Eyelash Transplants 101

Eyelash transplants: all you need to know about eyelash surgery

Eyelashes shield the eye from injury, dust and grit. They frame the eyes, and complete the facial appearance. People without eyelashes look strange to others, since they lack one of the normal features of the face.

There are a number of reasons people may have no eyelashes.

  • Facial injury and scarring due to automobile accidents, industrial accidents, chemical burns, eyelid tattoos, and long-term use of false eyelashes;
  • Surgical treatment, injury or tumors that results in the removal of eyelash follicles and tissue scarring;
  • Medical treatment of radiotherapy or chemotherapy for cancer that results in hair loss;
  • Trichotillomania, which is compulsive hair plucking of scalp hair, eyebrows and eyelashes;
  • Congenital atrichia, which is a birth defect causing a lack of body hair

Today, people receive eyelash transplantation to correct many of these issues, and also for esthetic purposes. We will review a history, reasons for and ways of doing eyelash transplantation.

Brief History of Eyelash Transplants

More than 90 years ago. Dr. Franz Krusius, a German physician, published his technique for reconstructing lost eyelashes by harvesting scalp hair with a small punch and transplanting donor hair into the eyelid with a needle that he designed. In 1917, German physician Dr. P. Knapp, inserted into the eyelid border a graft strip from the eyebrow. Papers published from the 1930s through the 1950s, many from Japan, continued to advance techniques of eyelash reconstruction.

In 1980, Emmanuel Marritt MD, a member of the International Society of Hair Restoration Surgery, published his technique for transplantation of single donor hairs from the scalp into the eyelid for eyelash reconstruction. In the same year of 1980, Robert Flowers MD reported a "pluck and sew" technique of eyelash reconstruction that is used today in a revised version by physician hair restoration specialists.

Types of Eyelash Transplants

  • Reconstructive- Eyelash transplantation for trauma or disease.
  • Esthetic – Eyelash transplantation to improve existing eyelashes.

Patient/Physician Consultation and Agreement

The patient and physician must agree regarding:

  • The patient's full understanding of the eyelash surgery procedure, including possible complications and recovery;
  • The anticipated outcome, including understanding that eyelash transplantation can achieve significant esthetic improvement but cannot achieve completely natural results.
  • In the U.S., a cost of $5,000 to $10,000 is common.

The patient may also ask the physician for credentials demonstrating training in eyelash transplantation.

Preoperative Preparation

Every surgical procedure requires preoperative preparation including:

  • Anti blood clotting drugs
  • Stopping vitamin E supplements
  • No alcohol use
  • Using an antiseptic soap
  • Taking antibiotics if prescribed 

Techniques of Eyelash Transplantation

Donor hair transplanted to the eyelid must match the quality of eyelashes. The transplanted hair will continue to grow in the eyelid. As it grows, the patient will have to regularly curl and trim the eyelashes.

Donor areas commonly used include the nape of the neck, the area above or behind the ears, eyebrows or legs.

Transplantation Technique

  • Eyelash transplantation is performed under local anesthesia. Mild sedation helps relaxation.
  • The surgical needle punctures the eyelid at the margin and a hair graft is placed inside.
  • Grafts are properly spaced. A normal upper eyelid contains about 100 lashes, and the lower about 60.
  • A session takes one to three hours, and patients usually have one to three sessions.

Postoperative Expectations 

  • Itching of the eyelids frequently occurs immediately after surgery and may persist for one or two days.
  • Use ointments, pain medicine and ice packs to avoid itching.
  • Wear goggles while sleeping to prevent scratching. Some physicians recommend keeping the eyes bandaged for the first 24 postoperative hours.
  • 7 to 14 days is required for complete postoperative recovery.
  • Coat the new eyelashes with lash oil, use an eyelash curler to encourage proper curl and trim regularly.

Potential Complications of Eyelash Surgery

  • Eyelid infection
  • Bruising and swelling
  • Graft displacement caused from scratching
  • Ingrown hairs
  • A downward pull of the lower eyelid
  • A turning in of the upper or lower eyelid
  • Poor placement or poor quality of eyelash grafts due to use of coarse hair as grafts, or placement of grafts that fails to achieve the desired esthetic result.
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