This document discusses eyebrow and facial hair restoration procedures. Traditional scalp flap or graft surgery is major surgery with poor results, while direct hair implantation (DHI) allows reconstruction using hair grafts from the scalp under local anesthesia. DHI can effectively treat eyebrow, mustache, sideburn, beard, and cheek areas lost to burns, trauma, scarring, or other causes. Before and after photos show restoration of eyebrows, sideburns, beards, and cheeks. DHI provides natural, permanent results with minimal invasiveness and high densities possible.

1. EYEBROW & FACIAL HAIR PROCEDURES Dr Anastasios Vekris, MD Plastic Surgeon

2. Introduction Scarring eyebrow loss is usually repaired with a hair-bearing island scalp flap or scalp strip grafting technique (classic plastic reconstructive surgery approach) Scarring facial hair loss is even more difficult to reconstruct, as there are no suitable hair-bearing flaps to cover the face Flap surgery is major surgery under general anesthesia & frequent complications Aesthetic results are very poor

3. Indications Burn scars Traumatic scars Chemical peeling scars Congenital absence of hair Eyebrow tattoo removal

4. Localities Eyebrows Moustache Sideburns Beard Cheeks

5. The DHI approach Reconstruction can be achieved with a minimally invasive technique under local anesthesia Hair grafts from the scalp can be successfully transplanted in the face All areas can be treated effectively Maximum density can be achieved Natural direction of growing hair

6. EYEBROW RESTORATION (before)

7. EYEBROW RESTORATION (after)

8. EYEBROW POST TRAUMATIC SCAR RESTORATION

9. SIDEBURNS RESTORATION (before)

10. SIDEBURNS RESTORATION (after)

11. BEARD RESTORATION

12. Cheek restoration (before)

13. Cheek restoration (after)

14. Cheek restoration (6 months)

15. Technical tips Only single and a few double-hair grafts must be used Optimal extraction with 0.8 mm punch Reception holes are mandatory Very low angle of placement in eyebrow restoration High density needed in eyebrow restoration Diverse direction of hair placement according to the area under treatment Up to 150-200 grafts may be needed for a total eyebrow restoration, a few more in men

16. Conclusions Optimal aesthetic results can be achieved with DHI transplantation The only minimally invasive approach to facial hair deficits Big densities can be achieved in small areas (e.g. eyebrow) More density can be added in a second procedure Natural & permanent results