Designing the Hairline

Abstract

Creating a natural hairline is important to a successful hair transplant. Modern hair transplantation techniques favor the exclusive use of follicular unit (FU) grafts to achieve recipient-site density and refinement. A better understanding of the characteristics that make up a normal hairline has resulted in significant advances in hairline design. The anterior frontal hairline is recreated exclusively with single-hair FUs to establish a natural “feathering” transition zone (TZ) between the forehead and the higher density central scalp. Posterior to this hairline transition zone, two-, three-, and four-hair FUs are used to provide density throughout the restoration area. It is important to follow the original hair direction and exit angle precisely when creating the recipient openings in order to maintain a natural hair growth pattern and to prevent transection of preexisting native hair or previously transplanted follicles. It is important to explain to the patient that the donor area has a finite number of grafts and that we do not have an unlimited donor supply. If there is any concern about graft supply and potential for further hair loss, it is better to be conservative and not place the hairline too low.