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 to the patient’s brows using follicular unit extraction.
The ideal candidate for an eyebrow transplant has realistic expectations. 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.
Scalp hair that is moved to the brow will typically grow faster and longer than normal eyebrow hair. It grows to the length that a normal head of hair would. Patients will need to trim it about every six weeks or as often as they feel like. Some patients have to do it more often because their hair grows faster than average.
Brow hair usually has a natural little curl or wave to it. Even people that have poker-straight hair have a little bit of a curl to their hair. It becomes important not only to trim the hair but to shape it as well so it has a more natural curve. There are a lot of little tricks that a doctor can do to get the hairs to grow in the right direction. Sometimes, we look at old photos of patients who had normal brow hair to get a better idea of what the hair is supposed to look like.
Sometimes, the patient would need to pluck a hair if it decides to grow in an absolutely different direction, which can happen occasionally. Although I do the best I can, sometimes there can be just a few hairs that just decide to grow in the oddest direction. I usually leave the hair long so the patient can get a preview.
On Using Body Hair
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.
Scalp hair has a higher survival rate and can last a lifetime, even if that person has male or female pattern hair loss. Body hair, however, might all go away by the time someone turns 60. 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.
Treating Patients with Burn Scars
When treating patients with burn scars, I use a bigger graft to establish a blood supply in that scar. In this case, it will usually take an additional 2-3 touchup sessions over 6 to 12 months to see appreciable results. Although the initial surgery isn’t as successful as anybody would like it to be, subsequent surgeries help fill in that area so that it doesn’t look sparse.
The density will never be the same as what nature put there for any hair transplant whether it is in the brows or on the head. Our instruments are way bigger than the hair is and even though we try to put it back as perfectly as nature intended, it will not be exactly the same. It is still fairly undetectable. Someone would only notice a difference if they did a count of hairs for every square centimeter. This surgery does not replace nature but tries to mimic it as much as possible.
I do not recommend this surgery for people with trichotillomania, a nervous condition that involves the plucking of eyebrows. 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 for the patient. It would be unethical for me to transplant brow hair back into a trichotillomania patient if they don’t have a plan of attack because it’s really worse for the patient. I often turn away patients because of it.
I recommend that those who lose hair because of trichotillomania get it under control with a psychologist, psychiatrist, or other medical professional. There are more treatment options for those with this condition these days.
Patients will often not want to acknowledge that they are plucking out their own hair. Once they actually acknowledge that they have a problem, than they have to seek treatment for it and make sure they have it under control and then we can consider putting brow hair back. However, most people with this condition struggle with it. It is involuntary, which is why it is difficult to get anybody with trichotillomania to have a successful hair transplant in their brows.
There are people who have scarring alopecia, an alopecia condition in which the body starts attacking the hair. It affects some people through brow spurts and then moves on to other patches on the head. With others, it may begin on their head or body somewhere, and then move on to their eyebrows. Sometimes it affects only one spot on a person’s eyebrows and is never recurrent. This condition is completely unpredictable.
If there is not some stability in the area, then we usually opt to wait instead of doing a transplant at that point.
Unlike crown hair, brows are the one spot a doctor can’t mess up on. People can hide their hairline by wearing their hair forward. However, the brow is right in front of a person’s face. There is no clothing or hat to hide that.
Brow hair transplantation can be a very big challenge since there is no room for error. It is not a perfect technique but at the same time, wonders can be achieved with patients if there is great attention to detail.