Can eyebrows and eyelashes be restored? Finding the cause first, then serums, tattooing and transplants

Thin brows and sparse lashes can be restored in several ways: a serum, a tattoo, a transplant, a set of false lashes. The reasonable first question is not which one, but why the hair went. This article explains why the cause comes first, and what each option is reported to do, and to risk, in the published evidence.

Why does the cause of eyebrow or eyelash loss come before any restoration?

Because the cause decides whether the hair can come back on its own, and some causes are medical problems that need treating in their own right. EyeWiki, the American Academy of Ophthalmology's clinical wiki, puts it directly: treatment of madarosis, the medical name for loss of lashes or brows, depends on treating the predisposing disorder, and identifying that disorder is critical.

The same page separates two kinds of loss. In non-scarring madarosis the follicle survives, and correcting the underlying disorder often brings the hair back. In scarring madarosis the follicle has been destroyed, and EyeWiki lists hair transplant, eyelash or eyebrow reconstruction and cosmesis as the viable options. The causes behind each, including thyroid disease, an autoimmune condition such as alopecia areata, long-standing blepharitis, hair pulling and the eyelid tumours that destroy lashes in one patch, are set out in eyelash and eyebrow loss in adults: what it can mean, and I will not repeat them here. Two of them have their own pages: blepharitis and lid margin disease and thyroid eye disease.

The practical point is a plain one. A serum or a tattoo can cover a gap, but it does not treat a thyroid problem or an eyelid tumour, and a gap that is lopsided, patchy or over a lump on the lid margin is a reason for an examination before any cosmetic decision.

Do lash growth serums work, and what do they risk?

The prescription-type serums are prostaglandin analogues, the same drug class as some glaucoma eye drops, and in trials they lengthen and thicken lashes over a few months. The evidence is about one drug in particular, bimatoprost, and about its use in adults with too few lashes (hypotrichosis).

Two Japanese multicentre, double-masked, vehicle-controlled trials, published in Aesthetic Plastic Surgery in 2014, tested it for four months. In 173 people with idiopathic hypotrichosis, 77.3% on the drug had at least a one-grade gain on the global eyelash assessment (a clinician's rating scale), against 17.6% on the dummy solution. In 36 people whose lashes had been lost to chemotherapy, the figures were 88.9% against 27.8%, and lash length rose by 2.65 mm against 0.99 mm. Side effects were similar between groups in the larger study (41.4% against 37.6%), and three people left it because of them.

A pooled analysis of six randomised trials in the Journal of Clinical and Aesthetic Dermatology (2015), covering 680 people on the drug and 379 on the dummy solution, lists what was seen: conjunctival hyperaemia, redness of the eye surface, in 6.3%, itching of the eyelid in 3.4%, darkening of the eyelid margin skin (blepharal pigmentation) in 3.4%, and skin hyperpigmentation in 0.6% against none on the dummy. Iris pigmentation, a change in the colour of the iris, was reported in two people, both mild. The authors write that most events were early, mild, localised and reversible when treatment stopped. Stopping because of side effects was 3.2% against 2.4%.

What these trials do not settle is the longer-term eyelid change that has been described with the same class of drug in glaucoma. That is covered next, because it is the part most often left out.

What is prostaglandin-associated periorbitopathy?

It is a set of changes around the eye reported with prostaglandin analogue eye drops: a deeper upper eyelid sulcus (the groove under the brow bone), loss of fat from the eyelid and orbit, a droopy upper lid, a slightly sunken eye (enophthalmos) and a flatter lower lid. The 2023 report in the Turkish Journal of Ophthalmology describes these changes in people using glaucoma drops, and says earlier work found bimatoprost produced more change than travoprost or latanoprost, though its own group was too small to say.

The same report offers some reassurance. In nine people who stopped the drops, eight eyes with a deepened sulcus improved a year later, and lower lid fat loss recovered partially in four eyes. These are people on drops for glaucoma, not people using a lash serum, and the small group makes it a signal rather than a rate. Whether a lash serum carries the same risk is not settled: it has not been shown to carry the same risk, nor to carry none. What the evidence supports is that anyone using one should know the class, tell their eye doctor, and report a deepening groove, a lower lid or a change in eye colour. People who are already on glaucoma drops of this class should ask the prescriber before adding a lash serum. The eyelid side of lash serums, extensions and eye makeup is covered by a colleague: Dr Ong Jin Khang at The Retreat Clinic explains what lash extensions, lash serums and eye makeup do to the eyelid, so I will leave that ground to him.

What are the risks of eyebrow microblading and tattooing?

The main risks are infection, allergy, lumpy inflammatory reactions and colour that does not stay where it was put. A 2025 review in Skin Appendage Disorders describes microblading as depositing pigment in the upper dermis with handheld blades, giving a natural, hair-like look that lasts up to about three years, whereas traditional tattooing goes deeper and lasts about two to eight years or more.

The same review calls infection rare, but records mycobacterial infection and preseptal cellulitis, an infection of the tissue in front of the eyelid, among the cases reported. It documents many granulomatous reactions (lumps of inflammatory tissue), including more than 20 cases of cutaneous sarcoidosis reported after the procedure, and pigment that turned a greenish hue, smudged or spread, or even darkened paradoxically. It also reports allergic reactions, including one in a person with prior nickel sensitivity, and the skin condition flaring along the new wounds in people with psoriasis, vitiligo or lichen planus. Its advice to clinicians is to discuss durability, infection risk and conditions that make a person unsuitable.

A brow tattoo hides the gap but leaves the cause untouched. Permanent pigment at the lash line carries its own set of problems, set out in sulam eyeliner, lash lifts and lash tints: what can go wrong.

Can eyebrows and eyelashes be transplanted?

Yes, and it is a recognised surgical option, mainly where the follicles are gone for good. A 2018 systematic review in the Journal of Clinical and Aesthetic Dermatology gathered 67 articles covering 354 patients from 18 countries. Burns accounted for 57.6% of the cases, followed by earlier surgery (12.8%), ageing (7.17%) and trauma (6.23%). Follicular unit transplantation was the most common method, and almost all patients had a mean follicular survival above 75%.

The review is clear about the technical points. Each graft is placed to match the position and orientation of the recipient hairs, so the direction of growth is a matter of planning rather than luck. Transplanted eyelashes must be trimmed and curled to prevent downward growth, which can lead to trichiasis, lashes rubbing the eye surface, and damage to the cornea; trichiasis is a problem in its own right. Reported complications include swelling, bruising, infection and, in eyelash cases, blepharitis or trichiasis. The review did not address how long to wait for the underlying disease to settle. EyeWiki's principle is that the underlying disorder is treated first; the review gives no waiting time, so the timing is a matter to settle with the surgeon.

Most of these reports are case reports and case series, with burns heavily represented, so they do not tell a person with a thyroid cause or alopecia areata what to expect, and whether grafted hair keeps growing when the cause is still active is a question for a doctor who knows the cause.

What about false lashes and extensions?

They are not a treatment, and they come with risks of their own: glue and remover can irritate or inflame the eye surface and lid, and the pull of the extension on the natural lash can add to the loss. I covered the allergic side in allergic eyelid reactions, lash extensions and cosmetics. If lashes are already sparse because of lid margin disease, adding weight and glue to a sore margin is rarely the place to start.

In what order should restoration be considered?

Find the cause, treat it, give the follicles time where the loss is non-scarring, and only then choose a cosmetic or surgical option, with its risks in front of you. The wider list of reasons eyes and lids can change is in what actually makes eyes look tired, and the lid-margin series sits under eyelid lumps, lashes and lid margin.