During an eyebrow transplant, we take hair from other parts of the patient’s body, usually from their head because that is where the most robust hair is located. These grafts are then implanted into the patient’s brows one follicular unit at a time.
The ideal candidate for an eyebrow transplant has realistic expectations and head hair that matches the caliber of the fine brow hair. The most common candidates are those patients who have over-plucked their eyebrows or have a congenital condition that makes them have less eyebrow hair than they would like. Some patients with no eyebrow hair just have a scar in that area and that can be filled in as well. Patients with auto-immune disorders or compulsive plucking (AKA Trichotillomania) are not good candidates for brow transplantation.
Scalp hair often grows faster and longer than normal eyebrow hair, so since the hair grafts are typically taken from the scalp, the hair grows to the length that a normal head hair would! Once it grows, patients need to trim the new brow hairs about every six weeks (or as often as they need it). For most patients this additional maintenance is a blessing since now they HAVE hair in the area, but for those who might be looking for LESS daily interaction with their brows, this might not be ideal. Either way patients can expect full results from the surgery at about 12 months after the operation with the earliest growth beginning at about 6 months.
The shape of the brow is often one of the main concerns of the patient. Differently-shaped faces are framed better by certain kinds of brow shapes, and there are many books on finding the right brow shape for your facial type. I have found that if hair still exists to guide the surgery, replacing the natural shape as much as possible ends up giving the most aesthetically pleasing and natural result.
Brow hair is also very directional and it lies flat to the skin. With the angles and flow of hair changing every few millimeters, it can be challenging to replace it in exactly the way that nature would have grown it. There are a lot of little tricks that a surgeon can use to get the hairs to grow in the right direction and lie as flat as possible. One trick is to use the natural curl of a hair to get everything to flow together. Another trick is to make the outline of the brow first and fill in the central area hairs one at a time. I usually leave the hair long so the patient can get a preview. Despite all the tricks though, perfection is hard to achieve, so if a hair decides to grow in an absolutely different direction than how it was placed in the surgery, the patient would need to pluck that hair or trim it short.
Scalp hair has the highest survival rate and can last a lifetime, even if that person has male or female pattern hair loss. The problem with body hair is that its survival rate is lower than that of head hair, which means that not all the hair being transplanted will grow. It also may require multiple procedures to maintain an ideal appearance. Due to its limited lifespan, I would only consider transplanting body hair for eyebrow hair loss patients if it is meant as a temporary transplant or if no other hair was available.
When treating patients with burn scars, it is important to view brow replacement surgery as a process, rather than as a one-time event. Blood flow is diminished in all scars, and so it is wise to try a few test grafts first. Once that is successful, I then use a bigger graft to establish a blood supply in that scar. In these cases, it will usually take an additional 2-3 touchup sessions over 6 to 12 months to see appreciable results. Although not as simple as a surgery without a scar, brow replacement can help fill in that area so that it doesn’t look sparse and restore a more normal appearance.
The density of hair after replacement surgery will never be the same as what nature put there for any hair transplant whether it is in the brows or on the head. As any experienced surgeon will tell you, this surgery does not replace nature but tries to mimic it as much as possible. That being said, it is still nearly undetectable. For most transplants, someone would only notice a difference if they did a count of hairs for every square centimeter. I have a standing bet with my patients that if someone ever notices they had a transplant as it is growing in, I will pay them $100. I have been doing this now for over a decade and I have not had to pay up yet!
There are few potential complications to this surgery. Patients may have small scars on the scalp where the hair grafts for the brows are removed (the incisions in the brows themselves are too small to cause a visible scar). They might also have small ingrown hairs as grafts grow in over the first 6-12 months following the surgery. As stated before, some grafts may decide to grow in an odd direction or at a different angle, in which case a patient might want to pluck or trim that particular brow hair.
I do not recommend this surgery for people with trichotillomania, a nervous condition that involves the plucking of eyebrows and other body hair. If these patients get an eyebrow transplant, it will reactivate their urge to pluck, which might cause them to pluck out all the new hair. This not only results in the loss of all the new hair, but scarring as well, which creates a worse situation. I recommend that those who lose hair because of trichotillomania get it under control with a psychiatrist or other medical professional because there are several medical options for treatment and the hair will often grow back on its own if you catch it early enough.
There are people who have scarring alopecia, which is a hair loss condition in which the body starts attacking its own hair. There are several different types of these, and all of the treatments are different depending on what version a person has. Alopecia Areata, which not a “scarring alopecia” is another hair loss conidtion which commonly affects the brows. Both scarring alopecias and alopecia areata can occur in the brows, and the initial treatment is medical, not surgical. Once the condition has stabilized for 2-3 years, surgery to replace any lost hair can be considered.
When replacing brow hair, few errors are forgivable. People can hide their hairline or hair at the top of their head with hats, hairstyles and even wigs. However, the brow is right in front of a person’s face. There is no clothing or hat to hide that, so the surgeon must use as much precision as possible to achieve the most natural and aesthetically pleasing look.
Thus, brow hair transplantation is in my opinion the most challenging hair restoration surgery of all since there is no room for error. It is not a perfect technique but at the same time, wonderful results can be achieved for patients if there is great attention to detail.
Written by Cosmetic Town Editorial Team
Based on an exclusive interview provided by Sara Wasserbauer, MD in Walnut Creek, CA.