Well, Actually is a column by Slate’s Shannon Palus. She tests health and wellness products to help readers figure out what they should try, what they should skip, and why.
The main reason people come to Robert Bernstein for work on their eyebrows is because they have adhered to eyebrow trends too well. Bernstein is a dermatologist specializing in hair transplants, and these days, he spends a lot of time reversing the work of overzealous plucking and waxing done back when thin, rounded brows were popular. I always suspected that the idea that you could inflict lasting harm on your brows by overthinning was a myth meant to make young women feel worried, in the same genre as masturbation making hands hairy, or funny faces getting stuck like that. But the hair follicles really can be damaged from all that repeated removal, says Bernstein: “The hair eventually gives up.”
Adding eyebrow hairs back onto a face is a process. Refreshed eyebrows cost, on average, about $5,700 a pair, Bernstein estimates. (I am reminded of the Dr. Seuss tale, The Sneetches, where beach-faring, bird-humanoid creatures pay to have stars taken off their bellies, then removed, then put back on, as the trend undulates.) Each transplant procedure takes several hours: Bernstein takes hair follicles from the patient’s scalp four or five at a time, and places them in the brow, one by one. Part of the reason it takes so long is because the hairs in eyebrows change direction as they near the nose, “like a feather,” and if you arrange them wrong, it’s permanent. In fact, Bernstein says it’s the most challenging procedure that he does.
Faced with a face desiring thicker brows, cosmetic surgery isn’t the first thing Bernstein recommends, especially if thin or patchy brows aren’t the result of damaged follicles but genetics. Instead, he recommends a topical treatment called bimatoprost, a chemical that encourages hair to grow for longer than it would left to its natural devices. This is also the active ingredient in Latisse, a serum that can be used off-label for eyebrows. I tried the stuff myself over several weeks in an attempt to bolster my own (naturally) patchy brows. Though it’s a prescription, I got my hands on some via the magic of internet medicine, after answering a few questions about my health history and uploading a photo of myself for a doctor to review. Bernstein also recommends patients try out minoxidil, aka Rogaine. I had already tried to Rogaine my eyebrows to life a couple years ago, at the suggestion of a dermatologist, to little success, so it was on to Latisse this time.
Bimatoprost is a synthetic version of a hormonelike substance, prostaglandin, that our bodies make naturally. The first use of bimatoprost was not to lengthen hairs but to lower the pressure inside people’s eyeballs, to reduce possible damage to the optic nerve, also known as glaucoma. It came on the scene in the early 2000s, delivered in an eyedrop branded as Lumigan. A big side effect was immediately apparent: “We’ve always known that glaucoma drops causes people to have longer lashes,” says Selena Fu, an ophthalmologist in Missouri, who used to use Latisse herself, to plump up her lashes. (She is also now a sales rep for Rodan & Fields, which makes a competing eyelash serum with another kind of synthetic prostaglandin, though she says she’s too lazy at the moment to use it.) In one study of nearly 1,000 patients using Lumigan to help their glaucoma, about half reported hair growth, making it the most common “adverse effect” of the drug, alongside eye irritation. Five percent of the participants who used the drug once a day also experienced a change in color on their eyelid(!).
In 2008, the makers of Lumigan got FDA approval for Latisse, with the same active ingredient and the same tiny turquoise-capped dropper bottle. But Latisse was specifically designed to grow eyelash hair, so it came with tons of disposable brushes, the size of a fat eyeliner brush, that you are supposed to use to paint the serum across your lid. (A fresh brush each time, for each eyelid, ensures that if one eyeball is infected, you’re not spreading around that infection.) You do this once a day, being careful not to let the serum drip, or not to fall asleep with your arm against your lid, lest you end up with a patch of enhanced arm hairs, which is what happened to a patient of Fu’s.
It was shortly after the release of Latisse that one of Bernstein’s colleagues figured it might work on brows too. In 2012, Bernstein and colleagues published a case study of a woman who came to their hair transplant clinic seeking help for her left eyebrow, which had been sporting very thin hair for many years (her right eyebrow was fine). They had the woman try using bimatoprost on the brow every other day for four months. It appeared to work, thickening her eyebrow, and making the hair darker. When patients heard about this new use for Latisse, Bernstein and his colleagues started prescribing it for brows frequently. “In the art of medicine we’re able to use things in any way we want,” says Bernstein, who, like so many people promoting procedures and potions, makes me think of my face as that of a living doll as I take on the endeavor of swiping Latisse across my brows each night.
Latisse claims that, applied to eyelashes, the drug works for about 80 percent of people. (It’s worth noting that in that same clinical trial, 20 percent of people reported finding the placebo effective at lengthening lashes.) In another study, paid for by and completed with help from employees of the manufacturer, a similar proportion of people experienced at least some improvement in their eyebrows after using Latisse, though a full 40 percent of the control group did too. More pertinently, just 18 percent of people in the Latisse groups noted that they were “very satisfied” with the change, and that’s probably on the high end, considering where the funding came from here. (Evidence from another study that compared the active ingredients in Latisse and Rogaine showed that Rogaine works about as often.) Caution that Latisse may not perform miracles goes double for people who have waxed and plucked a lot: Latisse cannot spawn new hairs—it can only make weak ones bigger. Bernstein advises that if you start using Latisse to use it on just one eyebrow, letting the other eyebrow act as a control. (This smart advice came too late for me, as I had already been using it for both, but it might not have worked anyway, because my eyebrows each have their own “look” in terms of where the hairs are distributed.)
Is it safe to buy Latisse or a similar eye-hair drug online with minimal oversight from a doctor? Bernstein advises against it, out of concern for drugs that are fake or tampered with, and patients not adequately understanding the risks if they’re not communicated directly by a doctor. If you’re seeking it out because your hair has started thinning suddenly, that’s a good reason to check in with a pro about what else might be going on. Rodan & Fields is currently caught up in a class-action lawsuit from consumers who say they were not warned of the side effects. That said, experts I spoke to emphasized that side effects from lash-enhancers are minimal, and, though eye irritation is possible, they are mostly cosmetic especially when applied to brows. After all, even if you use it on your lashes, you’re not dropping it into your eyeball. (As long as you’re careful, you’ll skirt that potential irritation.)
Latisse
Time investment: 30 sec./day
Value: Low
Effectiveness: Depends!
Delightfulness: Low
Rec: If you’re up for spend-y experiment.
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A main side effect of prostaglandin analogues is skin pigmentation, which both Bernstein’s case study patient and Fu herself experienced. Fu reported her own eyelid-color shift and that of three others in a 2010 case study, which includes before-and-after photos to illustrate how her lids became slightly brownish-red. But she didn’t really mind. “It’s almost like having eye shadow,” she told me. Plus, it seems to go away once you stop using it. Still, this was enough for me to stick to using it on my brows. Latisse can also make your actual eye color browner, a side effect that is infrequent, but “likely to be permanent,” according to the manufacturer.
There’s a bigger reason I won’t keep using Latisse: It just didn’t do anything noticeable enough after two months of use. Yes, you’re supposed to keep using it for three to see the full results—but according to the manufacturer, most people see fuller and darker hairs by now. The solution costs $100 per little bottle (an amount that is supposed to last just a month, though mine stretched easily to two, even following the directions to use one drop per eye-hair area; the use for brows is technically still off-label). Even still, that’s enough money that I needed more impressive results to keep investing. If you have the money, I still think it’s a worthwhile experiment to try for yourself, and certainly more economical than going full brow transplant, at least in the short term. But at this rate, it’s clear that on my brows, Latisse doesn’t beat my favorite eyebrow pencil.
