The American Journal of Cosmetic Surgery Vol. 24, No, 3, 2007 150

CLINICAL TECHNIQUES

A Cosmetic Surgeon's Decade of Experience Performing Eyelash Transplantation

Kathryn Duplantis, MD, FAAD, FAACS; Ludmila Cosio-Lima, PhD, CSCS; KatyReynolds, MD, FACP; Tabitha Hodges, BS

Introduction: Single-hair grafts to the eyelids, performed Loss of eyelashes has numerous causes. Trauma is using a very challenging technique, offer cosmetic surgery the most commonly reported etiology of eyelash loss patients a natural-looking solution for alopecia of the eyelid resulting from bums, scarring from infection (usually due to various causes, ranging from overcurling and trauma associated with tattooing and body piercing), and to systemic and metabolic processes. The technique de­ surgery. Excessive eyelash plucking and curling can scribed in this article requires the cosmetic surgeon to have lead to lash loss, as can trichotillomania, an obsessive­ a vast experience in both hair transplantation and eyebrow compulsive disorder associated with long-term hair transplantation. pulling, that requires treatment. In addition, hypothy­ Methods: We present a technique that requires simple roidism and other endocrine disorders are treatable instrumentation and the aid of one well-trained assistant. causes of eyelash loss. 1 Congenital disorders such as The procedure has been performed on 20 male and 350 congenital aplasia are also associated with eyelash 'emale patients over a JO-year period. Joss. 1 Results: The procedure has resulted in a mean graft Cosmetic surgical techniques forhair transplantation survival percentage of 95%. The technique produces to the eyelashes have improved but still remain cosmeticallypleasing outcomes, and complications are rare. a challenge. Few instruments are required. Complica­ Gonclusions: A challenging technique for eyelash trans­ tions are rare, and aesthetic results are typically plantation can successfullyeffect a pleasing and natural look pleasing for the patient. Figures 1 through 4 show the for cosmetic surgery patients. results of theeyelash transplantation procedures.

air transplantation is not only used for improving H male and female pattern baldness and brow and mustache alopecia but also for hair loss in other parts of the body, including the eyelashes. Transplanting to these areas is based on the same doctrine. Hairs will grow because of the effect of donor dominance. 1 Absence of eyelashes is not only cosmetically un­ natural but also makes the eyes more vulnerable to injury from dust and foreignbodies. Therefore, eyelash reconstruction is important in restoring functional anatomy and improving a patient's self-esteem. 1

Dr Duplantis and Dr Reynolds are fromthe Hair, Laser and Liposuction Center of Dallas, Texas. Dr Cosio-Lima and Tabitha Hodges are from the ·pniversity of West Florida, Pensacola, Florida. Correspondingauthor; Kathryn Duplantis, MD, FAACS, the Hair, Laser and Liposuction Center of Dallas, 6750 Hillcrest Plaza, Suite 223 Da11as, TX 75230 (e-mail: [email protected]). Figure 1. Patient No. I beforethe procedure (Left) and Received for publication April 6, 2007. 3 months after eyelash transplant (Right). The American Journal of Cosmetic Surgery Vol. 24, No. 3, 2007 151

Figure 2. Preoperative picture Qfpatient No. 2. (A) Patient who lost lashes due to overcurling. (B) Closeup of patient who lost lashes due to overcurling.

Reports from the historical literature reveal that from the eyebrow into the eyelash border. In 1980, eyelash reconstruction techniques date as far back as Marritt4 inserted hair follicle roots obtained from scalp 1 3 2 the early 1900s. - 1n 1914, Krusius reconstructed the punches into the eyelid border using a needle. 1n 1994, 5 eyelashes by inserting harvested punch grafts into the Caputy aud Flowers described the "pluck aud sew" 3 eyelash border. In 1917, Knapp inserteda stripof graft technique performed on patients with alopecia, which

Figure 3. Patient No. 2 at 18 months after second bilateral eyelash transplant. (A) Patient with newly transplanted grafts. (B) Closeup view Qf same patient with newly transplanted grafts. The American Journal of Cosmetic Surgery Vol. 24, No. 3, 2007 153

The surgeon cuts the single grafts, using a No. 10 (approximately I%) may develop perifollicular swell­ blade on sterile tongue depressors, and then places the ing, which creates a "cobblestone" appearance at the grafts on normal saline-moistened Telfastrips in a Petri ends of the grafts. This usually subsides after 4-6 dish. The patient is moved to a sitting position, and the weeks without treatment. If a patient manipulates the recipient site, which has been outlined by the patient grafts in the early stages of growth, this may lead to before surgery, is prepped, redrawn, and anesthetized. infection, scarring, cysts, or loss of grafts. The only With a 16-g Nokar needle, microslits are made that treatment is surgical removal of the involved grafts. follow the natural growthpattern of the eyelashes: care Obviously, patients with trichotillomania that are not in must be taken to count the number of slits. The surgeon remission are to be avoided. implants a single graft per slit by grasping the hair above the bulb and releasing it in the recipient site, using a small cotton swab to apply very gentle pressure to hold the graft in place. Special care is taken to Conclusions implant the hairs above the tarsal plate at a slant to Cosmetic reconstruction of the eyelash border can effect a natural look. be safely performed if single-hair grafts are carefully The number of grafts required depends on the length harvested and prepared and cautiously implanted. of the eyelids and amount of lash loss. Most often, Also, vigilant patient participation, including postsurgi­ between 20 and 40 grafts are required. Corneal shields cal follow-up and care of grafts, is inlportaut. New hairs are not used because they have not been found to be typically begin to grow within2 weeks, andfull growth helpful in protecting theeyes of the awalce patient. This can be observed in 3 to 6 months. For the best results, it part of the procedure is very challengingand requires a is extremely important for the surgeon to have vast steady hand. experience with both hair and brow transplantation. Although some have reported using no dressing, we apply a modified face-lifting dressing of fluffed 4X4 ;auze, Kling gauze, and Coban gauze to the donor sites. References Note that no dressing is placed over the recipient sites. 1. Gandehnan M, Epstein JS. Hair transplantation The dressing is removed after 24 hours. Four milli­ to the eyebrow, eyelashes, and other parts of the grams of Decadron is given intramuscularly to retard body. Facial Plast Surg Clin North Am. 2004:12(2): swelling. Diclofenac sodium and acetaminophen-hy­ 253-261. drocodone are prescribed for discomfort. 2. Krusius F. Ueber die einplflanzunglebender hare The grafts "set" in 72 hours. Full growth can be zur wimpembildung. Dtsch Med Wockenschr 1914;19: expected in 3-6 months, although growth should begin 958(in German). within 2 weeks of transplantation. Review figures 1 3. Chastain GL, Duplantis K. Eyebrow transplanta­ through 4 for photographs of before and after trnns­ tion: A simplified technique. Am J Cosm Surg. plantation results. 1999; 16(2):141-144. Postsurgical Care of Grafts 4. Marritt E. Transplantatiou of single hairs from Patients should avoid eye makeup on the eyelids for the scalp as eyelashes. Review of the literature and a case 6 weeks. In addition, light curling of the lashes should report. J Dermatol Surg Oneal. 1980;6(4):271-273. be discouraged for the first 3 months. Patients can 5. Caputy GC, Flowers RS. The pluck and sew lightly trim the new lashes after 6 weeks. technique of individual hair follicle placement. Plast Reconstr Surg. 1994;93:615-620. 6. Herndandez-Zendejas G, Guerrerosantos J. Results Eyelash reconstruction and aesthetic augmentation Mean survival percentage has been 95% for eyelash with strip composite sidebum graft. Plastic and Re­ grafts transplanted using this procedure. Some patients constructive Surgery. 1998;101:1978-1980.