eyelid skin darkening. The side effects that occurred in the largest percentage of participants were eye redness (3.6 percent) and itchiness (also 3.6 percent).

Eyelash transplantation

Eyelash surgery is a very specialized procedure that is performed by just a few surgeons. As is the case for eyebrows, donor hair for transplantation must be finer rather than coarser. All grafts are single hairs meticulously placed into the lid. As few as six hairs per lid may be adequate to create a natural effect.

Who Is a Good Candidate for Eyelash Transplantation?

Eyelash reconstruction may be required for reconstructing eyelashes damaged or lost due to injury or disease or for improving the aesthetics of existing eyelashes. For someone born without eyelashes

(congenitalatrichia) is only a candidate for eyelash prostheses that are fastened to the eyelid with adhesive.)

Techniques of Eyelash Transplantation

The donor hair must match the recipient area hairs as closely as possible and the best hairs for eyelash reconstruction are from nape of the neck or the area of the scalp above or behind the ears. Hairs taken from the eyebrows and legs are also used in eyelash transplantation. These hairs will grow and hence will need to be curled and trimmed periodically.

Transplantation Technique

Eyelash transplantation is performed under local anesthesia. The donor can be harvested by a very small strip or FUE. The recipient site is created by puncturing the eyelid at the margin and the graft is placed into it. Care has to be taken about the direction of curl of the grafted hair. Grafts are properly spaced and to prevent trichiasis. (A normal upper eyelid contains about 100 lashes, the lower eyelid about 60 lashes).

A session is performed in one to three hours. A desirable result may be achieved in one-three sessions. The number of sessions is dependent on patient characteristics, desired result, and the surgical technique.

Postoperative Recovery and Care

Moderate to intense itching of the eyelids is usually common immediately after surgery and may persist for one or more days. If it persists in high intensity after a couple of days, it may need to be assessed by the surgeon.

However Itching should be differentiated from discomfort; discomfort beyond one day is normal.

Scratching of the eyelids will easily dislodge transplanted hairs, itching should be relieved as much as possible by ophthalmic ointments, mild analgesics such as paracetamol and ice packs.

Wear goggles while sleeping to prevent inadvertent eyelid scratching. Some physicians recommend keeping the eyes bandaged for the first 24 postoperative hours.

7 to 14 days is required for complete postoperative recovery.

Coat the new eyelashes with lash oil, use an eyelash curler to encourage proper curl and trim regularly.

It is important for patients to understand that the transplanted hairs need to be manually curled so that they grow in a sloping curved direction as normal eyelash hair. It is also possible that some hairs may grow in a not intended direction- these hairs can be trimmed very short or sometimes trained to grow in just the right direction.


The following are the potential issues that may complicate an eyelash transplant.

  1. Eyelid infection; rapid recognition and treatment are essential to prevent spread.
  2. Bruising and swelling.
  3. Graft displacement caused when the patient scratches eyelids, causing failed growth.
  4. Ingrown hairs.
  5. Ectropion; eversion and downward pull of the lower eyelid, causing the eyelid to fall away from the eye.
  6. Entropion; turning in of the upper or lower eyelid margin.
  7. Poor placement or poor quality of eyelash grafts due to use of coarse hair as grafts, or placement of grafts that fails to achieve the desired esthetic result.