Eyebrow transplant: who it suits, how it is done and what to know beforehand

Who is an eyebrow transplant suitable for?

For people who have lost eyebrow hair for a reason that is no longer active, and who have suitable donor hair. The International Society of Hair Restoration Surgery (ISHRS) lists several situations in which eyebrow restoration is considered¹:

• Years of tweezing, until the hairs stop growing in a particular area, usually the outer end or tail of the brow.
• A scar, burn or injury that has left an area without hair. In a systematic review covering dozens of studies, burns were the most common reason for eyebrow transplantation⁴.
• Brows that have been sparse since birth, or a brow that was never full.
• Medical treatments, such as radiation or surgery in the area, that left a permanent gap.
• Change of shape: some people want to thicken an existing brow or change its line for purely aesthetic reasons¹.

The transplant is suitable for both women and men. The planning differs: a female brow tends to be more arched and finer at the tail, while a male brow is straighter and thicker. The design is based on the face, not on a single template⁷³.

When not to transplant, or when to wait

When the brow is thin because of a disease that is still active. A transplant does not treat the cause. If the cause keeps working, it can damage the new hairs as well. That is why the ISHRS stresses that a disease causing hair loss should be under control before restoration, and that compulsive pulling needs treatment first¹.

• Alopecia areata: an immune condition that causes hair loss in patches, including in the eyebrows. No transplant is done while the disease is active⁸². Details on the page alopecia areata in the eyebrows, eyelashes and nails (Hebrew).
• Frontal fibrosing alopecia (FFA): a condition that causes the hairline on the forehead to recede and often also eyebrow loss. It creates scarring around the follicle, and while it is active it can also damage the grafts⁹.
• Trichotillomania: a recurring urge to pull out hair. Without treating the urge, transplanted hairs may also be pulled out¹⁰¹.
• A cause that is not yet clear: new thinning of the eyebrows, especially when it appears together with hair loss on the scalp or body, warrants investigation before any decision².

How is an eyebrow transplant done?

With the FUE technique: individual follicles are extracted from a donor area and implanted one by one at a very sharp angle. In most cases follicles are taken from the back of the scalp, choosing fine hairs that match the eyebrow hair. Almost only single-hair units are used for the brow, so that the result looks natural³¹. One technical review described aesthetic eyebrow restoration with about 70 to 120 grafts, but the actual number depends on the size of the gap and the desired density³.

The delicate part is direction. Eyebrow hairs grow almost flat against the skin, in directions that change along the brow: at the head of the brow they point upward, and further along they slant sideways and down. Each graft is inserted at an angle and direction that mimic this pattern⁷³. Some clinics extract follicles without shortening the hair, so its curl can be seen in advance and matched to the brow¹¹.

The procedure is done under local anesthesia, without hospitalization, and takes a few hours. An overview of the technique is on the page FUE hair transplant (Hebrew).

How is the brow shape planned?

Draw first, transplant afterwards. Before the procedure the brow is drawn on the skin, checked in the mirror, and the line is decided together: where the brow begins, where it peaks and where it ends. When natural hairs remain, the design is built around them⁷.

A brow also has natural differences in density: the head and body are denser, and the tail is sparser. A brow that looks too uniform, like a drawn line, usually looks less natural. People who have had eyebrow tattooing or microblading in the past can have a transplant, but it is worth bringing old photos and discussing the existing line already at the consultation. A previous transplant done with hairs that do not match in curl or direction is sometimes corrected with an additional transplant¹¹.

What does recovery look like, and when do you see a result?

A week of small scabs, weeks of shedding, and months of growth. In the first days there is a small scab around each graft and sometimes mild swelling. During this period you do not rub, scratch or apply makeup to the brow, and you follow the instructions given at the end of the procedure. The ISHRS notes that complications after eyebrow restoration are usually mild pain and swelling¹.

The timeline is similar to that of a scalp transplant: after a few weeks the transplanted hairs usually shed, while the follicles remain in the skin. New growth usually begins around the fourth month, and the full picture is seen only after about a year, sometimes longer⁶. What to expect at each stage is detailed on the page hair transplant over time (Hebrew).

Why do the brows need trimming after a transplant?

Because the hairs remember where they came from. A hair moved from the scalp keeps the characteristics of the scalp, including its rate and length of growth. This phenomenon is called donor dominance, and it is also the reason a transplant lasts at all⁵. In practical terms: the hairs in the brow will keep growing longer than ordinary eyebrow hairs, so they are trimmed regularly and their direction is sometimes set with brow gel.

This is not a complication but part of the plan. It is worth knowing in advance and deciding whether it fits your routine.

What are the risks?

The risks are similar to those of a scalp transplant, on a smaller scale. A systematic review of eyebrow and eyelash transplants described low complication rates, and noted that the choice of technique depends on each patient's situation⁴. What can happen:

• Swelling, scabs and mild redness in the first days.
• A small inflammation around a follicle or a small cyst, which usually pass.
• Partial growth, especially in scar tissue where blood flow is lower³.
• Direction or density that does not look natural, when the design or the insertion angle is not precise⁷.
• Very small dots remain in the donor area, usually hidden by the hair¹².

It is not possible to know in advance exactly how many of the grafts will take. That is why the possibility of a touch-up later on is also discussed in advance. An in-depth page on this: complications after a hair transplant (Hebrew).

How is it done at Dr. Dana Buchbut's clinic?

First the cause is clarified, then the brow is planned together. At the consultation, Dr. Dana Buchbut, physician (M.D.), asks when the brow started to thin and what has been done to it in the past, examines the skin and hairs under magnification, and also examines the donor area. When an active disease is suspected, it is treated first, and sometimes that is the entire recommendation. When a transplant is suitable, the line is drawn together, density and the need to trim the hairs later are discussed, and you are told honestly what can be expected. The procedure is performed by Dr. Dana Buchbut herself, at the clinic in Ramat HaHayal, Tel Aviv, and at follow-up the take and growth of the grafts are checked. General information about transplants is on the page hair transplant.

The information on this page is general and for education only. It does not replace an examination, diagnosis or personal medical advice. Any decision about treatment is made only after an examination.