Periauricular hair transplantation enhances the cosmetic results of eyebrow transplantation: A retrospective study in Chinese recipients.

BACKGROUND: Eyebrow transplant surgeries have become increasingly popular in recent years. Periauricular hair, with its slow growth rate and fine caliber similar to eyebrow hair, has been strategically used in eyebrow transplants to achieve enhanced and authentically natural aesthetic results. OBJECTIVES: This study aimed to assess the postoperative clinical outcomes of using periauricular hair for eyebrow transplantation. METHODS: Data from 81 patients (72 women and 9 men) who underwent eyebrow transplantation with periauricular hair between October 2020 and September 2022 were analyzed. They were followed up for 15 months' post-surgery to evaluate recovery and complications. Patient satisfaction and quality of postoperative life were assessed using a 5-point Likert scale. RESULTS: For female patients, the average total number of transplanted hair grafts and surgery duration were 402.33 ±â€¯158.48 FU (follicular unit) and 193.86 ±â€¯66.69 min, respectively. Contrastingly, male patients exhibited slightly higher values, with an average of 481.78 ±â€¯126.43 FU and 229.00 ±â€¯96.80 min, respectively. No significant complications were reported during the postoperative follow-up. Patients expressed general satisfaction with immediate and 15-month postoperative outcomes, reflected in a mean overall satisfaction score of 4.90. The overall satisfaction of the subjects at 15 months postoperative was significantly higher than the preoperative satisfaction (Z = -8.483, p < 0.001). The eyebrow/forehead surgery did not have a significant impact on postoperative satisfaction (H = 5.355, p = 0.374 > 0.05); however, patients without tattoos tended to report higher levels of postoperative satisfaction (Z = 8.056, p = 0.004 < 0.05). Patient satisfaction ratings for physical function, psychological function, social function, and quality of life post-operation were 5, 4.95, and 4.94, respectively. CONCLUSIONS: Eyebrow transplant using periauricular hair can improve cosmetic outcomes and is a viable option in clinical practice.

Permanent Makeup Removal Severe Complication-Case Report and Proposal of the Protocol for Its Management.

Background: The purpose of this paper is to report the case of a patient who developed a local allergic reaction to the pigment used for permanent eyebrow makeup. In addition, the authors' protocol for the treatment of such a complication is proposed. Methods: A patient visited the clinic to remove permanent eyebrow makeup. In the patient's opinion, the eyebrows were too dark and incorrectly shaped. Upon physical examination of the brows, they were found to be over-pigmented and drawn outside the area of hair growth of the natural brow. Results: The patient underwent 24 treatment procedures to remove the pigmentation including four sessions of laser therapy and subsequent treatments using a chemical substance (remover). No adverse effects occurred during the initial phase of makeup removal (black pigment removal), but an allergic reaction appeared with the removal of the red-orange colored pigment (after the fourth laser therapy session). The following symptoms appeared: redness, swelling, and the appearance of papules filled with both serous fluid and pigment used for the permanent makeup. After each remover treatment, the allergic reaction decreased, and local symptoms gradually subsided. Additionally, topical corticosteroid treatment was implemented peri-procedurally. The patient's case suggests a secondary allergic reaction to the red-orange pigment used for permanent makeup. Conclusions: The literature on this topic is scarce; therefore, we present a regimen for the management of such complications. In addition, we draw attention to the fact that allergic reactions to pigment may not always occur immediately following skin pigmentation but may become apparent long after the procedure, such as when the allergen is "exposed" during an attempt to remove or correct the makeup.

3D Slicer reconstruction combined with neuroendoscopic keyhole approach for the treatment of cerebrospinal fluid rhinorrhea：2 cases report and literature review.

Background and importance: Explore the techniques, advantages and disadvantages of 3D Slicer reconstruction combined with transcranial neuroendoscopy in cerebrospinal fluid rhinorrhea surgery. Clinical presentation: We collected complete clinical data of two patients with cerebrospinal fluid rhinorrhea who underwent minimally invasive surgery using 3D Slicer reconstruction combined with transcranial neuroendoscopy through the supraorbital eyebrow arch keyhole approach in our hospital from June 2022 to May 2023. The patients were one male and one female, aged 50 and 63 years old. At the same time, a retrospective summary of relevant literature at home and abroad in recent years was conducted. 1 case had spontaneous cerebrospinal fluid rhinorrhea with secondary cribriform plate lesion, and the other 1 case had traumatic cerebrospinal fluid rhinorrhea. Both 2 patients were ineffective after long-term conservative treatment, and ultimately recovered after detailed preoperative evaluation and preparation and surgical treatment. Conclusion: Cerebrospinal fluid rhinorrhea is a challenging disease in neurosurgery, and improper management can lead to serious complications such as meningitis. Our team used 3D Slicer reconstruction combined with transcranial endoscopic minimally invasive keyhole surgery to treat cerebrospinal fluid rhinorrhea, achieving good results, proving that this combined technology has certain advantages and is a new surgical technique worth promoting. However, the widespread application and promotion of this technology in anterior skull base surgery still require comprehensive and reliable prospective clinical studies to test.

The muscular-deep fascial system: new findings on the anatomy of the structure attached to the superior orbital margin.

Studies on the muscular-deep fascial system which connects the upper eyelid, brow, and glabella, are lacking. This study aimed to explore the fine anatomy of the muscular-deep fascial system in the region between the eyebrow and the superior orbital margin. We included eight formalin-phenol-embalmed cadavers (16 sides of specimens), and categorized them into anatomical dissections and histological sections. Five cadavers (10 sides) were dissected for gross anatomical observation, whereas all soft tissues of the other three cadavers (6 sides) were dissected for tissue sectioning and histological analysis. Three tissue blocks and 16 strips in each block were trimmed, numbered, and sliced into these specimens. Hematoxylin-Eosin and Masson's Trichrome staining were performed. In the region between the eyebrow and the superior orbital margin, the frontalis was covered by the orbicularis oculi. Fibers of the frontalis muscle penetrated into the orbicularis oculi muscle bundles, and crosslinked around the eyebrow level. Both the frontalis and the orbicularis oculi were attached to the thickened multilayered deep fascia in this region, which could be regarded as the muscular-deep fascial system. The muscular-deep fascial system connects the frontalis deep fascia and deep forehead compartments down to the orbicularis-supporting ligament. The precise anatomy of the muscular-deep fascial system in the region between the eyebrow and the superior orbital margin may provide a valuable reference for soft-tissue fixation and suspension in facial surgery.

Follicular unit extraction combined with fractional carbon dioxide laser therapy for post-traumatic eyebrow scar with defects: A prospective and comparative study.

BACKGROUND: Eyebrows play a crucial role in the human body. While Follicular Unit Extraction (FUE) is a widely utilized and highly effective treatment for typical eyebrow deficiencies, it may not yield satisfactory outcomes for patients with post-traumatic eyebrow scars and defects. OBJECTIVE: A prospective comparative clinical study was conducted to explore the treatment outcomes of post-traumatic eyebrow scars accompanied by defects using a combination of ablative fractional CO2 laser therapy with FUE. METHOD: Between January 2019 and January 2023, we enrolled 30 patients with post-traumatic eyebrow scars and accompanying eyebrow defects, randomly assigning them to experimental and control groups. Patients in the control group received FUE treatment exclusively, whereas patients in the experimental group underwent CO2 fractional laser therapy on the eyebrow scars prior to FUE treatment. Alongside the patients' baseline data and the quantity of transplanted follicular units during surgery, we will compare the follicular survival rates between the two groups at 6 and 12 months post-treatment. RESULTS: Prior to FUE, there were no notable variances in baseline data between the two-patient groups. At 6 and 12 months postoperatively, the follicular survival rate in the experimental group was significantly higher compared to the control group. Additionally, patients in the control group were more prone to experiencing postoperative asymmetry between their eyebrows and developing curly hair. CONCLUSION: For patients with post-traumatic eyebrow scars accompanied by eyebrow defects, we applied ablative fractional CO2 laser therapy in combination with FUE treatment. This approach not only resulted in a higher follicular survival rate postoperatively but also led to the achievement of a well-defined eyebrow shape.

Clinic Analysis and Effective Improvement Tips for Poor Eyebrow Transplantation.

BACKGROUND: Follicular unit hair transplantation has greatly elevated the results of eyebrow restoration. However, unnatural and unbeautiful-looking results are still often seen after the surgery. OBJECTIVES: This study focused on poor eyebrow transplantation, discussed its possible reasons, and offered refined proposals. METHODS: A retrospective analysis was performed on 100 patients who were dissatisfied with the results of eyebrow grafting and came to our department from 2011 to 2021. Demographic characteristics, primary disease, and clinical data were objectively summarized and analyzed for these patients. RESULTS: The patients' medical charts and photographs were analyzed and summarized into the following outcomes: Thirty-six patients (36%) had sparse eyebrows. Forty-one patients (41%) had eyebrows with inhomogeneous density and disordered growth direction. Eleven patients (11%) did not have single-hair grafting. Seven reconstructed eyebrows (7%) had a poor connection with the remaining eyebrows. Five new eyebrows (5%) had inconsistent hair characteristics with the original eyebrows. Lower hair survival rates, insufficient understanding of naturally beautiful eyebrows, and inadequate communication with patients were the main reasons for poor outcomes. CONCLUSIONS: Good reconstructed eyebrows should have a high hair survival rate, and hair growth direction and characteristics should also be consistent with the natural eyebrow to achieve ideal surgical effects. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anatomical perspectives of brow-lifting using threads: Clinical cases with techniques.

INTRODUCTION: Tailoring surgical interventions to target age-related transformations is paramount. Many candidates seeking blepharoplasty commonly exhibit eyebrow ptosis, underscoring the necessity for surgeons to possess a comprehensive understanding of techniques for brow and forehead rejuvenation. METHODS: Various surgical techniques are available for eyebrow and forehead enhancement, contrasting the standardized approaches in upper and lower blepharoplasty. Thread lifting has gained popularity for forehead lifting, although a more precise term would be eyebrow lifting. The thread lifting methods using V and I techniques with floating-type threads (Secret Line, Hyundai Meditech., Inc., Wonju-si, Republic of Korea) are used. RESULTS: The natural aging process often causes the forehead and eyebrows to sag under the influence of gravity, leading to the appearance of heavy eyelids. Elevating the eyebrows can mitigate droopiness, enhance vision clarity, and rejuvenate the facial aesthetic. While non-surgical methods like Botulinum Toxin A can weaken muscles and potentially aid in brow elevation, their visible effects may be somewhat constrained. DISCUSSION: Surgical methods encompass endoscopic forehead lift, eyebrow lift techniques, and scalp excision-based forehead reduction surgery, each with specific advantages and drawbacks. Thread lifting bridges the gap between surgical and non-surgical modalities. Forehead areas often lack subcutaneous fat, requiring precise anatomical understanding for effective thread lifting. Cannula usage with partial tunneling ensures efficacy even in patients with strong adhesions. Presented cases showcase successful eyebrow lifting using cog threads, illustrating immediate and gradual post-procedure changes. CONCLUSION: Eyebrow thread lifting demands periodic procedures, offering subtler improvements than surgery. Anatomical knowledge is crucial, and the technique presents discomfort. Effects last about 6 months, requiring re-treatment as effects regress. Thread lifting, a middle ground between surgical and non-surgical methods, can rejuvenate brows with less downtime.

Cutaneous Squamous Cell Carcinoma on the Eyebrow of a Woman: A Rare Case Report.

The exact incidence of cutaneous squamous cell carcinoma (CSCC) or nonmelanoma skin cancer is unknown, and it is believed that the rate of occurrence is increasing with the growing elderly population and sun exposure, and it is more prevalent in males than in females. In this article, we describe the case of an 81-year-old woman who presented with a lesion on the right upper eyebrow. The patient had been consulting a dermatologist and undergoing treatment for three months. However, the lesion did not show any signs of improvement, and the dermatologist speculated that it might be a common wound that was healing slowly because of her diabetes. Imaging revealed an ulcerating skin lesion on the right upper eyebrow without connection to the deeper structures. Surgical intervention was chosen with the patient's consent. This rare case of CSCC on a woman's eyebrow showed that skin cancer can occur in unusual locations and in people without risk factors.

Standard Orbitozygomatic Craniotomy versus Mini Orbitozygomatic Craniotomy via an Eyebrow Incision for Microsurgical Treatment of Anterior Communicating Artery Aneurysms.

Background Skull base approaches are utilized to improve microsurgical treatment of cerebral aneurysms. Advantages include early proximal and distal control, increased visualization, and minimal brain retraction. Orbitozygomatic (OZ) craniotomies via pterional incision are commonly used for the treatment of anterior communicating artery (ACoA) aneurysms. A smaller, less invasive OZ craniotomy performed through an eyebrow incision may provide several advantages over a standard OZ approach. Objective We compare surgical outcomes of the standard and eyebrow OZ for the treatment of ACoA aneurysms. Design All patients who underwent microsurgical treatment for ACoA aneurysms by a single surgeon over an 8-year period were included in this retrospective analysis. Patient demographics and clinical data were collected. Participants Thirty-seven consecutive patients were identified, with 15 receiving eyebrow OZ and 22 receiving standard OZ. Main Outcome Measures Data were collected on patient demographics, pathology, intraoperative and perioperative data, and 30-day morbidity. Results A total of 100% of the eyebrow OZ group and 95.5% of the standard OZ group had complete aneurysmal occlusion. Four eyebrow OZ and six standard OZ patients had an intraoperative rupture. All were managed without complication. Two eyebrow OZ and one standard OZ patient died within 30 days of surgery. No patients in either group had aneurysm recurrence, required retreatment, or were limited intraoperatively by exposure. Conclusions The OZ approach via an eyebrow incision has similar outcomes to a standard OZ approach and is a safe option for the treatment of ACoA aneurysms.

A Gaze into the Eyebrow Standards of Asian Versus Caucasian Women.

BACKGROUND: Eyebrow position affects perceived facial expression and youthfulness, and its modification is a key component of facial rejuvenation. OBJECTIVE: This investigation aimed to assess the preferred vertical eyebrow position, apex location, and eyebrow shape in Caucasian and Asian individuals and to analyze gaze patterns during aesthetic judgment using eye-tracking technology. MATERIALS AND METHODS: The study included 76 Asian and Caucasian volunteers with no medical background. Eye movements were captured with a Tobii Pro Nano eye-tracker. Participants viewed AI-generated images of Caucasian and Asian females with varied eyebrow positions (ratios 1:1.3 to 1:2.5), shapes (angles 8° to 20°), and apex positions. Aesthetic preferences were rated on a 5-point Likert scale. Eye-tracking metrics and aesthetic ratings were statistically analyzed using ANOVA and bivariate correlations. RESULTS: Both genders across ethnicities preferred a moderate eyebrow position ratio of 1:1.6. For eyebrow shapes, a 12° angle received the highest ratings, while extremes were less favored, indicating a preference for moderately curved eyebrows. The most appealing apex position was above the lateral canthus for Asians, and halfway between the lateral limbus and lateral canthus for Caucasians. Eye-tracking revealed longer fixations on unattractive features, suggesting more complex cognitive processing, while attractive features were processed more efficiently. CONCLUSION: The study revealed that aesthetic preferences for eyebrow features are influenced by both ethnic background and gender, with a general preference toward moderately curved eyebrows and subtle variations in preferred positions. These findings suggest a need for culturally sensitive approaches in facial aesthetic procedures and highlight the potential of eye-tracking technology to enhance surgical planning. Surgeons are advised to adopt a conservative, patient-centered approach when modifying eyebrow features, considering individual and cultural aesthetics to maximize patient satisfaction. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Endoscopic Eyebrow Approach for Aneurysms.

INTRODUCTION: Considerable effort has been made to reduce surgical invasiveness, since Axel Perneczky introduced the supraorbital eyebrow approach as a core part of his keyhole concept in neurosurgery. But a limited approach does not facilitate an already serious and demanding task as aneurysm surgery. In this regard, the enhancement of the visual field before, during, and after microsurgical aneurysm occlusion is a safe and effective method to increase the quality of treatment. Indications/Contraindications: Based on the individual anatomical findings, the supraorbital keyhole approach provides access to most aneurysms of the anterior circulation. The approach is not recommended in large complex aneurysms, giant aneurysms, BA aneurysms located beneath the dorsum sellae, as well as cases of severe subarachnoid hemorrhage (SAH) and expected brain edema. COMPLICATIONS: Experience with endoscopic procedures in aneurysm surgery is limited to several clinical retrospective articles, and no major complications in conjunction with the endoscope were observed. Outcome and Prognosis: The supraorbital eyebrow approach has a low rate of complications and provides highly favorable cosmetic results. Endoscopic inspection prior to clipping might reduce overexposure and mobilization of the aneurysm. It was found that the rate of intraoperative rupture was decreased. The endoscopic post-clipping control helped significantly to reduce aneurysm remnants and unattended parent, branch, or perforator occlusion. CONCLUSION: The supraorbital eyebrow approach is a safe, effective and elegant approach in the treatment of most aneurysms of the anterior circulation. The additional enhancement of the visual field provided by the endoscope before, during, and after microsurgical aneurysm clipping might decrease the rate of intraoperative aneurysm ruptures and unexpected findings concerning aneurysm remnant occlusion and compromise of involved parent, branching, and perforating vessels.

[Frontozygomatic dermoid cysts]. / Kystes dermoïdes fronto-zygomatiques.

Dermoid cysts are embryological derivatives from soft tissues. They result from an ectodermic inclusion in the mesoderm, during the early embryonic development. These cysts have a slow development and are mostly encountered in the pediatric population. Eighty percent of them are located in the head and neck area, and most of them are on the frontozygomatic suture. They are superficial or deep on clinical examination. The diagnosis is mostly easy, sometimes with the help of radiological examination. The confirmation is histological. Surgical removed by an open approach, without cyst rupture is the gold standard treatment.

[The useful forehead, the impaired forehead, but the forehead repaired!] / Le front utilisé, le front traumatisé, mais le front réparé !

The forehead, although sometimes hidden by a fringe, is a major region of the face revealing many expressions such as fatigue, surprise, concern, anger… In reconstructive surgery, the forehead is frequently used as a donor site. This article looks at three aspects: the used, traumatised and repaired forehead. The forehead, with its high-quality hairless skin and proximity to the noble structures of the face, is a central donor site. The forehead flap is commonly used for nasal reconstruction, with several variations to meet different needs. Other pedicled flaps, such as the supra-eyebrow flap and the crane flaps, are also used for various facial reconstructions. The forehead can be affected by trauma, burns, vascular lesions and skin tumours. We are particularly interested "en coup de sabre" linear scleroderma, an autoimmune disease that causes cutaneous and subcutaneous fibrosis, sometimes associated with Parry Romberg syndrome. In addition, lesions of the temporal branch of the facial nerve lead to muscular paralysis, affecting the aesthetics and function of the frontal region. Precise knowledge of the anatomy of the nerve pathway is crucial to avoid iatrogenic lesions. The entire arsenal of reconstructive surgery is useful for repairing the forehead. Controlled wound healing, tension suturing and the use of local flaps are key techniques for repairing the forehead. Tension sutures are particularly effective for small losses of substance, and their orientation depends on the location. Advancement, rotation and transposition flaps are used for larger losses of substance. Skin grafts, although less aesthetic, are sometimes necessary. Skin expansion, although socially restrictive, is used to treat congenital giant nevi and increase the surface area of forehead flaps.

[Reconstruction of eyebrows by follicular transplantation]. / Reconstruction des sourcils par greffe folliculaire.

The eyebrow is an aesthetic unit playing an important role in the balance and expression of the face. It consists of hairs whose different orientations make its complexity. The main causes of eyebrow alopecia are repeated eyebrow plucking, reduced density due to age, and post-traumatic alopecia. Follicular transplantation is a simple surgical technique that corrects most cases of eyebrow alopecia. This involves implanting hair follicles, taken from the scalp or, more rarely, from a hairy region of the body, into the bare or sparse area of the eyebrow.

FUE as the first surgical option for hair reconstruction on scalp and facial skin grafts - case report.

Post-combustion alopecia presents a complex medical challenge with implications spanning dermatological and psychiatric disorders. The use of hair transplantation has proven to be a significant improvement for this condition. However, the current management involves various techniques, each with advantages and disadvantages. Progressive skin expansions, surgical scar reduction, and skin grafts containing hair follicles yield unsatisfactory aesthetic outcomes and have limited applicability as a first-line treatment for fire victims. So far, follicular unit extraction (FUE) has proven to be one of the most versatile procedures in such cases, having the potential to restore a natural anatomical profile closely resembling the pre-traumatic appearance that led to the traumatic alopecia. Additionally, it contributes to the improvement of associated psychiatric comorbidities, facilitating proper social reintegration and enhancing overall quality of life. This report focuses on a case of post-combustion alopecia and severe facial distortion due to third-degree burns resulting in severe psychiatric comorbidities, which benefited from a proper social reintegration and improvement of the quality of life after three consecutive sessions of FUE for scalp and eyebrow hair.

Dual-plane lift-and-hold technique for brow ptosis in young patients with facial paralysis.

BACKGROUND: Direct browlift is useful but leaves a scar above the brow. We proposed a dual-plane browlift to avoid facial scarring while effectively resolving brow ptosis in young and young adult patients. METHODS: Seven patients with facial palsy underwent dual-plane browlift between July 2018 and June 2022. The mean postoperative follow-up period was 31.9 months. Skin resection at the hairline was combined with subcutaneous dissection down to the inferior margin of the brow to "lift" the brow. Fascia lata strips were fixed to the dermis just inferior to the eyebrow to "hold" the brow, and the strips were suspended upward through the subperiosteal tunnel and fixed to the periosteum. Brow height was compared before and after the procedure and with the contralateral side. RESULTS: The reported complications included slight hematoma at the recipient site, temporary difficulty in closing the eye, and seroma at the fascia donor site. The paralyzed side showed significant differences between the preoperative period and postoperative months (POM) 3, 6, and 12, but differences were not shown in the intervals between POM 3 and 6, 6 and 12, or 3 and 12. The difference in eyebrow height between the paralyzed and nonparalyzed sides was significant preoperatively but not at POM 3, 6, or 12. All scars matured well, and the fascia silhouette was not visible in the forehead region. CONCLUSIONS: Dual-plane browlift enables rigid suspension using the fascia lata and excises flaccid skin without leaving facial scars, yielding excellent cosmetic quality and stable long-term outcomes.

A Modified Subbrow Blepharoplasty for Correction of Severe Upper Eyelid Skin Laxity.

BACKGROUND: Periorbital aging is characterized by dermatochalasis, lateral hooding and malformation of multiple eyelid creases. Rejuvenation of periorbital region is of great concern in aging Asians, especially for the females. However, the conventional subbrow blepharoplasty was indicated for mild or moderate skin laxity. For severe laxity, double-eyelid incision is necessarily to be involved. This study aims to improve the severe upper eyelid dermatochalasis through an extended subbrow single-incision approach with desirable outcomes. METHODS: Patients underwent this surgical method from October 2020 to April 2022 were retrospectively reviewed. The redundant skin and orbicularis oculi muscle were excised through a spindle-like subbrow incision delicately designed in the sitting position. Surgical outcomes were evaluated by heights of designed line from the palpebral margin to the pupil center (HPPC), medial cornea (HPMC), and lateral canthus (HPLC) at different follow-ups. The overall satisfaction score of cosmetic outcomes was assessed by an independent surgeon and patients themselves based on the evaluation of: subbrow scar, eyelid symmetry, lateral hooding lifting, visual block improvement and brow shape. RESULTS: A total of 75 cases were reviewed, including 3 men and 72 women. The preoperative HPPC, HPMC, and HPLC were 4.27 ± 0.40, 4.72 ± 0.45 and 3.41 ± 0.35 mm. The values were postoperatively improved to 7.01 ± 0.46, 6.57 ± 0.34 and 5.69 ± 0.26 mm, respectively, presenting significantly different (p < 0.05). The mean surgeon satisfaction scores were 3.6 ± 0.6 (range, 2.0-4.0), and patient satisfaction scores were 3.5 ± 0.6 (range, 2.0-4.0). No hypertrophic scar, sunken upper eyelids or other complications was found. CONCLUSIONS: The modified subbrow blepharoplasty method is an effective and safe alternative for correcting severe upper eyelid skin laxity, which can achieve both good cosmetic outcomes and functional improvement. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Paracoccidioidomycosis after eyebrow micropigmentation: Unusual reactivation or a new form of transmission by cutaneous inoculation?

We report a case of unusual paracoccidioidomycosis reactivation after eyebrow micropigmentation in a Brazilian patient. The cutaneous lesion was the only clinical manifestation. Direct cutaneous inoculation in dermal tissues with Paracoccidioides sp. is extremely rare, explaining why paracoccidioidomycosis is not classically considered a cutaneous implantation mycosis.