Eyebrows may be lost for a variety of reasons including thyroid and other systemic diseases, alopecia areata, burns, tattoos, infections, repeated plucking, congenital inability to grow eyebrows and a genetic tendency for eyebrows to thin, or disappear, over time.

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 can last 3 to 7 years, enabling the scalp hair to grow much longer.

Eyebrow Transplant Technique

Another important part of eyebrow restoration is that only individual hair follicles can be used.  Since the scalp naturally consists of 1 to 4-hair follicular units, hair taken from this area must be divided up into 1-hair grafts using a stereo-microscope.  Technically speaking then, an eyebrow transplant is not really follicular unit transplantation, but rather an ultra-refined form of micrografting.

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

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.

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 procedure may be considered.  During this interval, the eyebrow can be tweezed and shaped as needed.

Dr. Bauman's eyelash transplants were featured on CBS's THE EARLY SHOW. The Early Show followed eyelash transplant patient, Kim, before and after her eyelash transplant with Dr. Bauman. Bauman patient, eyelash transplant recipient and salon owner, Jodi Hussey, is also interviewed several months after her procedure. This story included a detailed animated explanation of how the procedure is performed. To watch the video click the picture to the left. For a larger version of the CBS Early Show.

Eyelash Transplants were featured on NBC's TODAY SHOW. Today show's Janice Lieberman follows cancer-survivor--Veronica Garner--before, during and after her eyelash transplant procedure with Dr. Bauman. "Eyelash Stylist" Ellie Malmin, was featured in the story as she trimmed, tinted and permed Bauman patient, Erica Lynn's transplanted lashes.

Cosmetic eyelash transplant procedure patients before and after. Dr. Bauman describes the procedure and demonstrates the technique for NBC6. Patients Jodi Hussey and Erica Lynn are interviewed. This is the clip that aired in both the Palm Beach and Miami areas.

What is alopecia areata?

Alopecia Areata is a hair loss disorder. In most cases the scalp hair falls out in small round patches, but in some cases Alopecia Areata can result in total loss of hair on the head, the face and the body.

Who is affected by alopecia areata?Alopecia affects approximately 1.7 percent of the population with both men and women being equally affected. About 25 percent of patients have a family history of the disorder.

What causes alopecia areata?It is considered that Alopecia Areata is an autoimmune disease. Normally the immune system protects the body against infection and disease. In an autoimmune disease the body’s immune system mistakenly attacks some part of its own body. In the Alopecia Areata disorder it is thought that the immune system attacks the hair follicles from which the hair grows. In addition there is believed to be a genetic component in some cases and some studies have shown a link with stress.

Medical tattoo – a versatile solution to eyebrow and eyelash hair loss If the Alopecia Areata disorder results in the loss of the eyebrows and the eyelashes medical tattoo also known as cosmetic tattooing, semi permanent make up, permanent makeup or micropigmentation can provides a long term answer to the problem.Realistic looking eyebrows can be constructed by creating the illusion of ultra fine hair strokes through the implantation of pigments into the skin. If you have sparse or no eyelashes medical tattoo eye enhancement can give definition to the eyes either in a natural enhancement or a flattering make-up affect, that does away with the need for constant make-up re-application – and the major benefit for to medical tattooing to reconstruct the appearance of eyebrows and eyelashes is the effect never smears off the skin even though sleep, sport and the weather.For more information on alopecia visit www.alopeciaonline.org.uk

Transplantation to the eyebrows is a procedure designed to restore growing hair to eyebrows that are overly thin, scarred, or completely missing.  The donor hairs usually come from the scalp which, when transplanted into the eyebrows, continue to grow for a lifetime and therefore need to be trimmed typically once a month.  To provide a natural appearance, the hairs are transplanted primarily one and occasionally two at a time, the natural way eyebrow hairs grow.  This is a very delicate procedure, requiring perfect placement of these hairs into tiny (half-millimeter) incisions that are angled at just the right direction and positioned to mimic natural growth.  The use of all-microscopically dissected grafts allows their placement into the smallest possible incisions so as to minimize scarring and damage to already existing hairs. 

A procedure typically involves the placement of 50 to as many as 350 hairs into each eyebrow, depending upon the existing amount of hair and the desired size and density.  Performed usually under a mild oral sedative, the 2 hour procedure is essentially painless, as is the recovery period.  For the first 2 to 4 days after the procedure, tiny crusts are around each transplanted hair.  By 3 to 5 days, other than some occasional mild pinkness which fades out by the first week, patients are able to return to normal activities without any sign of having had a procedure.  Sutures that are placed in the donor area are removed at 1 week.  The transplanted hairs fall out at around 2 weeks, then start to regrow at 3 months, where they will continue to grow for a lifetime. 

There are few risks with the procedure, and most are those associated with standard hair transplants.  The donor site incision, usually 1 to 2 inches long, typically heals as a 2 mm or narrower wide incision, easily concealable with existing hair in the area.  Occasionally a few hairs grow in less than the ideal direction- these few hairs can be plucked out if desired or sometimes trained to grow in just the right direction.

• Thyroid disease
• Pregnancy
• Hormone Intake: Danazol, BCPs, Progestesrone, Diethystilbesterol (DES), HCG (pregnancy hormone)

Chemotherapy

The insults of chemotherapy are not insignificant. Chemotherapy affects the production of many cell types, not just the cancer. That is why so many of these therapies result in temporary hair loss.

Here are some of the more common chemotherapy agents that can cause hair loss: (this is not a complete list)

• Chemotherapy Agents: Cyclophosphamide, Bleomycin, Daunorubicin, Methotrexate, Tamoxifen, Taxol, Vinblastine, Colchicine, Melphalan, Systemic 5-Florouracil, Etoposide, Ethambutol, Interferon Alpha, Interleuken

Infiltrating Cancer

Cancer whether locally growing or one that is spreading into the skin may push out hair in areas in which it is overtaking. Sometimes this will appear as an obvious surface growth (especially with skin cancer), and other times there may be a lumpy thickening of the area such as when lymphoma or leukemia cells infiltrate deeper tissue.

• Mycosis Fungoides, a T Cell Lymphoma of the Skin.
• Leukemia Cutis, a state where leukemia spreads from the bloodstream into the skin.
• Local Skin Cancer, including Basal Cell Carcinoma and Squamous Cell Carcinoma.
• Kaposi’s Sarcoma

Infections

Infectious conditions can either directly affect the hair follicle, or hair shaft, or create such inflammation in the region that you literally scratch the hair out. Patchy hair loss is a good indication of problems like Syphilis. Infiltration of the infection deep within the skin such as what occurs with Hansen’s Disease can squeeze the hair follicles out of the way.

• Fungal infections: Just like those on the scalp, fungal infections can occur on hair bearing areas of the face as well and lead to typically temporary hair loss.
• Lice: The itching and scratching cycle associated with lice of the brows and lashes can cause you to literally pull them out.
• Hansen’s Disease (aka Leprosy): Can infiltrate the brow region leading to thinning eyebrows.
• Syphilis: Who thought that a venereal disease could cause hair loss? However, syphilis can cause “moth-eaten” hair loss in more advanced stages.

Autoimmune Disorders

The definition of an autoimmune disease is that the body turns on itself, mistakenly destroying tissue that belongs. In other words, the body basically thinks that a germ is present and is out to get rid of it. Autoimmune diseases are a broad category and encompass a multitude of diagnoses. Here are a few that can lead to hair loss.

• Lupus Erythematosus: All autoimmune diseases can put hair at risk. Inflammation of the skin due to a variety of lupus-like conditions may result in patchy hair loss.
• Alopecia Areata: In this condition, hair is specifically targeted by the body for destruction. A random condition where any hair is potentially at risk.
• Vitiligo: This disease where the color-making cells of the skin are destroyed may cause enough inflammation to accidentally result in some hair loss as well.

Inflammation from “Common Skin Conditions”

That itch, scratch cycle can lead to more inflammation, and ultimately hair loss. Few people are aware that “routine” skin diseases can sometimes result in hair loss, but here they are:

• Seborrhea
• Psoriasis
• Atopic Dermatitis/Eczema
• Contact Dermatitis

Skin Growths

If something happens to be growing on the surface, chances are the hair isn’t going to be able to penetrate through this thick shell-like barrier. Remove the growth, and you may be able to re-grow the hair. Keep in mind, however, that if removal leads to significant scar formation, the hair may not re-grow.

• Seborrheic Keratosis: Age-related “barnacles of life”.
• Moles
• Sebaceous Hyperplasia: Growth of specific oil glands.
• Warts
• Hemangiomas: Blood vessel growths.

Infiltrating Disorders

This is a mixed bag of conditions that all have 1 thing in common. They all create an environment within the dermis (lower portion of the skin) that squeezes out the hair follicle’s ability to flourish.

• Alopecia Mucinosis: A disorder in which a viscous material called mucin infiltrates the deeper areas of the skin, resulting in hair loss.
• Sclerosing Disorders: Scleroderma, Morphea and Discoid Lupus Erythematosus.
• Scars: Particularly large keloids.

Medication

Everybody knows someone who has had an unusual reaction to a medication. Eyebrows can be affected just like any other hair if a medication is known to cause hair loss. Here are some of the general categories and major players within them.

• Antihypertensives: Propranolol, Atenolol, Captopril, Clonidine
• Antidepressants/Psychotics/Emotional Stabilizers: Prozac, Lithium, Haldol, Amitriptylene, Sinequan (Doxepin), Imipramine
• Seizure Medication: Phenytoin (Dilantin), Phenobarbital, Valproic Acid

Heavy Metal/ Elemental Poisoning

It’s hard to believe in this day and age that we could be poisoned by our environment, but periodically, you hear about a case. Here are a few compounds to be aware of:

• Mercury
• Arsenic
• Thallium
• Iodine
• Gold: A side effect from taking it for the control of diseases such as Rheumatoid Arthritis.

Vitamin/Mineral Overdose

Too much of a good thing often leads to problems. Excessive oral ingestion of vitamins can be a real problem when it comes to the skin.

• Nicotinic Acid: A "B" vitamin.
• Vitamin A: This also applies to its derivatives like Accutane, Etretinate, etc.

Anti-Inflammatory Medications (NSAIDS)

• Naproxyn: Such as Naprosyn, Alleve, etc.
• Ibuprofen: Such as Motrin, Advil, etc.
• Acetaminophen: Such as Tylenol.

Miscellanous

• Halothane: Used for general anesthesia.
• Hypertriglyceridemia: Very high blood fats called triglycerides.
• Topical ophthalmic betablocker agents/drops (such as Timolol) may cause reversible eyebrow or eyelash loss.
• Trichotillomania, a habit of pulling out hair. Repeated insult of plucking out the hair can destroy the hair follicle and lead to permanent loss.
• Over-plucking. Yes, over-plucking can again lead to destruction of the hair follicle and potentially permanent loss of the hair over time. Eyebrow hair follicles tend to be sensitive to removal of the hair, so plan your brow shape and try not to get carried away tweezing.
• Androgenic Alopecia, that condition that causes “balding” can also lead to thinning of the eyebrows over time. While some may argue this to be a hormonal condition, others would include it with the general category of age-related problems.

Eyebrows and eyelashes make an important contribution to facial symmetry and presentation of self to others. A person without eyebrows and/or eyelashes may feel very self-conscious about his/her appearance. Transplantation or reconstructive surgery can often restore eyebrows and eyelashes.

Eyebrows and eyelashes are lost in a variety of ways:

• Physical trauma—e.g., auto accident, thermal, chemical or electrical burns
• Systemic or local disease that causes loss of eyebrow and/or eyelashes
• Congenital inability to grow eyebrows and/or eyelashes
• Plucking (to reshape the eyebrow) that results in permanent loss of eyebrows
• Self-inflicted obsessive plucking or eyebrows and/or eyelashes (trichotillomania)
• Medical or surgical treatments that result in eyebrow or eyelash loss—e.g., radiation therapy, chemotherapy, surgical removal of tumor.

The cause of eyebrow/eyelash loss is evaluated in medical history and examination prior to consideration of hair restoration:

• Systemic or local disease that causes hair loss must be under control to assure that hair restoration can succeed
• Obsessive-compulsive plucking (trichotillomania) must be treated to assure that restored hair will not be plucked out
• Trauma, burns or surgery may have resulted in formation of scar tissue; reconstructive surgery may be necessary before eyebrow/eyelash restoration. The degree of eyebrow loss may vary from complete to partial; the degree of loss may be a consideration in selection of the restoration procedure.

Some patients have no eyebrow/eyelash loss, but seek eyebrow/ eyelash enhancement for cosmetic reasons.

Eyebrow Hair Restoration

A number of procedures are available for restoration of all or part of the eyebrow:

Transplantation of micrografts or single hairs from a donor area to the eyebrow, and A reconstructive flap or graft procedure that brings a strip of hair from another site to the eyebrow.

The patient and surgeon must agree on the procedure best suited to the needs of the patient. Eyebrow and eyelash restoration procedures are usually performed in an outpatient setting. Postoperative complications are usually limited to minor pain and swelling.

Reconstruction of the Eyebrow Using Flaps or Grafts

Reconstructive surgery has been used for many years to restore missing eyebrows or to repair partially missing eyebrows. Technical considerations and the needs of the patient determine which reconstructive procedure is used:

Transplants—A strip of hair-bearing skin and subcutaneous tissue is removed from a donor area on the scalp and grafted into the surgically-prepared eyebrow site. The transplant procedure is performed by selecting a hair-bearing area of scalp with hair that is of appropriate texture and orientation to serve as eyebrow hair. Micrografts of one to two hairs placed into incisions should be used for eyebrow reconstruction.

Scalp-to-eyebrow pedicle flaps— (Less commonly used) A strip of hair-bearing skin and subcutaneous tissue is raised from the temple area just in front of the ear, with its blood supply (a branch of the superficial temporal artery and vein) attached. This type of donor graft attached to a blood supply is called a pedicle flap. After the pedicle flap is raised, the recipient area (the eyebrow) is prepared to receive the flap. A subcutaneous "tunnel" is created from the base of the pedicle flap to the eyebrow recipient site; the flap is pulled through the tunnel and secured to the recipient site with stitches. The pedical flap’s blood supply nourishes the grafted tissue until the grafted tissue develops its own blood supply from surrounding tissue. Hairs grown from grafts and pedicles may have to be "trained" with gel or wax to lay flat to the skin like eyebrow hair; grafted hair also may have to be trimmed occasionally.

Transplantation to Correct Eyebrow Loss— A purpose of transplantation of hair to the eyebrow is to recreate the eyebrow in a natural contour. Patient and physician must work together to outline the eyebrow area to conform to the natural symmetry of the patient’s face. Depending on the size of the area to be transplanted, more than one transplant session may be required; two or more sessions several months apart are common.

Donor hair for the transplant is taken from a site that furnishes finer rather than coarser hair; finer hair is a better "match" for eyebrow hair. Donor hair is transplanted as micrografts of one to two hairs. Each graft is placed into an incision prepared for it. The use of single hairs or micrografts permits meticulous adherence to the eyebrow contour for a natural appearance.

As the transplanted hairs grow in their new position they may require occasional trimming as well as "training" with gel or wax.

Eyelash Hair Restoration

Transplantation is the only procedure used to restore eyelash hair. This 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.

Itching is a common and troublesome postoperative complication. If the patient gives in to temptation and scratches, there is risk for dislodging the hair grafts and initiating infection. Eyeglasses may be worn to deter scratching. The dermatologist can prescribe medications to relieve itching.

Training of transplanted hairs into eyelash conformation is accomplished by use of lash oil and an eyelash curler.

Eyebrow transplants and eyelash transplants were originally introduced to patients who had suffered from burns or congenital malformations of the eye. However, since this procedure has been perfected, people suffering from either complete or partial eyelash or eyebrow loss now have an available medical alternative. In the past, some people opted for eyebrow tattoos to recreate lost eyebrow hair, but tattoos can be obvious and look unnatural. This procedure will restore natural looking eyebrows and eyelashes that will last a lifetime. This procedure can also be used simply to thicken existing eyebrows or to lengthen existing eyelashes for cosmetic reasons.

Causes
Many reasons can cause both men and women to lose eyebrow or eyelash hair. These include:

• burns;
• scars;
• diseases;
• congenital inability;
• self-inflicted obsessive plucking;
• medical or surgical treatments such as radiation therapy and chemotherapy.

Procedure
Transplanting eyebrows or eyelashes involves extracting “donor” hair one follicle at a time.. Dr Jones matches up hair form other parts of your body for the desired thickness and curl. Eyelash hair, for example, is coarser than eyebrow hair. The eyebrow or eyelash hair is placed in the same direction as native eyebrow hair or eyelashes to create a natural look. The direction of the curl is also chosen when inserting the follicles to imitate the regular curl of your lashes and the hole to receive the new follicle can be made with a slight arc to promote a curl. Density varies with gender: women often have more eyelashes than men. Patients feel no pain or discomfort during the procedure, as local anesthetic is used. The entire procedure takes a few hours to perform and usually requires only one session.

With careful attention to the direction and angle of the growth of the new hairs, we can successfully transform patchy or absent eyebrows and/or eyelashes into natural-looking ones.

Results
The eyelashes and eyebrows are your own naturally growing hair. Unfortunately, hair grows in cycles so you will have to be patient. It usually takes a few months before the new hair starts to grow. Both eyelash and eyebrow transplant surgeries yield very positive results.

Post-operation
Few patients experience complications following the procedure. The most common are a small area of purplish discoloration under the eyelids for a few days, minor itching, pain and possibly swelling in some patients. The results yield no visible scarring or tufting and appear quite natural. Patients should avoid scratching the area. For 4 to 5 days following the procedure, tiny scabs appear like dots of sand on the skin, but these fall off. Once the new eyebrow or eyelash hair grows in, it is indistinguishable from natural looking eyelashes and eyebrows. They will require regular trimming as they will continue growing like hair on the scalp.

Eligibility and Cost
Not everyone is a candidate for this procedure. For example, victims of trauma or burns may require reconstructive surgery before eyebrow or eyelash restoration. The degree of hair loss must also be taken into consideration before effectively evaluating the feasibility and complexity of individual cases. In addition, it is difficult to estimate the cost of the procedure since cases vary from one patient to another. Please call for a consultation.

Dr Jones is a skilled hair transplant surgeon and is now regularly seeing patients for eyelash transplants and eyebrow transplants. After this procedure, patients will enjoy their beautifully shaped and contoured eyelashes and eyebrows for life.