The ins and outs of brow restoration

Remember when thinly arched eyebrows were popular in the 90s and early 2000s? Like many trends, that one went out of style, and natural, fuller brows are more in line with today's taste. Yet, years of plucking and waxing may have left you unable to regrow your brows to their natural shape and fullness.

It may seem like a small detail, but our eyebrows provide natural structure and emphasis to the face, with fuller brows definitely being more sought after these days. For those with thinning or sparse hair due to over-plucking, waxing, age or health conditions, it's easy to feel self-conscious about their appearance. However, this concern doesn't need to be permanent.

One solution to sparse or thinning brows is a plastic surgery procedure – brow restoration. Also known as brow transplant procedures, these surgeries involve rebuilding the eyebrows by transplanting hair from elsewhere in the body. This safe and effective procedure offers dramatic, permanent results with a remarkably high patient satisfaction rating.

This procedure can be a game changer for those with thin brows, but patients may not be aware of its existence and what it actually entails. Celebrities like Chrissy Teigen have brought it into the spotlight more recently, sharing her own journey and results on Instagram, but it's still a lesser-known procedure in the plastic surgery specialty.

To gather more insight into the topic of brow restoration and eyebrow transplants, we spoke with ASPS Member Surgeon Shim Ching, MD. Keep reading to discover his thoughts about the procedure, how it's typically performed and the results that can be expected from a successful brow transplant.

ASPS: When considering facial aesthetics, many patients are concerned with the appearance of their eyebrows due to thinning or sparse hair. However, few are aware that there are solutions within the field of plastic surgery that can address these concerns naturally and effectively, such as brow restoration via transplant. How popular is this area of procedures at your practice?

Dr. Ching: I would say that it's fairly common for us to do this procedure. The eyebrows are fairly important parts of female facial aesthetics. It's so common now for women to have permanent makeup in the eyebrow area, and I would say the vast majority of our patients have eyebrow tattooing these days. Tattoos can only achieve so much, and some women prefer to have actual eyebrow hair if they're lacking in that area. Just having a tattoo isn't quite as nice looking as it is combined with natural-looking eyebrow hair.

ASPS: Who are the typical patients who come to you for brow restoration?

Dr. Ching: We don't see any specific patients with brow restoration – it really varies. There aren't really any specific age groups or particular patient profiles. We do see some patients who are looking for revisions to previous brow restoration. This process is really difficult, as we have to remove the previous work and then completely do it over.

ASPS: Are there any particular patient profiles that are more commonly seen than others?

Dr. Ching: We see more women than men. Men, as a benefit of having more testosterone and male characteristics, generally have really good eyebrow hair. Although, we do see some men occasionally!

ASPS: Are there any patients who are better candidates for brow restoration than others?

Dr. Ching: Not really. It's a fairly universally applicable procedure to all patients who want more eyebrow hair.

ASPS: How do you typically perform eyebrow transplants or brow restoration at your practice?

Dr. Ching: We harvest hair from the back of the head. In contrast to hair restoration, where we're storing hair on the top of the head and need a thicker follicle, we focus on harvesting finer hair from the back of the neck. A lot of patients will get a strip harvest, which involves extracting a strip of hair and can leave a scar, but it's minimal. A majority of patients don't mind harvesting a strip from the back of the head, so that's what we tend to use, but it's based on patient preference.

On the other hand, some surgeons utilize FUE, or follicular unit extraction, in which hair follicles are harvested one by one using a small circular punch. This is best for patients who are looking for a faster recovery and no scarring.

ASPS: What is the recovery process like for this type of procedure?

Dr. Ching: It's actually fairly easy! The harvest area heals up pretty quickly, whether we take a strip or harvest grafts individually. In the eyebrow or the region where we're restoring the hair, we make tiny slits, and the individual grafts are placed into the slits. Each graft is like an island of skin, and in the center is a follicle – this is what we're transporting. They are singular follicular units. Hair will grow in groups of one, two or three generally. Sometimes, the grouping is really tight, and to separate them can damage the follicle. So, in different parts of the head, we may transfer the doubles or the triples, but in eyebrows, we'll only do singles. If hair grows from a bunch in the eyebrows, it doesn't look natural.

ASPS: What are the results that can be expected with this type of procedure?

Dr. Ching: The results are really quite nice for patients who have been self-conscious about their eyebrows. We're essentially moving hair from one part of the body to the eyebrow. Patients will have actual eyebrow hairs and the kind of eyebrow that they want. It's a very rewarding procedure for both the patients and us, the surgeons.

ASPS: Do you have any advice for patients who are considering a brow transplant or brow restoration?

Dr. Ching: It's always important to find an experienced and qualified provider of this service. Head hair is one thing, some imperfections can be not as noticed, but the eyebrow is right in the front of the face, and any deviation from how the surgery should be done is going to be noticeable. For example, the angle of the hair coming out of the eyebrow is really quite critical. The hair is almost growing parallel to the surface of the forehead. So, if the hair isn't transplanted at the correct angle, it will look off and unnatural and it's very difficult to fix that.

ASPS: Do you have any additional insights around this topic that you'd like to share?

Dr. Ching: One thing that patients should consider if they get this done is that usually, our eyebrow hair grows to a certain length and stays a certain length. For whatever reason, when we transplant from the head to the eyebrow, that hair continues to grow. There is some care involved to cut the eyebrow hair, to trim it, basically, so that it doesn't get too long.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.