QHow I do it: Treating age-related eyebrow hypotrichosis

A
Cynthia Trickett, PA-C, MPAS

Cynthia Trickett, PA-C, MPAS

Medically reviewed on 5.1.2023 by Gary Goldenberg, MD

Eyebrows are a critical feature of the face.  They serve to divide the top third of the face from the bottom two thirds and are involved in expression, social communication, and cosmetic appearance.  In recent years, there has been a trend toward full, wide, long, and darkened eyebrows. 

Eyebrow loss can have many underlying causes and conditions, including dermatoses (seborrheic dermatitis, contact dermatitis, eczema, follicular mucinosis, amyloidosis), autoimmune (alopecia areata, lichen planopilaris, frontal fibrosing alopecia, psoriasis, discoid lupus, Graham Little syndrome), infection (tinea, leprosy, syphilis), endocrinopathy (thyroid disorders), and exogenous causes (radiation, chemotherapy, trauma, medications [chemotherapy, pembrolizumab], trichotillomania) and malignancies (CTCL, mastocytosis).  Rarely, there are also genodermatoses associated with eyebrow hypotrichosis (keratosis follicularis spinulosa decalvans, ulerythema ophryogenes, ectodermal dysplasia, and multiple other syndromes).1 

For the patient with likely age-related eyebrow hypotrichosis, the practitioner can employ several treatment options once other causes have been ruled out. 

Topical minoxidil 2%, although approved for androgenetic alopecia of the scalp, has been shown to be effective for enhancing eyebrow growth in a Japanese study.2

Case reports and randomized controlled trials have shown that bimatoprost 0.03% is effective for eyebrow thinning.3

Although experimental, platelet-rich plasma (PRP) can be considered for patients who do not respond to topical therapies. I usually combine this with PRP for the scalp.

The cosmeceutical RevitaBrow® touts that it protects against breakage but does not specifically state it improves growth.  Nevertheless, some patients report ‘healthier-looking’ eyebrows.

Eyebrow transplant, first pioneered by Dr. Shoji Okuda in 1939, is also an option but requires high-quality surgical technique.4

Lastly, patients may consider semipermanent tattoo or dermaplaning with tint, both of which I recommend being done by professionals with years of experience. 

References:

  1. Chanasumon N, Sriphojanart T, Suchonwanit P. Therapeutic potential of bimatoprost for the treatment of eyebrow hypotrichosis. Drug Des Devel Ther. 2018;12:365-372. doi:10.2147/DDDT.S156467
  2. Lee S, Tanglertsampan C, Tanchotikul M, Worapunpong N. Minoxidil 2% lotion for eyebrow enhancement: a randomized, double-blind, placebo-controlled, spilt-face comparative study. J Dermatol. 2014;41(2):149-152. doi:10.1111/1346-8138.12275
  3. Carruthers J, Beer K, Carruthers A, et al. Bimatoprost 0.03% for the treatment of eyebrow hypotrichosis. Dermatol Surg. 2016;42(5):608-617. doi:10.1097/DSS.0000000000000755
  4. Gupta J, Kumar A, Chouhan K, Ariganesh C, Nandal V. The science and art of eyebrow transplantation by follicular unit extraction. J Cutan Aesthet Surg. 2017;10(2):66-71. doi:10.4103/JCAS.JCAS_27_17