Your Questions
Your Questions
Q: Dr. Eppley, I am interested in nerve repair. I had eyebrow hair transplants three times. The last time I had done was over one year ago. Since then I have had electric, shock like, tingling, numbness pain and crawling sensations that are felt along the eyebrows and down sides of nose. Smoking and stress worsen nerve pain and nothing relieves it. It lasts all throughout the day. I feel I have had a nerve cut in that area and wondered if I would be a candidate for surgical repair to this area? It causes much distress in my life. I would be happy to hear any input from you
A: With eyebrow hair transplants I can theoretically see that injury to the nerves under the eyebrows could account for either pain or sensory loss by either the injection of a local anesthetic into the eyebrows or from the creation of a needle tract for the placement of the transplanted hair follicle. The distribution of the pain should help determine if this could be the source.
The only nerves that are under the eyebrows are the supratrochlear and supraorbital nerves. In detailing the anatomy of the supratrochlear nerve, it is a branch of the frontal nerve (1st division of the opthalmic division of the fifth cranial nerve. It comes out right below the inside the brow bone and comes up onto the forehead in the glabellar muscle region. It supplies feeling to the skin of the upper eyelid and the glabellar region of the forehead. The larger supraorbital nerve, also a branch of the frontal nerve, comes out either right under or on the brow bone right below the inner half the eyebrows and supplies feeling to the frontal sinus and skin of the forehead all the way up into the scalp. As you can see from this anatomical description, injury to either of these nerves does not account for the distribution of the pain down along the sides of the nose. That is the vexing part of your pain symptoms
But using the analogy where there is smoke, search for a fire. It is fair to say that it must be some type of injury to these nerves. At this late date, actual repair of a cut nerve if it existed would not be possible. All that can be done at this point is an endoscopic approach to decompress and release the supraorbital and supratrochlear nerves, possibly wrapped in fat graft to prevent secondary scar tissue formation around them. This is exactly what is done in migraine surgery. Whether this would work for you is unknown. One test you could do is to inject Marcaine local anesthetic around these nerves to determine of that provides temporary symptom relief. If it did that would provide you with great confidence that is the source of the problem and an endoscopic release may provide some symptom improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had eyebrow hair transplants 12 days ago. Anyway, it seems like the transplanted hairs have been falling out these past few days. There wasn’t much crusting or scabbing, and I have not noticed any blood on my eyebrows. I’ve spoken with my surgeon who has told me that it’s normal for the transplanted hairs to fall out. But I’m still a little concerned, which is why I would like your opinion as to whether this shedding is normal? If so, why do these transplanted hairs fall out and not continue growing?
A: The basic concept of any hair transplantation procedure, including eyebrow hair transplants, is to do follicular (hair bulb) transfer and implantation. The hair shaft is merely a handle by which to do that. It provides a convenient means to move the hair follicle into a new site. The shock of the transplantation procedure causes the shedding of the dead hair shaft 10 to 14 days after the procedure and is both expected and normal. The transferred hair bulbs are intact under the skin and new hair will not be seen until grows out from the follicle. Given the rate of hair growth, it will take months to see new hair emerge and a full six months to have the desires hair length that you seek.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ll be getting eyebrow transplants done next Monday. I’ve also been looking at getting some fillers to augment my radix (and possibly glabella). Anyway, my surgeon has advised me that it should be fine to get fillers shortly after the transplants (he suggested doing it next Friday) as they won’t be in the same area as the transplants. Just wondering though, will getting fillers so shortly after the eyebrow transplants have any adverse effects on hair growth? Thank you for taking the time to answer me.
A: In short, there is no correlation between having eyebrow transplants and injectable fillers. Even if the fillers were being injected right under the brow at the same time as having hair transplants, it would not affect the take of the hair transplants or how well they would subsequently grow. Given that the injectable fillers would be placed in the radix of the nose, away from the hair transplants, makes it even ‘safer’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in pursuing more information about eyebrow transplants. My eyebrows have thinned considerably in spots and they appear uneven. Therefore, I would like to have this corrected. I am curious as to how many sessions I may need to have in order to get my eyebrows as full as I’d like them to be. I have attached photographs of what my eyebrows currently look like and a photograph of my eyebrows as I would like them to be.
A: Eyebrow hair transplants represent the smallest surface area for hair transplantation that is done regularly. While once used just for traumatic eyebrow hair loss, it has become popular for women of all ages to thicken naturally sparse eyebrows or eyebrows which have become thinner with age or plucking. If you count the number of hairs in your existing eyebrow, you will see they are approximately 80 to 100 hairs in each eyebrow. ( I know because I counted yours) To double or triple the density of hairs in your eyebrow (which is what you are showing in your ideal picture), you would need 100 hairs or roughly 40 to 45 follicular units per eyebrow. How many hairs that can be transplanted depends on how close together they can be placed into the slits made for them. On a realistic basis it can be hard to place more than 20 to 25 follicular transplants in each eyebrow in a single session. That may be enough when they are fully grown but you would have to make that judgment six months after the initial session. Thus, one session may do but it is best to always plan on a ‘touch-up’ session depending how the hairs take or to add more for eceb greater density. As a general rule, hairs take about 6 to 8 weeks before you will see significant growth or when they start visible growing. It also takes this amount of time for the little ‘dots’ that surround each transplant to fade and blend into the surrounding skin.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Will getting the hair transplants have any adverse effect on brow ridge implants? My surgeon has informed me that he’ll be using sheets of intermediate hardness silicone to build up the brow ridges while carving them to smoothen them out by hand. He will also only use sutures to secure them rather than using screws. Is this something that you do too, and should I insist on him using screws? For reference, the incision will be made via the upper eyelids.
A: My method doing brow bone implants (rather than cement) is quite different. Symmetry of the implants shapes and ideal location on the bone is a challenging issue when more limited access approaches are being done. I prefer to use either preformed brow bone inplants (made out of silicone and using designs from other patients) or have custom ones made off of the patient’s 3-D CT scan. Then I place them through en endoscopic approach and secure them into place with a percuatneous 1.5mm screw technique.
There are no adverse effects of hair transplants on the underlying brow ridge implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I read about you on some forums and was recommended to contact you regarding this issue. Anyway, based on your website, you seem to be one of the few surgeons who perform brow ridge implant and eyebrow hair transplants. Basically, I’ll be getting my brow ridge implants done next week, but I also have an appointment set up for my eyebrow hair transplants a month later. However, the surgeon doing the brow ridge implants has asked me to wait 6 months between procedures, whereas the hair transplant surgeon has advised me that it shouldn’t be too big of an issue to space them 3-4 weeks apart. Based on your experience, do you think it will be fine for me to get the brow ridge implants done, recover for 3-4 weeks and let majority of the swelling subside, then get the eyebrow transplants? Or, should I wait 6 months? I understand that it’ll take 6 months for swelling to subside fully, but will the small amount of residual swelling at 3-4 weeks post-op present a major risk to the eyebrow hair grafts? I sincerely thank you for taking the time to answer this as you are doing me a huge favor.
A: I see no biologic reason as to why eyebrow hair transplants can not be done a month or so after brow ridge augmentation. The blood supply to the eyebrow tissue is unaffected by the underlying implants, regardless of whether the overlying tissues have fully resolved their swelling and achieved final tissue adaption. In addition, the access incision for the brow bone implants is far away from the eyebrows and has no deleterious effect on their blood supply, even if a revision may be needed and done on them later.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can you answer a few questions about eyebrow transplants? I hardly have any right now since they fell out when I was 21 due to taking birth control pill. They never came back. Does the transplant last forever or do you have to keep having the transplant? Are the eyebrow hairs normal looking? How is the procedure done?
A: Eyebrow hair transplants are like any other form of hair transplantation. The goal is to create living hair that is permanent. How much of the hair transplant survives is likely what you are referring to as ‘having to keep having the transplant’. Normally 100% of the hair transplant does not survive so an additional procedure may be needed to fill in any areas in which the grafts have not taken. Once a hair has taken, it will be permanent because the bulb or follicle has taken. Technically, hair transplantation is about tranferring the hair follicle (the growing portion of the hair) and the actual hair is nothing more than a handle to manipulate and carry the follicle to the recipient site. Once the hair has taken, it will grow faster than normal eyebrow hairs and will require more frequent trimming.
Eyebrow hair transplantation can be done under local or IV sedation anesthesia. The donor site is the scalp, usually taken from the finer hairs behind the ear. It requires at least 50 to 75 hairs per eyebrow or a total of 150 to 200 hairs for both eyebrows.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, if eyebrow loss is due to disease process like alopecia and not to behavioral issues such as trichotillomania or over plucking, would it still be considered cosmetic or might insurance cover part of the procedure(s)? I realize cost may vary, but since I would be traveling a fair distance for a consultation, can you provide ballpark estimate of cost? Thank you.
A: Short of traumatic loss of part or all of the eyebrows due to trauma( burn, avulsions), insurance is not going to cover eyebrow hair transplants. Thin or thinning eyebrows are viewed by insurance as a cosmetic problem not a medical one. Generally speaking, most eyebrow hair transplants need about 150 to 200 hair on each side. (more may be needed) At $10 per each indivudal hair transplant that would bring the cost to about $ 4,000 for the procedure which is done in an office setting under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had an injury and got a little scar over my right eyebrow. Because of this I have slightly lees eyebrow hair over that eyebrow. Is this something you can fix? I only need to fix 5-10% of the eyebrow hair on the right side.
A: Lacerations that cross into and through the eyebrow will frequently result in a bald spot or a scar area that is missing hair. This is the result of either actual injury and loss of hair follicles, separation of the eyebrow hairs by scar, or both. Depending upon the size of the eyebrow defect, there are two approaches to restoring eyebrow hair continuity. In many cases, the scar can be excised and the eyebrow hair margins brought back together through simple scar revision realignment techniques. This works well for small eyebrow defects. In larger eyebrow defects, it may not be possible to bring the normal eyebrow margins together without shortening the horizontal width of the eyebrow or distorting its shape. In these size defects, eyebrow hair transplants are needed. The hair grafts are harvested from behind the ear. It may only take 10 to 25 hair transplants to correct most eyebrow defects. Meticulous placement is needed to get the right hair orientation that matches the natural changing orientation of the hairs as they go from the inside of the eyebrow out to the tail of the eyebrow.
Dr. Barry Eppley
Indianapolis, Indiana