Author: Dr. William Rassman

I am a male, only 18 years old and starting back in elementary school my eyebrows have gotten less and less hair. Now its evolved to on both eyebrows only half being thick. It looks like half eyebrows, goes from normal looking to just bald. Is there anything i can do? It can be very embarrassing. I am not plucking or pulling my hair. They just keep getting thinner.

The most common cause of loss of eyebrow hair is plucking of the hair. I realize you said that you aren’t pulling or plucking, but many people who do pull out their hair (including eyebrows) deny that they do it. This is an obsessive compulsive disorder called trichotillomania. If the loss of eyebrows are not connected to plucking or pulling them, I wonder if you have any other hair loss or if it is limited to just your eyebrows.

Eyebrow transplants are an excellent solution for thin eyebrows. I have seen loss as your describe in the outer half of the eyebrow and have replaced the hair with scalp hair, which is very effective. Scalp hair in the eyebrows must be trimmed about twice a week to keep them short and they need to be cut on a slight angle to create a point to their ends.

I see in many hair transplant surgery photos that technicians place the grafts on the scalp. Since the placing is so crucial (angle, position, etc) how do surgeons leave this to technicians? Also, the survival of the extracted hair follicles is also a crucial matter, how safe is to leave the follicles’ processing to technicians?

is there a center where technicians intervene minimally and where skilled surgeons take charge in most of the procedure? in other kinds of surgeries I have watched, technicians and nurses are just there to pass the instruments to the surgeon, hold them, and generally do not interfere with the main procedure, so I really need to know a HT center mostly crewed by surgeons and not a big name surgeon that leaves the procedure to technicians

The total man-hours to do a surgery of 2500 grafts may be 30-40 hours. No doctor can do it all and I would not want them to try to do it all, because by the time the doctor finished, the grafts would be dead. This is a team surgery and graft survival is a complex process that requires many skilled people to do the job.

My technicians are highly skilled, working 8 hours/day doing either cutting the grafts or placing the grafts. When I used to do much of this work, I worked along side of the technicians and set the standards for training, and the skills needed for cutting and placing. Today, I still work along side of the technicians, though I work more in a supervisory role.

If you employed 4 surgeons in addition to myself, the costs would be out of sight for most of our patients and the quality would not be as good as the surgeons will most likely not have the manual skills that the technicians have. The secrets to success in getting the results that the patients want and need is that such a team approach needs (1) skills, (2) speed, (3) good and tight quality control systems, (4) good organization.

So, at 17 years old, I’m in between a Norwood 2 and 3 hairline and was aiming to get a transplant. I understand that this is very young, but I’m transgendered and the hairloss has stopped with the use of hormone replacement therapy so I was curious as to if I’d be at least able book a surgery date when I’m 17, to have the surgery when I’m 18. I’d have parental consent too if that’s important.

Yes, you can do it if you find a surgeon willing to take you on. You run risk for balding based upon any testosterone production, but if you have your testicles removed, that would mitigate that risk. I am not an expert on the effectiveness of the drugs you are presently using without orchiectomy. I would let your doctors tell you those answers.