Do Eyelashes Grow Back?
Yes, eyelashes do grow back after loss as long as the hair follicles remain intact and undamaged. 1, 2
Understanding Eyelash Regeneration
Eyelashes follow a natural growth cycle similar to other body hair, but with unique characteristics that affect their regrowth potential:
- Hair follicles retain regenerative capacity indefinitely when not destroyed by scarring, trauma, or disease, allowing for potential regrowth even after many years of loss 1
- The eyelash growth cycle consists of distinct phases (anagen/growth, catagen/transition, telogen/resting), with a relatively short anagen phase compared to scalp hair 3, 2
- Mouse models demonstrate that eyelash follicles complete their growth cycle earlier than pelage hairs and have strictly regulated exogen (shedding) phases 3
Critical Factors Affecting Regrowth
The key determinant is whether follicles are intact or destroyed:
- Non-scarring conditions (like alopecia areata, temporary trauma, or medication side effects) preserve follicle integrity and allow full regrowth potential 1, 4
- Scarring conditions (such as chronic blepharitis with cicatricial changes, burns, or sebaceous carcinoma) permanently destroy follicles and prevent regrowth 5
Clinical Conditions and Prognosis
Conditions with Good Regrowth Potential
- Alopecia areata: As long as follicles are not destroyed, regrowth potential remains, though recovery from severe forms (alopecia universalis) occurs in less than 10% of cases 5, 1
- Temporary medication effects: Eyelashes typically regrow after discontinuation of causative agents 4
- Mechanical trauma or trichotillomania: Follicles usually remain viable if not repeatedly damaged 5
Conditions with Poor Regrowth Potential
- Chronic blepharitis with scarring: Focal lash loss (ciliary madarosis) may indicate permanent follicle damage, especially when associated with conjunctival cicatricial changes 5
- Sebaceous carcinoma: Loss of normal eyelid margin anatomy and focal lash loss are concerning signs requiring biopsy 5
- Ocular mucous membrane pemphigoid: Cicatrizing disease leads to permanent follicle destruction 5
Treatment Options to Enhance Regrowth
When follicles are intact but eyelash growth is suboptimal:
- Prostaglandin F2α analogues (bimatoprost, latanoprost) can stimulate eyelash growth, with bimatoprost FDA-approved for hypotrichosis, making lashes longer, thicker, and darker 5, 6
- Evidence for prostaglandin analogues in alopecia areata-related eyelash loss shows mixed results: one study demonstrated 45% achieving complete or moderate regrowth over 2 years, while shorter trials showed minimal response 5
- Bimatoprost extends anagen duration without causing follicle neogenesis, resulting in more and longer eyelashes 3
Important Clinical Pitfalls
Always investigate persistent unilateral eyelash loss or asymmetric patterns:
- Chronic unresponsive "blepharitis" with focal lash loss may indicate sebaceous carcinoma requiring urgent biopsy 5
- Marked asymmetry, resistance to therapy, or loss of normal eyelid margin anatomy warrant pathological evaluation 5
- Before biopsy for suspected sebaceous carcinoma, consult pathology regarding frozen sections and conjunctival mapping for pagetoid spread 5
Distinguish between reversible and irreversible causes:
- Microscopic evaluation of epilated eyelashes can identify Demodex mites in chronic blepharoconjunctivitis, a treatable cause 5
- Look for signs of cicatrizing disease (subepithelial fibrosis, fornix foreshortening, symblepharon formation) that indicate permanent damage 5
Timeline and Expectations
- Natural eyelash growth is slower than scalp hair, with a growth rate that has been documented through imaging and follicle studies 2
- Even in cases of longstanding loss (35+ years), follicles may remain viable and capable of reactivation, though this is uncommon 1
- The eyelash follicle is sensitive to external environmental factors, systemic/topical medications, and cosmetics, all of which can affect regrowth 2