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People’s experiences of eyebrow transplantation: A qualitative study
*Corresponding author: Kourosh Zarea, Department of Nursing, Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. kourosh1685@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Elahi M, Zarea K, Molavynejad S, Shami M. People’s experiences of eyebrow transplantation: A qualitative study. J Cutan Aesthet Surg. doi: 10.25259/JCAS_319_2025
Abstract
Objectives:
Eyebrows are a significant aspect of facial esthetics, and eyebrow loss can substantially affect an individual’s quality of life, often leading to a perceived reduction in physical attractiveness. This study aimed to explore individuals’ experiences before and after undergoing eyebrow transplantation.
Material and Methods:
This qualitative study used content analysis to explore the experiences and insights of professionals involved in natural eyebrow transplantation surgery. The study was conducted over 4 months, from April to July 2024. A total of thirty participants, each possessing extensive expertise in the field, were recruited for the study after providing informed consent. Data collection was performed through semi-structured interviews, allowing for in-depth exploration of participants’ perspectives while maintaining a flexible interview format. The collected data were systematically analyzed using established qualitative content analysis techniques, which facilitated the identification of prominent themes, patterns, and insights related to surgical practices, patient outcomes, and professional experiences.
Results:
The analysis revealed two main categories: Issues related to eyebrow baldness and outcomes of eyebrow transplantation. The issues associated with eyebrow baldness include factors such as genetic predisposition, aging, and certain medical conditions that contribute to hair loss in the eyebrow region. The outcomes of eyebrow transplantation encompass both benefits, such as improved esthetic appearance and increased confidence, and potential complications, including scarring, uneven hair growth, and transplant failure. Recognizing these categories is crucial for clinicians and patients to make informed decisions regarding treatment options and to establish realistic expectations.
Conclusion:
Eyebrow transplantation has gained popularity as a cosmetic procedure. Participants’ experiences indicate that the procedure can significantly enhance appearance and boost self-confidence. However, potential complications such as rashes, itching, social stigma, and additional costs have been reported, emphasizing the importance of high-quality service and thorough pre-operative consultation to ensure satisfactory outcomes.
Keywords
baldness
Eyebrows
Eyebrow loss
Qualitative research
Transplantation
INTRODUCTION
Eyebrows serve multiple functions that are crucial in human interactions, facilitating understanding and empathy. Furthermore, eyebrows contribute to facial esthetics, influencing perceptions of attractiveness and individual identity. They may also play a role in sexual dimorphism, aiding in the differentiation of gender characteristics. Overall, eyebrows are an integral component of facial anatomy, with both functional and esthetic significance that impact social communication and personal appearance.1
Eyebrow movement plays a prominent role in a person’s ability to communicate effectively and is controlled by the muscles around the eyes. All of the muscles around the eyes are connected to the hairy skin of the eyebrow or to the skin of the eye socket.2-4 The average eyebrow length in men is 5.5 cm and in women is 5.0 cm. The maximum eyebrow width in men is 1.5 cm and in women, it is 1.3 cm.5-7 Ekman and Friesen8 systematically examined the function of eyebrows in facial expressions that indicate emotions (happiness, sadness, anger, fear, disgust, and surprise), and their results showed that eyebrows play a key role in the expression of several emotions, including happiness, surprise, and anger. For example, in the expression of anger, eyebrows (in combination with narrowed eyes and a tightly closed mouth) are usually drawn downward and inward. Strategically positioned, eyebrows protect the eyes from harmful exposures such as dust and sweat. Their unique color, shape, density, and distribution help define facial features. In line with this, a study has shown that eyebrows may be as important as the eyes in facial recognition.9 Despite the importance of eyebrows, some people experience eyebrow loss at some point in their lives. Hair loss has many causes, including primary skin damage, hypothyroidism, burns, autoimmune diseases, infections, cancers, trauma, and congenital factors.9-11
Therefore, eyebrow hair loss can be an indicator of many congenital and acquired diseases, as well as a physiological phenomenon due to aging. Sometimes, what causes the most concern and fear for patients who suffer from eyebrow hair loss is the judgment of others about their appearance, which can lead to absenteeism and non-participation in social activities such as sports.12 Beyond the obvious cosmetic consequences, eyebrow loss may have significant functional and social consequences. Eyebrow loss can have a detrimental effect on psychosocial functioning. While scalp baldness is a highly publicized issue, eyebrow baldness has not received sufficient attention, so treatment options for it are also more limited. In addition to acknowledging the patient’s cosmetic concerns, it is the physician’s responsibility to recognize potential underlying conditions in patients with eyebrow loss.9
Several cosmetic surgery procedures, including botulinum toxin injections, permanent tattooing, and eyebrow lift surgery, specifically target the appearance of the eyebrows and can lead to damage.1 It is also important to consider that surgery around the eye area for esthetic purposes can alter facial expression and affect the patient’s emotional behavior and perception.13 Unfortunately, there are no guidelines for treating eyebrow loss, and due to the limited number of medications available, treatment is not always possible. Available and recommended treatments include steroid therapy, progesterone analogs, immunotherapy, and eyebrow transplantation.12
Eyebrow restoration with hair transplantation has become a valuable procedure that requires a high level of skill and experience.14 Hair transplantation for the treatment of eyebrow loss was pioneered by Dr. Okuda in 1939 and has been performed for many years since. With the increasing skill of eyebrow transplant specialists, it is now possible to perform high-quality surgical techniques that produce satisfactory and realistic results for the patient.5 In general, in eyebrow transplant surgery, the density of the transplant is completed in one or more sessions as needed, and after transplantation, there will probably be some misalignment in 10–15% of the follicles, and regular trimming (in most cases, every 2 weeks) is required.5,15,16
There are different methods for eyebrow hair transplantation.17 One of the eyebrow transplant methods is the follicular unit extraction technique. In this method, the desired growth, density, and orientation of the eyebrow hairs are not achieved. While follicular unit transplantation (FUT) has been used for a long time as one of the newest and best eyebrow transplant methods, using single hair grafts for eyebrow transplantation.18-20 One of the benefits of FUT eyebrow transplantation has been reported to be improved quality of life, leading to discontinuation of prescribed medication for depression and social dysfunction.21
Studies conducted in the field of hair transplantation have focused on different surgical methods, complications, and results after transplantation. Explaining the experiences of people before and after eyebrow transplantation can help identify the different causes of eyebrow loss, the advantages and disadvantages of eyebrow transplantation, the impact of eyebrow baldness on the physical, psychological, and social aspects of individuals, and their quality of life. The present study aimed to explain the experiences of people before and after eyebrow transplantation.
MATERIAL AND METHODS
Study design
Qualitative approaches have an explorative nature and enable researchers to explore the complexity of phenomena that happen to the healthcare providers, policy-makers, and clients.22 This was a qualitative design using a content analysis approach, and the research was conducted between April and July 2024.
Participants
Thirty individuals with extensive experience in natural eyebrow transplantation surgery, who consented to participate in the study, were interviewed.
Data collection
In this study, the researchers employed a purposive sampling method to gather comprehensive information. Considering the study’s objectives, individuals who had undergone natural eyebrow transplantation surgery and possessed extensive experience in this field and who were willing to participate were interviewed. The research was conducted in Ahvaz, a city in southwestern Iran, at the Athar Hair and Skin Center. Interviews took place in a quiet environment, with each session lasting approximately 60 mins.
A semi-structured interview approach was utilized to collect data. This method involved asking initial questions in a broad manner, followed by more specific inquiries as the interview progressed, based on participants’ responses. The process began with introducing the study, explaining its purpose, and obtaining participants’ consent to conduct the interview and record audio. The interviews started with open-ended questions, including demographic inquiries such as: “Please tell me about the time you had your eyebrow transplant.” As the interview advanced, additional targeted questions were posed, guided by preliminary findings and aligned with the research objectives. Some of the questions included: “What factors contributed to eyebrow loss? Please describe your experience,” “What were the outcomes of eyebrow transplantation?” “How has eyebrow transplantation affected your personal and social life?” and “Please share your experiences regarding this.” The interviewer adapted subsequent questions based on participants’ responses, ensuring they aligned with the main research questions. During responses, probing questions like “Please explain further” were used to gather more detailed information. Data collection continued until saturation was reached, meaning no new themes or clusters emerged from the data. Each participant was interviewed only once.
Data analysis
Data collection and analysis were conducted simultaneously. The study data were analyzed using Morse and Field’s qualitative content analysis method.23 At the start of the analysis, the transcribed text was reviewed multiple times to fully engage with and understand the interview data’s overall context. Following this, the content of each interview was divided into fundamental meaning units, with irrelevant data removed, and the text was coded line by line. Subsequently, the codes were grouped into sub-categories and broader categories based on their similarities and differences, which were then organized into overarching themes.24 The researchers first typed the recorded interviews into Word and then imported them into MaxQDA 2020 for analysis.
Trustworthiness
Trustworthiness is a critical aspect of qualitative research. A study is considered trustworthy if readers can review and verify the data collection and analysis processes.25 To ensure the credibility of the analysis in this study, the peer-checking method was employed. Researchers independently analyzed the interviews and then compared the resulting concepts, categories, and themes. Any disagreements were resolved through discussions until a consensus was reached. In addition, the member-checking method was used to enhance data credibility. After analyzing each interview, participants were provided with a summary of the findings and asked to confirm whether the concepts accurately reflected their experiences or perspectives. Their feedback and additional insights were incorporated into the final analysis. To further ensure trustworthiness, an audit-trailing approach was adopted, with all study records meticulously maintained for potential review and verification.26
Ethical considerations
The study was approved by the ethical code (IR.AJUMS. REC.1403.096) at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The researchers made an effort to maintain the confidentiality of the information gathered from the participants. The participants had the right to withdraw from the study at any point during the research, and the final results were shared with them.
RESULTS
After interviewing 30 eyebrow transplant recipients, the researchers reached data saturation. The mean age of the study participants was 34.06 ± 9.17. The characteristics of the study participants are summarized in Table 1.
| Variables | Number | Percent |
|---|---|---|
| Age (years) | ||
| 20–35 | 17 | 56.67 |
| 36–50 | 13 | 43.33 |
| Marital status | ||
| Singel | 10 | 33.33 |
| Married | 20 | 66.67 |
| Education level | ||
| Diploma | 13 | 43.33 |
| Bachelor and above | 17 | 56.67 |
| Job | ||
| Housewife | 14 | 46.67 |
| Employee | 16 | 53.33 |
After data analysis, two main categories (Physical and Psychosocial self) were extracted from the data. Using direct quotes from the participants, the meaning of each theme and subtheme is reported. The results related to the categories are summarized in Table 2.
| Themes | Categories | Sub-categories |
|---|---|---|
| Physical self | Reasons for hair loss and baldness | Repeated eyebrow tattoo and waxing |
| Burn | ||
| Congenital sparse eyebrows | ||
| Pregnancy | ||
| Physical manipulation of eyebrows | ||
| Post- transplant issues | Rash and itching | |
| Eyebrow loss | ||
| Eyebrow growth | ||
| Psychosocial self | Psychological issues | Increased self-confidence |
| Improving body image | ||
| Social stigma | ||
| Social issues | Disruption in work relationships | |
| Social communication disorder | ||
| Additional costs | ||
| Improved work and social relationships |
Physical self
This topic includes two categories: Causes of eyebrow loss and baldness, and post-transplant issues, and the subcategories of each of these categories are given below, along with quotes from participants. The participants in the study had thinned, deformed, and bald eyebrows for various reasons, and faced a series of issues due to eyebrow baldness.
Reasons for hair loss and baldness
The study participants cited repeated tattooing and removal, burns, congenital sparseness of eyebrows, pregnancy, and physical manipulation of the eyebrows as causes of their eyebrow loss and baldness. The following quotes from the participants indicate the causes of eyebrow loss and baldness.
Repeated eyebrow tattoo and waxing
“After the 1st time I tattooed my eyebrows, the crown of my eyebrows fell out, and the 2nd time I tattooed my eyebrows, all of my eyebrows fell out and they never grew back” (A 36-year-old woman).
“Well, I had good eyebrows, but I used to tattoo my eyebrows a lot. Sometimes I would make them thicker, sometimes thinner, and I would wax them every time. Of course, I had oily skin, so my eyebrow tattoo would come off after a while. After I waxed my eyebrows, the waxing area was scarred, and my eyebrows never grew back after waxing” (A 42-year-old woman).
Burns
“Once a water heater exploded in my face and my face and eyebrows were burned with flames. It was truly a miracle that my skin healed, but my eyebrows never grew back” (A 29-year-old woman).
Congenital sparse eyebrows
“My eyebrows have been very thin and sparse since childhood. I was never satisfied with the density and shape of my eyebrows” (A 25-year-old woman).
Pregnancy
“During my second pregnancy, my eyebrows fell out and didn’t grow back even after 4 years” (A 40-year-old woman). “I got pregnant when I was seventeen, and my eyebrows fell out during pregnancy. In general, our family loses our eyebrows during pregnancy” (A 33-year-old woman).
Physical manipulation of eyebrows
“I dyed my eyebrows a lot, trimmed them a lot, and plucked them, and they became very sparse, to the point where there were only a few strands left, and I had to go get an eyebrow tattoo” (A 50-year-old woman).
“When I got married, it was fashionable to make eyebrows very thin, even to shave them. I thinned my eyebrows and trimmed them so much that they became sparse and lifeless” (A 46-year-old woman).
Post-transplant issues
After eyebrow transplantation, they faced physical issues, including acne and itching in the eyebrow area, eyebrow loss, and excessive eyebrow hair growth.
Pimples and itching
“One of the issues that bothered me a bit after the transplant was the pimples on my eyebrows and the itching that they caused, which were resolved with the medications you prescribed and the care I took myself” (A 40-year-old woman).
Eyebrow loss
“At 1 time, my eyebrows were in the loss phase, and I was very worried that they would not grow anymore, but fortunately, they started to grow after 2 months, and after 5 months they grew completely” (A 33-year-old woman).
“Even though you had explained to me about the dormant phase after transplantation and I was fully aware of it, I was still afraid that my eyebrows would fall out and not grow anymore, but after a few months they all grew and I am very happy” (A 50-year-old woman).
“Some parts of my eyebrows did not grow after the dormant period ended, which needs to be repaired” (A 23-year-old woman).
Eyebrow growth
“I have to trim my eyebrows every 2 or 3 days. They grow quickly. Sometimes I don’t have time to trim them, and they become long and irregular” (A 37-year-old woman).
“In general, the growth of transplanted eyebrows is faster than the growth of my own eyebrows, and I have to trim them at least twice a week. Of course, I learned how to trim them and I do it myself in front of the mirror” (A 42-year-old woman).
Psychosocial self
The experience of the participants in the study after eyebrow transplantation showed improvement in psychological and social issues. They also experienced psychosocial issues before eyebrow transplantation, the results of which are reported separately below.
Psychological issues
Participants stated that eyebrow transplantation led to increased self-confidence and improved body image.
Increased self-confidence
“When I first meet people, everyone pays attention to my eyes and eyebrows. Since I had my eyebrows transplanted, my self-confidence has increased a lot” (A 32-year-old woman).
“Since I had my eyebrows transplanted, I no longer wear makeup because these eyebrows have restored the beauty of my face. Before I had my eyebrows transplanted, I used to stand in front of the mirror for 2 h doing my makeup, which took up a lot of my time” (A 33-year-old woman).
“After my eyebrows were transplanted, my husband tells me a lot that I am beautiful and compliments me, and it has made my self-confidence go up, and I like my face” (A 42-year-old woman).
Improved body image
“I am 40 years old, but because I had no eyebrows, everyone who saw me thought I was sixty. Since I had my eyebrows transplanted, I feel younger. Even after my transplant, my eyelids are not drooping and I no longer need Botox” (A 40-year-old woman).
“After my transplant, every morning when I wake up, I look at myself first. I really like my eyebrows. I recommend all my friends to get transplanted” (A 29-year-old woman).
Improved work and social relationships
According to the participants in the study, after the connection between work and social relationships, they improved.
“When I want to go to work or out of the house, I no longer have to put on makeup and draw eyebrow pencils. I always say that I wish I had had eyebrow implants 10 years ago so I would’t have had so much trouble. I recommend all my friends and colleagues to get implants. Tattooing is very unnatural and artificial” (A 41-year-old woman).
“Now I have natural eyebrows, the same style I liked, and I no longer worry about unexpected guests coming to our house. Before, when I didn’t have eyebrows, guests would come suddenly and I wouldn’t have time to draw eyebrow pencils, and that’s why I was embarrassed” (A 50-year-old woman).
Social issues
The participants in the study stated that they faced a number of social issues due to eyebrow baldness, including social stigma, disruption of professional relationships, and social communication.
Social stigma
“When I woke up in the morning, I would quickly apply eyebrow pencil so that no one would notice that I had no eyebrows. My friends would say that my face looked like it had been painted because I was applying eyebrow pencil so much” (A 28-year-old woman).
“Everyone who saw me thought I had cancer because I had no eyebrows. I was upset about this and would rather stay at home than go out” (A 46-year-old woman).
Disruption in work relationships
“Once I was at work, I would sweat or something would get on my eyebrows and my eyebrow pencil would come off. Then think about it, I had half my eyebrows missing. I had to carry a pencil and a mirror at work and I was embarrassed in front of my colleagues” (A 30-year-old woman).
Social communication disorder
“When I went to a party, my eyebrow pencil would come off, and then suddenly I would see that I had eyebrows and that I didn’t, and that was really painful for me” (A 43-year-old woman).
“When I was traveling or at the pool, I always had a pencil in my hand and I was stressed that my eyebrow pencil would come off. And I was really bothered by that, so I got dark tattoos to compensate for the lack of hair” (A 30-year-old woman).
Additional costs
Eyebrow baldness was costly for the study participants, as the following quotes illustrate.
“I used to spend a lot of money on tattoos every time, and then my skin became oily and didn’t take color, so I had to go get tattoos 3 or 4 times a year” (A 40-year-old woman).
“I used to get tattoos every year that cost the same as an eyebrow transplant, so I decided to get permanent eyebrow transplants once and for all” (A 37-year-old woman).
DISCUSSION
This study aimed to explore the experiences of people who received eyebrow transplants before and after eyebrow transplants. The results of the present study showed that these people have lost their eyebrows for various reasons and are involved in a series of psychosocial and economic problems due to eyebrow baldness that are bothersome for them. After receiving an eyebrow transplant, despite the physical problems caused by the transplant, eyebrow transplantation has led to improved social and psychological work relationships due to the change in their facial appearance. The results of eyebrow transplants can lead to an increase in the quality of life. People cited the causes of their eyebrow baldness as repeated tattooing and removal, burns, congenitally sparse eyebrows, pregnancy, and physical manipulation of the eyebrows. The results of a systematic review showed that the most common reason for needing hair transplantation was burns, which occurred in about 57% of cases.11 Skin diseases such as psoriasis, seborrheic dermatitis, atopic dermatitis, telogen effluvium, and other skin diseases can contribute to eyebrow and eyelash loss. On the other hand, dysfunction of endocrine glands such as the thyroid and parathyroid plays an important role in causing this process.27
People reported experiencing physical issues after eyebrow transplantation, including acne and itching in the eyebrow area, eyebrow loss, and excessive eyebrow hair growth. The results of a study by Shichang et al. in 2024 showed that various factors, including medication, shampooing, and emotions, affect patients’ self-management abilities after hair transplant surgery.28
The results of the present study showed that eyebrow baldness was costly for the study participants. In this regard, the results of a 2023 survey by Vankar on hair transplant clinics showed that the total cost of hair transplantation in the United States is approximately $13,610.29
Participants also stated that eyebrow transplantation led to increased self-confidence and improved body image and that their work and social relationships improved after the transplant. A similar study reported that quality of life and psychosocial functioning increased after hair transplantation. Patients’ physical and mental health scores also showed significant improvements in quality of life after hair transplantation. In this study, life satisfaction increased after the procedure and stress and anxiety were significantly reduced after hair transplantation.30 A study by Adamowicz et al. (2022)31 in Poland found that a significant number of patients with androgenetic alopecia reported negative effects on their self-esteem, emotional well-being, and social functioning; in particular, young men experienced higher levels of embarrassment due to baldness. It seems that today, with the rise in beauty standards and the increase in the number of celebrities who have openly undergone hair transplants, it has not only attracted public attention but has also contributed to advances in hair transplant surgery.32
Implications and application of findings
The findings of this study have significant implications for nursing and clinical practice, particularly in the areas of patient education, psychological support, and post-operative care. Clinicians can utilize these insights to educate patients about the diverse causes of eyebrow loss, such as repeated tattooing, burns, congenital sparseness, pregnancy, and physical manipulation, enabling them to make informed decisions regarding transplantation. Pre-transplant counseling should also address the psychosocial challenges associated with eyebrow baldness, including social stigma, disruptions in professional relationships, and communication difficulties, while emphasizing the potential for enhanced self-confidence and improved body image following the procedure. Post-transplant care protocols should be established to manage common physical issues such as acne, itching, temporary eyebrow loss during the dormant phase, and excessive hair growth, ensuring patients are well-prepared for the recovery process. The economic benefits of transplantation over temporary solutions like tattooing should be highlighted, as repeated cosmetic procedures can incur comparable costs. Psychological support is essential, given the emotional burden of eyebrow baldness and the transformative impact of transplantation on self-esteem and social interactions. By setting realistic expectations about the recovery timeline and potential challenges, healthcare providers can alleviate patient anxiety and improve satisfaction. Interdisciplinary collaboration involving dermatologists, psychologists, and nurses is crucial to address both the physical and emotional dimensions of eyebrow loss and transplantation. Furthermore, these findings can inform public health initiatives aimed at raising awareness about the causes of eyebrow loss and available treatment options, thereby reducing stigma and encouraging individuals to seek appropriate care. Future research should focus on long-term outcomes of transplantation and comparative studies of different restoration methods to refine clinical practices further. Integrating these insights into clinical practice ensures a holistic, patient-centered approach that not only addresses the medical aspects of eyebrow baldness but also provides the emotional and social support necessary for patients to achieve optimal outcomes and improved quality of life. The findings of this study can highlight the complications patients face after transplantation and their effects on various aspects of an individual’s life. In addition, documenting the experiences of patients who have undergone natural eyebrow transplantation can guide future research by identifying their care needs, informing the development of tailored care programs, and enhancing service delivery, ultimately leading to improved transplantation outcomes.
Limitations and strengths
One of the main limitations of the present study is the limited generalizability of the results, and the most important strength of the study is the lack of similar studies and the discovery of new concepts.
CONCLUSION
Eyebrow transplantation as a cosmetic procedure has attracted the attention of many people. The experiences of the participants in this study indicate that this procedure can have a significant impact on improving the appearance and increasing self-confidence of individuals. However, possible complications such as rashes and itching, social stigma, and additional costs have been reported in the experiences of individuals, highlighting the need to pay attention to the quality of service and careful pre-operative consultation. Ultimately, eyebrow transplantation can be an effective option for individuals seeking to improve the appearance of their eyebrows, but the success of this procedure requires careful research and informed choice.
Authors’ contributions:
Maasumeh Elahi, Kourosh Zarea, Shahram Molavynejad and Maryam Shami: Study concept and design, Maasumeh Elahi and Kourosh Zarea. Shahram Molavynejad: Analysis and interpretation of data, Maasumeh Elahi and Maryam Shami: Drafting of the manuscript: All Authors confirmed final revised of manuscript.
Ethical approval:
The research/study was approved by the Institutional Review Board at Jundishapur University of Medical Sciences, number IR.AJUMS.REC.1403.096, dated May 25, 2024.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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