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Eyebrow
reconstruction with hair transplants
We generally take them for granted, but eyebrows are very important
pieces of facial equipment. The eyebrows play an important role
in conveying human emotions such as anger, sadness, happiness and
surprise. We only really notice just how important eyebrows are
when they are missing. Partial or complete loss of eyebrows may
produce varying degrees of facial disfigurement, easily recognized
by onlookers and much to the annoyance of the affected individuals.
Although female patients are prepared to sacrifice eyebrow tissue
for the sake of fashion, males on the whole prefer their eyebrows
thick and full.
Some instances of eyebrow loss are not suitable for transplantation
such as eyebrow loss through alopecia areata, alopecia induced
by certain toxins (particularly thallium – a rat poison)
which can cause the loss of the outer third of the eyebrows (called
hertegoeths sign). For alopecia areata and many other forms of
inflammatory alopecia, any transplanted hair follicles would also
come under inflammatory cell attack, so a hair transplant would
not help. A similar issue would occur with toxin induced eyebrow
loss, the transplanted hair follicles would be affected by the
toxins. Most forms of eyebrow loss that cannot be treated with
a hair transplant are reversible hair loss conditions and they
can be treated in other ways. Inflammation induced eyebrow loss
is usually treated with topical creams or local injections of corticosteroids.
Toxin induced alopecia is preferably treated by avoiding the toxins!
However, other forms of eyebrow loss can be treated quite successfully
with an eyebrow transplant. The earliest hair transplant micrografts
were applied to the eyebrow more than 30 years before their application
to the scalp became the standard of care. Eyebrow transplants may
be conducted because the individual has received an injury to the
area and permanent destruction of the eyebrow hair follicles. Burns
patients may benefit from an eyebrow transplant. People with facial
injuries from car accidents often undergo reconstructive surgery,
first to replace the damaged eyeball socket and then to replace
the lost eyebrow follicles using a hair transplant. Others may
have minor defects only affecting part of the eyebrow. Basal cell
carcinomas (a slow growing form of skin cancer) can develop in
the eyebrow area. They usually have to be surgically removed in
a process called Mohs surgery. Because the basal cell carcinoma
is often closely associated with adjacent hair follicles (at least
some basal cell carcinomas are actually outgrowths from hair follicles)
the follicles have to be cut out too. This leaves an area of scarred
skin with no follicles and this can be successfully treated with
a hair transplant.
Some people opt for an eyebrow transplant for cosmetic reasons.
They may have been born with thin brows or virtually no eyebrows
and want to improve the definition around their eyes. Limited eyebrow
growth is particularly common in some far East Asian populations.
Some individuals may destroy their eyebrow follicles through repeated
plucking. Cosmetically, thin eyebrows were in vogue through the
1970s and some women repeatedly plucked their eyebrows to get “the
look”. But fashion is fickle and today greater eyebrow definition
is de rigeur. Unfortunately, eyebrow follicles are relatively easy
to damage (compared to scalp or beard follicles for example) and
repeated plucking can cause so much damage that the eyebrow follicles
are unable to regrow. Others may be affected by trichotillomania,
a compulsive repeated hair plucking. Some focus on the eyebrows.
If they can overcome their trichotillomania, then an eyebrow transplant
may replace the destroyed hair follicles.
An eyebrow transplant is a relatively complex procedure. It requires
some experience on the part of the surgeon to get the transplant
to look natural. The hair of an eyebrow is thinner, has complicated
directional changes, has an acute angle between the skin and hair
shaft, a smaller diameter, slower growth, as well as changes in
orientation over the brow area. When grafting eyebrows in small
target areas of hair in the medial brow portion, surgeons must
be concerned about the upward direction of natural hair growth.
Mid and lateral brow follicles grow with central convergence in
a flat direction almost parallel to the skin. Special consideration
must be paid in order to maintain eyebrow symmetry and to avoid
distortion of the hairline. All these factors have to be considered
when implanting the hair. A standard hair transplant surgeon may
not have the experience to make an eyebrow transplant look natural.
A good hair transplant surgeon would refer such a patient to a
plastic reconstructive surgeon with the ability to do a good job.
Better still, if you need an eyebrow transplant, seek out reconstructive
surgeons and approach them directly.
Sometimes, if there is only a small area of the eyebrow that needs
attention, the surgeon may just redistribute the eyebrow hairs
from elsewhere. This is most often done by cutting out the affected
eyebrow portion and then moving the rest of the eyebrow inward
to close the site. Sometimes though, there are too few or no eyebrow
hair follicles left so this option is not available. In these cases,
hair is taken from elsewhere on the head. Some surgeons have used
the small hairs from around the ears to reconstruct eyebrows with
some success. Others take the hair follicles from the back of the
scalp, as with standard scalp hair transplants. They may just take
the finer hairs for transplantation to the eyebrow. Still others
take a thin strip of skin and hair follicles from the scalp and
graft this to form the new eyebrow. Which approach is used depends
in part on the nature of the eyebrow loss (whether it is from burns,
injuries, or repeated plucking) and also on the personal preference
of the surgeon. In the medical literature it is clear there are
two schools, one proposing flaps as generally the best method to
reconstruct eyebrows and the other proposing implantation of hair
follicles in ones and twos over the brow area. A few surgeons are
using an approach combining the two methods. Transplanted strips
of scalp skin can give the eyebrows an overly dense appearance.
In theory, the method of transplanting individual hairs should
give the most natural result. However, this is a time consuming
and technically challenging approach and it only works well in
the hands of an experienced surgeon.
Whether the scalp hairs are transplanted individually or as larger
graft flaps, the transplanted scalp hair follicles retain their
scalp growth characteristics so they grow for several years and
at a fast rate (0.35mm a day) unlike eyebrow follicles that grow
relatively slowly (approx. 0.1mm a day) and each growth period
lasts 3-6 months. Because of this, if scalp hair follicles are
transplanted to the eyebrows, the eyebrows will require regular
trimming to keep them in shape.
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reconstruction with hair transplants references
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