Background: The eyebrow and eyelash are two major sites in facial hair transplantation. Different methods have been experienced for better results. Surgeons tend to use smaller grafts. The authors modified the follicular isolation technique and added de-epithelialization to reduce complications and improve outcomes. Methods: Sixty patients were allocated to either the isolation group or the isolation plus de-epithelialization group. Some patients underwent both eyebrow and eyelash transplantation; therefore, 79 procedures were performed on 60 patients. Scar formation, number and percentage of surviving transplanted hairs, hair growth orientation, and satisfaction with outcome were reviewed at 6 months. Results: The mean number of preserved transplanted hairs in eyebrow transplantation at follow-up was not significantly different between the two groups, but the mean percentage of preserved transplanted hairs was significantly higher in the isolation plus de-epithelialization group. In eyelash reconstruction, the mean number and percentage of surviving hairs were significantly higher in the isolation + de-epithelialization group than in the isolation-only group. The isolation + de-epithelialization group had more cases of normal hair growth direction in both eyebrow and eyelash transplantation cases, although the difference was statistically significant only in eyebrow reconstruction. Conclusions: This study showed that follicular isolation plus de-epithelialization had better outcomes and fewer complications than did follicular isolation alone. This could be due to less need for suture in recipient sites, less risk for burying of epithelium of graft in the recipient site, less need for manipulation, lower graft volume, and less need for blood for survival and for removal of sweat glands. Clinical Question/Level of Evidence: Therapeutic, II.
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