Life With Alopecia: Your Guide to Microblading, Eyelash Extensions, and More

Mar 23, 2023

You don't have to settle for patchy eyebrows and sparse lashes. These cosmetic treatments can help when hair loss affects your face.

Hair loss due to alopecia can be discouraging. It impacts not only your outward appearance, but often your self-esteem as well. While many people who have alopecia feel confident in the visible display of their condition, others may be interested in camouflaging or disguising hair loss.

Alopecia areata (AA), a type of alopecia or hair loss, is categorized by patchy or complete hair loss. It's a type of autoimmune disorder that occurs when the body's immune system attacks its own hair follicles, which can cause hair loss in any spot where it naturally grows. Meaning, it can affect more than just your scalp.

People with more severe forms or progressions of alopecia areata, including alopecia totalis (AT) or alopecia universalis (AU), often experience near or total body hair loss. In fact, research shows that in up to 76 percent of cases, alopecia can affect the eyebrows and eyelashes — two of the most prominent, visible areas of the body.

But living with alopecia areata doesn't mean you have to accept facial hair loss if you’re not comfortable with it. Several cosmetic procedures are available to help address AA and conceal the look of sparse or missing facial hair.

Learn more about these semipermanent cosmetic options to improve eyebrow and eyelash loss.

Microblading is a semipermanent cosmetic procedure that's similar to tattooing. It's often used to fill in sparse or nonexistent eyebrows, and the results provide a very natural appearance.

With microblading, a cosmetic dermatologist or licensed aesthetician uses a handheld device that has tiny blades with ink inside. Micro incisions are then made in the skin where the semipermanent color is then added.

The initial procedure often takes a couple of hours. A second appointment is typically made to tweak the initial design. Microblading does fade after a year or so, so future touch-ups are necessary to maintain the look.

Microblading costs vary widely depending on where you live and who performs it, but you can expect to pay at least several hundred dollars.

While it can be mildly uncomfortable, microblading is generally thought to be less painful that tattooing. "The main difference is that the depth of microblading is more superficial than a typical tattoo," explains Robert Finney, MD, a board-certified dermatologist at Entière Dermatology in New York City.

For those with alopecia areata who are considering microblading, consult with your dermatologist before undergoing this procedure. Certain things that may accompany alopecia could pose an issue, such as:

"With alopecia areata, there's also small risk of Koebnerization, which is a phenomenon where friction or trauma can cause patches of the disease," explains Dr. Finney. Also known as the Koebner phenomenon, it triggers the appearance of new lesions on otherwise healthy skin, which means "there's a small risk the microblading could trigger a flare," he adds.

Be sure to carefully vet the specialist who will perform the microblading, as it's a delicate procedure. Consider seeking out a cosmetic dermatologist who has familiarity with alopecia areata to perform this procedure.

The microblading world has exploded of late, with brand new variations on the theme.

One is called nanoblading, which uses even more delicate needles compared with microblading, and results in super fine lines that look like real human hair. Want even more detail above your eye? Try 6D microblading to create the illusion of more hair on the brow using short and long strokes of the device.

Another form, known as microshading or micropigmentation, can be performed on the eyebrows and eyelash area to add color or an ombre appearance. Micropigmentation consists of tiny dots that are made with a motorized instrument shaped like a pen. This device penetrates the skin more deeply than microblading and can last up to twice as long as a result.

As to the risks of any of these blading and shading techniques, some swelling and bleeding can occur; infection may also develop and allergic reactions to the inks are sometimes possible. That's why it's important to work with an aesthetician or cosmetic dermatologist who understands AA when considering this type of procedure.

For the loss of eyelashes due to alopecia areata, eyelash extensions are sometimes recommended if there's enough lash hair remaining to which the extensions can be attached. If you’re experiencing a period of regrowth and want to thicken and enhance the lashes you already have, this might be an option for you.

While they’re related to false eyelashes, extensions are semipermanent pieces that are glued on individually by an experienced aesthetician. Extensions last for a couple of weeks — whereas false eyelashes are usually a one-time thing that you wear for a day. Extensions cost more, too. You may have to pay around $150 for the initial application, which can take an hour or more to complete. You’ll also have to pay to maintain and refill the lashes, potentially adding several hundred dollars more to the total cost.

False eyelashes may be the only choice for those with more severe alopecia resulting in minimal or no existing eyelash hair to work with, says Finney. "With false eyelashes, you can glue the strip to the skin just above the lash line, which doesn't require existing eyelashes — and this would be the better route for most patients," he explains.

Eyelash extensions are not without risk. The American Academy of Ophthalmology reports that certain adhesives made with formaldehyde used to create extensions may cause an allergic reaction or lead to swelling of the lid or an infection of the cornea or eyelid. What's worse, the application of cosmetic eyelash extensions could even result in more permanent eyelash loss.

So, proceed with caution, and always consult your dermatologist before considering a cosmetic procedure like this.

Alopecia areata is often characterized by patchy hair thinning and uneven growth when it returns. To combat this outcome, consider laser hair removal. This common medical procedure involves using a laser beam of light to heat up hair follicles and delay future hair from sprouting.

While not completely permanent, laser hair removal can be a quick and relatively inexpensive way to remove errant hairs on the upper lip, chin, and other areas. Though it does take multiple appointments to achieve the desired result.

The risks related to laser hair removal include redness at the site and swelling, as well as possible lightening or darkening of your skin color once the procedure is complete. In rare cases blisters and changes in the skin's texture can occur. Keep in mind that this cosmetic treatment isn't recommended for the eyelids or eyebrows as this area is sensitive and could easily be injured. As with any other cosmetic procedure, talk to your dermatologist before giving laser hair removal a go.

If you’re weary about undergoing a cosmetic procedure, this option is for you. Cosmetic counters are packed with makeup options that can help:

Brow fillers in particular are more popular than ever and come in the form of pencils, powders and crayons that can create the shape you want. Gels can add shine and hold your design in place. Both eyebrow and eyelash makeup come in a wide array of colors to match many skin tones and hair colors too.

Work with your dermatologist to determine which strategies you’re most comfortable trying to help boost your confidence about your appearance.

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