Eyebrow Restoration in Deep Facial Burn: Follicular Unit Extraction Hair Transplantation after Nanofat Graft

Abstract

Background: Eyebrows play an important role in protecting the eyes, and also transmit facial expression. Restoration of eyebrow loss after deep thermal burns is a challenging task because a scarred recipient area may affect the success rate of the hair transplantation outcome. Trials to improve this outcome via preparation of pretransplantation recipient area are mandatory. Methodology: Seventeen patients (20 eyebrows) with partial or total postburn eyebrow loss were recruited. Nanofat injection was done as a preparatory step before hair transplantation. Patients were followed up monthly for 6 months after follicular unit extraction. The outcome was assessed both objectively by phototrichoscopy and patient satisfaction, and by incidence of complications. Results: The mean eyebrow density of the recipient side was found to be 88.60 ± 29.96 hair follicle per cm2, compared with 133.95 ± 38.38 on the control side. The mean eyebrow thickness of the recipient side was found to be 0.07 ± 0.01 mm, compared with 0.06 ± 0.01 on the control side, The overall satisfaction was 60% regarding the density, 80% regarding direction, and 65% regarding symmetry. However, when it comes to texture, 45% were satisfied. Conclusions: Restoration of eyebrow loss after deep facial burn is a challenging procedure. Improving the recipient area before hair transplantation is recommended to achieve a satisfactory outcome. Waiting until maturation of the scarred tissue of the recipient area and preparation of it with nanofat can achieve a satisfactory outcome.