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How bone structure can impact on the graft numbers and design.



BHR Clinic Patient Advisor
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Genetics dictate the way we look, the bone structure of our face, hair characteristics and hair growth/loss patterning to a large extent.

A hair transplant is a cheat on nature; using nature €™s reserves we have the ability to design a head of hair a person never had, create a hair line lower than even as a pubescent didn €™t exist

The NW scale is generic to give us an idea of the pattern hair loss can take in a male, but does not take into account the facial bone structure, and how this can change graft numbers and design. If we take two NW6 cases it is possible for there to be a vast difference in surface area maybe from 250 to almost 400 cm2 to cover due to bone structure.

Bone structure can result in the recipient area being larger than the donor area and this being the case it is not wise to design a low flat hair line either because it used to be or through desire but to design with the future loss in mind. It is important to restore facial balance, not just from the front elevation but sides and top. By restoring just the frontal hairline you may create an unnatural facial proportion so the rounded wide design should be avoided at all cost.

The idea is to bring the hairline design until or before the curve of the forehead, when the hair grows longer it will give greater illusion of coverage and facial balance anyway and even short the design will be pleasing to the eye, naturally match the bone structure and blend with the temporal angles. The forehead bone structure could be more square, round, oval or triangular and the hairline design must match it to ensure facial/special awareness. The hairline is unique to a person €™s bone structure and not a set template, or sometime not even to match the hair line from younger years as the facial expressions and bone structure change over the years.

Larger facial bone structure can be recognised with a broad forehead, flatter surface and a crown that drops twice, maybe three times. Larger or more pronounced bone structure can require maybe 30% more grafts to cover the average zone; if the hair line does not match the bone structure in relation to the patterning of hair loss this can result in a front loaded design, many grafts being used to restore an area and the creation of an unnatural pattern of hair growth, high frontal density and a design not fitting the patterning of hair loss behind the frontal.


Staff member
Great informative post Stephen,lots of facts and easy to understand.

This is something thats not really talked about much,the size of your head etc.

Thanks for sharing this info with ther forum community.




I always wondered, for example if two NW6 patients with identical hair characteristics/density only difference being size of head/bone structure would be able to get the same coverage €¦

Great post as always.


Valued member
so is getting your thumb stuck in a car door...


Valued member
Hi Stephen,

Excellent information as usual. I'm always impressed by the intention to detail. Bone structure and face framing, as described above, apply to what I'm about to ask but.........

As we discussed in Brussels people do not have symmetrical faces and I commented on how I noticed Dr. Bisanga had drawn a deliberately unsymmetrical hairline for me which mirrored how things were prior to recession.

I told you at the time I thought that was excellent and you explained to me the signs he looked for in order to determine this. Is there anything you could add to this topic to include unsymmetrical faces unlike in the mannequin heads above? I would think there must be a few crossover points with this topic.



BHR Clinic Patient Advisor
Hi martinvain,

Hope you're well.

As you say, the face is not the same on either side, they are not exact mirrors of each other, lumps, bumps can be slightly different and this has to be taken into consideration when designing the hair line. Initially it can look a little "odd" when an asymmetrical line is drawn, and one side seems too pronounced or visa versa, too flat or deep, but when grown out it will look perfectly natural.

If you try to make it symmetrical it can have an artificial, manufactured, man made look about it, too perfect in design, and this can scream a hair transplant regardless how good the placement is. You know when you look at someone and cannot quite figure out what is wrong but you know it is not natural. Attention has to be taken to the temple regions and the forehead, it's quite common one side to have a slightly protruding or flatter structure. Below you can see an example, more obvious before the op, the left side as looking is more pronounced but when the hair has grown although there is nothing as such symmetrical, it looks perfectly natural and even takes away the obvious difference in the bone structure.