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    Lashing out

    Cosmetic eyelash transplant procedure popular — but problematic


    Dr. Wasserbauer
    WALNUT CREEK, CALIF. — While doctors have performed eyelash transplants for some time on patients who lose their eyelash hair due to accident or disease, with increasing frequency, the transplants are being requested for cosmetic reasons. While some practitioners are concerned that patients are not adequately informed of potential dangers associated with the procedure, others claim the procedure is safe in trained hands.

    HAIR HARVEST Sara Wasserbauer, M.D., a hair transplant surgeon, who completed a hair transplant fellowship with Matt L. Leavitt, D.O., tells Cosmetic Surgery Times that the permanent option suits people who are willing to maintain the transplanted lashes.

    Since Dr. Wasserbauer usually retrieves hair for the lashes from behind the ears on a patient's head, the transplanted hairs will grow on the eyelids as they would on the scalp. This requires those who receive the transplants to regularly trim and perm the new eyelash hair.

    "So, you have to have an educated, willing patient," Dr. Wasserbauer says.

    EYE OF THE NEEDLE Cosmetic eyelash transplantation usually involves only the upper eyelids, according to Dr. Wasserbauer, who practices in Walnut Creek, Calif.

    Dr. Wasserbauer generally gives patients Valium for relaxation. She next anesthetizes the eyelids and harvests hair from the back of the head, leaving it long, if possible, so that she can determine if the hair curls and in what direction. She then takes a curved needle (similar in shape to a carpet needle) and, using a microscope, threads the end of the long hair through the needle to sew it into the top of the lid, between a person's first and second rows of original, natural lashes.

    Once she pulls the hair through the lid, she removes the needle and gently pulls on the hair, anchoring the hair follicle in the lid. The imbedded hair follicle then has the requisite environment for viability.

    The procedure, which generally involves transplanting from 15 to 50 lashes, usually takes about four hours to perform.

    The hair will grow to the length it did on the scalp, so patients must trim the transplanted hair to prevent it from growing into the eye and causing vision problems. The transplanted hair must also be permed approximately every six weeks, so that it curls away from the eye as the other lashes do.

    Dr. Wasserbauer prefers to use the finer hair on the head because she says coarse hair makes the eyelashes resemble toothbrushes.

    "You do not want to leave patients with something less natural than what they started with," she notes. "You want fine, delicate hair. Usually I find that hair behind the ears."

    CANDIDATES AND CONTRAINDICATIONS People who have trichotillomania tend not to be candidates for the procedure because pulling at their transplanted eyelashes could cause scarring, according to Dr. Wasserbauer. And alopecia sufferers generally do not have sufficient donor hair for lash hair retrieval.

    The doctor also avoids performing the procedure on patients with eye conditions that cause rubbing or on those who have excessive dry eye. The procedure is also contraindicated in Asian patients who have had blepharoplasty to give the appearance of eyelid creases as the scarring on the lids results in a compromised blood supply, making it an unsuitable environment for the transplants.

    ROOTING ROUTE Side effects from surgery, according to dr. wasserbauer, tend to be minor. patients often develop chalazions and styes after the surgery, which readily heal with hot compresses. in rare instances, dr. wasserbauer says she drains the infections or prescribes antibiotics.

    She sees transplant patients the day after surgery, checking placement of the lashes and pulling those lashes that are crossed, at bad angles or which do not look right.

    Most patients have swelling around the eyes the day after surgery and bruising that lasts for a few days.

    "After two to three weeks, the newly implanted lashes will usually fall out, which is a good sign that the hair follicle has taken root and will grow new hair," she says. "At three to six months, you will have the new hairs growing in."

    ENTER CONTROVERSY This is not a surgery suitable for most patients, contends Ann P. Murchison, M.D., assistant professor in the department of ophthalmology, division of oculoplastic and orbital surgery at Emory University, Atlanta, Ga.

    Dr. Murchison is lead author of a recent review and case report published in the journal Ophthalmic Plastic and Reconstructive Surgery, which examines safety issues related to eyelash transplants. She and colleague Dr. Ted Wojno became concerned about recent media attention on cosmetic eyelash transplantation because ophthalmologists had begun to see serious complications from the surgery.

    "The transplanted lashes are not normal eyelashes; they are not programmed to curve away from the eye and stop growing at a set length. As a result the lashes can grow in any direction, including towards the eye, and need trimming regularly. [Eyelash transplantation] can cause eye problems, including eye irritation, infections of the eye and potentially vision loss," Dr. Murchison says.

    Problems resulting from the surgery include corneal abrasions and ulcers from implanted lashes rubbing on the corneal surface. This can lead to ongoing severe irritation or even loss of vision from infection.

    While pulling eyelashes will temporarily relieve the irritation and forestall potential corneal damage, a transplanted lash will grow back.

    "The unfortunate thing is that to permanently get rid of the lashes, you often have to do another surgery, which can create additional eyelid scarring," Dr. Murchison says.

    She also explains that the surgery places patients with otherwise healthy eyes at risk.

    "Patients need to be aware that these will not be normal eyelashes and they have the potential to damage the eyes," Dr. Murchison says.

    For more information
    Murchison A, Wojno T, Trichiasis after Eyelash Augmentation with Hair Follicle Transplantation, Ophthal Plast Reconstr Surg., 2007, In press.

    Lisette Hilton
    Lisette Hilton is a writer in Boca Raton, Fla., who heads up her company, Words Come Alive.

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