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Chapter: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |17 | 18
PATIENT GUIDE TO SURGICAL & MEDICAL HAIR
RESTORATION
PAGE 10 |
The All-Important Hairline: Our Facial Frame |
| The frontal hairline is singularly the
most important feature of the entire head of hair. It is the aspect of our
hair/skin interface that we, and others, see first. When we look in a mirror, or
walk into a room, when someone sees us and makes eye contact for the first time,
the hairline stands out. On a subconscious level, beyond the rational, it speaks
volumes about our age, attractiveness, suitability as a mate, even about our
health and vitality. Why is the hairline of such significance? It frames the
face. This simple statement belies the artistic and cosmetic impact of this
all-important frontal zone. One of the reasons that many men with frontal
balding instinctively go for the "comb-over" effect, is that it creates a
hairline of sorts; it frames the face at the top and at the temples. The problem
is that it is so patently obvious to everyone else as an attempt to disguise the
balding. Framing of the face is an artistic metaphor. Imagine a painting without
a frame. It may be a pleasing image, but it is incomplete. Add a nice, tasteful
frame and voila! You have a complete, aesthetically appropriate presentation.
Similarly, frontal hairline balding takes away the frame; restoring the hairline
restores the frame. The resulting appearance is one of youth, vigor and
vitality. |
Planning the Hairline |
| Often, hairline planning is a compromise
between the patient and the surgeon. This does not imply that the patient does
not know what is best for him, or that the physician is wiser. What it does
imply is that people have a tendency to want the hairline too high or too low.
The low, rounded adolescent hairline will look inappropriate on a 40 year-old
man. In fact, it may lend a caveman or "Neanderthal" appearance to his visage.
Young men in their early twenties may require repeated explanation of the
reasons for not creating an adolescent hairline for them. They still remember
quite vividly (unlike the middle-aged man) their own, low hairline at the age of
sixteen. Often, they are rather distraught about their loss of hair, and do not
identify with their future selves at thirty, forty, or fifty. This is where the
ethical hair restoration surgeon must explain and counsel for the patient’s
benefit, rather than playing on fears and illusions in order to make a quick
profit. Conversely, a middle-aged man seeking hair restoration surgery may fear
that a hairline that is not adequately receded at the temples may seem
unsuitable for his age. The fact of the matter is, that a hairline placed too
high accentuates the balding, by focusing attention on the wide, high expanse of
the forehead and frontal area. This concept may be easy enough to visualize if
properly explained. At any rate, if one must err slightly to the extreme, it is
always better to start slightly too high, than with a hairline that is too low.
One can always, in a second session, bring the hairline down by artfully adding
follicular units in front of the existing border. Still, it is much more
desirable to get the hairline right on the first try. After all, the primary
goal of almost all first hair transplant sessions is to re-establish the
hairline and frontal region, in order to frame the face. This facial framework
achieves the most dramatic cosmetic and visual effect of hair restoration
surgery. |
Hairline Repair or Revision |
| Repair or revision of the poorly done
hairline is one of the most rewarding facets of the hair surgeon’s art, and
often one of the most challenging. The border may be overly regular, with a
symmetry that defies nature; conversely, it may by so disordered and
asymmetrical as to be unnatural. Again, it may appear tufted, revealing the
so-called doll’s hair effect. It might be too high, or more likely too low.
Sometimes, the hairline is so overly rounded across the forehead as to be
"bowl-like" in nature. All of these deficiencies can be corrected to some
extent. The most difficult to correct is the low hairline. Even if the grafts
are large ones, and can be cut out and dissected into follicular units (FU’s)
for use elsewhere, scarring will result. This can be partially treated with
dermabrasion and possibly lasers, but unless hair from further back can be
styled forward to cover them, the scars will be detectable to some degree. We
see here a graphic example of the necessity for good, rational, artistic
planning when dealing with the hairline. Again, get it right the first time! The
unnaturally straight or regular frontal border may be revised with the careful,
selected placement of follicular grafts in front of, and among, the existing
grafts; also, large grafts within and behind the hairline may be excised and
re-used if necessary, with the hair around them acting as scar camouflage.
"Softening" of the hairline is accomplished with the judicious use of single
hair FU’s, in a more random pattern, which is harder than it sounds. Humans have
a tendency when performing repetitive tasks, (such as making recipient
incisions), to fall into a pattern of some regularity. It requires skill and
effort to defeat this tendency and to achieve "randomness"; it’s not truly
random, however, but more a "controlled disorder". There are several possible
remedies for an overly rounded hairline. One can blunt the fronto-temporal
angles at the sides of the head to apply a more graceful curve to the margin.
Alternately, a "widow’s peak" may be constructed at the middle of the forehead,
which will soften and break up the arc of the frontal border. In the event the
hairline has temporal recessions that are inordinately deep for the patient’s
ethnic or racial background, then these concavities may be moderated by adding
FU’s; this will render the margin "flatter". Finally, a repair session can be
exploited to increase the density of the frontal area, if adequate donor
reserves exist. This technique can also be employed to fill in around
mini-grafts that look "tufted", or just to augment the density after an initial,
successful follicular unit transplant. To reiterate, the frontal hairline is the
most important area to be considered in most men with pattern baldness.
Reestablishing the hairline has a great cosmetic impact, regardless of the
degree of balding, and should generally be the goal of the first session of
follicular unit transplantation. It must be remembered that reconstruction of
the frontal area will have a profound aesthetic impact on the balding person,
even if there is a limited store of donor hair. |
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