Refinements in hair transplantation techniques have made natural-appearing facial hair transplants possible. Restoring eyebrows, beards/goatees, and sideburns have all become popular procedures, because of the amount of information readily available and the fact that the results can be outstanding. A variety of factors can cause lack of hair on the face, including genetics, prior laser or plucking, trauma, and the sequelae of prior cosmetic surgery. The scarring and hairline distortion caused by cosmetic surgery can be nicely repaired with hair transplant techniques.

Patients have a variety of personal desires regarding how they want their facial hair to appear. For many men, a strong goatee/mustache is the priority, often complemented by full sideburns. For those willing to have a larger number of grafts, restoration of a full beard is a common request, whereas other men want just a “strap” beard, a narrow band of beard that runs along the jawline. Proper understanding of the patient’s goals is critical for having a successful outcome with these facial hair procedures. Because of how these patients have suffered or have been concerned about their undesirable beard appearance, most tend to have a very good idea of what they hope to achieve. In younger patients particularly, the presence of already existing or risk of future male pattern hair loss must be accounted for and explained to the patient.

As with all of these facial hair transplant procedures, the goal in eyebrow restoration is to come as close as possible to restoring the density, direction, and angle of growth, and the distribution of hairs to how they grow naturally. Because of their highest reliability in regrowth, hairs from the scalp typically serve as the transplants, and, because they continue to grow, need to be trimmed on a regular basis. For most patients, the linear scar from a donor-site strip is acceptable, easily concealed by hair longer than typically a half inch. However, for patients who prefer to have a shaved head, the follicular unit extraction procedure avoids this linear scar.

A variety of medical conditions can be associated with eyebrow loss. Although medical conditions constitute a small percentage of cases that present, hypothyroidism must be ruled out as a medical cause, and if trichotillomania is involved, it must be resolved, otherwise the transplanted hairs may also be plucked out. More common causes include genetic predisposition, overzealous plucking, prior laser and occasionally a tattoo.

Patients must have realistic expectations, and understand the possible limit in density that can be achieved and the typical 10% to 15% incidence of transplanted hairs not growing in the ideal direction in which they were planted. The hairs will need to be groomed and trimmed regularly to maintain a nice look.

These facial procedures are all effective when performed properly on patients who have informed and realistic expectations. Achieving consistent results requires adherence to careful technique and the assistance of experienced hair technicians.