Planning of hairline design and follicular grafts placement is of extreme importance to the successful aesthetic and natural final result of a hair transplant. It is one of the most intricate aspects of the procedure. It is difficult to master, and therefore this is the area where the most mistakes are made.
While planning a hairline in men it is very essential to remember that thinning is a process which continues throughout life, and that there is a limited quantity of hair available for harvesting from the permanent donor region. There is a possibility of running out of enough hair to transplant both the frontal as well as crown regions. As a matter of fact, in most cases of MPB, it is usually sensible to correct the front one-third to half of the scalp and leave the crown completely. Another alternative is to wait for the right time when the front region of the head gets completed and then decide considering the concern of the patient with the crown and is there adequate hair left to treat that area.
We can divide the scalp into some important zones; the three regions with good potential to be treated are the frontal region, mid-scalp, and vertex (crown).
For recreating a frontal hairline, we draw a line from the midline anterior most point or mid-frontal point (MFP). Usually we place this point at 7-11 cm above the midglabellar line, approximately at the point where the fore head transitions from being vertical on the front to gradually sloping posteriorly.
In the next step, a curved line is drawn from the mid-frontal-point (MFP) moving upward and to the lateral side of the apex, which is the highest point of the fronto-temporal recessions.
While transplanting the frontal and mid-scalp regions, a keen eye should be kept on the mid-portion of the posterior hair line which must not advance the vertex transition point (VTP). Ahead of the “VTP” the hair direction starts changing and the hairs of the crown start taking the shape of a whorl, and there is a radial swaying in a 360 pattern.
The variety of hairline placement patterns depend on multiple factors such as the age of the patient, nationality, extent of present and possible further thinning hair loss patterns and expectations An isolated frontal forelock may be planned if the patient is very bald or very young patient with a possibility of getting very bald in the future.. This is one of the safest ways to accomplish a conventional hair relative to a considerable balding area.
The Crown:-
The crown, when transplanted does not give as much cosmetic gain as compared to the front. Some men show less concern about the vertex as they do not notice it and are unwilling to treat that area. Limiting crown transplantation just to a single or two sessions of light coverage can provide the patient as well as the surgeon with additional donor hair in reserve if any concern arises in the future.
Hairline that is too angulated, symmetrical and sharp can be eye-catching and render an unnatural look. The anterior hair line is a little wavy (or feathered) in an irregular manner, so that the hair line is softened and abrupt straight lines are avoided. An initial defined zone of evenly spaced single hairline. Anterior to this zone, micro-irregularities employing three to four single-haired FUs are utilized in clusters as well as scattering random. Single-haired FUs, placed erratically in front and between groupings. In this way the hairline is softened and abrupt straight lines are avoided. What is created is a gradually increasing density in a hairline zone, approximately 5-10 mm in width.
Dr Pradeep Sethi, MD (AIIMS, New Delhi)
Dr Arika Sethi, MD (AIIMS, New Delhi)
429, Street number -8, Rajender Nagar, Dehradun
+91-8057541540, 0135-2750096
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