Eyelash Transplantation Techniques and Experience

I. Course Introduction

This tutorial will elaborate on the physiological functions and anatomical characteristics of eyelashes, indications and contraindications for eyelash transplantation, detailed technical points of the surgery, and postoperative care. It aims to help practitioners improve their technical skills and clinical outcomes in eyelash transplantation.

II. Physiological Functions and Anatomical Characteristics of Eyelashes

1. Physiological Functions:

• Eyelashes are short hairs arranged in a semi-arc shape on the edges of the upper and lower eyelids.
• As the second line of defense for the eyes, they shield against strong light and prevent dust, foreign objects, and sweat from entering the eyes.
• They work synergistically with the eyelids to protect the cornea and eyeball.

2. Anatomical Characteristics:

• Location and Arrangement: They grow on the anterior lip of the eyelid margin, typically arranged in 2-3 rows, and are soft and curved.
• Quantity and Length: Upper eyelashes are usually more numerous and longer than lower eyelashes. Each eyelash contains a single follicular unit. The normal number of eyelashes is approximately 100-150, with an average length of 8-12 millimeters. This serves as a reference for transplantation quantity and length; however, since transplanted eyelashes are sourced from scalp hair and are relatively thicker, the planting density is usually about half of the physiological quantity.
• Growth Angle:
  • When eyes are open and looking straight: The inclination of upper eyelashes is approximately 110-130 degrees.
  • When eyes are closed: The inclination of upper eyelashes is approximately 140-160 degrees. This angle makes the eyelashes appear denser and more curled when the eyes are closed.

III. Indications for Eyelash Transplantation

• Congenital absence or sparseness of eyelashes.
• Acquired eyelash defects due to:
  • Telogen effluvium.
  • Immune diseases (e.g., alopecia areata).
  • Infections, trauma.
  • Eyelash loss due to postoperative scarring.
• Desire for a denser appearance of normal eyelashes: For cosmetic purposes, this is a common reason for transplantation.

IV. Contraindications for Eyelash Transplantation

• Individuals with excessive laxity of the upper eyelid skin.
• Patients with congenital blepharophimosis syndrome.
• Individuals with specific unsuitable eye conditions:
  • Single eyelids with significant puffiness.
  • Upper eyelid ptosis (if transplantation is strongly desired, correction via brow lift or blepharoplasty is recommended first).

V. Detailed Technical Points of Eyelash Transplantation

1. Preoperative Design and Quantity Assessment:

• Personalized Design: Design based on the patient’s eye shape (e.g., eye size, length) and personal requirements. The number of grafts can be appropriately increased for patients with wider palpebral fissures and good eyelid tissue elasticity.
• Planting Quantity: Generally 60-80 follicular units per side. For patients with better conditions (e.g., wider palpebral fissures, thick and elastic eyelid tissue), 80-90 units can be planted.
• Planting Distribution: Primarily concentrated in the middle and outer two-thirds, where relatively thicker follicles are planted. The inner one-third uses lighter-colored, finer, and softer follicles to achieve a more natural effect.

2. Donor Area Selection:

• Ideal Donor Areas: Retroauricular area, temporoparietal region (sideburns), or the edge of the occipital hairline.
• Hair Screening Criteria: Select the finest and softest hairs possible. Fine, soft hairs have a relatively slower growth rate and provide a better visual effect, avoiding an artificial, stiff appearance caused by overly coarse hairs.

3. Anesthesia:

• Anesthesia Method: Local infiltration anesthesia.
• Anesthetic Drugs: Standard local anesthetics (e.g., lidocaine).
• Needle Insertion Site: Approximately 5 mm above the upper eyelid margin.
• Needle Insertion Tool: Use ultra-fine injection needles, such as 32G.
• Injection Technique: Typically, insert the needle in the middle of the upper eyelid and slowly inject the anesthetic towards the inner and outer canthi. The anesthetic dosage per side is about 1 ml.
• Precautions: Inject slowly and gently, avoiding rapid or forceful movements to prevent damage to the rich capillary network of the upper eyelid, which can cause bleeding or hematoma.

4. Graft Harvesting (FUE Technique):

• Technique Application: FUE (Follicular Unit Extraction) is currently widely used.
• Retained Hair Shaft Length: Retain a hair shaft length of about 1 cm during extraction. A longer hair shaft helps in determining the hair’s curl direction and controlling the planting angle during implantation.

5. Graft Preparation and Screening:

• Separation Standard: Separate into single follicular units.
• Tissue Cleaning: During separation, thoroughly remove excess epidermis and subcutaneous tissue (white tissue) around the follicle. The cleaner, the better. This effectively prevents the postoperative appearance of “white dots” (follicular ostia keratinization or sebaceous plugs). (Although related to individual constitution, meticulous cleaning can significantly reduce the incidence of white dots.)
• Sorting by Thickness and Color: Classify the separated follicles by thickness and color depth, and arrange them separately for easy access according to the design requirements during planting. Thicker, darker follicles are used for the middle and outer two-thirds; finer, lighter-colored ones are used for the inner one-third.

6. Planting Technique Details:

• Planting Tool: Commonly use international standard 23G needles, with the tip bent at approximately 90 degrees.
• Planting Site: Plant around the existing eyelashes (above, below, left, right), starting about 5 mm from the inner canthus.
• Planting Density and Layers: Usually 2-3 rows are planted, depending on the patient’s natural conditions. The lecturer currently prefers planting 2 rows, achieving density through staggered arrangement, to avoid a cluttered look if 3 rows are added to existing eyelashes.
• Needle Holding and Insertion: Insert the needle with the bevel facing upwards, at an angle of about 60 degrees to the existing eyelashes. Insertion depth is about 3-4 mm, reaching the musculofascial layer. The upper eyelid tissue is about 5 mm thick, and the hair bulb is about 2 mm long; this depth is sufficient to stably fix the follicle.
• Angle Control (Key):
  • Outer Canthal Area: When planting, the angle should be artificially adjusted inward (upward) by about 20 degrees from a direction parallel to the existing eyelashes. This is to counteract gravity, preventing the transplanted eyelashes from drooping when the patient stands, and ensuring they align with the original eyelashes.
  • Inner Canthal Area: The planting angle can be parallel to the existing eyelashes; no additional downward adjustment is needed. Hairs transplanted in the inner canthal area are finer and softer, and the density is not high, so the effect of gravity is minimal.
• Needle Insertion Requirements: Apply even force, move gently and slowly, and avoid perforating the eyelid. If the needle becomes blunt and resistance increases, replace it promptly (can be replaced 2-4 times). Do not repeatedly puncture with a dull needle to save needles, as this increases trauma, creates irregular channels, and leads to poor force control.
• Immediate Extraction and Implantation: Coordinate site making and implantation closely. Implant the follicle immediately after needle withdrawal. Avoid long delays after withdrawal, which can lead to difficulty in follicle implantation, bulb coiling, or incorrect direction. If there is minor bleeding, gently dab with sterile gauze.

7. Postoperative Care and Precautions:

• Immediate Care:
  • Gently rinse with saline solution and straighten the direction of the transplanted eyelashes.
  • Apply a thin layer of erythromycin or chlortetracycline eye ointment to the base of the eyelashes. Its viscosity helps to fix them in place and prevent disorientation of the newly implanted eyelashes due to blinking or other movements.
• Regular Trimming of New Eyelashes:
  • Natural Trimming Technique: To prevent transplanted eyelashes from growing out as stiff, cylindrical shafts, a special trimming method can be used. Use a serrated blade (like an eyebrow razor), tilting the blade at about a 45-degree angle to trim the eyelashes. The serrated blade creates eyelashes of varying lengths with a beveled cut surface, more closely resembling natural eyelashes.
  • Trimming Frequency: Depends on the patient’s individual needs and hair growth rate.
• Important Precautions:
  • Ocular Protector: An ocular protector must be used throughout the surgery to prevent accidental injury to the eyeball during the procedure. Before placement, 2-3 drops of topical anesthetic can be instilled into the eye to reduce discomfort, and the patient should be instructed to relax and cooperate. Anesthetic drops can be applied intermittently during the surgery to keep the eyeball moist and provide continuous pain relief.
  • Transplanted Hair Length: The extracted hairs should not be too short; it is recommended to retain a length of about 1 cm (8-10 mm). Hairs that are too short are difficult to control in terms of planting direction and angle, affecting the naturalness of the postoperative result.