Eyelash Transplants

Eyelashes are an important aspect of everyone’s facial appearance. Besides their primary function of shielding the eye from injury, dust, or grit, the eyelashes frame the eyes.

Together with other facial landmarks, the eyelashes have a special role in creating a unique facial appearance. Therefore, a person without eyelashes can have a strange appearance. There are various causes of eyelash loss, including genetics, physical damage, age, or others.

Eyelash transplantation is a procedure of enhancing sparse, weak, short, or thin lashes and improving their appearance. Unlike eyelash extensions and lifts, eyelash transplantation offers permanent results – of course, if it is performed correctly by a certified plastic surgeon or ophthalmologist. The procedure, however, is not as scary as it sounds. It involves harvesting the hair grafts from one part of the body and their transfer to the eyelash area.

What is eyelash transplantation?

Eyelash transplantation is a surgical procedure performed to enhance eyelash hairs or correct eyelash hair loss.

In eyelash transplantation surgery, the donor hair from some part of the body (usually the back of the scalp) is being moved into the eyelash area, either the upper or lower eyelid. This guarantees a fuller lash appearance. It is necessary that the donor hair matches the quality of eyelash hair as much as possible.

While the transplanted hair will grow in the eyelid, the patient will have to follow a particular regimen of curling and trimming the transplanted hairs as they grow. Many candidates consider eyelash transplantation for cosmetic purposes. Still, the best candidates are those who experienced trauma (burns or avulsion) to the eye area, those who have genetically short or scanty lashes, or the ones who developed complications from tattooing infections.

The history of the eyelash transplant procedure started approximately 90 years ago. It is when German doctor Franz Krusius published an article about the reconstruction of eyelash hair loss. He described the harvesting of the hair from the scalp using a small punch and transferring those hairs into the eyelid with the needle he designed. It was also a German physician, Dr. P. Knapp, who inserted a composite free graft strip taken from the eyebrow into the eyelid border in 1917. The articles published afterward, mainly from Japan, contributed to eyelash reconstruction technique advancement.

Dr. Emmanuel Marritt first described the single donor hair transplant to the eyelid in 1980. That same year, Dr. Robert Flowers published the article about the „pluck and sew“ technique that is in use today. However, it was revised and advanced many times until today.

Initially, the eyelash transplantation was performed for medically required reasons to correct eyelash hair loss. However, esthetic facial enhancement is a quite new development.

It is important to note that eyelash transplantation has to be performed by specialized doctors, either plastic and reconstructive surgeons or ophthalmologists highly trained for such a procedure.

Characteristics of eyelash loss

The eyelash hair loss, or madarosis, can affect either both sides of the face or just one. Furthermore, it can lead to complete or partial eyelash hair loss. In other words, you may lose all the eyelash hair, or only some, resulting in hair thinning of the affected areas.

The eyelash loss can also be scarring or non-scarring. Scarring madarosis implies more damage and permanent eyelash loss. In contrast, in non-scarring madarosis, the internal hair structure is preserved so that the hair loss could be reversible.

Madarosis occurs due to many reasons. Some are more common, while the other ones are pretty rare. For example, if you use too much mascara and your lashes start to fall out, it might signify an allergy. On the other hand, applying it too roughly may cause physical trauma and again lead to eyelash loss. This occurs more than you would expect! The beauty treatments, such as lash lifts, can cause damage to the eyelash hair follicles and result in madarosis.

Any injury to the face in the eyelids region, scarring, accidents, burns, tattoos, surgeries, tumors, radio- and chemotherapy, some medications, or nutritional deficiencies, may all lead to lash loss.

However, eyelash loss may occur as a sign of certain underlying and sometimes severe diseases. These include alopecia areata, hyperthyroidism, hypothyroidism, scleroderma, psoriasis, rosacea, dermatitis, or discoid lupus erythematosus.

Trichotillomania, representing compulsive hair plucking, can also be the cause of eyelash loss, as well as congenital atrichia, meaning the absence of all body hairs from birth.

Infections can also cause eyelash loss. Blepharitis, for example, is the inflammation affecting the eyelids, which can cause the eyelashes to fall out. In addition, leprosy, the bacterial infection affecting the skin, nerves, eyes, and nose, may also lead to eyelash loss.  However, many bacterial, fungal, or viral infections may cause eyelash loss.

 The medical history and examination are the key in treatment decisions, as every cause requires different treatment options.

Procedure options

The treatment options greatly depend on the underlying cause of eyelash loss or thinning.

For example, if the cause of the eyelash loss is psychological disease trichotillomania in which the patient voluntarily pulls their eyelashes out, it will require a different treatment plan as compared with the patient with endocrinological disorders, alopecia areata, or trauma.

Prior to the decision on treatment, a reputable and certified doctor should perform a serious and detailed evaluation of a patient’s medical history, perform a physical examination, perform analyses, and choose the treatment accordingly. The treatment options can be non-surgical or surgical (eyelash transplantation).

Non-surgical treatment options are various. In some cases, eyelashes will regrow over time. In endocrinological causes, medications for hormone regulation should be enough to stop and prevent the lashes from falling out.

Besides the cause, the time required for eyelash regrowth also varies depending on the extent of the eyelash loss. Some other medications may also aid in eyelash regrowth. For example, the doctor can prescribe eye drops of bimatoprost in some cases.

Furthermore, several products exist for lash growth promotion. There are several options in cases in which eyelash loss is not a sign of serious health issues and is caused by aging, pregnancy, hormonal disbalance, rough lash treatments, and so on. You may first think about eyelash extensions. This procedure is becoming more popular each year. It has advanced over time, and nowadays, it offers natural-looking false eyelashes that are easy to apply and wear. However, the lash extensions can last only up to six weeks, even if they are applied by an experienced esthetician. A lash lift can also provide some minor increase in lash size if the lashes look thin. The new esthetic procedures also offer permanent mascara additionally, so the lashes can look denser. There is also an ointment available by prescription, Latisse. Its active ingredient, bimatoprost, safely and effectively promotes the eyelash growth cycle. As a result, the eyelashes become thicker, fuller, longer. Platelet-rich plasma (PRP) treatment and even stem cells could also be helpful. However, the results are not long-lasting.

The only permanent solution for eyelash loss is the procedure of eyelash transplantation. In this procedure, the surgeon may perform either FUT (follicular unit transplantation), FUE (follicular unit extraction), or DHI (direct hair implantation) technique. The fine hair is harvested from the scalp, from the leg, or from the other parts of the body. Depending on the technique (FUT, FUE, DHI), these hairs are then implanted into the eyelids.

Unfortunately, this procedure is not available on the NHS, as it is a cosmetic procedure.

Donor area

Donor hair grafts that are transplanted from some part of the body into the eyelid must have similar quality as the lash hair as much as possible.

The hair transplanted to the eyelids continues to grow, and, as it does, the patient has to follow a specific regimen of curling, perming, and trimming the transplanted hair on the eyelids.

As the eyelashes have a very specific structure, the donor areas are limited to the fine body hairs. The common donor areas are the scalp above or behind the ears, the nape of the neck, eyebrows, hair from the legs, and other areas in which the surgeon can find the appropriate, fine hairs for transplantation.

Cost of eyelash transplants

Eyelash transplantation is a very specialized and delicate procedure requiring precision and expertise.

Therefore, it is quite an expensive procedure, not covered by insurance. However, because the number of grafts required is lesser than for other hair transplant procedures, eyelash transplantation is more affordable. The exact number of grafts depends on the existing and desired eyelash density. A normal number of eyelashes on one eye is around 160 –  about 100 in the upper eyelid and about 60 in the lower eyelid.

The exact cost varies by the surgeon, experience, clinic (location), and the harvesting technique. The price may vary from £3500 to £4500 for both lashes in the UK. On the other hand, in Turkey, this type of surgery is somewhere around £1000-£2000 for both lashes.

Surgery in the UK vs. Turkey

When considering eyelash transplantation surgery, one may decide to perform the surgery domestically or abroad.

Many people choose Turkey for hair transplant procedures, as there are many hair transplant clinics, and the prices are pretty affordable.

As abovementioned, there is a difference in the price for the surgery itself, with Turkey clinics offering lower prices for eyelash transplantation. However, you should consider other expenses, as well. For example, if you perform the surgery in Turkey, you will have to additionally pay for the plane tickets, hotel accommodation,  insurance costs, sick leave from your job or spending vacation days.

Other than costs, the procedure does not differ much. Surgeons in both countries use the same techniques while performing eyelash transplantation. Also, it is performed as a one-day surgery, lasting for one to three hours, under local anesthesia and mild sedation. Preoperative preparation and postoperative care are also the same.

Although the price is always an important factor, the primary focus should be on the end results. As the eyelash transplantation complications are more severe as compared with the other hair transplantation surgeries on the scalp, choosing a surgeon with a good reputation and experience and a reliable clinic is essential.

Risks and considerations

The eyelash transplantation procedure is essentially surgery. Therefore, you may think of the possible risks and complications.

Among other transplantation procedures, eyelash transplant is the most delicate because of the closeness of the eyes and the sensitive eyelid tissue. The complications are not common, but when they develop, they may be severe.

There is a slight risk of eyelid infection development, for example. This requires rapid recognition and prompt reaction and treatment. Considerably serious complications could be ectropion and entropion. Ectropion is a downward pull and eversion of the lower eyelid.  This may cause the eyelids to fall away from the eyes. Contrary, entropion is the turning in of the eyelid margin. Other risks include bruising, swelling, ingrown hairs, graft displacement caused by the patients’ scratching of the eyelids, poor placement or quality of grafts, or failure to achieve the desired results.

Of course, you should take all the aspects into consideration. However, as above stated, the primary concern should be choosing a certified and experienced surgeon and reliable clinic. In case of complications, it would be better if your surgeon is close. And, of course, you should strictly follow the surgeon’s preoperative and postoperative instructions to prevent any complications.

Eyelash transplant timeline

The recovery period after eyebrow transplantation is faster as compared with the other hair transplants. The complete eyelash transplantation process, from initial doctor consultation to full recovery, may take up to one year.

• Week 1 – 2 before the procedure: You will plan the procedure. You will first choose the clinic and your surgeon. You will meet him/her and discuss the entire procedure. Ask all the questions you have. If you are satisfied with these answers, you will arrange the surgery date. 
• The procedure itself: 1-3 hours. 
• Day 1 after the surgery: You will be discharged the same day with a surgical dressing on the donor area. You will be recommended with minimal activity.
• Week 1-2: You may notice small scabbing and light bruising in the eyelids, or more precisely, the lash line. The scabbing will shed on its own. Although it can take about 12 days for a full recovery, the signs of the surgery are often gone by the end of the second week after the surgery.
• Week 2-3: The transplanted eyelash hair falls out and spends a few weeks in the resting phase before re-growing. 
• Week 12: Hair will start and continue to re-grow.
• Months 6-12: You can see the final results. In the meantime, you will have to maintain your new lashes using an eyelash curler and trim them regularly.

Before and after pictures

See the results of the eyelash hair transplant procedure on the pictures below:

•            Eyelash hair transplantation, before and after.

•            Patient with eyelashes damaged by rough mascara application before and after the eyebrow transplant procedure.

•            Results of the eyelash hair transplantation.

•            Stunning results: before and after the eyelash hair transplantation.

Results and aftercare

The recovery period is relatively short after the eyelash transplant procedure. However, the final results are not visible until approximately six months after the procedure. Your surgeon will give you a set of instructions, both before and after the surgery.

You will be asked not to take anti-inflammatory or blood-thinning medications at least one week prior to the procedure. The surgeon will also advise you to cease alcohol consumption and smoking during that time. You should not eat after midnight the night before the surgery.

After the surgery, the surgeon will recommend the minimal activity for 24 hours after the procedure. You will not be allowed to use eye make-up for one week or apply mascara or eyelash curlers for approximately weeks. You should wear your goggles for the first week, mainly when you are sleeping, in order to protect the transplanted lashes. Some doctors even recommend keeping the eye bandages for the first 24 hours after the surgery.