male and female eyebrow restoration
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Male and female eyebrow restoration

Hair transplantation techniques have improved considerably and a patient can expect to regain their natural hair density and flow with the help of these advancements. With proper guidance and evaluation from the hair surgeon, a patient irrespective of his age, gender, ethnicity and skin color can expect to regain most of the hair lost that might have resulted from inheritance or accidents. The patient is evaluated for the type, rate and pattern of hair loss, medications that the patient is under, his expectations from this procedure, hair characteristics and prior surgical scar evaluations if any. Most often the main focus of hair transplant is the density of hair achievable after a transplant. This depends on the patient’s natural hair density, a point which much be made clear prior to any transplant by the surgeon, lest the patient’s expectations are shattered. In many cases, hair density can be achieved by use of medications such as finasteride or minoxidil after hair transplantation to retain consistency which is mostly under the discretion of the patient.

Finasteride and Minoxidil are two popularly used medications for patients with early hair loss and those who might need them after hair transplants. Finasteride is a 5-alpha reductase type 2 inhibitor and controls the conversion of testosterone to dihydrotestosterone. When scalp hair follicles absorb dihydrotestosterone, they thin down and wither out from the scalp. Finasteride prevents this. Usually taken as an internal medication, some men who use finasteride have been found to experience symptoms of sexual dysfunction, which can be remedied by discontinuing the use of this drug. The effect of finasteride is visible only after 6-8 months of usage and is seen to be very effective in men with Hamilton –Norwood balding types II to IV and satisfactory in patients of type V and VI groups. Finasteride is not officially administered in women, though some dermatologists do use it off label for female pattern baldness.

The mechanism of action of minoxidil is not completely understood, but it seems to have a direct hair growth promoting effect. 2-4 drops of the solution is applied on the scalp twice daily for 6-8 months for results to show. Like Finasteride, patients of type II through IV are the most benefited while those in type V and VI have some benefit. Some of the side effects have been dryness and itchiness of the scalp.

When we analyze different kinds of alopecia, it is notable that for a patient who looses hair both from the scalp as well as the eyebrows, a hair transplant for the eyebrows is preferred to the scalp transplants. This is because losing the eyebrow means loosing definition of the face. The presence of eyebrows gives the face its value to stage different expressions. It is generally seen that most of the patients seeking eyebrow transplants have been accident victims or cancer patients who desperately need cosmetic help. The best source for donor hair in eyebrow transplants has been from the back of the head. Although not a perfect cosmetic procedure, this transplant can revive facial features to a large extent and the patient needs to take care of the hair by trimming it every two weeks or as need be.

In any hair transplant procedure, the donor site is first anesthetized using 1% lidocaine and epinephrine in the ratio 1:2,00,000. An ellipse of donor scalp of dimension 1 cm x 10-20 cm as required for scalp transplants and 3 cm x 0.4 cm for eyebrow transplant is excised along with intact hair follicles and stored in chilled saline. This strip is then made into follicular units for transplantation by surgical assistants while the surgeon closes the donor site wound and prepares the recipient site. The recipient site is anesthetized using 1% lidocaine and 0.25% marcaine along with epinephrine. The hair surgeon then transplants the follicular units according to the site maintaining the angle of insertion and number of follicles for maximum mimicking of nature.

Natural hair lines differ in different patients. The distance between the eyebrow and the natural hair line should not be the governing factor while deciding natural hair line of a patient but his pattern and progress of hair loss and how he will look when there is continuous hair loss even after successful transplants. When a patient undergoes hair transplantation and regains a certain definition in his hair, then he must be able to maintain that look for many years to come.

The problem of hair loss in women is different as compared to men and they are not as accepted socially as men with hair loss. Except for those patients who have inherited hair loss, most women experience thinning of hair and not complete hair loss like men. Hence they turn to hair surgeons for cosmetic enhancement for increasing hair density. Most often the hair loss is in the front locks and the partition area which experiences repeated wear and tear.

Male and female eyebrow restoration references

  • Avram M. Follicular unit transplantation for male and female pattern hair loss and restoring eyebrows. Ophthalmol Clin North Am. 2005 Jun;18(2):319-23, vii. PMID: 15935294
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