Expertise in eyebrow restoration
There are few doctors that have the experience of Dr. Epstein in eyebrow transplantation. For over 15 years, Dr. Epstein has specialized in this refined aesthetic procedure, having performed over 750 of them. His work has been featured in numerous media stories and published scientific articles and textbook chapters, as well as his given multiple lectures on his techniques at national and international meetings.
Eyebrow restoration, also known as eyebrow transplantation, permanently restores hair to eyebrows that are overly thin, unaesthetic in shape, have scarring, or are completely missing. The absence of hair can be due to genetics, over plucking, prior laser hair removal, thinning due to aging or thyroid or other hormonal abnormalities, or scarring from a burn or prior surgery. Some patients seek to have restored full thick eyebrows, others a subtle thickening, while others to have a scar made less visible. Another group of patients seen by Dr. Epstein are those seeking reparative procedures, due to poor prior work done elsewhere.
Donor Hairs for Eyebrow Transplantation
The best donor hairs for eyebrow restoration come from the scalp, due to their reliability of regrowth, texture and curl, and a variety of other factors. The hairs need to be trimmed typically every 10 days, a requirement that our patients feel is a minor tradeoff for having fuller aesthetic eyebrows. Patients will occasionally request the donor hairs be from the leg or pubic or other regions, however the unreliability of regrowth and the challenges of achieving density with these hairs is the reason their use is discouraged.
These scalp donor hairs can be achieved using either the FUE (follicular unit extraction or excision) or the FUT (follicular unit transplantation also called “strip”) technique. In most cases, FUE is the indicated technique, however in women who will never plan on cutting their hair short, the taking of a small strip to get some of the grafts combined with if needed some grafts by FUE is the chosen technique- called the “hybrid” approach. The technique used will be discussed with each patient.
In order to achieve the optimal combination of density and naturalness, the majority of grafts contain 2 hairs, with some 1 hair grafts and if appropriate some 3 hair grafts, all according to Dr. Epstein’s determination.
Provide a natural appearance, the hairs are transplanted primarily one and occasionally two at a time, the natural way eyebrow hairs grow.
This is a very delicate procedure, requiring perfect placement of these hairs into tiny (half-millimeter) incisions that are angled at just the right direction and positioned to mimic natural growth.
The use of all-microscopically dissected grafts allows their placement into the smallest possible incisions so as to minimize scarring and damage to already existing hairs.
Achieving naturalness in eyebrow transplantation as per Dr. Epstein
Dr. Epstein meets with a patient he performed an eyebrow transplant on over a year from when the procedure was given.
Patient Gallery
Procedure of 600 grafts Before and after
400 grafts Procedure Before and After
Before and after eyebrow transplant 650 grafts
Severe scarring as a result of attempted laser removal of a prior eyebrow tattoo (before) required the complete excision of this patient’s eyebrow (intermediate after), which was then restored with an eyebrow transplant (after)
Before and after 650 grafts
* All patients are unique and individual results may vary.
The procedure
An eyebrow transplant performed by Dr. Epstein typically involves the placement of 150 to as many as 400 grafts into each eyebrow. This is a true aesthetic procedure, with every step that will determine the final outcome all personally performed by Dr. Epstein. This include:
- Designing the eyebrow, with patient input, to be assured that there is not only symmetry but that the shape complements the individual face and eye region structure and meets the patient’s goals
- Graft dissection along with FUE or FUT graft harvesting. It is essential that the proper combination of one, two, and even occasionally three hair grafts when indicated are used to achieve the ideal balance of density and naturalness. Note that after years of experience, Dr. Epstein has determined that most eyebrows are better restored using primarily two hair grafts rather than exclusively single hair grafts
- Making each recipient site so that the desired angle and pattern of hair growth is achieved, and that the recipient sites follow the design chosen
- Graft placement so that each graft is placed so that the hair curl complements the desired direction of growth and that the grafts placed actuate the desired final result according to the recipient sites
The procedure is typically performed under oral sedation and local anesthesia, however the occasional patient chooses twilight sedation. Taking two to usually four to five hours, the entire procedure, as is the recovery, essentially painless.
Who is a good candidate
The most common reason patients undergo an eyebrow transplant is to restore a more natural shape or improved density due to prior overplucking. Thinning due to getting older or a consequence of anemia or low thyroid levels are also a common reason, as is simply being born with thin eyebrows. Other indications include scarring from prior cancer surgery or trauma, or undesirable results caused by a prior less-than-ideal performed transplant. In fact, Dr. Epstein has particular expertise in these trauma and reparative cases, due to the enormous benefits it can provide to the patient. Some of these trauma case patients are kids in their pre-teens who have borne the scars of prior dog bites and other causes.
The patient needs to understand that the realistic goal of surgery is not necessarily perfection (although that is always strived for) but a significant improvement. The occasional patient will want a second procedure a year or more later to achieve greater density and or to make a minor change to the shape, however the great majority- over 90% – of his patients undergo just a single procedure. The procedure can be performed on patients ranging in age from (mature) nine year olds to those in their 70s. This is a safe and minimally invasive procedure. Prior tattoo or microblading is not a contraindication to the procedure being successful, although in some patients with scarring from prior tattoos there is a risk of a lower percentage of hair regrowth- in these cases, Dr. Epstein will make some slight alterations in his technique, as well as inject PRP (platelet rich plasma) into the eyebrows to optimize regrowth. Finally, the patient must be understanding of the need for regular trimming of the transplanted hairs, as these are scalp donor hairs and will usually continue to grow.
Patient Gallery
Shows the first week healing course
Shown is the patient prior to transplant with the eyebrows marked out, and her result 10 months after 650 grafts
This young boy had a prior poorly performed eyebrow transplant to reconstruct an eyebrow lost from a dog bite, with resultant scarring (before). He first underwent the removal of each prior placed graft, then several months later an eyebrow transplant which gave him a significantly more aesthetic outcome.
Attempted removal of prior eyebrow tattoo with chemical peel left raised scarring (before). In a two stage repair, first the scarred portions of the eyebrows were excised and allowed to heal (intermediate), then six months later the eyebrows were restored with a transplant procedure (after).
Before and after 700 grafts to eyebrows
* All patients are unique and individual results may vary.
Options for evaluation
CONSULT IN PERSON – You can meet with Dr. Epstein in the Miami office if you live in or will be visiting south Florida. Here you can not only have a chance to discuss your goals and undergo a full evaluation, but also see the modern facility that is designed with patient comfort and safety in mind. Our office is located in South Miami close to Coconut Grove, Coral Gables, downtown Miami and Miami Beach, and is just 20 minutes from Miami International Airport. The office is on the campus of South Miami Hospital (affiliated with Baptist Health), and provides covered underground parking and sufficient privacy. Please be sure to bring your parking ticket for validation. You can schedule a consultation or learn more by clicking HERE.
CONSULT BY WEBCAM – Dr. Epstein is no stranger to webcams, having provided hundreds of patients consultations over the past five years. Today, this has become the most popular method for patients to “meet” Dr. Epstein, especially considering that most patients are traveling from out of town. Your consult can be performed just like a regular in-office consultation, with the doctor discussing with you your goals and explaining his recommendations in a formal manner from the comfort of your home, your office, or even your car. The most common formats for the webcam are FaceTime or Zoom, but other modalities are available. You can schedule a consultation or learn more by clicking HERE.
EVALUATION BY PHOTO REVIEW – This is an easy way to have your case evaluated, without any charge. By sending your photos, along with information on your age, hair loss history, any prior therapies or procedures, family history of hair loss, and your goals, Dr. Epstein can provide his recommendations and advice. If desired, once you receive his recommendations, you can have a webcam or in-office consultation to learn more, however by photo review you will have the opportunity to ask questions and speak with his assistant Roxy or Dannette who will be able to guide you through this process.
The Procedure and recovery
As most of our patients come from out of town, the consultation is usually conducted by either photo reviews or webcam consultation with the doctor, who will evaluate the patient for candidacy, learn the patient’s goals, then make his recommendations. The patient will then meet with the doctor the day before or morning of the procedure, at which time a final plan will be settled upon.
Most patients have the procedure performed under oral sedation, but twilight sedation is offered and must be selected ahead of time. Local anesthesia insures a virtually painless procedure. Eyebrow design is performed with as much input from the patient as desired, with Dr. Epstein extensively experienced with this artistic process. The procedure then takes typically four to five hours, and involves the harvesting of the donor hairs by FUE or FUT, followed by recipient site formation after which the grafts (which have been dissected down under the microscope according to Dr. Epstein’s instructions) are placed into the recipient sites one at a time. Performing as many eyebrows- typically three weekly- as we do, there is a specialized “team” of eyebrow assistants who work with Dr. Epstein exclusively in these procedures.
Once the grafts have been placed, Dr. Epstein will sit the patient up to evaluate the results, then make any refinements as indicated. At this point the patient’s input is obtained, and further adjustments are made according to this feedback. The procedure is not completed until both doctor and patient are fully satisfied. Note that there will be some mild to moderate swelling at this time, but this swelling and some bruising will typically resolve over two to five days, Most patients fly back home one or two days after the procedure. The eyebrows are to be kept dry for the first five days after which normal exercise and most activities can be resumed. Tiny crusts around each transplanted hair will fall out by four to five days, meanwhile the donor area should not be visible whether FUE or strip technique was used for harvesting the grafts, unless the patient has very short hair in which case by three days the area should be healed. Most patients are presentable at three days with the wearing of large sunglasses, or with the excuse that a “tattoo to the eyebrows” was performed. Mild pinkness if present will usually fade by 10 to 14 days, occasionally longer, but once the hairs are growing in at three to four months this will be resolved.
Proceed with confidence, learn about your options
It is important that our patients consult with Dr. Jeffrey Epstein before deciding the best treatment option, so that they approach the procedure with confidence of achieving the desired result. Please submit this form to be contacted and learn more.
Testimonials
Related Procedures: Facial Hair, Body Hair Transplant
He is also frequently the featured speaker at the International Society of Hair Restoration Surgery meetings on his techniques and he is sought after by doctors from throughout the world who want to learn more about his area of expertise.
Read his latest article in Plastic Surgery Practice Magazine.
Frequently Asked Questions
Eyebrow restoration is arguably the most meticulous type of hair transplant because of (1) the delicate nature of the area to which we are transplanting follicles and (2) the unique way in which hairs grow in the eyebrows. It is very easy for an eyebrow transplant to look unnatural and it is up to the individual surgeon and the creation of the recipient sites to make sure that the end result looks totally natural, particularly in the angle at which the hairs grow and the shape of the eyebrow. It is also important to know that the surgeon is using the smallest possible tools, 0.5 mm small, to create these recipient sites and that only single hair follicles are being placed into the eyebrows to make sure that the most refined and natural looking results are achieved.
If done properly, absolutely. It is important that the surgeon pays particular attention to the angle at which they are creating the recipient sites for each individual follicle to be placed because this will dictate not only the shape of the eventual eyebrows but also the density of the transplanted hairs and most importantly the direction in which the hairs eventually grow. Particularly with the “head” of the eyebrow toward the bridge of the nose, it is important that the hairs typically grow more vertically and of course very close to the skin instead of perpendicular to the skin. As we get closer and closer to the “tail” of the eyebrow, then it is important for them to grow more toward the ears.
Probably no hair transplant technique is more technically demanding than eyebrow transplantation, which requires 325 single hair grafts in a single eyebrow. Direction in terms of the vertical as well as horizontal positioning, as well as how the hairs lie flat against the forehead skin, are all key elements to achieving a natural result. I personally perform two to three of these eyebrow procedures every week and have done so over the past several years, providing myself and my specially designated eyebrow team a tremendous amount of experience with these procedures. I always advise prospective patients to do their homework and to really look at a doctor’s before and after results before making a decision.
Related Articles
- Foundation for Hair Restoration on NBC 6 for June 10, 2004
- Surgery changing faces, starting with the eyebrows
- Eyebrow Transplants Changing The Way You Look
- Dr. Epstein appears on Japanese TV to discuss eyebrow transplants
- Eyebrow Transplantation article
Why choose Dr. Epstein
- Dr. Epstein first attended Swarthmore College, then moved on to medical training at the University of Vermont College of Medicine.
- Trained in head and neck surgery/ear, nose, and throat at the University of Miami/Jackson Memorial Hospital, earning a fellowship from the American Academy of Facial Plastic and Reconstructive Surgery during this time.
- Then trained in the San Francisco Bay area and was awarded the Jack Anderson Memorial Award for achieving the highest score in the nation on his board exams.
- Has been recognized for many years as one of the Best Surgeons in America, and he has been continuously listed for years in Castle Connelly’s Top Doctor Guide, an unbiased rating of doctors in many different specialties.
- Founder and Director of the Foundation for Hair Restoration and Plastic Surgery.
- Unusual for his field, Dr. Epstein holds triple board certifications in the fields of hair restoration surgery, facial plastic surgery, and otolaryngology (head and neck surgery), and is a Fellow of the International Society of Hair Restoration Surgery.
- He is an Assistant Clinical Professor at the University of Miami, a Fellow of the American College of Surgeons, and was previously the President of the Florida Society of Facial Plastic and Reconstructive Surgery.
- To give back to the community, Dr. Epstein provides pro bono reconstructive surgery to children, veterans, and other people in need.
