Eyebrow Reconstruction: Technical Strategies

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The eyebrows have a combined linguistic and affective function and play a key role in facial expressions. Eyebrows loss (madarosis) has various etiologies [1, 2] and may cause disfigurement and discomfort. Eyebrow transplantation is the best aesthetically acceptable procedure that is performed to improve the patient’s appearance and self-esteem. Reconstruction techniques using micrografts of various sizes usually yield good results. Transplantation methods vary from physician to physician; some use a 18-21-G needle with stick-and-place, some use implanters, and others use premade incisions with a tiny microblade, such as a 15 Sharpoint, and place the grafts afterward. The success of reconstruction depends on the surgeon’s knowledge of eyebrow anatomy and his or her ability to reproduce the angle and direction of single-hair grafts to achieve natural results [3]. Here we report our successful, easy approach, with more than 90 cases of eyebrow reconstruction by follicular unit transplant (FUT). Eyebrow design is critical [4] and has three key points: symmetry, direction, and angle. We obtained perfect symmetry by drawing the eyebrow on transparent paper, which is then used as a template for the design of a perfectly symmetrical contralateral eyebrow (Fig. 1). The donor hair is the scalp, in the occipital area, where a strip with an appropriate number of bulbs is harvested. Strip harvesting is about 45 to preserve the adjacent bulbs. Extensive dissection of at least a 1-2-cm margin to suture the donor area without tension ensures a good scar. Micrografts are prepared by means of magnification, and each hair graft is transplanted microsurgically into an incision prepared for it by using of a needle bayonet of 18/19 G (Fig. 2a). This needle is extremely handy; it simplifies and speeds up the creation of the microincision. It overcomes the main difficulty of the eyebrow transplant, reproducing the very acute angle between the hair-stem and the skin. Indeed, this needle is inserted with ease at an acute angle, virtually flat to the skin (Fig. 2b), reproducing the correct original anatomy and shortening the operative time. On average, 100-300 follicular unit grafts are transplanted microsurgically (Fig. 3). Patients who have this eyebrow transplantation for both reconstructive and aesthetic reasons (Fig. 3) are generally very satisfied. The presented technique simplifies the precise, oriented placement of single-hair grafts and has been time-tested by the senior author for the last 20 years. The bayonet needle is a novel and simple approach to FUT, with satisfactory results and a very low complication rate. It is safe, effective, minimally invasive, and very handy in allowing rapid movement. Furthermore, it has no additional costs because it is packed on the operating table by a 18/19-G needle. The results of our technique are natural, beautifully shaped, and contoured. The one problem is that the hair will continue to grow, which necessitates trimming the hair monthly. After a few years, hair transplants adapt to the recipient site by a mechanism that we call ‘‘field effect,’’ as in pubic restoration [5] and other ectopic transplants. However, this is a minor problem for most patients because the defect is caused by a disfigurement due to oncological surgery (Fig. 4), radiotherapy (Fig. 5), burns or severe Electronic supplementary material The online version of this article (doi:10.1007/s00266-011-9712-1) contains supplementary material, which is available to authorized users.