by Greg Williams, hair transplant surgeon at the Farjo Hair Institute

After years of plucking and tweezing, have you been left with thin and sparse eyebrows? If so, then you’ll be pleased to know that it’s fixable with an eyebrow hair transplant, but it is not for everyone. Here are seven things you need to know about the procedure.

What are the possible treatment options for eyebrow hair restoration?

The first part of recommending a procedure or treatment that will solve the problem of thinning eyebrows is to ensure that the diagnosis for the eyebrow hair loss is correct. Some women come to me thinking that they have caused damage to their eyebrows by plucking them, but actually there is an underlying dermatological condition that has been amplified by regular plucking.

Dermatological conditions that have a direct impact on eyebrow hair loss include alopecia areata (often thought to be associated with stress), frontal fibrosing alopecia (a condition that affects women over 50 and can result in a loss of eyebrows but also hair loss along the hairline and scalp) and ulerythema ophryogenes (another inflammatory dermatological condition of unknown cause). Low thyroid function also commonly causes lateral eyebrow loss.

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Latisse® – a topical liquid treatment of 0.03% bimatoprost typically used to encourage eyelash growth – can be tried for eyebrows, but it usually works better for hypotrichosis, which is when there are hairs but they are fine and short.

Once underlying dermatological conditions are ruled out and it has been established that the thinning or sparsity of eyebrow hairs is down to plucking, the management options include doing nothing, using makeup, having micropigmentation tattooing, or a undergoing a hair transplant.

What is involved in an eyebrow hair transplant, and where does the donor come from? Are patients awake when they undergo the procedure and does it hurt? Are women more likely than men to ask for the procedure?

The donor hairs for an eyebrow hair transplant are typically taken from the head as in a regular hair transplant to the scalp. Patients are usually awake during the operation, but I often give a light oral sedative to make the local anaesthetic procedure as tolerable as possible. Once the local anaesthetic has been injected, the rest of the procedure should not be painful.

Both women and men come to me for consultations but eyebrow hair loss is far more common in women. On the other hand, women are much more likely to use makeup than men. Men don’t tend to pluck their brows extensively and so progressive hair loss in men is likely to have a dermatological or hormonal cause.

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What happens during eyebrow transplant surgery? How long does the procedure take and how many follicles are transplanted? Do I have to go to hospital to have it done?

The whole procedure requires a very specialist knowledge of the transplant site – the incision is made at a very acute angle in order to match the natural direction of the hairs, and the curl of the hair is orientated towards the skin so as to achieve the optimum aesthetic result. The eyebrow is divided up anatomically into three areas – the head, body and tail – and each has different direction of hairs naturally which must be mimicked in order to achieve the most natural-looking result.

The length of the procedure usually depends on how many follicular unit grafts are being inserted, and the ease of insertion. With patients who have darker hair, I tend to use single hair grafts, but with lighter hair colours, there can be two hairs in each graft in order to achieve greater density. A typical transplant usually has 300 to 350 follicular unit grafts per brow, with a varying number of hairs – it all depends on the amount of eyebrow hair loss and how wide and long the eyebrow needs to be. The surgery needs to take place in an operating room environment that has Care Quality Commission (CQC) registration. This can be in a clinic facility or hospital.

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After the surgery has taken place, how long are patients likely to wait in order to see some results? Do they require specific aftercare, or can they manage it at home?

Transplanted hairs usually fall out after two weeks; however, the stem cells will have already integrated into the surrounding skin by this time. It takes three months for new hairs to start to grow and at least three months of growth to see results, so typically by around six months post-surgery the patient should be able to judge the early result. Final results can be assessed after about a year. Facial appearance should be back to normal by two weeks following surgery, by which time any swelling and bruising should have resolved. Once the hairs start growing, they will grow as long as scalp hairs and therefore need trimming every five to seven days.

Case study - before
But it’s not just about pluckers is it – aren’t some cases caused by androgenetic alopecia in women?

Androgenetic alopecia does not cause eyebrow hair loss in women.
Why would someone opt for a transplant over cosmetic tattooing? What are the most common side effects of the surgery?

Micropigmentation tattooing is a very viable treatment for those who don’t require, or want, a transplant.  However, while some people do refer to cosmetic micropigmentation tattooing as ‘3D eyebrows’, obviously they are not actually three dimensional. Hair transplantation provides the patient with an actual eyebrow, with the natural look, feel and behaviour of the one that has been lost. The two techniques can be used in combination and hairs can be transplanted over an eyebrow tattoo. Conversely, small gaps in eyebrows can be filled with tattoos and thin eyebrows can be made to look thicker by tattooing a ‘background’ colour.

Case study - afterHave hair transplants amongst women become more commonplace? Are you noticing an increasing number of patients and how much does it typically cost?

Yes, hair transplants across the board have become more commonplace, eyebrows included. This is as a result of greater media coverage of the great looking and natural results that can be achieved. In addition, it is relatively affordable, costing between £2,000 and £4,000 depending on the number of grafts required.

Find out more about hair and eyebrow transplants with Greg Williams or Bessam Farjo at   Do you have a question for Greg or Bessam? email