33.    Eyebrow transplantation in a case of keratosis pilaris atrophicans. 
Nilofer Farjo, Bessam Farjo, Farjo Medical Centre, Manchester, UK

Eyebrow transplantation is a well-recognised restorative procedure in cases of diminished/absent eyebrow hair. The commonly treated causes include traction loss (i.e. eyebrow plucking), traumatic loss (burns, accident scars), and congenital fine/sparse eyebrows. Hair transplantation in scarring alopecia only is successful in cases of ‘burnt-out’ conditions and then only in situations where there is no compromise to the blood supply. The case described is that of a 33-year-old man who presented with longstanding problems with his eyebrows beginning in infancy. His eyebrows were largely absent and there was erythema and “pimples” of the skin in the upper canthal area. He had not previously sought a medical opinion on his condition so the patient was sent to a dermatologist for a diagnosis. The dermatologist’s opinion was that this was a case of burnt-out keratosis pilaris atrophicans/ulerythema oophyrogenes. Keratosis pilaris atrophicans is a condition present from early infancy and is characterised by erythema and horny plugs beginning in the outer halves of the eyebrows and then moving medially. It may affect the cheeks also. The eyebrows are eventually destroyed.
There is no reference in the literature of a case that has been transplanted and as the patient was keen to have a trial at eyebrow restoration the decision was made to perform a single procedure. Bilateral single-haired grafting was performed with incisions made by 15 degree sharpoint blades. A total of 100 hairs per eyebrow were inserted. During the procedure there was higher than average bleeding and swelling was noted to be high on the left side. The grafts in this area were also more difficult to place. After approximately three months the patient noticed new hairs growing. At the postoperative review at six months scalp hairs were growing abundantly. The patient was happy with the results and opted for two further procedures to increase the density. Two years after the initial procedure the hairs are growing and the skin has shown no signs of inflammation.