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Introduction to Hair Transplant
Hairline Design
The first step in hair
replacement
is the design of the proposed hairline. In a way, it is also the
most important step and upon which the remainder of the procedure is
based upon (unless of course the objective is only to fill the central midscalp and/or crown). The hairline is also the most obvious
part of a hair transplant given its exposed position right in the front.
Accordingly, a properly designed hairline will establish a suitable
frame to the face and create a frame as well for the remainder of the
hair transplant work.
Good hairline design is truly
an artistic endeavor that combines experience, judgment and a keen artistic
eye. The surgeon must contemplate how that hairline will properly
fit a person’s facial features, stage of hair loss, shape of the
existing temple hairline, etc. To fully convey the artistic part
of hairline design is clearly impossible in this tutorial. However,
certain guidelines do exist to help a prospective patient understand
how Dr. Lam and Ms. Karamanovski design a hairline. Part of the
reason for this tutorial is to explain what should not be done when
designing a hairline, as some patients who do not understand the principles
of natural hairline design request a hairline that is too low or too
wide that would look, in short, unacceptably unnatural. Unfortunately,
a large percentage of work performed at the Lam Institute is
correcting
work done by other surgeons who also do not understand these fundamental
principles.
This tutorial will focus
almost entirely on defining the overall shape and position of the hairline.
It will not focus on how to create the actual recipient sites that soften
the hairline into a natural, undulating and irregularized zone of transplanted
hair. A hairline is truly not a line by the time the procedure
is actually carried out. The strong line that is designed at the
beginning of the case is transformed into a softened zone of transplanted
hair that resembles the irregular contour of a coastline with its natural
outcroppings of jetties and eddies. Therefore, a hairline can
be divided into a “macro” hairline that is defined by the
overall shape and position and a “micro” hairline that is
composed of the actual creation of recipient sites that accommodate
the hair grafts. This section will focus entirely on the “macro”
hairline. For a discussion of the components that define the “micro”
hairline, please visit the
recipient
site section of this website and, more specifically, the hairline
recipient site video (Quicktime
| Windows
Media) in that section.
Hairline Position
The first place to begin
hair transplant hairline design is to designate the lowest acceptable point of the central
hairline, which is defined by the transition from the horizontal to
the vertical scalp, as illustrated.
As the scalp gradually slopes
from a horizontal to a vertical orientation, the intersection at 45
degrees represents the point below which the hairline will appear unnatural.
Of course, the hairline may be designed above this point based on the
shape of one’s head, type of hair loss encountered, recession
of the temporal hair, among other criteria. Alternatively, the
hairline can be designed slightly above this central point with a widow’s
peak that approaches or meets this point instead.
As a reminder, this tutorial is not intended to be exhaustive and describe
every permutation that can exist or every principle of hairline design
ever proposed but to offer a basic lesson on what constitutes a natural
looking hairline.
The hairline from a profile
view also should slope upwards gently and never the reverse, i.e., slope
downward. When designing a hairline, it is important to view the
hairline from the front, obliquely from both sides, both profile views,
top down, and in a mirror to ensure that the slope, angle, shape, and
position are just right before beginning the hair transplant.
Hairline Shape
The shape of the hairline
should be designed in such a way as to match a patient’s head
and facial features. For instance, a wider head should have a
hairline that matches the wider arc of the frontal scalp. Conversely,
a narrower head should be designed with some suppression (concavity)
of the outer limit of the hairline. Of course, rules are made
to be broken. And that is where artistry and science meet.
In addition, calculating the number of hairs that must be dedicated
to the central scalp, the hairline, and the temple may also influence
the possible design of a hairline. All of these considerations
must be weighed when contemplating the perfect hairline shape for a
particular individual.
Temple Position and Shape
Where does the
hairline end? Have you noticed why you immediately can spot a
“combover”? The reason that a combover looks unnatural
is that hair in the temple is swept over the central hairline, which
is not how hair grows and falls on a non-receding scalp. The outer
limit of the hairline falls along an imaginary point drawn through the
outer corner of the eye. Any hair that falls outside of this line
should be considered temple hair and should be recreated as such.
That is why poorly designed hairlines that violate this rule, i.e.,
extend beyond the outer limit of this line, always look unnatural and
are very hard to correct when poorly executed. As mentioned in
the
recipient
site section of this website, the temple hair grows at different
angles to the hairline and should be recreated differently.
When designing
the hairline, the position and shape of the temple hair must always
be considered. The temporal angle represents the “unzipping”
of the hairline and the temple and should exhibit an angle in which
the temple and the hairline roughly match in shape and in angle.
This is why a “toupee” or a hair system can at times be
easily spotted as unnatural. If the toupee extends forward without
temple hair that matches it, it creates what is known as a “lid
effect” and thereby may appear unnatural. The temple to
hairline angle should closely match. If someone wears a hat to
camouflage one's baldness, all you have to do is look at the degree
of temple recession to estimate how much loss that person has centrally
along the hairline. When designing a hairline, always respect
the relative position and shape of the temples.
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