Today I would like to discuss hairline design in Hair Transplantation. Many factors need to be taken into account when considering how to design a hairline in a Hair Restoration procedure. The patients age and eventual donor to recipient ratio are two very important factors to take into account when designing a hairline. When examining a patient for the first time, I always estimate the patients eventual hair loss pattern. By doing this I can estimate how many grafts the patient will eventually need to cover all the thinning areas, not just the areas that are thinned at the time of examination. I can also estimate the patients total donor supply (the total amount of grafts the patient will be able to donate from the permanent hair zone). In patients who are younger (under age 35) and experiencing hair loss, chances are they are going to lose much more hair over the next 30+ years. Many times these patients want to be very aggressive with their hairline design and location because they cannot imagine how much more hair they are going to lose and how much donor hair they will eventually have. My job is to educate the patient as to why we need to be conservative with the hairline design in a young patient undergoing the procedure for the first time. I explain that every persons donor reserves are finite and once the donor hair is depleted, there is no more. That is why it is so important to use every hair in the most judicious way so that the patient ends up with a completely natural result that looks as good when they are 35 as it does when they are 65. I always try to stay on the side of being more conservative in the hairline design on a patient’s first hair transplant procedure. Everyone who has this procedure once has it performed at least a second time, so I typically explain that I would prefer to bring the hairline down a little in a second procedure rather than risk depleting donor reserves or placing the hairline in a unnaturally low position. You can very easily lower a hairline, but once the hairline is too low, you have a problem. Also, if given the choice of having a slightly more mature hairline with greater density, or a lower hairline with lower density, most people will always choose to have more density and a slightly higher hairline. Older patients with mild to moderate thinning can have a more aggressive hairline design as in most of these cases there is no risk of depleting the permanent donor reserves. Another consideration is hair to skin color contrast. Dark hair on light skin shows through more than light hair on light skin or dark hair on dark skin, so in patients with a non-ideal hair to skin color contrast, this must also be taken into account on how aggressive to get in designing the hairline in their hair transplant procedure. Hair curl and caliber also play factors as a slight increase in hair diameter by only .1mm can add up to a 30% increase in cosmetic density and curly hair also can add greater amounts of cosmetic density than fine straight hair. Finally, the most important factor in designing a hairline is to maintain a irregular irregularity to the hairline. There can be no straight lines and the irregularity cannot be in a linear fashion. This is something that is not appreciated by many physicians practicing in the field of Hair Transplant surgery today. A bad hairline design is a dead giveaway for a hair transplant and must not occur under any circumstances. Only single hair grafts must be used in the first 2-3 mm of the hairline, and we always tend to use the finer grafts in the hairline.
Thank you for reading my brief explanation on my approach to hairline design in Hair Restoration procedures.
All the best,
Marc Dauer, MD