Eyebrow Restoration

The eyebrow is an important part of facial symmetry and contributes to the aesthetic appearance of men and women. Eyebrows frame the face and draw attention to the eyes and represent the first facial structures we look at as a society and thus have a significant impact on a person’s appearance.  It has an important role in human communication and facial expression for this reason, many women feel distressed if they experience the loss of their eyebrows. It is common in human over history to change their eyebrow shape and thickness by removal, make up or tattoo according to their tribe, culture or the fashion at their time.

About Eyebrow

The eyebrow is an area of thick, delicate hairs on the brow ridge above the eyes and its follows the shape of the lower margin of the brow ridges in human. Main function is to prevent sweat, water, dandruff and other debris from falling down from scalp and forehead into the eye besides, they help shield the eyes from sun.        

Average Growth Rate

On average, it takes about 6-8 weeks for eyebrow to grow in, for the average pre-puberty and post-pubescent child, hair grows in at about 0.14 mm each day. For an adult and an elder, hair grows at a rate of about 0.16 mm. daily. Eyebrows have the slowest rate of regrowth on the body compared with hair on the scalp and body hair as its growth cycle can last 12-15 weeks

Each phase has specific characteristic that determine the length and fullness of the hair.

Phase I (Anagen Phase): hair follicle active growth phase. During this phase root of the hair divides rapidly adding hair to the shaft. this phase determines the length of the hair. It can last between 30-45 days.

Phase II (Catagen Phase): is a short transition stage that occurs at the end of the Anagen phase. Catagen phase cuts the hair off from its blood supply and from the cells that produce new hair. The growth stops, and the hair follicle shrinks. this when some hair will shed and all out. as soon as the follicle is complete in the catagen phase then it will move on to the last phase.

Phase III (Telogen): is the resting phase and lasts for 2-4 months. Approx. 14% of the hair is in the resting phase. During this time the hair does not grow and remans inactive. The hair stays attached to the follicle while the dermal papilla stays in the resting phase below.

At the end of the telogen phase the hair follicle re-enters the Anagen (growing) phase. The dermal papilla and the base of the follicle join together again, and a new hair begins to form. Medications (certain drugs) and certain diseases such as cancer drugs and thyroid disease can cause eyebrow to take longer growth cycle than the initial 12-15 weeks to grow.

Eyebrow hair that is plucked or threaded begins regrowing after about 2-3 weeks. Plucking involves using tweezers to remove the hair by its root from the hair follicle. Threading involves dragging a piece of cotton thread across the surface skin and removing hair in it is path. As with tweezing, hairs are removed by the root.

Consistent eyebrow removal can eventually lead to diminish growth, thinning eyebrow and dormant follicles, especially after the age of 40s.

Anatomy of the Eyebrows

Can be divided into 3 parts: head, body and tail. The head is the most medial portion of the eyebrow, measuring 5-10 mm in length, and is usually below the orbital margin, with the hairs oriented vertically. The body is approximately 25-30 mm long and is usually the densest, widest, and most prominent portion of the eyebrow. The hairs in this part is directed obliquely or horizontally. The tail is approximately 10 mm long, is the narrowest portion of the eyebrow with the least density especially end part of it and lies above the orbital margin.

Eyebrow hair can vary according to ethnicity, with Asians possessing thinner, very straight-growing hairs and African possessing thicker hair with an extensive curt.

Eyebrow Design

Men and women have distinguishing differences in their eyebrow. Men typically have thicker eyebrows that are horizontal. Whereas women have a more delicate and more elegant defined shape.

Proper angulation of the hair follicle is the most important feature of any eyebrow transplant. The hair in the supper part of the central edge of the eyebrow usually points upward to the hairline, while the hair on the lateral aspects points horizontally, towards the ears. The hair in the upper part of the eyebrow should pointed slightly downward and the lower portion slightly upward, so that they will coverage in the middle, forming a slight ridge and resembling the pattern of a feather.

Eyebrow Shape Types

Eyebrow Loss in Women

The eyebrow shape has a significant impact on a person’s appearance and look. Eyebrow hair loss is very noticeable because eyebrows are a prominent facial feature and this is why so many women feel distressed if they experience the loss of their eyebrows. Identify the reason of hair loss is the first step in treating the condition.

What are the most common causes for eyebrow hair loss? Repeated tweezing can cause eyebrow loss.

  1. Normal aging process
  2. Nutritional deficiencies.
  3. Congenital causes
  4. Trauma, burn, auto-accident, chemical or electrical burns
  5. Radiation or chemotherapy
  6. Medical: Autoimmune or systemic disease or hormonal changes that occur during menopause and pregnancy can cause eyebrow loss.
  7. Thinning of eyebrows can be a late sign of hypothyroidism.
  8. Obsessive Compulsive Plucking referred to as trichotillomania
  9. After laser for eyebrow tattoo removal; It is Temporal hair loss as the hair follicle is deeper in skin so, unlikely to be destroyed by the laser for tattoo removal. But, always a small risk.

Eyebrow loss for temporal reason like plucking or hormonal changes, can regrow after 6- 8 weeks by its own. However, we do need to speed the process or stimulate the growth in more permanent eyebrow hair loss cases where the disorder permanently damage the hair follicles. Consistent eyebrow removal can eventually lead to diminish growth, thinning eyebrow and dormant follicles, especially after the age of 40s.

Symptoms of Eyebrow Hair Loss:

The symptoms include hair thinning, bald patches or total hair loss within the eyebrow area. Hypothyroidism typically causes loss to the outer 2/3 of the eyebrow. Redness, itching or scaling often accompanies eyebrow loss from skin infections. Hair will appear broken at skin level when a fungal infection is the cause. Eyebrow loss from repeated plucking or tweezing is limited to areas where hair removal occurred.

Thinning Eyebrows or Sparse Eyebrows

Thinning eyebrows or eyebrows that have turned grey or white and wiry with age are a common problem with men and women. This may lead many people to think about the possible upsides of getting eyebrow tattoos.

What are the most common causes for thinning or wiry eyebrow? There are many things that can cause thinning eyebrows, such as:

  1. Aging: which are often driven in part by genetics: very common cause of thinning eyebrow hair which cannot be avoided. As we age our hair tends to get thinner and hair growth slows. Hair that turn grey or white is often a different texture than darker hair, and can lead to wiry, out of control eyebrow hair.
  2. Nutrient Deficiency & Hair Growth: deficiencies in nutrients that negatively affect the hair on the scalp can lead also to sparse or wiry eyebrows. So healthy diet is very important to have a healthy scalp and eyebrow hairs.
  • Biotin (Vitamin B7) has a role in strengthening and conditioning our hair (commonly found in eggs).
  • Vitamin B12, its deficiency can cause weak or brittle hair shafts.
  • Vitamin D, a common deficiency and vitamin D, helps in activation of hair growth but, if deficiency usually easily treated.
  • Even iron and zinc may help hair follicles produce hair at a faster rate and found in lean meat or lentils. Both common to find their deficiencies in gastric sleeve patients.
  • Adequate protein is also needed to encourage healthy hair growth and needed to repair damaged hair.
  • Omega-3 fatty acids have shown to hydrae damaged hair and found in fatty fish like salmon.
  1. Over-Plucking or over-zealous waxing: Tweezing is a seemingly safe method to groom the eyebrows, as result last longer than shaving. But, over-plucking actually can damage the hair follicles and lead to permanent eyebrow hair loss and are often the most common cause of eyebrow loss; whilst most avoidable, it happens to nearly all of us who groom our brows.
  1. Hypothyroidism: another medical reason for thinning and wiry eyebrows but it can also cause full loss of lateral part of the eyebrow. Usually getting better after treatment of hypothyroidism.
  2. Atopic Dermatitis: known also as atopic eczema, medical condition that might lead to thin eyebrows. It affects around 20% of population in their lives and is more common in younger children. When it affects the eyebrows, the skin around it will be red and itchy.

“Eyebrow Hair Transplant”

For men or women who have lost the natural full appearance of their eyebrow (permanent hair loss or thinning) and have limited response to non-surgical methods of treatment.  Last option to restore the natural and youthful eyebrow appearance is by hair transplant which is not to create perfect eyebrows shape but to significantly improve their appearance.

Who is the right candidate for an eyebrow hair transplant?

Anyone who is suffering from thinned eyebrows is considered to be good candidates for the procedure if non-surgical modalities of treatment were not satisfactory to the patients. It has to be healthy person, and in case of medical causes of eyebrow hair loss has been treated properly.

Follicular Unit Transplantation Technique:

It provides the easiest and best surgical method for fast and simple eyebrow restoration and compared to the Strip Method as graft or flap. It is faster and easier healing, no sutures or scars, and less post-operative down time. This procedure mostly commonly for females. However, in smokers, diabetics, the elderly, and in cicatricial cases, the growth rates may be slower. Usually 80% of the transplanted hairs will grow, and of these, 10% to 15% will grow in a different direction likely due to the contracture of the skin, so need to cut or use a gel to grow in more aesthetic directions. FUE, by using single hair follicle from the central occipital area of the scalp which is the most appropriate done area, but the lateral part of the occipital region (back side of the scalp) because they contain the greatest number of single-hair follicular units with the smallest diameter.

The donor hair can be harvested by wither stip removal or Follicular Unit Extraction “FUE”. It is important to consider when FUE is used, as it is necessary to trim the donor hair, making it difficult to orient the correct angle and direction of the hairs. Generally, 200-300 follicular units are necessary for each eyebrow. In a donor strip of 1 cm width and 4-8 cm in length it is possible to obtain 400-450 pf 1-2 hair grafts.  It is also preferable to obtain the follicular units using the strip technique over FUE as it allows for the collection of longer hair (1-2 cm length).

It is simple surgical outpatient procedure done under a local anaesthesia by nerve blocks. 2- hair grafts should be implanted in the central area of the eyebrow and 1-hair graft in the external area. This pattern allows soft and natural appearance.  The angle and direction of the grafts should be individualized according to each part of the eyebrow. Important parts of it is to maintain the normal anatomical position of the eyebrow, symmetry, directional changes of the hair from inner side to outer or lateral border of the eyebrow. The precision of placement of the eyebrow hair graft is very important. Attention is paid to the creation of a lovely rise of the arch or the enhancement of the existing arch. Generally, 150-300 grafts are placed in each brow. Depending upon your individual genetic, age, cause of loss of eyebrow hairs and desired density may require more than one procedure to obtain desired look. Surgery is best spaced a minimum of 8 months apart in order to observe the full effects of the first surgery.  

Head: the most medial aspect of the head, the hairs tend to grow vertically, and the graft can be placed sparsely to accentuate a feathering appearance. Moving laterally, the hair then change from a vertical to horizontal direction of growth.

Body: along the body, the superior hairs tend to grow at a slightly inferior angle, while the inferior hairs tend to grow at a slightly superior angle, allowing a greater density and natural aspect. The tail: when the section is reached, the hairs grow horizontally in a slightly caudal direction. At the end of the tail, a second feathering zone is created by placing the finest 1-hair grafts in a progressively sparse concentration. It is very important to pay attention to the exit angle; the angle of the recipient site should be as acute as possible to allow the hairs to grow in a parallel position relative to the forehead. The growth direction of curly hair must be considered to enhance the natural effect.

Postoperative Care:

There are many recommendations for post-procedure care, including occlusion with a transparent dressing for 4 days followed by the use of petroleum jelly. 2-4 weeks post-surgery, the implanted hairs fully embed. Tinny crust that form after surgery fall off in about 10 days, bruising after surgery is common and it may take a week or more to resolve. Oedema and periorbital hematoma may occur and usually resolve in 2 days.  After that time, there is no evidence of the procedure as the transplanted follicles go into a dormant period of about 3-4 months. This is often a difficult period for patients as they eyebrow will look like it did priori to surgery. Sometimes pseudo-folliculitis can occur in the transplanted area- this usually resolves spontaneously. Occasionally, some follicles can heal with a different direction of growth to that originally intended during transplantation and require trimming. Again, patience is needed during this period.

It is necessary to cut the hairs short once to twice a week in order to obtain the ideal length and shape, as they grow quickly as your scalp hair. The transplant hair may straighten them, pluck them, was them, dye them and cut them to the desired length.

Later the eyebrow hair growth will slow down over time and the hair will begin to assume some of the characteristics of the original eyebrow hair due to influence of the recipient site.

Conclusion:

Eyebrow restoration by hair transplant offers satisfactory aesthetic outcomes, with a 3-D effect. It is a relatively safe procedure with low morbidity. The key of its successful is to preserve the correct angle of the hairs to achieve a natural design.

References:

  1. Avram M. Follicular unit transplantation for male and female pattern hair loss and restoring eyebrows.Ophthalmol Clin N Am2005;18:319-23.
  2. Bernstein RM, Rassman WR. Follicular unit transplantation: 2005. Dermatol Clin2005;23:393-414.
  3. Civaş E, Aksoy B, Aksoy HM, Eski M, Yucel K. Hair transplantation for therapy-resistant alopecia areata of the eyebrows: Is it the right choice? J Dermatol2010;37:823-6.
  4. Ergün SS, Sahinoğlu K. Eyebrow transplantation. Ann Plast Surg2003;51:584-6.
  5. Gandelman M. Eyebrow and eyelash transplantation. In: Unger WP (ed). Hair transplantation. Marcel Dekker: New York, 1995.
  6. Gandelman M. A technique for reconstruction of eyebrows and eyelashes. Semin Plast Surg2005;19:153-8.
  7. KumarA, Karthikeyan K. Madarosis: A marker of many maladies. Int J Trichology 2012;4:3-18.
  8. Unger WP, Shapiro R, Unger R (eds). Hair transplantation (Fifth edition). Marcel Dekker: New York, 2010.
  9. Vachiramon A, Aghabeigi B, Crean SJ. Eyebrow reconstruction using composite graft and microsurgical transplant. Int J Oral Maxillofac Surg2004;33:504-8.

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Disclaimer

This document is designed to supply useful information but is not to be regarded as advice specific to any particular case. It does not replace the need for a thorough consultation and all prospective patients should seek the advice of a qualified physician

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