Madarosis is the medical term to describe the loss of eyebrows or eyelashes. They serve both important functional and cosmetic roles; their loss can be distressing for patients. The causes of madarosis are diverse, ranging from autoimmune and endocrine disorders to infections, genetic factors, neoplastic diseases, nutritional deficiencies, and trauma. Depending on the underlying cause, madarosis can be classified as either scarring or non-scarring.3
Physiology
The anagen phase of eyebrow hair growth generally spans approximately 2 to 3 months, followed by a catagen phase lasting 2 to 3 weeks, and a telogen phase of similar duration, around 2 to 3 months.4 Age-related changes in eyebrow appearance may include thinning and depigmentation, which are commonly observed as part of the normal aging process. Conversely, in some individuals—particularly males—aging may instead be associated with increased eyebrow density.1
Common Causes
The underlying causes discussed represent the most frequent causes of eyebrow loss, though numerous other disorders may also contribute. 6
- Alopecia Areata
- Steroids
- Prostaglandin Analogues
- Immunotherapy
- JAK Inhibitors
- Trichotillomania
- Frontal Fibrosing Alopecia
Key Essentials for Choosing the Right Shape
Selecting the ideal eyebrow shape should take into account the natural structure of the face, the current thickness and pattern of the eyebrows, and the individual’s aesthetic preferences. Achieving a natural and balanced result also depends heavily on the surgeon’s expertise in designing and executing the transplant with precision.
- Natural Arch
- Straight Brow
- High Arch
- S-Shaped
The Procedure Itself
1.FUE for Eyebrow Restoration
Follicular Unit Extraction (FUE) is the most commonly technique for harvesting individual hair grafts, offering several advantages—including minimal discomfort, quick recovery, low risk of visible scarring, and reduced donor site trauma. A 0.8-mm punch, whether used manually or with a motorized device, is generally considered the most appropriate tool. 5
2.FUT for Eyebrow Restoration
Follicular Unit Transplantation (FUT) is a less commonly used method for eyebrow restoration. It involves excising a thin strip of scalp below the occipital area. The strip is carefully dissected under magnification into individual follicular units, then refined into single-hair grafts.5
Post-Operative Care
It’s normal for small crusts to form around the transplanted hairs in the first few days after the procedure. These typically fall off on their own and patients should gentle wash. Mild redness or a pink tint may remain at the transplant sites, but this usually ends within a couple of weeks.2 The transplanted hairs typically shed within the first two weeks as a normal part of the process. New growth generally begins around three to four months after the procedure.
References
- Kantarci FA, Kantarci MN, Bilgi S. Age estimation using level of eyebrow and eyelash whitening. Med Sci Monit. 2014;22(20):97–102.
- Klingbeil KD, Fertig R. Eyebrow and Eyelash Hair Transplantation: A Systematic Review. J Clin Aesthet Dermatol. 2018;11(6):21-30.
- Nguyen B, Hu JK, Tosti A. Eyebrow and Eyelash Alopecia: A Clinical Review. Am J Clin Dermatol. 2023;24(1):55-67. doi:10.1007/s40257-022-00729-5
- Nguyen JV. The biology, structure, and function of eyebrow hair. J Drugs Dermatol. 2014;13(1 Suppl):s12–6.
- Rajput RJ. Hair Transplant for Eyebrow Restoration. Indian J Plast Surg. 2021;54(4):489-494. Published 2021 Dec 14. doi:10.1055/s-0041-1739253
- Starace, M., Cedirian, S., Alessandrini, A.M. et al.Impact and Management of Loss of Eyebrows and Eyelashes. Dermatol Ther (Heidelb) 13, 1243–1253 (2023). https://doi.org/10.1007/s13555-023-00925-z
