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Dr. Christopher Tzermias

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Right hairline design. Why is it so important.

It is easy to understand that someone had hair transplantation if the hairline does not look natural.

The key to a natural looking hair transplantation is good hairline design.

The hairline – i.e. the first line of hair at a person’s forehead – is the part of the hair that is most seen in social interactions. It is the part that is examined when the wearer looks in the mirror several times each day. If the hairline does not look natural, then the hair transplant will be noticed. A hair transplant should be seen, but never noticed.

Hair transplantation techniques that were used in the past had unsatisfactory results, mainly due to the poor hairline they were referring to. In close company, the wearer was often embarrassed to notice other peoples’ eyes being drawn up to their hairline, which was formed by unnatural lines of hair tufts. This is the reason why the result of older hair transplantation techniques was characterised as “doll’s look”, a problem that we overcome with the modern Advanced Micro-FUE technique.

Punch grafting, in which parts of the scalp are transferred from the donor to the recipient areas, provided high density in some parts of the scalp, but with appalling hairlines that were too abrupt, pointing the wrong way, and not placed where the human eye expected to see a hairline. Similarly, the results of scalp reduction surgery, in which the hairless parts of the scalp are removed, are far from excellent; This technique offers more hair on the top of the head, but hairlines that were scarred and pointing in the wrong directions.

To design the hairline, the doctor should be experience, following the appearance of a natural-looking hairline. Nature does not provide straight lines, so any hairline that looks like it was drawn with a ruler will not look natural.

Furthermore, hairlines provided by nature do not spring abruptly from the top of the forehead like a wall of hair. Nature provides a transition zone of fine hairs – sometimes called a feathering – to ease the eye from the barren expanse of forehead to the hair coverage at the top of the head.  Therefore, when designing the hairline, it should consist of follicular units containing just one or two hairs, providing a less thick hair, and large sized follicular units (containing three, four or five hairs) should be placed as we move towards the top of the head for thicker hair.

Another thing that should be mentioned is that a natural hairline is neither too close to the eyebrows, nor too far away. In this respect, nature adheres to a rule of thirds: the distance from the hairline to the eyebrows should be roughly the same distance from the eyebrows to the bottom of the nose, and the same distance from the bottom of the nose to the chin. So, when we look at someone’s face, our eyes (unconsciously) expect to see a face that has three similarly-sized zones. If a poorly executed hair transplant has created a hairline that is either too high or too low, the rule of thirds is upset and the transplant will look unnatural.

Finally, a hairline should reflect the person’s age. Even on men who do not have hair loss problems, their hairline will recede around the time of puberty by around 2cm. This is the mature hairline. It will also thin slightly as the diameter of the individual hairs reduce. So, a bald man in his forties who requests a hair transplant should receive a hairline similar to a man in his forties who is not balding. Any attempt to recreate the man’s hairline as it was when he was a child will result in an unnatural appearance.

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