Eyebrow Reconstruction

Updated 3/2017-- photos and all links removed as many are no longer active and it's easier than checking each one.

The eyebrow plays an important role in facial harmony and eye protection. Eyebrows can be injured by burn, trauma, tumor, tattooing and alopecia. Eyebrow position, contour, and movement are important features of facial expression. There are some really nice tips on "shaping your eyebrow" here. Many of those tips can be used in reconstructing an eyebrow. I particularly like these:

• The best shape for eyebrows is a straight line from the beginning of the eyebrow to the arch, and then a soft curve from the arch out to the end of the eyebrow.
• Go with the natural line of your eyebrow. All bone structure is different, and so are your eyebrows. Not sure where your eyebrows should be? Run your finger along your eyebrow bone. That's exactly where the line of your eyebrow should be. If you try to arch your eyebrows too high above the bone, it will look too fake. Stay with the arch that works best with your bone structure. It's the one that you naturally have already.
• Make sure the beginning and end of the eyebrow is on the same line. If one side is too high up or too far down, it can throw off the shape of the eye.
• The goal of perfect eyebrows?
  To bring attention to your beautiful eyes, not your eyebrows.

The pictures here illustrate how important brows are to how our face looks. The first is pre-transplantation and the second post. To me it is a dramatic difference.

Eyebrow Anatomy and Physiology
The density of eyebrow hair generally remains stable with age. Men often have an increased number of eyebrow hairs than women. The eyebrow is frequently altered in appearance by plucking.

There are four very distinct characteristics of eyebrow hair:

• The direction of eyebrow hair changes dramatically in different parts of the brow. In the region of the eyebrow nearest the nose, the hair points upward, almost vertical in orientation. The hair across the top of the eyebrow points outward and downward. The hair in the lower part of the brow grows outward and upward.
• The hairs of the eyebrow emerge from the follicle at a very acute angle so that the hair grows flat to the skin’s surface. This is in contrast to scalp hair where the angle between the hair and scalp can be 45 degrees.
• The hairs grow as individual strands, rather than in the 1- to 4-hair follicular unit grouping that are characteristic of scalp hair.
• The growth cycle of eyebrow hair is very short. This means that eyebrow hair will grow (in anagen) only for about 4 months before it enters the resting (telogen) phase and falls out. In contrast, scalp hair has a growth phase that can last 3 to 7 years, enabling the scalp hair to grow much longer.

Methods for Eyebrow Reconstruction include:

• Hair Transplant Grafting -- It is important to follow the natural hair direction very closely. This entails very subtle angle changes to recreate the fan-like splay of hair at the medial end of the brow and the converging hair direction as one moves laterally along the brow. You want the hair will lie as flat as possible on the surface of the skin as it grows so the recipient sites have to be created at very acute angles to the skin surface. Only individual hair follicles should be used. If the patient’s hair is waved or curly, it is important to rotate the hair so that curve of the hair shaft follows the natural curve of the eyebrow.  The hair transplanted to eyebrows will continue to grow and must therefore be periodically cut. This leaves a cut-end that is not as delicate as the fine-tipped end of an untouched hair. In the process of healing, all wounds contract. This may slightly change the hair's flat orientation and result in eyebrow hair that is slightly more elevated than one would like. Over time, the transplanted scalp hair will slowly begin to approximate the growth pattern and characteristics of the existing eyebrow hair, but may never totally match it. The appearance of eyebrow hair transplants will mature over the course of a year. During this interval, the eyebrow can be tweezed and shaped as needed.
• Superficial temporal artery island flap with anterior or posterior branch -- There are two draw backs for use of this flap--1) the frontal area is a common site of hair loss in men and this can affect the reconstructed brow and 2) the hair will grow downward when placed in the brow position
• Island flap from lateral parietal area -- This area of scalp is not usually affected by alopecia. This flap used the superficial temporal artery. The hair will grow in the correct direction, sort of (see above on the complex changes of direction of eyebrow hairs). Care must be taken so that when the flap goes through the cutaneous tunnel of the temporal area, there is no torsion or tension.

Complications

The complications will depend on what procedure is done. For each there is always the risk of infection, bleeding, and scar (donor site and brow site). For the flap techniques, there is the risk of loss (partial or complete) of the flap to necrosis. To each, there is the possibility of a poor result.

And though most of us don't wish to have Groucho Marx eyebrows, you must admit the way he "wiggles" them can make you laugh. Check him out in this scene from "Monkey Business"

REFERENCES
Comparison of Four Surgical Methods for Eyebrow Reconstruction; Indian Journal of Plastic Surgery, Vol 40, #2, pp 147-152, 2007; Omranifard Mahmood, Koushki A Mehrabi
EYEBROW TRANSPLANTS -- From Scalp to Brow; Plastic Surgery Products 2006; 34-8; William R. Rassman, M.D. and Robert M. Bernstein, M.D.
Eyebrow Reconstruction; Plastic & Reconstructive Surgery, 107(5):1225-1228, April 15, 2001; Juri, Jose M.D.
Reconstruction of ear, eyebrow, and sideburn in the burned patient; Plast. Reconstr. Surg. 55: 312, 1975; Brent B
Reconstruction of the Localized Eyebrow Defect; Plastic & Reconstructive Surgery. American Society of Maxillofacial Surgeons 50th Anniversary. 100(3):685-689, September 1997; Cedars, Michael G. M.D.
Aesthetic Analysis of the Eyebrows; Plastic & Reconstructive Surgery. 99(7):1808-1816, June 1997; Gunter, Jack P. M.D.; Antrobus, Steve D. M.D.
Eyebrows--Oculoplastic Gallary
The Model Eyebrow by Elle von Frendenberg; The Beauty Newsletter(blog), November 8, 2006
Anatomy of ‘A Beautiful Face & Smile’; J Anat. Soc. India 52(1) 74-80 (2003); Patnaik, V.V.G; Singla Rajan, K; Bala Sanju.