4847 Longterm Result of the Hair Transplantation for Therapy Resistant Alopecia Areata of Eyebrows with An Unexpected Complication: Double Eyebrow

Friday, May 6, 2011
Ekrem Civas, MD, Dermatology, Civas Clinic,, Ankara, Turkey, Muhitdin Eski, MD, Department of Plastic Reconstructive and Aesthetic Surgery Gulhane Military Medical Academy, 06018 Etlik, Ankara, Turkey, Hasan Mete Aksoy, MD, Plastic and Reconstructive Surgery Clinic, Private Konak Hospital,, Ýzmit, Turkey and Berna Aksoy, MD, Dermatology Clinic, Private Konak Hospital,, Ýzmit, Turkey

Alopecia areata is a common autoimmune skin disorder with an unpredictable clinical course. When the face is affected it makes the appearance of the patient unpleasant. The treatment of alopeaisa areate is  challenging for both the patient and thephysician. One of the treatment modality for the hair loss of eyebrow   is hair transplantation (1-3). In this case report we present the long term result of the hair transplantation in a patient whom had a  therapy-resistant alopecia areata affecting both eyebrows.


Case Report: A 24-year-old male patient  was treated with hair transplantation for therapy-resistant alopecia areata affecting both eyebrows in 2007. At the time of hair transplantation he gave a history of quick loss of all body hair and treatment with psoralen and ultraviolet A (PUVA) therapy for alopecia universalis 4 years previously. He reported that all body hair re-grew except his eyebrows within the  two years period.  Although the patient had various medical therapeutic agents there was no eyebrow re-growth.This led to a major psychological impact on the life of the  patient. Prior to hair transplantation, alopecia areata of the eyebrows was stable for 18 months following the last medical treatment. Since than the patient had  hair transplantation  with  using the follicular unit extraction (FUE) technique. 350 single -hair  and 75 two-hair containing grafts,  harvested from occipital area,  were used to reconstruct  both eyebrow alopesia. The hair re-growth rate was 80% without any topical or systemic therapies for alopecia areata at the end of the 24th postoperative month.  This result was accepted for publication in 2009 (1). However, the patient  applied with the complaint of double eyebrow appearance due to re-grew of original eyebrows without use of any local or systemic therapy for alopecia areata at the end of 3rd postoperative year (Figure-1). This un expected  complication make the appearance of the patient very unpleasent. We have decided to wait for at least one year to conclude that clinical course of the disease is stable and following that period we are planning to remove the transplanted hairs via laser epilation.


3 years following the hair transplantation  with  using FUE technique, the  patient displayed spontaneous eyebrow re-growth with a distracting appearance of double eyebrow. At the present time, the transplanted hairs cause embarrassment for the patient and there is a potential therapeutic problem.


This case clearly shows that waiting for about two years is not enough to decide on any form of surgical intervention for the treatment of therapy resistant alopecia areata. The effect of transplanted hair graft on  the  alopecia  is not known, but the knowledge obtained from  limited published papers and this case report show that it may induce the   re-growt of original eyebrow or transplanted hair may be lost due to recurrence of the disease (1,2). If hair transplantation  is performed the shape and size of the eyebrow to be reconstructed should be  the original size and shape to prevent double eyebrow appearance in case of spontaneous re-growth of eyebbrow. It appears that the  hair transplantation is not the right choice for the treatment of therapy resistant alopecia areata.



  1. Civas E, Aksoy B, Aksoy HM, Eski M, Yucel K. Hair transplantation for therapy-resistant alopecia areata of the eyebrows: is it the right choice? J Dermatol 37(9):823–826, 2010
  2. Barankin B, Taher M, Wasel N. Successful hair transplant of eyebrow alopesia areata.J Cutan Med Surg. 9:162-164,2005
  3. Wang J, Fan J. Cicatricial eyebrow reconstruction with a dense-packing one-two- hair grafting .Plast reconstr surg. 114:1420, 2000
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