Frontal Fibrosing Alopecia – Eyebrow Transplantation

  • Best Results12 months+
  • Treatment Recovery7 days
  • Procedure Time2 hours
  • Skin SpecialistDavin Lim
  • Duration of ResultsVariable
  • AnaestheticNumbing
  • Back to Work1-2 days
  • Cost$-$$

Frontal Fibrosing Alopecia - Eyebrow Transplantation

FUE eyebrow transplantation has transformed how we manage this condition. The procedure involves transferring single units of hair follicles from the unaffected back scalp to the eyebrows. The success rate is good, however patients should be mindful of recurrence & progression over time.

FactsFacts On FFA & Eyebrow Hair Transplants

  • FFA or frontal fibrosing alopecia frequently affects the eyebrows
  • Eyebrow hair loss occurs early in this condition. Regrowth is highly unlikely
  • Hair transplantation gives good results for the first few years following FUE
  • Long term studies show that there is a steady decline in follicles after several years
  • Newer pulsed medical therapies can, in theory, preserve hair follicles post transplantation
  • FUE is not performed unless remission is longer than 2 years

What is FFA or lichen planopilaris?

FFA or frontal fibrosing alopecia is a variant of lichen planopilaris. This entity was first described by a famous Australian pathologist, Dr Kossard from Sydney. This is a common disorder. Though we don’t know exactly why it happens we know that-

  • Women are more susceptible
  • It occurs in mid to elderly patients, most commonly post menopausal
  • There has been a genetic link to FFA
  • It involves the frontal scalp & eyebrows
  • Though progressive, hair loss generally is confined to the ‘frontal’ areas

Who is a good candidate for FFA hair transplantation?

The consensus is that frontal fibrosing alopecia should be dormant or in remission for at least 2 years before consideration of hair transplantation. This applies to both eyebrows & scalp transplantation.

Remission can be defined in several ways, most importantly no inflammation in the eyebrows, frontal & temporal area of the scalp. Serial photography will confirm remission. Additionally, there will be an absence of physical signs such as perifollicular scaling, redness & casts (your medical dermatologist will examine & guide you). Additionally, clinical symptoms such as itch will be absent. 

What is involved in eyebrow transplantation?

Eyebrow FUE involves taking hair from the back part of the scalp & transferring it to the eyebrows.

In the context of FFA, the harvesting technique is strip FUE. This means we only take a 1-2 cm area of follicular units without the need for shaving the scalp. I only take single follicular units as this gives a more natural appearance to the brows. Once harvested, the single follicular units are placed on chilled saline gauzes awaiting transplantation.

The eyebrow is designed, & recipient sites are angled accordingly. I then place the harvested single units one by one into the area.

Where are the hairs harvested from?

Healthy hairs are harvested from the back of the head known as the occipital scalp. This area is usually free from inflammation that destroys the hair follicles.

Before any transplantation, a close dermatologic examination is required to exclude inflammation. In some cases, a scalp biopsy is performed to exclude microscopic inflammation.

Davin’s Viewpoint on FFA & eyebrow transplantation

FFA is very common. It is a form of LPP or lichen planopilaris. This condition is more common in women, rarely seen in men. Eyebrow loss is one of the first clinical signs, followed by hair loss in the frontal scalp.

We now have data regarding follicular unit extraction follow ups spanning 5 years (in the context of scalp hair). Studies show good uptake at 12 months, with a steady decline of follicles thereafter. We are now undertaking methods to preserve follicles using pulsed topicals. This can potentially improve graft survival rates. 

Do not consider FUE if you are not compliant with topical & or systemic medication (as guided by your dermatologist). It’s akin to an organ transplant without immunosuppressive agents (chances are it will fail). Eyebrow transplantation should only be considered if your FFA is stable, with a remission rate of longer than 2 years.

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