Natural Reconstruction: A Comprehensive Standardized Operating Procedure for Restoring Eyebrow Loss Due to Scarring

Background: Scarring that results in eyebrow loss is a cosmetic problem that can result in severe psychological distress. Although hair transplantation is increasingly used for eyebrow restoration, graft loss may occur, preventing achievement of desired results. Single-hair follicle transplantation, however, may be effective. The authors describe outcomes of a standardized method of eyebrow reconstruction, involving single-hair follicle transplantation combined with follicular unit extraction, in patients with absent eyebrows because of scarring. Methods: This study was approved by the institutional ethics committee of Nanfang Hospital and all patients provided written informed consent before surgery. The medical records of patients who underwent eyebrow reconstruction from 2012 to 2019 for eyebrow loss caused by scar formation were reviewed retrospectively. Outcomes evaluated included satisfaction, graft survival rate, and long-term complications. A nine-step standardized operating procedure was established for eyebrow reconstruction in patients with eyebrow absence attributable to scarring. Results: During the study period, 167 patients (205 eyebrows) underwent eyebrow reconstruction. Following the first stage of reconstruction, 95 percent of patients were highly satisfied with the density and natural appearance of their eyebrows. The average graft survival rate was 85 percent (range, 70 to 90 percent), significantly higher than the 75 percent survival rate previously reported. Fewer than 5 percent of patients underwent the second stage of reconstruction, with these patients expressing satisfaction with their outcomes. No obvious complications were observed. Conclusion: This standardized method may optimize outcomes in patients with eyebrow absence attributable to scarring.