Mr Asim Shahmalak details the history of eyelash transplants and shares his technique for treatment
Eyelash transplants were originally developed to help victims of accidents and traumas who had subsequently damaged their lashes permanently. Burns victims, for instance, can often be left with no eyelashes at all – damaging their facial symmetry and selfesteem. The first eyelash transplant was carried out 17 years ago in Brazil,1 and once surgeons at a hospital in San Paulo first began performing the procedure, word spread quickly around the world about its possible life-changing benefits.
Over time, surgeons have begun to realise that eyelash transplants can also be performed for aesthetic reasons; patients with naturally thin eyelashes could benefit, particularly those who have permanently damaged their eyelashes using glue-on false eyelashes. Wearing these false lashes can sometimes rip out natural follicles, leaving patients with virtually bald eyelids.
There are only a few surgeons in the world currently carrying out eyelash transplants today. I performed the very first eyelash transplant in the UK in 2009,2 on a young woman who suffered from trichotillomania,3 a condition where a person feels compelled to pull their hair out. It received a lot of publicity and was one of the most fulfilling moments of my career; the patient told me afterwards that it had changed her life.
In this article I shall explain how to assess patients for the procedure, and detail the treatment process and expectant results.
Eyelashes make an important contribution to facial symmetry and presentation of oneself to others. A person without eyelashes may feel very self-conscious about his/her appearance. Like general hair transplant surgery, eyelash surgery can be required due to a number of reasons:
Fashion dictates, to a large degree, the way people use their eyelashes. There is a range of cosmetic aids that can help eyelashes appear longer, thicker or of a different colour. In recent times, I have witnessed more and more people looking to eyelash transplantation in order to get the eyelashes they want. Such transplants are relatively new developments, however they are becoming increasingly popular as women covet the fuller eyelashes popular with celebrities.
The key questions I consider from the outset of the consultation are: does the patient really need an eyelash transplant, and are they suitable for the procedure? It must be noted that eyelash transplants can only be carried out on the upper eyelid, as the hair does not grow as well on the lower lid. From my experience, hairs on the lower lid grow very straight and are difficult to curl and trim.
During the consultation, I am looking for gaps in the eyelid where hair, harvested from the scalp, can be transplanted. This is not always possible with an accident victim as their eyelids can be badly damaged. In these cases, I may have to wait for a plastic or ophthalmic surgeon to rebuild the eyelid so there is an area where the transplant can take place.
It is also important to make sure that the patient can close their eyes completely. Some trauma victims cannot close the full lid and this makes a transplant impossible because the new transplanted lashes could damage the eye.
Many eyelash transplant patients have suffered from trichotillomania and it is imperative you are satisfied that they have been cured of the condition for at least two years before performing a procedure. In my opinion, the risk of them relapsing and ripping out the transplanted hair is too great prior to two years as trichotillomania can be a challenging condition to treat.4
I often perform eyelash transplants on women who have damaged their eyelids by gluing on false eyelashes. With these patients you need to be sure that there is a healthy upper eyelid where new eyelashes can be transplanted. If the procedure is being performed for aesthetic reasons, you need to be sure that the patient genuinely needs the operation; I tend not to treat patients who simply want longer eyelashes. In these cases, I prefer to recommend an eyelash conditioner such as RevitaLash or Latisse, which can help lashes to grow longer.
Wearing false lashes can sometimes rip out natural follicles, leaving patients with virtually bald eyelids
I need to make sure there is a decent gap of approximately 1-2mm in the eyelid for me to insert the new follicles. Without sufficient gaps to fill, I run the risk of damaging the existing healthy follicles in the lid.
The process starts by removing a section of hair from the patient, typically from the back of the head where hairs tend to be longer, making it easier to thread them through the upper eyelid. An area (1 x 1cm) of scalp is numbed with a local anaesthetic and a small strip of hair is removed and the scalp sewn back with stitches. Harvesting is fairly quick, usually taking no more than 10 minutes to surgically remove the strip. As there would be from any mild surgical treatment, patients will experience some mild discomfort from the harvesting area, however they don’t tend to experience any pain at all in their upper eyelid following the threading of the new lashes – either during or after the procedure. There will be a small amount of scarring, though it only tends to be visible on patients with very short hair.
Following the harvesting, the scalp strip is given to a technician who separates the hair tissue into single hair follicular grafts under a microscope. I will choose the hair grafts for the transplant individually – I am always looking to use longer hair, about 3-4 inches long, so these strands can be easily threaded into the donor area. Once I have the donor grafts, the upper eyelid is anaesthetised and I insert the grafts by threading with a curved needle. It is a long and painstaking job because each graft has to be individually threaded. Surgical loupes are used which are magnified to six times their normal size to assist with this process and ensure the hairs are placed in exactly the right position on the lid. A normal eyelid will have between 100 and 150 lashes per eye. In an eyelash transplant, I look to add between 25 and 60 new lashes to the upper lid. The operation normally takes around three to four hours and the success rate is very good – between 80 and 90%. To arrive at this success rate I assess patients from six months to a year after their operation. I then count the number of follicles that have been transplanted and check how many of these new hairs have survived.
One of my successful eyelash transplant patients was a 42-year old woman who had an eyelash transplant at my clinic two years ago.5
The patient had damaged her natural eyelashes from becoming addicted to wearing false lashes for 20 years. The patient was left with just three eyelashes on her upper right lid and 19 on her upper left lid. The damage was made worse when she got an eye infection which caused itching and she rubbed off many of her already weakened natural lashes. With almost completely bald upper lids, the patient was too embarrassed to leave her house or even let her family, boyfriend or friends see her without her false eyelashes. Patient A’s eyelash transplant was carried out over a single day at Crown Clinic. She had 70 eyelashes transplanted into her eyelids in a three-hour operation. A strip of hair was taken from the back of her scalp and the individual hair follicles removed. I then threaded each hair into the skin at the bottom of her upper eyelids. Patient A felt some mild discomfort in the harvesting area at the back of her head, however this passed after a couple of days. She had swelling in both upper eyelids for two or three days following the operation, which eventually resided. It took around six months for the new eyelashes to fully bed into her eyelids. I assessed the patient six months after the operation and found that 95% of the transplanted follicles were now growing healthily in her upper eyelids. Patient A reported that she first noticed positive results two months after the operation, however the new lashes did not look their best until six months after the operation.
I travelled to my home city of Karachi in January 2013 to perform hair, eyebrow and eyelash transplants on seven women who had been horrifically scarred in acid attacks.6
I helped a 24-year-old woman (Patient B) by giving her two new eyebrows and eyelashes on her right eye with hair transplanted from the back of her head in a series of intricate operations performed over three days. As Patient B was the victim of an acid attack, it made the procedure slightly more complicated because you have to assess the eyelid very carefully to ensure that it is will be receptive to the transplanted hair. In this case, the patient’s eyelids were receptive, despite extensive damage to the lids from the attack. The operation had a success rate of around 85% when Patient B was assessed a year after the procedure. Patient B had no complications, however there was mild pain in the harvesting area for two days following the operation. She felt no pain in her eyelids either during or after the operation, though there was some gentle swelling which went down after two days.
The patient will need between three to five days to recover, while there will be bruising and swelling around the eyelid. We advise that they do not wash their face for the first couple of days following the operation to allow the new follicles to settle in. It takes around six months for the new lashes to grow to their full length and be seen at their best.
As with any surgery, there can occasionally be complications such as an infection, which can usually be remedied with antibiotics. Also, there is a chance the new follicles will grow into the eyelid – these would need to be removed either by plucking them out or via surgery if they become embedded inside the eyelid. There can also be swelling at the base of the follicle, which again can be treated with antibiotics. As the donor hair is taken from the scalp, it grows just as hair on the head does. This means it will need trimming every week and curling, too, so that the new lashes blend with the existing natural lashes. At Crown Clinic we provide all patients with a cutting and curling kit so they can do this at home, though some prefer to get this done at a beauty salon.
We have found that with some patients, over several years, the donor hair has taken some of the properties of the natural eyelashes – growing more slowly than scalp hair and also curling naturally. In these cases, the transplanted hair may only need trimming once every three weeks.
Eyelash transplants are an increasingly common cosmetic procedure, which are performed for both medical and aesthetic reasons. In my experience the success rate of this treatment has been very high and complications are rare. Patients who have lost their eyelashes can suffer severe damage to their self-esteem. At Crown Clinic we have treated patients who are so embarrassed by their bald eyelids that they refuse to leave the house without wearing false eyelashes. Eyelash transplants can, however, provide profound benefits to patients, increasing their confidence and allowing them to lead normal lives in the years after a procedure. It must be noted that eyelash transplantation is an extremely complicated procedure and only a handful of surgeons in the world currently carry out this operation. Only a qualified surgeon should carry out an eyelash transplant and thorough training is essential.
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