Eyelash Transplantation: Who, Why and How

Eyelashes have an anatomical function of shielding the eye from injury, from dust and grit.

Eyelashes frame the eyes, and together with eyebrows, hairline, cheek bones, nose, lips and chin create the facial appearance that is unique to every individual.

A person without eyelashes has a strange appearance because they lack one of the important anatomical landmarks of facial normality.

Absence of eyelashes has a number of causes (see Eyelash Surgery):

  • Facial injury and scarring due to automobile accidents, industrial accidents, chemical and thermal burns, eyelid tattoos, and traction alopecia associated with long-term use of false eyelashes;
  • Surgical treatment; injury or tumor that results in removal or eyelash follicles and tissue scarring;
  • Medical treatment;  radiotherapy or chemotherapy for cancer that results in hair loss;
  • Trichotillomania; compulsive hair plucking of scalp hair, eyebrows and eyelashes:
  • Congenital atrichia-congenital absence of hair on all parts of the body.

Initially used to correct loss of eyelashes, esthetic facial enhancement is a relatively recent development. Some doctors believe it should continue to be reserved only for medically necessary eyelash replacement.


Brief History of Eyelash Transplantation
90 years ago. Dr. Franz Krusius, a German physician, published his technique for reconstruction of 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 composite free 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 in use today in revised version by physician hair restoration specialists (a revised version was described by Marcelo Gandelman MD, in the standard textbook "Hair Transplantation", Second Edition, edited by Walter Unger, MD).


Who Is a Good Candidate for Eyelash Transplantation?

  1. Reconstructive-eyelash transplantation for trauma or disease.
  2. Esthetic - eyelash transplantation to achieve an esthetic enhancement of existing eyelashes, but the hair shaft diameter and curl of the donor hair can make the outcome unattractive.
  3. Not suitable; (A congenital atrichia patient is a candidate only for eyelash prostheses that are fastened to the eyelid with adhesive.)


Physical Examination and Medical History
Every person being considered for eyelash transplantation must have a complete physical examination and laboratory tests if indicated, and must provide a detailed medical history.


Patient/Physician Consultation and Agreement
The patient and physician must agree regarding:

  • The patient's full understanding of the procedure, including possible complications and postoperative recovery;
  • The anticipated outcome (esthetic enhancement), including understanding that eyelash transplantation can achieve significant esthetic improvement but cannot achieve completely "natural" results associated with natural eyelashes (it is necessary for the patient to use an eyelash curler and to trim eyelashes for the rest of their life) ;
  • Cost; In the U.S., $5,000 to $10,000 is common.

The patient may also ask the physician for credentials demonstrating adequate training in eyelash transplantation in addition to training in hair restoration surgery. The physician should understand eyelash anatomy and esthetics, and have training and experience in methods of donor hair harvest and eyelash graft placement.


Preoperative Preparation
Every surgical procedure requires preoperative preparation.

  • anticoagulant drugs such as aspirin and warfarin (Coumadin)
  • stop vitamin E supplements
  • no alcohol
  • use an antiseptic soap for facial cleansing
  • take antibiotics if prescribed by the physician.


Techniques of Eyelash Transplantation
Donor hair transplanted to the eyelid must match the quality of eyelashes as much as possible. The transplanted hair will continue to grow in the eyelid; as it grows, the patient will have to follow a regular regimen of curling the transplants, and trimming them.

Donor areas commonly used include the nape of the neck or the area of the scalp above or behind the ears. Hairs taken from the eyebrows and legs are also used in eyelash transplantation.


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 into it.
  • Grafts are properly spaced and to prevent trichiasis . (A normal upper eyelid contains about 100 lashes, the lower eyelid about 60 lashes).
  • A session is performed in one to three hours. A desirable result may be achieved in one-three sessions. The number of sessions is dependent on patient characteristics, desired result, and the surgical technique.


Postoperative Recovery and Care

  • Pruritus (moderate to intense itching) of the eyelids frequently occurs immediately after surgery and may persist for one or more days.
  • Persistent itching beyond one day may indicate a postoperative complication that requires the physician's attention. (Itching should be differentiated from discomfort; discomfort beyond one day is normal).
  • Scratching of the eyelids will easily dislodge transplanted hairs, itching should be relieved as much as possible by ophthalmic ointments, mild analgesics such as acetaminophen (Tylenol), and ice packs.
  • Wear goggles while sleeping to prevent inadvertent eyelid 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

  • Eyelid infection; rapid recognition and treatment are essential to prevent spread.
  • Bruising and swelling.
  • Graft displacement caused when the patient scratches eyelids, causing failed growth.
  • Ingrown hairs.
  • Ectropion; eversion and downward pull of the lower eyelid, causing the eyelid to fall away from the eye.
  • Entropion; turning in of the upper or lower eyelid margin.
  • 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.

Medical Treatment for Eyelash Enhancement.
A class of drugs known as prostaglandins can be used as a  medical approach to eyelash enhancement. The best known is latanoprost drops, currently administered to treat glaucoma. Ophthalmologists noted that latanoprost lengthens and darkens existing eyelashes. It does not stimulate new growth.

Side effects include blurred vision, eyelid inflammation, permanently darkened eyelashes, thickening of the eyelashes, permanent darkening of the iris of the eye, and a temporary burning sensation.

The use of prostaglandin analogues for reasons other than glaucoma treatment has not been thoroughly investigated. Their use for eyelash enhancement should be approached with caution.

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