Eyelash Transplantation Using the Long Hair FUE Technique and Direct Implantation with an Implanter Pen

Introduction: Eyelashes perform essential esthetic and physiological functions, including eye protection and contributing significantly to facial expression. Eyelash loss (madarosis) can have a profound impact on a patient’s self-esteem and quality of life. Eyelash transplantation is technically challenging because of the delicacy of the eyelid region and the need for extreme precision. This study describes the authors’ approach to eyelash transplantation using the long hair follicular unit excision (FUE) method, with direct implantation via an implanter pen.

Methods: This case series included 5 female patients who underwent eyelash and/or eyebrow transplantation. Although the primary focus of this series was eyelash transplantation, some cases also underwent eyebrow or hairline transplantation performed in the same session, which is reported for completeness. The technique consisted of long hair FUE using a motorized system with a 0.95mm punch, graft selection and processing under stereoscopic magnification, and direct implantation using a 0.90mm implanter pen at a natural implantation angle of 5–15 degrees. Graft numbers, surgical time, postoperative outcomes, and complications were recorded. Directionality improvement was qualitatively assessed based on standardized postoperative photographs.

Results: Eyelash transplantation involved 40–70 follicular units (FUs) per procedure. Combined procedures involving eyebrow transplantation and/or hairline reconstruction required the greatest total number of grafts. One patient developed mild trichiasis, which resolved after removal of the misdirected eyelash. One patient sustained a corneal injury related to the ocular protector, which resolved completely after ophthalmologic treatment. Postoperative photographic evaluation suggested satisfactory graft alignment and esthetic integration in all five patients, with two requiring management of complications. Hair growth became clinically evident at 3–6 months postoperatively, with apparent maintenance of curvature and acceptable density. These findings are based on qualitative clinical and photographic assessment and should be interpreted cautiously given the limited sample size.

Conclusion: Long-hair FUE with direct implantation using an implanter pen appeared to be a feasible approach to eyelash restoration in this limited case series. This technique may facilitate precise control of graft direction and a natural esthetic appearance. Because complications occurred in 2 of 5 patients and outcomes were assessed qualitatively, larger studies are needed to better characterize its safety and effectiveness.