Eyebrows are the most expressive feature and create a masterline of the face. It is the reference point towards which all other angles and contours of the face are set. Restoring eyebrows have become a very popular procedure due to the growing information and outstanding results. With the extensive experience of authors in the field of follicular unit extraction (FUE), especially in advanced baldness, body hair transplant and facial hair restoration, it is now feasible to perform high-quality surgical techniques creating satisfactory results and a happy outcomes to patients with realistic expectations.

Eyebrows constitute a very important and prominent feature of the face. With growing information, eyebrow transplant in Iran has become a popular procedure. Although it is a small area, it requires a lot of precision and knowledge regarding anatomy, designing of brows, extraction and implantation technique. This article gives a comprehensive view regarding eyebrow transplant with special emphasis on follicular unit extraction technique, which has become the most popular technique.

Before Eyebrow transplantation

Anatomy

Eyebrow has been divided into 3 sections:

Anatomy of eyebrow showing 3 sections, head (red), body (blue), and tail (green) from medial to lateral end

. Head: It is most inner portion, pointing upwards for 0.5–0.7 cm. It contains small calibre, lighter color hair. Some individuals do not like to highlight this section and want to keep it minimum.

. Body: This is the central 2.5 cm part which is most dense and wide. In the medial part, hairs point upwards and laterally. At medial limbus, central convergence begins leading to herringbone pattern, that is, lower portion points upwards and upper portion points downwards creating a ridge of high density.

. Tail: It is the outer 2 cm where central convergence continues till tail end. This is a less dense area filled with smaller calibre hair. This area becomes less pronounced with age.

An ideal brow includes an ideal mediolateral extent and an ideal shape. The medial end of brow should start on the same vertical plane as the lateral extent of ala and inner canthus. However, it may change according to intercanthal distance. Brow should begin medial to medial canthus for an increased intercanthal distance (equal to an eye width apart) and lateral to medial canthus for decreased intercanthal distance. The eyebrow should end laterally at an oblique line from the most lateral point of the ala through lateral canthus.

The major consensus in the past was to keep medial and lateral ends at the same horizontal level. Still some believe that the medial brow should be lower than the lateral brow and should start as a continuation of the superciliary ridge. Excessive elevation of medial brow can lead to surprised look. Even medial placement of peak creates ‘surprised’ appearance. Low medial brow with a high lateral peak induces angry look. Inferior placement of lateral edge can create a sad expression.

The apex or the arch should lie on a vertical line directly above the lateral limbus. However, this is the most controversial point of eyebrow implantation, and recent consensus is to keep the arch more lateral than the lateral limbus and may be just medial to the lateral canthus.

In males, the eyebrows overly the orbital rim, are heavier and thicker with little or no arch. The lateral brow appears more prominent, because there is uniform thickness and density throughout. However, in females, the eyebrow extends a few millimetres above the orbital rim. There is a pleasant arch peaking in the lateral third. The medial part is more dense and thicker than the lateral end. The average length of eyebrow is 5.5 cm in men and 5.0 cm in women. The maximum eyebrow width is 1.5 cm in men and 1.3 cm in women.

An idealized brow will be an eyebrow drawn taking consideration of above-mentioned features on an idealized face, that is, an oval face. However, the brow is supposed to be individualized according to the face shape. The basic concept is to have more horizontal portion to make a long face appear more round and to have more vertical orientation to create an illusion of length in round faces.

The oval face will require soft angled idealized brow. The goal in a round face is to make it appear longer which is achieved by high arch eyebrows with peak moved out towards the end of brow and tail kept short. Gentle curving of brow is avoided. Long face should have flat eyebrows to make the face appear shorter. The goal in a square face is to soften or just balance a strong jawline. The brow should start with a little curve and then add more angle to balance it. The peak should be directly above the square of jaw and stronger the jawline, more defined the peak should be.

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Pre-procedure Evaluation

The most common indications of eyebrow transplant are cosmetic such as congenital absence or inadequate coverage, of a normal appearing eyebrow requiring darker color or an uneven eyebrow with lack of lateral third or medial portion. The other common indications are trichotillomania, scar due to trauma, burn or tumors, stable alopecia areata, madarosis due to hypothyroidism, leprosy, etc.

A right candidate is one who has realistic expectations, understands limits in density achieved, and has a pronounced defect than purely cosmetic purposes and stable or treated disease.

The patient should be counselled regarding the limit of density achieved in a single session and requirement of a repeat session if desired density is not achieved. The patient should also be counselled regarding need for doing make-up using eye brow pencil to enhance the results achieved. Furthermore, there will be some misdirection in 10%–15% follicles and trimming would be regularly required (biweekly in most). However, growth rate may get synchronised with time due to recipient codominance.

No special pre-operative blood work is required except ruling out blood-borne viral infections such as HIV, hepatitis B and C. Anesthesia sensitivity test should be done to prevent any anaphylaxis.

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During Eyebrow transplantation

Eyebrow transplantation Methods

Previously, hair-bearing superficial temporal artery island flap leading to brush looking eyebrow and whole strip grafting causing poor growth were used. Neither the desired growth nor desired direction was achieved with either of these primitive techniques. Follicular unit transplant (FUT) has been used for a long time using single hair grafting for brow transplant. However, with growing advent of Follicular Unit Extraction (FUE), brow transplant can be done easily without the unease of any sutures and with minimal downtime. There has been use of artificial hair implantation for eyebrow reconstruction, especially in cases where donor area is not available, for example, alopecia universalis. However, author prefers not to use them because of the risk of foreign body reaction which scars the area permanently leaving more psychological impact than having no or sparse eyebrow. In case of limited donor area availability, it is preferable to do camouflage techniques only.

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Anesthesia

Since there is not a single nerve which supplies the eyebrow, a single nerve block would not be possible to anaesthetize the full brow. Eyebrow is usually innervated by infratrochlear, supratrochlear, supraorbital, lacrimal and zygomaticotemporal nerves. It is better to give a ring block by infiltration with lignocaine and bupivacaine with adrenaline to have immediate and prolonged action. Use of tumescence is restricted to minimum amount to prevent post-procedure eyelid swelling. Pressure taping is applied just below the eyebrow on the eyelid to decrease post-operative swelling.

Hairline Designing

Usually, the patient is first asked to recreate the eyebrow known as desired eyebrow. Then, an effort is made to have active inputs from the patient to choose from desired brow, ideal brow and individualised brow. It eliminates the gap between expectation and outcome leading to more happy patients later. Pre-cut eyebrow templates are also available but they are usually not preferred as it leads to formation of less aesthetic eyebrows.

Special precaution should be taken for ensuring symmetry of eyebrows. After finalising the shape, mark the normal eyebrow on one side. This marking is then transferred to a sterile Telfa pad by applying moderate pressure which is then cut along the markings, and a template is obtained. This is then reversed horizontally and placed over the opposite brow area at desired height and position and the new brow is marked.

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After Eyebrow transplantation

The recovery period for an eyebrow transplant is relatively quick. You’ll notice some scabbing around the brows within the first few days. It’s important to not pick at these. You may need to avoid vigorous exercise for up to 3 weeks following your surgery. You’ll start to see the transplanted hairs fall out after a few weeks. This is completely normal. Your new brow hairs should start to grow over the next several months. In the meantime, you may need to trim the transplanted hairs to brow length.

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Eyebrow transplant surgeons

It is important that you seek the assistance of experienced and skilled Eyebrow transplant surgeons in Iran who have provided a suitable condition for people with limited budgets to do Eyebrow transplant in Iran easily. It is worth explaining that the quality provided by Iranian surgeons is far higher than other countries including Turkey and India.

Eyebrow transplant surgeons in Iran, have performed numerous procedures annually which make surgeons in Iran more experienced than other countries, due to high demand and low costs of Eyebrow transplant in Iran, thousands of people travel to Iran every year in a way that you can perform Eyebrow transplant in Iran by the best rhinoplasty surgeons with affordable and reasonable price.

The factors that the best Eyebrow transplant surgeons should have:

1. Experience

Because of performing a great number of procedures, they become knowledgeable and highly skilled which make them very famous worldwide.

2. Expertise in different types of Eyebrow transplant surgery

It is of paramount importance that your surgeon be expert in various types of Eyebrow transplant.

Eyebrow transplant cost

How much does it cost for eyebrow transplant in Iran?

Typical costs: An eyebrow transplant typically costs between $300 and $1000, including the surgeon fee, anesthesia and facility fee.

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