Hair here, then there: Odd transplants take root

For aesthetician Mindy McGinty, eyebrows aren’t just sculpted arches framing her face — they’re a walking billboard for her business. So when she lost her eyebrows after a “bad experience with permanent makeup,” she was completely distraught.

“I wanted to give the illusion of a fuller brow so I got them tattooed,” says the 53-year-old from Gilbertsville, Pa. “But over time, the dye changed color and my eyebrows literally turned salmon orange. I had no choice but to get the tattoo removed with laser and the laser destroyed all my hair follicles.”

McGinty tried to make do with “fauxbrows” — powdering them on, penciling them in, even gluing on strips of hair which “came off every time I made a face.” But after several years, she’d had enough.  After months of research, she decided it was time to “borrow” eyebrows from the back of her head — via a hair transplant.

Thanks to advances in technology, hair-transplant procedures are sprouting up all over the country and the human body. While the majority of transplants still involve the scalp (and that remains the primary donor area), doctors are now able to harvest and replant hair follicles into eyebrows, eyelashes, beards, mustaches, sideburns, chests and beyond, allowing a growing number of people to become members of what you might call the “movable hair club.”

Nearly 99,000 surgical hair restoration procedures were performed in the United States in 2008, according to the International Society of Hair Restoration Surgery, a non-profit medical association. Of that number, approximately 93,000 procedures were scalp transplants (hair transplants to fill in bald or thinning areas), followed by 3,484 eyebrows, 1,369 mustache/beard procedures and eyelashes with 531 procedures.

“As the technology has changed from the large plugs we saw in the old days to moving single hairs, we can now do reconstruction in other places,” says Dr. Ken Washenik, medical director of Bosley, a large hair-restoration surgery provider, and the former director of dermatopharmacology at New York University School of Medicine. “You can transplant hair to any place you have hair.”

Hair down there?
The follicular unit, a naturally-occurring cluster of one, two, three or more hair follicles, seems to be the key to the current hair-restoration renaissance. In the early days of hair transplants (the procedure originated in Japan in the late ‘30s and was first performed in the U.S. in the early ‘50s), each skin graft (or plug) would contain as many as 20 hairs — less than subtle on the scalp and downright scary in an eyebrow.

Implanting individual units, or individual hairs, however, can leave the patient with a more natural look, however, allowing doctors to implant where no one has implanted before.

“The oddest one I’ve done is a pubic hair transplant,” says Dr. Paul T. Rose, former president of the International Society of Hair Restoration Surgery (ISHRS) and founder of a hair restoration clinic in Tampa Bay, Fla. “The gentleman who came to me had scars in his pubic area and had lost his hair. We took hair from the back of his head and moved it to the pubic area, in a pattern that fit the male pattern of pubic hair.”

Hairs are generally gleaned one of two ways.

“Strip harvesting,” involves taking out a strip of scalp skin, usually from the back of the head, and then microscopically separating that strip into hundreds — or thousands — of follicular units. Scalp hair transplants require thousands of grafts; an eyebrow transplant requires several hundred.

“Follicular unit extraction” (FUE) is a newer process in which the clusters are harvested individually with what Rose calls a “miniature cookie cutter.”

Both methods can leave scars on the donor site.

“If you strip harvest, you suture it close and can wind up with a linear scar on the back of the head,” says Rose. “In FUE, you have little holes that fill in by themselves over time. But if you harvest enough and you cut the hair very short, there can be little white dots that your eye can pick up sometimes.”

Once the hair is harvested and the follicular dissection gets underway, the doctor makes tiny incisions in the patient’s scalp or eyebrows or mustache or sideburns or pubic area and the seeding begins.

Roger Choukroun, 71, of Stamford, Conn., had both his eyebrows and his scalp done to help restore what time had thinned.

“I went there at 7:30 a.m. and left around 5:30 p.m.,” he says. “It was a full day and a complete operation, but I was able to drive myself home. Although I looked a little weird with a bandana and large glasses.”

The procedure can be time-consuming, especially if large areas are being transplanted or if the hairs are going into delicate areas (like eyelashes or eyebrows) where properly angling — and avoiding a proverbial “wild hair” — is crucial.  Results take time as well; follicles lie dormant for at least three to fourth months before new hair begins to sprout.  

McGinty’s new eyebrows, which were seeded in April 2008, took about 700 implants. Eight months later, she opted for a second procedure “just to fill in the areas where the hairs didn’t come in.” According to ISHRS, 43 percent of hair restoration patients achieve their desired result after one procedure; the rest have more.

While the price tag for a hair transplant may cause some to wince — an eyebrow or mustache/beard procedure runs around $3,000 to $5,000 and most transplants are not covered by health insurance — patients say the procedure itself is not terribly painful, claiming the shots to numb the donor and transplant sites generally cause the most discomfort. Bruising can occur at the transplant site afterwards; in the case of eyebrow transplants, that can mean black eyes.

Why do it?
Overplucker's remorse is the main driver of eyebrow transplants, but hair loss due to disease, scarring, or age often play a role in other facial hair procedures.

Culture also plays a role in the places where people have transplants. Pubic hair transplants (for women) are quite popular in Asia; in the Middle East, it’s all about chest and beard transplants.

Forty-one-year-old Peter Boon of Miami opted to have head hair transplanted to his chest in 2001 after years of feeling dissatisfied with the smooth look nature gave him.

“I wasn’t ashamed to take my shirt off or anything but I felt like I was missing something out of life,” he says. “I wanted to be hairier.”

Boon talked to his physician and various dermatologists and was eventually referred to a hair-restoration specialist. Since his initial procedure, he’s returned for hair transplants to his face (allowing him to grow a full beard instead of just a goatee) and to his stomach area (“I’m now covered from my belly button up to my neck”).

Not for everyone
Hair transplants are not for everyone, experts emphasize, especially those suffering from conditions such as hypothyroidism or alopecia areata, both of which can cause ongoing hair loss.

Some patients “may have a correctable medical reason for the hair loss that should be treated rather than going to surgery. If a patient comes in with a low level of thyroid hormone, you treat their thyroid, you don’t just transplant their eyebrows,” Washenik says.

Similarly, not just any dermatologist or hair doctor is able to perform these delicate surgeries.

“Any doctor can hang up a shingle [and do them] but that’s where you get problems,” says Spencer Kobren, consumer/patient advocate and founder of the educational nonprofits American Hair Loss Association and the International Alliance of Hair Restoration Surgeons. “I’ve seen a lot of complaints about hairs growing all over the place on eyebrows. Or sometimes the grafts are too big. They’ll use a two to three hair graft in an eyebrow instead of a single hair and it looks completely artificial.”

Kobren advises patients considering a particular kind of hair transplant to find a doctor who does at least 100 of the procedures a year, to speak to the doctor’s transplant patients and to check out online forums to thoroughly vet the surgeries — and the things that might go sideways (literally and otherwise).

“These procedures can make a big difference in someone’s appearance but the key is to do your research, your due diligence,” he says. “Don’t just go and have a transplant because you saw an ad in a magazine. A lot of people are so desperate they don’t realize what the downside can be and then they wish they’d never had it done. Surgery is always your last resort.”

Keep the scissors handy
One last important note: you can take the eyebrows out of the scalp hair, but you can’t take the scalp hair out of the eyebrows. In other words, no matter where you transplant head hair on the body, it will continue to grow just like head hair.

“I trim my eyebrows all the time,” says McGinty. “And I’ve been training them with hair wax. The hair on the back of your head is a little coarser than what’s on the actual brow so the wax helps to soften it. And some of the hairs will grow straight out, not all of them will lay flat. But if you take little mustache scissors and trim them down and across, you can’t tell.

“You would never think to look at me that my eyebrows came from the back of my head.”

Back To Top