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Eyebrow and Eyelash Hair Transplantation: A Systematic Review
Abstract
The objective of this systematic review was to investigate the etiologies of hair loss of the eyebrow and eyelash that required hair transplantation, the optimal surgical technique, patient outcomes, and common complications. A total of 67 articles including 354 patients from 18 countries were included in this study. Most patients were women with an average age of 29 years. The most common etiology requiring hair transplantation was burns, occurring in 57.6 percent of cases. Both eyebrow and eyelash transplantation use follicular unit transplantation techniques most commonly; however, other techniques involving composite grafts and skin flaps continue to be utilized effectively with minimal complication rates. In summary, many techniques have been developed for use in eyebrow/eyelash transplantation and the selection of technique depends upon the dermatologic surgeon's preferences and the unique presentations of their patients.
... Hair transplantation techniques have evolved dramatically over the last fifty years [14]. Hair transplantation refers to the procedure of transplanting individual hair follicles from one place to another [14]. ...
... Hair transplantation techniques have evolved dramatically over the last fifty years [14]. Hair transplantation refers to the procedure of transplanting individual hair follicles from one place to another [14]. The harvesting of donor hair follicles is accomplished either by amputating a strip of hair-baring skin called strip harvesting or by removing hair follicles individually [14]. ...
... Hair transplantation refers to the procedure of transplanting individual hair follicles from one place to another [14]. The harvesting of donor hair follicles is accomplished either by amputating a strip of hair-baring skin called strip harvesting or by removing hair follicles individually [14]. The major eyebrow transplantation techniques include the Follicular Unit Transplantation (FUT) technique, Composite Grafts (CGs), and skin flaps [14]. ...
Abstract
The eyelash and eyebrow are equally important as anatomical
structures with protective function and aesthetic value. Improvement
to both the eyelash and eyebrow has galvanized the cosmetic industry
to search for the perfect eyelash and brow. Current techniques and
apparatus utilized are beneficial but have their limitation. Novel
therapies are gaining momentum to discover the perfect yet safe
eyelash and brow.
Keywords: Eyebrows; Eyelash; Therapy
... Postoperatively, patients might experience scalp redness, local allergies, and curly, fine new hair, which heightens anxiety (Abt et al., 2018). Thus, it is necessary to pay attention to the psychological changes of these patients, providing appropriate support, alleviating negative emotions, and enhancing satisfaction (Klingbeil and Fertig, 2018). ...
Background
The success of hair transplantation surgeries for androgenetic alopecia is evaluated by postoperative long-term outcomes. Patients' self-management during the long recovery period affects this outcome.
Objective
This study aimed to explore patients' self-management status, facilitators, and impediments in the postoperative period and to provide a reference for developing a postoperative self-management intervention program.
Methods
Patients who underwent hair transplantation for androgenetic alopecia were selected using purposive sampling. They were interviewed using one-to-one semi-structured interviews at a general tertiary hospital in Hangzhou from March to April 2022. Qualitative research analysis software Nvivo 12.0 was used to analyze the collected data.
Results
The self-management of postoperative patients with androgenetic alopecia during the recovery period encompasses six areas: more problems with postoperative medication (e.g., not being able to take medication on time) and wound care (e.g., not daring to shampoo, etc.), not being able to review their postoperative condition on time (due to busy schedules at work and at home), more hindrances to the establishment of good living habits (affected by overtime work, socialising, and bad habits of the people around them), and seeking positive ways of relieving bad emotions (stress, anxiety, depression, etc.), worrying about one's image during recovery and taking the initiative to obtain and use resources to promote recovery (through the Internet, books, etc.)
Conclusions
Various factors impact the postoperative self-management abilities of patients, including medication, shampooing, and emotions. It is essential to design support programs to enhance these abilities and improve long-term hair transplantation outcomes.
... Eyebrow transplantation is a widely-accepted procedure resulting in positive longterm results in patients with eyebrow loss due to trauma or excessive plucking [106]. However, in FFA, the procedure remains controversial. ...
Frontal fibrosing alopecia (FFA) is a type of cicatricial alopecia predominantly observed in postmenopausal women, with the incidence rising since its initial description in 1994. The exact etiopathogenesis of the disease has not been completely elucidated. FFA is characterized by an inflammatory process affecting the hair follicles of the fronto-temporal hairline, leading to its gradual recession. Eyebrows, particularly the lateral parts, may also be affected. Early diagnosis and an implementation of effective therapy to limit the inflammatory process are crucial in halting disease progression. Various treatment possibilities have been reported, including anti-inflammatory and immunosuppressive agents, as well as 5-alpha-reductase inhibitors, retinoids, and antimalarial agents. The use of phototherapy and surgical procedures has also been described. However, most available data have been obtained retrospectively, frequently consisting of descriptions of case reports or small case series, and not from randomized controlled trials. In addition, the etiopathogenesis of FFA remains unclear and its course unpredictable, occasionally being linked with spontaneous stabilization. Hence, no precise guidelines exist regarding treatment modalities. Therefore, the aims of this study were to provide a comprehensive review of the efficacy of existing therapeutic modalities for FFA and to highlight novel therapeutic options.
... composite skin graft, and hair transplantation. [1][2][3][4][5][6] Use of a superficial temporal artery island scalp flap has several drawbacks, in that the restored hair is denser and thicker than before scarring, having a brush-like appearance with sharp boundaries. [7][8][9] In addition, these procedures require extensive dissection, which is complex and time-consuming. ...
Background:
Scarring that results in eyebrow loss is a serious psychological and cosmetic problem. Although hair transplantation is increasingly utilized for eyebrow restoration, graft loss may occur, preventing achievement of desired results. Single-hair follicle transplantation, however, may be effective. The present study describes outcomes of a standardized method of eyebrow reconstruction, involving single-hair follicle transplantation combined with follicular unit extraction (FUE), in patients with absent eyebrows due to scarring.
Methods:
This study was approved by the institutional ethics committee of Nanfang Hospital and all patients provided written informed consent before surgery. The medical records of patients who underwent eyebrow reconstruction from 2012-2019 for eyebrow loss caused by scar formation were retrospectively reviewed. Outcomes evaluated included satisfaction, graft survival rate and long-term complications. A nine-step standardized operating procedure was established for eyebrow reconstruction in patients with eyebrow absence due to scarring.
Results:
During the study period, 167 patients (205 eyebrows) underwent eyebrow reconstruction. Following the first stage of reconstruction, 95% of patients were highly satisfied with the density and natural appearance of their eyebrows. The average graft survival rate was 85% (range, 70-90%), significantly higher than the 75% survival rate previously reported. Fewer than 5% of patients underwent the take second stage of reconstruction, with these patients expressing satisfaction with their outcomes. No obvious complications were observed.
Conclusion:
This standardized method may optimize outcomes in patients with eyebrow absence due to scarring.
An eyebrow is defined as the line of short hairs located above each eye in humans.
Biblical verses related to eyebrows are examined from a contemporary perspective.
This exploration covers the history, anatomy, positioning, aesthetic presentation, expressions associated with eyebrows, and variations in eyebrow dimensions across different countries. Clinical presentations and management of eyebrow-related conditions are discussed.
The position of the eyebrows is an important factor in human aesthetic perception. The attractiveness of eyebrow position and shape vary through an aesthetic analysis of their characteristics.
The eyebrows and eyebrow fat pads, key structures in upper facial aesthetics, are particularly vulnerable to age-related changes. Major aging changes are a drooping of the brow (brow ptosis), excessive accumulation of skin in the upper lid (dermatochalasis), and a prolapse of orbital fat, in the upper and lower lids caused by weakening of the septum and orbital connective tissues. The medial eyebrow height increases with age, whereas it remains stable at the level of the lateral canthus.
Preferences for eyebrow dimensions vary across different countries.
In this Research, various strategies are addressed for coping with various medical conditions that can adversely affect the appearance and health of eyebrows.
In conclusion, the Biblical verses referenced in this study provide valuable insight into the cultural and symbolic significance of the eyebrow. These findings highlight the important role the eyebrow has played throughout human history. For a thorough analysis, it is crucial to examine its historical context in greater depth.
The hair-bearing superficial temporal artery flap is one of the traditional options for total eyebrow reconstruction. The anatomical variation of the superficial temporal artery has been well discussed; however, the anatomy of the superficial temporal vein is highly diverse. The authors report the use of preoperative computed tomography (CT) angiography in a 27-year-old man with a total eyebrow defect caused by thermal burn injury. The authors harvested a 6×1.5-cm pedicled hair-bearing superficial temporal artery flap from the area where the parietal branches of the superficial temporal artery and vein were running in close proximity, according to the CT angiography findings. Postoperatively, the flap survived completely without any vascular compromise. The authors believe that preoperative visualization of the superficial temporal vessels with CT angiography is highly beneficial in performing safe eyebrow reconstruction with a hair-bearing superficial temporal artery flap.
Background:
Because the structure of eyebrows is complicated, students need a lot of practice to become familiar with the distribution pattern of eyebrow hair.
Objectives:
The current study was designed to investigate the training methods for eyebrow design and planting practice before eyebrow hair transplantation to improve eyebrow planting quality.
Methods:
Twelve surgeons were selected. The six surgeons in the experimental groups had never performed eyebrow transplantation surgery, whereas the six in the control group had experienced of eyebrow transplantation surgery. Students in both groups received theoretical and simulated eyebrow hair transplantation instruction. Students were required to master standard eyebrow transplantation, The results of the training group and the control group trainees were compared before and after training.
Results:
The results revealed that the experimental and control groups' overall results significantly improved compared to before the Training (P <0.05). After theoretical Training, two-dimensional simulation training, and three-dimensional simulation training, eyebrow shape, symmetry, hair angle, and density after the three-dimensional simulation training statistically significantly improved (P <0.05). There was no statistically significant difference, and the students in the control group did not demonstrate any improvement in their capacity to arrange the eyebrows or shape them symmetrically. After training, however, the hair's angle and density substantially improved.
Conclusions:
The experimental group's technical ability in simulated eyebrow planting significantly improved. The present study demonstrated that the students could develop their skills and get closer to the level of surgeons with experience in eyebrow transplant surgery by integrating theoretical lectures with practiced procedures.
Resumen
Gracias a los considerables avances experimentados a partir de la década de 1980, la cirugía de la alopecia se ha consolidado como la técnica de referencia para corregir la alopecia androgénica masculina y femenina. Los nuevos métodos de exploración permiten determinar con precisión la causa de la alopecia y tener una idea más precisa de su evolución a largo plazo. En relación con la movilización, se han desarrollado dos técnicas, la extracción mediante banda y la extracción folicular, que hacen que el trasplante sea mucho más eficaz y menos complicado desde el punto de vista quirúrgico que las técnicas de expansión del cuero cabelludo, reducción de la coronilla o colgajo. Con respecto al trasplante propiamente dicho, se han realizado muchos progresos, no sólo para aumentar la tasa de supervivencia de los injertos, sino también para hacer que la implantación sea indetectable a simple vista. Para preservar los injertos, los cirujanos están utilizando actualmente soluciones de conservación optimizadas, así como una instrumentación menos traumática para las unidades foliculares. Finalmente, los métodos de implantación tienen ahora en cuenta la densidad del cabello y su distribución y el tipo de folículos pilosos, con el fin de obtener el resultado más natural posible. El refinamiento de las técnicas actuales de trasplante capilar permite igualmente corregir otros territorios pilosos, como las cejas, la barba y el bigote o también las cicatrices de lifting.
Eyebrows and eyelashes serve important anatomical and social functions, and hair loss at these sites can impact patients significantly. Acquired eyebrow and eyelash loss (madarosis) may be due to a variety of underlying local or systemic disease processes; in other cases it may be idiopathic. There is a dearth of literature relating to eyebrow and eyelash loss, and there is limited guidance to help clinicians treat these clinical presentations in comparison with scalp alopecia. Here, we discuss the acquired causes of eyebrow and eyelash alopecia, our clinical approach to diagnosis and review treatment options for clinicians.
Riassunto
Grazie ai notevoli progressi compiuti a partire dagli anni ′80, la chirurgia della calvizie si è affermata come la tecnica di riferimento per la correzione dell’alopecia androgenetica maschile e femminile. I nuovi metodi di esplorazione consentono di determinare con precisione la causa dell’alopecia e di avere un’idea più precisa della sua evoluzione a lungo termine. In termini di prelievo, sono state messe a punto due tecniche, il prelievo tramite strisciolina e il prelievo tramite estrazione follicolare, che rendono il trapianto molto più efficiente e meno pesante dal punto di vista chirurgico rispetto alle tecniche di espansione del cuoio capelluto e di riduzione della chierica o dei lembi. Per quanto riguarda il trapianto vero e proprio, sono stati fatti molti progressi, non solo per aumentare il tasso di sopravvivenza degli innesti, ma anche per rendere l’impianto non rilevabile a occhio nudo. Per preservare gli innesti, i chirurghi utilizzano oggi delle soluzioni di conservazione ottimizzate, nonché una strumentazione meno traumatica per le unità follicolari. Infine, i metodi di impianto ora tengono conto della densità dei capelli, della disposizione dei capelli e del tipo di follicoli piliferi per ottenere il risultato più naturale possibile. Il perfezionamento delle attuali tecniche di trapianto di capelli consente anche di correggere altre aree pilifere come le sopracciglia, la barba, i baffi o persino le cicatrici da lifting.
Background:
Follicular unit extraction (FUE) is a minimally invasive surgery that is becoming popular in hair restoration in cicatricial alopecia (CA).
Aim:
Evaluation of FUE with or without platelet rich plasma (PRP) in scarring alopecia PATIENTS AND METHODS: Twenty patients with CA were randomized into two groups. Group A (10 patients) underwent FUE, group B (10 patients) underwent FUE+PRP. PRP was injected one week before surgery, then monthly after surgery for 3 months. Follow up was done after 3,6 and 12 months by calculating the density of surviving follicular units and the survival rate.
Results:
In group A, there was statistically significant increase in mean survival rate which was 30.30% At 3 months, 67.26% at 6 months and 78.15% at 12 months. In group B, there was a significant increase in mean survival rate being 30.14% at 3 months, 58.75% at 6 months and 69.74% at 12 months. There was no significant difference between both groups at anytime during follow up period.
Conclusion:
FUE is a preferred procedure for hair restoration in CA with few side effects. The role of PRP in HT is controversial. In the present study, PRP does not significantly affect the survival rate of hair grafts.
Supplemental Digital Content is Available in the Text.
Background:
Leukotrichia is one of the difficulties of vitiligo treatment. Hair follicle transplantation is an efficient method to treat vitiligo-associated leukotrichia. A trichiasis electrolyzer, commonly used for treating trichiasis, can be used to damage and remove the depigmented hair follicles.
Objective:
To evaluate the efficacy of the electrolysis of depigmented hair using a trichiasis electrolyzer combined with single hair follicle transplantation for the treatment of vitiligo-associated leukotrichia.
Methods:
A total of 15 patients with stable vitiligo-associated eyebrow and eyelash leukotrichia were enrolled from Department of Dermatology, Hangzhou Third People's Hospital between January 2020 and January 2021. All patients were treated using a trichiasis electrolyzer combined with single hair follicle transplantation. The patients were followed up at the first week, the first month, the third month, and the sixth month after surgery. The texture and growth state of the transplanted hair were observed, and the number of surviving transplanted follicles and regenerating depigmented follicles were recorded.
Results:
The transplanted hair grew as expected with natural shape. No local infection or obvious scar were observed. Most of the depigmented hair in the lesion area re-pigmented and only a few depigmented hairs regenerated. The average survival rate of the transplanted hair follicles was 71.6%, and the average regeneration rate of the depigmented hair was 11.6%.
Conclusion:
The electrolysis of depigmented hair using a trichiasis electrolyzer combined with single hair follicle transplantation was an effective and safe method to treat vitiligo-associated leukotrichia.
Considering the significance of hair for beauty, especially for women, it is easy to understand why hair loss often causes severe emotional distress and affects quality of life and why people’s desire for hair restoration includes hair transplantation. This chapter presents an overview of hair loss classification, hair transplantation, patient selection and preoperation evaluation, instruments and settings, follicular unit transplantation method, follicular unit extraction method, donor area and recipient area, postoperation care, pitfalls and complication, hair transplantation in scaring alopecia, and hair transplants in other sites of the body.
Background
Eyelashes play an important role in perception of beauty and protection of eyeballs. The outcome of eyelash restoration varies and mainly depends on the surgeon’s technique and no standard procedure exists.
Aims
To evaluate the effect of modified single‐hair follicular unit grafting to aesthetically restore eyelashes and provide a potential alternative of standard procedure.
Patients and Methods
A total of 34 patients with sparse or partially absent eyelashes who underwent modified procedure were included. Single‐hair grafts were harvested from the donor site (post‐auricular, nape, frontal hairline area). Grafts were transplanted with 23 gauge needle and fine forceps in the modified procedure. The patients were followed for a mean of 12 months after surgery.
Results
All patients were satisfied with the result 12 months after the surgery. An average of 46.5 grafts (34‐68) were transplanted in each upper eyelid. The mean graft survival rate after 1 year was 87.2% (84%‐92%). Of the 34 patients, 3 patients received a second session to achieve a denser appearance. No significant complication as trichiasis, infection, scarring or eyeball injury occurred.
Conclusion
This modified single‐hair follicular unit grafting is a good alternative for aesthetic eyelash restoration with good cosmetic results, relative easy maintenance, lack of complications, and long‐term patient satisfaction.
Modern hair restoration surgery is based on a technique known as follicular unit transplantation in which follicular units (FUs) are the exclusive structures used as hair grafts. In Part 1 of this two-part review, we describe how the techniques employed in hair transplantation have evolved into their present forms. Anatomic concepts of specific relevance for dermatologists are discussed, including the distribution and ex-vivo morphology of scalp FUs. Male androgenetic alopecia and female pattern hair loss are the most common reasons for hair loss consultations with dermatologists and will be the primary focus of this review. However, as not all hair disorders are suitable for transplantation, this review will also describe which scalp conditions are amenable to surgery and which are not. In addition, guidelines are provided to help dermatologists better define good or bad candidates for hair transplantation. Finally, other conditions for which hair transplantation surgery is indicated are reviewed.
Feuerwerksverletzungen sind praktisch immer Folge einer Fehlfunktion oder fehlerhaften Bedienung von Feuerwerkskörpern. Häufig sind bei diesen Verletzungen sowohl der Augapfel als auch die Periorbita beteiligt. Nach der Versorgung von vital gefährdenden Blutungen haben die Verletzungen des Augapfels Vorrang vor der Behandlung periorbitaler Wunden und Verbrennungen. Ziel aller lidchirurgischen Eingriffe bei diesen Verletzungen ist es, Spätschäden wie einen Lagophthalmus, ein Symblepharon oder ein Entropium mit Trichiasis sowie die Keratinisierung der Lidkante oder der Lidinnenseite zu verhindern. Die Therapie der Lid- und periorbitalen Verletzungen erfordert ein erhebliches Maß an Zeit sowohl für die aufwendigen operativen Maßnahmen wie auch für die erforderlichen Heilungs- und Ruhephasen. Bei vielen Patienten bleiben jedoch trotz aller therapeutischen Maßnahmen eine gravierende Minderung der Sehfähigkeit und belastende ästhetische Entstellungen zurück, die eine erhebliche berufliche und soziale Beeinträchtigung zur Folge haben.
Background:
Eyebrow hair loss is usually a primary feature of frontal fibrosing alopecia (FFA), which causes significant distress to patients and consequently seek medical help. Eyebrow hair transplantation is a well-accepted and aesthetically successful treatment, but there is a lack of information about the short- and long-term results in this subset of patients.
Objective:
To report the short- and long-term eyebrow hair transplantation results in patients with FFA.
Patients and methods:
Ten patients diagnosed with FFA underwent eyebrow hair transplantation. The transplanted hairs were harvested from nonaffected follicles of the occipital scalp skin. On average, 120 to 270 single-hair follicles were implanted per eyebrow.
Results:
Eighty percent of patients achieved excellent hair growth at 6- to 12-month follow-up and satisfactory short-term results (<2 years). However, majority started losing the transplanted hairs after 3 to 4 years. Only 1 patient did not lose transplanted hair in the long-term follow-up (>4 years).
Conclusion:
The results of eyebrow hair transplantation in FFA patients are variable and contentious. The short-term outcome is satisfactory, but in most patients, a progressive loss of transplanted hairs can be expected. Therefore, FFA patients inquiring about eyebrow transplantation should be advised about the high possibility of hair graft loss over time.
Background:
Eyelash leucotrichia is cosmetically disfiguring condition and remains a therapeutic challenge in successful management of vitiligo.
Aims:
To study the efficacy of eyelash transplantation in management of eyelash leucotrichia associated with vitiligo.
Materials and methods:
Fifteen patients with eyelash leucotrichia were treated with follicular unit transplantation. Improvement in leucotrichia was evaluated using objective assessment.
Results:
Out of fifteen patients, good to excellent response was seen in 13 patients (86.67%), fair in one patient (6.66%) and poor in one patient (6.66%).
Conclusion:
Eyelash transplantation is safe and effective method for eyelash leucotrichia.
Summary: Fine hairs of the head and nape areas have been used as donor sources in eyelash transplantation but are straight, coarse, and grow rapidly, requiring frequent eyelash maintenance. This is the first reported case of eyelash transplantation by follicular unit extraction using leg hair as a donor source; findings were compared with that of another patient who underwent a similar procedure with donor hairs from the nape area. Although both patients reported marked improvement in fullness of eyelashes within 3 months postsurgery, the transplanted leg hair eyelashes required less frequent trimming (every 5-6 weeks) compared with nape hair eyelashes (every 2-3 weeks). Additionally, in leg hair eyelashes, the need for perming to sustain a natural looking eyelash curl was eliminated. Eyelash transplantation using leg donor hair in hirsute women may result in good cosmetic outcomes and require less maintenance compared with nape donor hair.
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0. American Society of Plastic Surgeons
(C) 2015 American Society of Plastic Surgeons
The temporoparietal fascia flap has been extensively used in craniofacial
reconstructions. However, its use for eyebrow reconstruction has been
sporadically reported. We describe a successfully repaired hair-bearing
temporoparietal fascia flap after traumatic avulsion of eyebrow. Temporoparietal
fascia flap is a versatile tool and should be considered as a therapeutic option
by all plastic surgeons.
Wide resection of malignant skin tumors in the upper orbital region often results in soft-tissue defects involving the eyebrow. We used composite skin grafts from the area around the sideburns for 1-stage reconstruction of skin and eyebrow defects. The results were aesthetically satisfying because the hair and shape of these regions were similar to those of the original eyebrow, and donor-site closure was easy with inconspicuous scar. The survival of full-thickness skin graft area of composite grafts from sideburn facilitates revascularization of thicker hair follicles in the graft and allows safe, natural eyebrow reconstruction.
Objective:
The purpose of this study was the introduction in clinical practice of the combined application of traditional reconstructive surgery and intense pulsed light (IPL) for the restoration of a post-traumatic eyebrow defect.
Case:
The authors present a case of surgical eyebrow reconstruction with an axial temporal hair-bearing scalp island flap. A persistent localized erythema and a marked difference in hair density in comparison with the contralateral one harmed the eventual surgical outcome.
Results:
A combined sequential treatment with IPL achieved both hair density and skin erythema reduction, and eventually allowed for a very satisfactory result.
Conclusions:
Our experience demonstrated the efficacy of the integrated multidisciplinary approach involving traditional plastic reconstructive surgery and the innovative new technologies in aiming for perfection.
We report the reshaping of the eyebrow by follicular unit transplantation from excised eyebrow skin in extended infrabrow excision blepharoplasty.
The method was carried out in two patients with moderate or significant dermatochalasis. The areas to be excised from the infrabrow and intrabrow skin were decided upon and the area of hair transplantation was planned in the suprabrow area and the tail of the eyebrow. The skin was removed and the excised intrabrow skin was dissected into single follicular units. Tiny incisions were made with a scalpel, and grafts were inserted using fine forceps.
Almost all transplanted eyebrow follicles took successfully, resulting in eyebrows of a desirable shape as planned preoperatively. The reshaped eyebrows had a natural appearance since the transplanted hairs were similar to those of the original eyebrow. The eyelids still looked youthful rather than operated-on. Finally, the evidence of blepharoplasty was hardly visible and patient satisfaction was quite high. The patients felt more ease in opening their eyes and obtained a wider visual field.
Our study demonstrated excellent results with hair transplantation from eyebrow to eyebrow, a finding which, to our knowledge, has not been previously reported. Our method can be used for selected patients, especially men, with moderate to severe dermatochalasis, who find a reduction or change in the shape of the eyebrow unacceptable.
Reconstruction of the eyebrows, eyelids, and destroyed lacrimal drainage system is a challenging procedure for plastic and reconstructive surgeons. In the case presented, a superficial temporal fascial flap was designed for reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in a one-stage procedure in facial burn patient. To the authors' knowledge, this is the first combined reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in one surgical procedure with pedicled superficial temporal fascial flap including skin island and buccal mucosal graft. During the 1-year follow-up period, no complication was encountered and patient healed uneventfully.
Purpose:
This case study demonstrates a new operative method of eyebrow reconstruction, in which the hair density of the reconstructed eyebrow is controlled by the surgeon and is more similar to that of the uninjured side, resulting in a more natural facial expression and greater aesthetic value for our patients.
Materials and methods:
The operation was divided into two stages: Stage 1: Implantation of a soft tissue expander into the corresponding subgaleal position of the parietal branch of the superficial temporal artery on the injured side, followed by dilation of the expander until the density of the hair on the expanded scalp reached a suitable value and was lower than that of the uninjured eyebrow. Stage 2: Harvesting of the scalp island flap pedicled by the superficial temporal artery, the end of which was attached to the expanded scalp, followed by the downward movement of the flap to the defect site of the eyebrow via a subcutaneous tunnel, resulting in new eyebrow formation.
Results:
In eight cases who were monitored for 4-16 months of follow-up, almost all of the reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance, which was consistent with preoperative expectations; the transplanted hairs were highly similar to those of the original eyebrows. All participants remained healthy after the operation, which was indicated by sufficient blood supply to the expanded flap and normal growth of a new eyebrow without postoperative complications.
Conclusion:
Our study demonstrated the excellent performance of an innovative procedure in which a expanded scalp island flap pedicled by the superficial temporal artery was used in the construction of a new eyebrow. It can be performed very safely and reliably to ensure expected results.
Level of evidence v:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Background:
Partial or total eyebrow defects after trauma or tumor excisions have been repaired by several surgical technique and algorithms. However, these algorithms are often complicated and difficult to apply clinically. We therefore established a simplified surgical algorithm for the treatment of eyebrow defects using flap reconstruction.
Methods:
During the period between January 2009 and December 2015, a total of 21 Chinese patients (12 males, 9 females) with eyebrow defects were treated with eyebrow flap reconstruction. The ages ranged from 12 to 51 years. The patients included 13 cases located on the left and 8 cases on the right eyebrow. These defects were caused by trauma (5 patients) and tumor excision (16 patients). Among them, 6 patients were treated using superficial temporal artery island flap, while 15 patients were treated using the V-Y advancement pedicle flap based on the orbicularis oculi muscle. The minimum defect area was 0.8 × 1.0 cm and maximum area was 2.3 × 4.3 cm. All patients were followed up for 6 months to 5 years postoperatively. The clinical effects of eyebrow reconstruction were evaluated using a designated scoring system.
Results:
All 21 flaps survived without significant complications and the shapes of the reconstructed eyebrows were continuous, symmetrical and with good integrity. According to the rating scale, there were 13 excellent, 8 good reconstructions among all patients. After an average of 9 months of follow-up, all patients had no recurrence of tumors and no infection or scarring.
Conclusions:
Based upon our experience with 21 patients who underwent eyebrow reconstruction for various eyebrow defects, we believe that our simplified surgical algorithm can serve as a model for the treatment of patients with eyebrow defects.
Eyebrows serve a key role in eye protection, communication, and self-expression. Trends in eyebrow grooming are constantly evolving, often requiring plucking, waxing, or laser hair removal to style. When combined with the natural thinning of the brow with aging, the result can be a sparse or even absent eyebrow hair over time. Follicular unit transplantation provides a means of restoring eyebrow fullness and architecture. With careful attention and augmentation of follicle transfer techniques, a natural end result is possible.
© 2015 Wiley Periodicals, Inc.
Follicular Unit Transplantation (FUT) is performed using large numbers of naturally occuring individual follicular units obtained by single-strip harvesting and stereo-microscopic dissection. Donor wound scarring from strip excision, although an infrequent complication, still concerns enough patients that an alternative solution is warranted.
The purpose of this paper is to introduce Follicular Unit Extraction (The FOX Procedure), in which individual follicular units are removed directly from the donor region through very small punch excisions, and to describe a test (The FOX Test) that determines which patients are candidates for this procedure. This paper explores the nuances, limitations, and practical aspects of Follicular Unit Extraction (FUE).
FUE was performed using 1-mm punches to separate follicular units from the surrounding tissue down to the level of the mid dermis. This was followed by extraction of the follicular units with forceps. The FOX test was developed to determine which patients would be good candidates for the procedure. The test was performed on 200 patients. Representative patients who were FOX-positive and FOX-negative were studied histologically.
The FOX Test can determine which patients are suitable candidates for FUE. Approximately 25% of the patients biopsied were ideal candidates for FUE and 35% of the patients biopsied were good candidates for extraction.
FUE is a minimally invasive approach to hair transplantation that obviates the need for a linear donor incision. This technique can serve as an important alternative to traditional hair transplantation in certain patients.
Patients of different ethnicities have specific characteristics that are essential for hair transplant surgeons to understand so that aesthetic results can be achieved. In this article, the approaches of follicular unit extraction and follicular unit grafting or strip hair transplants for pattern hair loss are reviewed, along with the procedures of eyebrow and beard transplants and surgical hairline advancement/forehead reduction surgeries, within various ethnic groups.
Partial loss of the eyebrows can be the result of epilation, scars, and inflammatory diseases. Facial hair and eyebrows play a major role in our mimetic expression and interaction. Therefore, facial hair restoration of the eyebrows can improve the appearance and psychological well-being of patients. We report the use of partial longitudinal follicular unit transplantation (PLFUT) to restore eyebrows. A total of 10 patients (age between 18 and 59 years; mean, 39 years) have been treated with PLFUT to restore the eyebrows. The grafts were harvested from the occipital area of the scalp. Suitable grafts were impregnated with a preservative solution and implanted into the eyebrows areas. Hair growth in the donor area as well as the eyebrows was observed before treatment and at intervals of 1 week, 3 months, and 1 year after treatment. Evaluation of the donor area reveals no visible scars with almost all hair follicles in the donor site reproducing hairs after 1 year. All treated patients were satisfied or very satisfied with their cosmetic results. PLFUT is a reliable, patient friendly method suitable for hair restoration of eyebrows in healthy persons as well as in burn scar tissue.
Refinements in hair transplantation techniques allow the experienced surgeon to create natural-appearing facial hair transplants. Restoring eyebrows, beards/goatees, and sideburns have all become popular procedures, and the results can be outstanding. This article provides a comprehensive review of hair grafting techniques to achieve the best results in restoring various hair-bearing areas of the face, including the eyebrows, beard/goatee, and sideburns, and repairing the alopecic scarring from prior facial plastic surgery.
Hair transplantation is a continuously evolving field. The procedure was originally developed by Dr. Orentreich in 1959, but he applied it only to the androgenic alopecia. Potential applications for hair grafting extend beyond treatment of hair loss.
Our study group consisted of 25 cases of 23 patients. The causes of scar resulting to hair loss were burns, operation, and trauma. The scalp strips or follicular unit extracts were harvested from occipital, posterior auricular, dog-eared scalp, adjacent scalp area, and nuchal area. The recipient sites were scalp, eyebrow, lip, and eyelid.
The follow-up cases over 6 months after operation were 18 among total 25 cases. The result after hair follicle transplantation was excellent (44.4%), good (38.9%), fair (11.1%), and poor (5.6%).
The hair follicle transplantation on the scar tissue is more difficult than grafting on normal tissue because the scar is accompanied by poor blood circulation and stiffness of tissue. The patients with burned scar achieved more favorable result than did others. Incision scars are deeper than burned scars, and their success rates are poor. We should recommend the patients that hair follicle transplantation on the scar may need secondary or more operations for the aesthetically better result.
Ectodermal dysplasia (ED) is a hereditary syndrome which affects the ectodermal layer and thus appendages originating from this layer like hair, teeth, and sweet glands. The hairs of the scalp and eyebrows are sparse and broken and sometimes absent in ED patients. We reported a case of ED who underwent successful hair transplantation for her eyebrows.
A 17-year-old female with previously known Ed referred to our clinic because of absent lateral eyebrow hairs. She also had hypodontia (she lacked incisor teeth) and hypohydrosis. We designed a hair transplantation procedure for the lateral third of her eyebrows with follicular unit transplantation (FUT) method. We selected the occipital part of the scalp as the donor. After 6 months and 2 years follow-up, the patient was quite satisfied with her appearance.
The facial appearance of ED patients could be corrected well enough by hair transplantation methods.
The eyebrow and eyelash are two major sites in facial hair transplantation. Different methods have been experienced for better results. Surgeons tend to use smaller grafts. The authors modified the follicular isolation technique and added de-epithelialization to reduce complications and improve outcomes.
Sixty patients were allocated to either the isolation group or the isolation plus de-epithelialization group. Some patients underwent both eyebrow and eyelash transplantation; therefore, 79 procedures were performed on 60 patients. Scar formation, number and percentage of surviving transplanted hairs, hair growth orientation, and satisfaction with outcome were reviewed at 6 months.
The mean number of preserved transplanted hairs in eyebrow transplantation at follow-up was not significantly different between the two groups, but the mean percentage of preserved transplanted hairs was significantly higher in the isolation plus de-epithelialization group. In eyelash reconstruction, the mean number and percentage of surviving hairs were significantly higher in the isolation + de-epithelialization group than in the isolation-only group. The isolation + de-epithelialization group had more cases of normal hair growth direction in both eyebrow and eyelash transplantation cases, although the difference was statistically significant only in eyebrow reconstruction.
This study showed that follicular isolation plus de-epithelialization had better outcomes and fewer complications than did follicular isolation alone. This could be due to less need for suture in recipient sites, less risk for burying of epithelium of graft in the recipient site, less need for manipulation, lower graft volume, and less need for blood for survival and for removal of sweat glands.
: Therapeutic, II.
A novel and successful case of eyebrow reconstruction, in dormant keratosis pilaris atrophicans, is presented. Keratosis pilaris atrophicans is a benign hereditary disorder of unknown aetiology. Grouped keratotic follicular papules and perifollicular erythema affect the cheeks and eyebrows, with a subsequent atrophic stage that results in scarring and alopecia. It often presents during early infancy with remission during adulthood. A 33 year old man presented with scarring and alopecia of the eyebrows and was followed over a total 4 year period during which reconstruction was achieved using individual hair follicle micrografts. Composite scalp grafts and flaps, more often than hair follicle micrografting techniques, are described in the literature for reconstruction of the eyebrows in a range of conditions. This case provides an encouraging example of successful micrografting in dormant inflammatory cutaneous disease.
This article describes the management of chemical burns to the Asian face with resultant full thickness loss to the right side of the face including the eyelid and nose. We detail the techniques used to reconstruct the face which include skin grafting according to the aesthetic units of the face, accurate placement of junction lines, use of a chondrocutaneous graft to reconstruct the alar grove and scalp strip grafting for eyebrow reconstruction. We obtained a successful result that minimised scar formation in the burnt Asian face.
The absence of an eyebrow, either partial or total, has been observed in patients with craniofacial clefts, such as the Tessier 9 to 13 cleft. Several techniques have been used to improve the appearance of the region, such as island scalp flaps and scalp strip grafting, with limited or marginally satisfactory aesthetic results. The authors report 2 patients with craniofacial clefts in whom a novel technique combining 2 separate surgical approaches, micrografting and tattooing, was used. The use of micrografting with single or double hair units, properly angulated, produces natural-looking and satisfactory results with a minimum of morbidity. Excellent volume and appearance of the eyebrow may be achieved in a single session using this technique. Tattooing performed subsequently over the microimplanted hairs provides the illusion of greater density to the eyebrow, resulting in an appearance closer to normal.
Eyelash hairs have certain unique properties such as parallel direction, limited length, and tapering, which makes eyelash reconstruction considerably difficult. Several methods for eyelash reconstruction have been reported. Among them, strip composite eyebrow graft is the most suitable because the properties of eyebrow hairs are very similar to those of the original eyelash hairs. A rich blood supply in the eyelid ensures a good survival of the graft. Careful selection of the donor strip harvesting site is critical for preserving a good direction of hairs. The thickness of the graft strip should be determined considering the optimal thickness of hairs being obtained. When suturing the graft strip to the recipient bed, the burying method is suitable for preventing the protrusion of the graft. A well-performed surgical procedure results in a postoperative outcome that closely resembles the natural eyelashes.
Reconstructing the eyelash margin is a challenge for plastic surgeons because eyelashes have specific characteristics. There is still no gold standard procedure for this type of reconstruction, which seeks to protect the eyeball and make the eyelid appear natural. The eyebrow composite graft can be a good option for reconstructing the eyelash margin because it is technically simple and safe, and takes advantage of the structural similarity between the eyelashes and eyebrow. The results presented showed the effectiveness of the technique by providing improved occlusion and a good aesthetic result.
The authors have indicated no significant interest with commercial supporters.
Eyebrow reconstruction is a challenge because eyebrow hair is unique. Although various surgical methods have been used to reconstruct eyebrow defects, to the best of our knowledge, the use of eyebrow free flaps for eyebrow reconstruction has not been reported. We describe the successful reconstruction of a large eyebrow defect using a supraorbital artery perforator free flap and show that microvascular eyebrow transplantation is another tool for reconstructing large eyebrow defects. Accordingly, we recommend that microvascular eyebrow transplantation be considered a useful option for the reconstruction of large eyebrow defects.
Extracted partial longitudinal follicular units can be used as complete follicular units to regenerate completely differentiated hair growth. The partial follicular units that remained in the dermis in the donor area can survive and produce hairs. This technique enables us to multiply hair follicles in vivo, while preserving the donor area and therefore is suitable in persons, who have a relative small donor area compared to the recipient area, as in scalp burns.
With this study, we try to determine if partial longitudinal follicular unit transplantation (PL-FUT) can be used for facial and/or scalp burns.
Four burn victims (age 22-39 years, mean 27.75 years) were treated in the face (eyebrows, and beard) and/or on the scalp with PL-FUT. The grafts were harvested with hollow wave-tipped needles with an inner diameter of 0.6mm from the occipital area of the scalp. The suitable longitudinal partial follicular units were impregnated with a preservative medium, and implanted into the recipient area. Hair growth in the donor area as well as the recipient area was observed before treatment, and at intervals of 1 week, 3 months and 1 year after the treatment.
After evaluation of the donor area, sometimes a few little white spots were visible, but almost all hair follicles in the donor site re-produce hairs after 2 years. All treated patients had satisfactory or very satisfactory cosmetic results in the treated area.
Longitudinal partial follicular unit transplantation (LP-FUT) may represent the first reliable patient-friendly method to generate two hair follicles from one hair follicle with consistent results and preservation of the donor area. Therefore, this method is very suitable for people with facial and/or scalp burns.
Alopecia areata is a common skin disorder of presumed autoimmune etiology and it usually shows an unpredictable course. Treatment of alopecia areata is challenging. There is very little information on the use of surgical therapies for the treatment of alopecia areata in the medical published work. A 24-year-old male patient was referred to a private hair transplantation clinic owned by one of the authors for the treatment of therapy-resistant alopecia areata affecting both eyebrows. He had quickly lost all body hair 4 years prior beginning from the scalp. He received psoralen and ultraviolet A (PUVA) therapy for alopecia universalis and all body hair re-grew except his eyebrows. Alopecia areata was stable for the 18 months following the last medical treatment he received. Because there was no response to various medical therapeutic agents, we decided to transplant occipital hairs to the eyebrow area. After the patient understood and accepted all risks, occipital hairs were transplanted to the eyebrows by using the follicular unit extraction technique. Postoperatively, the patient did not receive any topical or systemic therapies for alopecia areata. Although 40% hair re-growth was detected in his eyebrows at 1 year postoperation, this rate was 80% by 2 years postoperation. However, there was resistance to re-growth in the medial eyebrow regions. New eyebrows grew as occipital hairs and required trimming. His satisfaction from the surgical procedure was 90% at the end of the 24th postoperative month. Surgical treatment of diseases like alopecia areata is still controversial. Our case report offers an additional contribution to the published work on the surgical methods used in the treatment of stable alopecia areata.
The Authors describe the reconstruction of an eyebrow, in a case of complete traumatic avulsion, using a scalp island flap based on the superficial temporal artery, in a young person aged 32 years. The lesion represented a serious aesthetic disablement capable of causing disturbed psychic equilibrium and individual relationships, in view of the fact that the eyebrows play a decisive role in the characterisation of the face and expressive gestures. The strategy of using a scalp island flap with a limited amplitude only slightly larger than that of the site in which it was inserted enabled optimal projection of the newly constructed eyebrow to be achieved during suturing.
Severe burn is a common problem affecting victim's eyebrows. This study aims to assess the effectiveness, complications and patients' satisfaction in two eyebrow reconstruction surgical methods. Up to now, many reconstruction methods, their specific advantages and complications have been introduced. This study compares a new method (subcutaneous pedicle island flap), which is scarcely discussed, with a standard method (superficial temporal artery island flap).
This is a clinical trial conducted during 2003-2005 at the Al' Zahra' Hospital. Forty patients with eyebrow defect due to burn injuries were selected by convenience sampling. They were allocated to two groups randomly. The control group underwent a surgery for 'superficial temporal artery island flap' and the case group for 'subcutaneous pedicle island flap'. Data were gathered using two questionnaires. The first one included demographic data, patient history and condition of the eyebrows prior to surgery, effectiveness of surgery and complications. The second was a smiley face visual scale for patient's satisfaction. Data analysis was done using SPSS software (version 12; SPSS Inc., Chicago, IL, USA).
Findings showed that in the control group, 80% were female of a mean age of 22 years (SD=6/30) and in the case group 75% were female, of a mean age of 21/80 years (SD=8/28). Fisher's exact test showed a significant difference between the type of surgery and hair-growth direction (p=0.003). In addition, Mann-Whitney U test showed a significant difference between the type of surgery and patient satisfaction (p=0.002). Analysis showed that there is no significant difference between the type of surgery and bleeding, congestion, flap necrosis, temporary hair loss in flap and donor-site alopecia (p>0.05). Surgeon's experience shows that surgery time and learning curve in the case group is lower than that in the control group.
Subcutaneous pedicle island flap is an appropriate and easy method with good efficacy, lower complication and more reasonable and acceptable patient's satisfaction. Therefore, this method is recommended for burn patients with eyebrow defects.
The field of hair transplantation has evolved considerably over the last quarter century. Performed correctly, the cosmetic results of contemporary hair transplantation are virtually undetectable in women and men. Large, pluggy "punch grafts" have been replaced with natural-appearing follicular unit grafts, which maintain their existing anatomy and with proper technique can match the orientation of surrounding hair follicles.
To review all of the steps involved in hair transplantation surgery and to provide an overview of medications used in conjunction with transplantation to help prevent hair loss.
The authors review key aspects of the consultation, physical examination, selection of appropriate candidates, excision of donor area, hairline design, graft creation and placement, and postoperative instructions. The role of medications such as minoxidil and finasteride in preventing ongoing hair loss is an essential part of the treatment plan. For nonsurgical candidates, other treatments such as wigs, hairpieces, and camouflages are reviewed. Future trends may involve the use of low-level laser light therapy, dutasteride, and cloning of follicles.
Patients and physicians alike are pleased with the results of contemporary hair transplantation, and physicians can now recommend the procedure without reservation. The authors have indicated no significant interest with commercial supporters.
The authors have indicated no significant interest with commercial supporters.
Eyelash reconstruction performed by vibrissae transplantation, which has not been reported previously, is described.
A case is presented of "free" flap based on the frontal branch of the left superficial temporal artery and its surrounding soft tissues, without any proper vein for anastomosis, successfully transferred for eyebrow reconstruction. One can argue that this flap was a Wolfe graft. It probably was not for two reasons. First, "hairy Wolfe grafts" are always composite grafts with a thickness of 3-4 mm, as the base of the hair follicles lies in the subcutaneous tissue. Second, the edges of the flap were not sutured to the surrounding skin. Therefore, vascularization is unlikely from the surrounding skin and there was constant, definite oozing from the edge of this flap.
We have reviewed our experience with reconstruction of eyebrow alopecia secondary to thermal injury in the pediatric patient. Reconstruction was performed with free composite strip grafts or vascularized island pedicle flaps. The complication rates for eyebrows reconstructed with vascularized island pedicles with respect to loss of a significant portion of the flaps (30.8 percent) and malalignment of the grafts (23.1 percent) were significantly greater (p less than 0.001) than the significant tissue loss (10.6 percent) or graft malalignment (7.9 percent) observed for free composite grafts. Hair density was more predictably restored with the free composite graft technique (p = 0.0004). The patients reconstructed with composite grafts had 89.4 percent acceptable results in contrast to 38.5 percent acceptable results obtained with the island pedicle technique. Based on these findings, we reserve the use of the vascularized island pedicle technique for male patients with unilateral alopecia and heavy hair density in the remaining eyebrow and in cases where free composite grafts have failed. The remaining patients are initially treated with free composite grafts with acceptable results in the overwhelming majority of cases.
An improved understanding of the vascular supply of the layers of the temporal fossa has increased the potentiality of reconstructive techniques involving this area. Each separate vascularized layer of this region can be used, yet the temporoparietal fascial flap is the more useful for treating a wide range of composite defects. It represents an ultra thin coverage which is useful in resurfacing exposed bone, tendons and vital structures such as nerves and vessels, in providing neovascularity as a recipient graft bed and in providing coverage or lining in major facial reconstructions. We describe our experience with the temporoparietal fascial flap which represents our choice for reconstructing composite defects in orbital, malar, auricular and cheek areas when what is required is a thin, pliable, well vascularized flap to carry a scalp or skin graft, to resurface exposed cartilage, bone and nerve, and to fill soft tissue contour defects. Illustrative cases from the authors' clinical experience are presented, to demonstrate various combinations of the temporoparietal fascial pedicle with other tissues in the reconstruction of the ear, eyebrows, eyelids, malar, cheek and parotid areas.
Reconstruction of the eyebrows using a vascularised hair-bearing island flap is presented. The quality, density and direction of growth of hair for reconstruction of the eyebrows can be selected by using free vascular bundle transfer to prepare a secondary vascularised island flap.
In this report, we described a strip composite sideburn graft, which was successfully used in seven patients for either eyelash reconstruction or eyelash aesthetic augmentation. The donor site provides enough hair-bearing skin for the repair of large eyelash defects or its liberal use in eyelash aesthetic augmentation, and the resulting scar is easily concealed. The aesthetic result obtained in all patients was highly satisfactory.
We describe a surgical reconstruction after micrographic surgery of a recurrent basal cell carcinoma of the middle third of the left eyebrow. After micrographic surgery there was a 46- x 26-mm defect in the middle part of the eyebrow. To perform a cosmetically satisfactory repair a combined nude and hair-bearing full-thickness skin graft was harvested from the contralateral postauricular temporoparietal region and placed in the defect with hair growth direction of the graft and the recipient bed in the same direction. By using a combined nude and hair-bearing full-thickness skin graft, larger eyebrow defects can be repaired with an optimal functional and aesthetic result.
Reconstruction of the eyebrow has historically been accomplished with temporal scalp pedicle flap formation or free composite scalp grafts. These two techniques may be associated with substantial morbidity and a false, overly dense eyebrow appearance. Hair transplantation of the eyebrows has been described with excellent results, but is relatively underreported in the literature.
To determine whether modern techniques of micrograft hair transplantation can suitably re-create an aesthetic eyebrow in a case of iatrogenic eyebrow alopecia.
A 33-year-old woman with iatrogenic eyebrow alopecia underwent four sessions of eyebrow micrograft hair transplantation to re-create both eyebrows.
Suitable aesthetic eyebrows were re-created in a symmetric fashion with proper hair orientation. The process was time consuming and tedious, but highly effective.
Eyebrow transplantation is a suitable alternative to pedicle flap formation and composite scalp grafting. It is a straightforward procedure that can be performed in the office under local anesthesia with minimal attendant morbidity. The result may be superior to that seen with more involved eyebrow replacement procedures.
To search a new option for aesthetic reconstruction of the eyebrow.
Under local anesthesia, a scalp strip was harvested from the back of the head, closed to the hairline. Under 2 times magnification, the strip was then divided into a series of follicular-unit micrografts with 1-3 hairs. Usually, 150 micrografts were needed per eyebrow in a man whereas 100 micrografts in a woman. After the micro-slits or micro-slots were prepared in the recipient site, the grafts were implanted into the holes, parallel to the original hair directions.
From Apr 1998 to Feb 2000, thirty-two patients with 48 eyebrow-losses, resulted from burn scar, skin grafting, chemical peeling, lesion excising or congenital loss, were treated by this one-session operation. All of the patients were satisfied with the results. The grafted hairs grow in the direction of normal eyebrow, which achieve 95%-96% survival even in a scarring area. The appearance of the reconstructed eyebrows was more natural, close to the normal eyebrow, compared to the traditional methods.
The above-mentioned technique is a simple, safe and effective method for eyebrow reconstruction. It might be an ideal method for eyebrow reconstruction with the appearance much closer toa normal eyebrow.
The eyebrow is an important subunit of facial aesthetics and expression. Partial or total absence of the eyebrow is an unacceptable and disturbing condition. Aesthetic eyebrow reconstruction is a challenging problem for the reconstructive surgeon. In this paper a simple and reliable procedure for eyebrow reconstruction is presented. An aesthetically satisfactory result was obtained and a perfect match with the undamaged eyebrow was achieved. In selected cases this technique may be a strong alternative to the procedures that had been defined earlier.
Aesthetic eyebrow reconstruction is notoriously difficult. Various techniques have been used, including strip grafts, island flaps, punch grafts, and scalp micrografts. Each technique has certain disadvantages and aesthetic constraints. A new donor site for micrograft brow reconstruction is described. Hair micrografts harvested from the nape of the neck provide genetically fine, short hairs that are better suited for brow reconstruction than scalp hair. By using a simple technique under local anesthesia, the brow can be reconstructed with near normal hair orientation, hair caliber, and density.