Injury to the eyebrow area and overplucking are some of the reasons for eyebrow hair loss. Some seek a solution for this in microblading, while others dislike it because the results are two-dimensional, which can seem unnatural. A more natural look can be achieved with an eyebrow hair transplant.

What are the steps of an eyebrow hair transplant?

Surgeries can slightly differ based on the case, but overall the steps are as follows:

• Marking the outline
• Harvesting the grafts
• Making the recipient sites
• Implanting the grafts

How is the shape of the eyebrow determined?

When marking the outline, the surgeon focuses on symmetry and making the shape look natural for the patient's face. The length of the brow is 6-7 cm for most people. The arch peak of the eyebrow is usually about 3-4 centimeters from the head of the eyebrow. But the surgeon shouldn't simply rely on these dimensions; there is an artistic aspect to making the eyebrows look natural. The surgeon's team and patient also give feedback and suggestions for the shape of the brow.

Is graft harvesting painful?

Some patients are nervous about the harvesting part of the procedure since they worry it will be painful.

Before the hair harvesting part of the procedure begins, the patient is given antibiotics and an anti-inflammatory steroid. Ambien and Valium can also be offered to calm the nerves. The donor area is numbed with a local anesthetic; this way the nerve endings that come up from the back of the neck are stunned. The patient might feel some pressure but not pain.

What technique is used for graft harvesting?

FUT is typically used for an eyebrow transplant for women. FUT extraction is done by cutting out a strip of skin and fat. The grafts that are in the strip are then individually divided. A benefit of FUT, apart from not having to shave the back of the head, is that the surgeon is able to see the natural curl of the hair better. This makes it easier to match the curl of the previously existing hairs in the eyebrow.

How does the surgeon remove the strip?

The segment that is being removed is first marked. The surgeon makes incisions following the markings that they previously made. The surgeon first holds the blade at an angle, then, as they go deeper, they go straight down so that the bulb of the hair is not damaged. The area needs to be released all the way around before the surgeon begins to go underneath it. The surgeon's team helps them by keeping the site clean from blood since the scalp area is vascular. After the strip is removed, the surgeon's team divides it into the grafts that will be placed into the recipient sites.

What is the donor area?

The donor area is typically the back of the scalp. When searching for a donor area, the surgeon looks for a segment with good hair density and scalp elasticity. The segment usually has 80-100 follicular units per centimeter squared.

How are the recipient sites made?

The angle of the eyebrow hairs is consistent; mostly, they lay flat. To achieve the angles without having to keep the blade flat to the skin, the surgeon can use a custom-cut blade angled within the blade holder. It is beneficial first to create the incisions at the perimeter of the markings since they can rub off prematurely. Once the borders are outlined, the surgeon starts building up the density within the markings. 

The direction of the eyebrow hairs changes, as well as the density. At the head of the brow, the direction of the hair is vertical, and the density is more sparse. From the top of the head of the brow, hairs turn laterally. That line can be followed to the tail of the brow. The hair of the brow creates a fishbone pattern with the top hairs going downwards and the bottom hairs going slightly upwards. The central hairs are more lateral. The surgeon tries to follow the pattern of the hairs for a natural result.

The surgeon may use a 0.5 mm blade intermixed with a 0.6 mm blade. A single hair graft can be put into a site made with a 0.5 mm blade, while a double-hair graft can be placed into a site made by a 0.6mm blade. Single-hair grafts will be predominantly used, but two-hair grafts are put into the body of the brow to give it more fullness.

How are the grafts implanted?

Once the surgeon has made all of the recipient sites, the surgeon's technicians place the grafts into the sites. Implanting the grafts is challenging because the eyebrows have a lot of mobility. The curl of the implanted hairs must also match the surrounding hairs. As such, the surgeon needs to have a highly skilled team. The surgeon oversees this part of the procedure and instructs the technicians to make changes as they are required.