Relatively strong, low forelock - Placement of transplanted grafts

[Barren]

Hi,

This is something I often wonder when reviewing patient post-op photos, to be honest, largely because it will apply to me should I have a procedure.
If we take a patient who has signifcant recession, but their forelock remains strong and the patient would like their hairline rebuilt, why, as far as I can see, do many doctors place grafts in front of the forelock?

To me, one of the weakest areas of a hairtransplant is the hairline, by weakest I mean the aspect of a hairtransplant that would potentially 'give the game away'. Some of the most natural looking transplants I have seen are where the transplanted hair is placed just behind the forelock or what remains of it, leaving existing native hair exposed thus hiding the transition from skin to transplanted hair that would occur should the doctor place gafts in front of the forelock.

I guess doctors do this so that there's a more uniform appearance to the hairline instead of a mixture of native and transplanted hair, and also if they expect that the forelock will eventually thin out?

However, what if prior to hairloss the patient had a naturally low hairline, and the forelock remains strong in this position, if the patient feels that the transplanted hair can't go lower than the forelock, what is the best strategy in that case? I know it would vary from doctor to doctor, but I'd like to get peoples opinion on this

Thanks

 

[mattj]

The position of the forelock and remaining density will determine whether grafts are planted in front of it and/or within it. If grafts are planted in front of it then this will mean that the patient wanted the hairline lower. Many or most patients when they come to the point when they want a hair transplant will have experienced recession right across the front and need follicles throughout this area. Even if the forelock is still quite low, it will often have lost density and require strengthening with grafts.

You'll find some results where grafts were only used to fill the temples, though.

 

[Barren]

Thanks Matt

 

[Nervousnelly]

No matter what the circumstances, it should always be a concern to go too low with the hairline. I do understand your question and I believe that the physician should in most cases incorporate the forelock but also assume that it might not always be there. Ofcourse there are certain individuals that retain it, but as Matt stated, they still likely need an increase in density.

I also like the idea of a clinic trying to error to the side of conservative. Please keep in mind that the higher the hairline the more density that can be achieved with the limited supply of grafts.

Also, understand that although I do comprehend what you are stating about the hairline being the most critical aspect of a HT, the most skilled physicians in the world can essentially recreate nature. I remember Dr. Ron Shapiro stating that in terms of what can be achieved with the naturalness of a hairline we have reached the pinnacle of what can be done. It essentially can't be better in the hands of the most skilled and artistic physician.

NN

 

[Barren]

Hi NN,

My question arose from the fact that I have enough recession at the age of 30 to warrant being very cautious about the usage of donor with future loss in mind. My forelock is quick low and if the transplanted grafts where placed in front of it, the hairline that would result would be considered quite agressive. Thanks for your input, it will be an important aspect to discuss with the doctor prior to any procedure

 

[Nervousnelly]

Do you have photos? That would help us all to assess things for you. Personally, from what you have described, I believe it would be in your best interest to NOT go lower than your forelock and be conservative.

I have in fact seen a few cases where the physician went above the forelock and suggested to patient that they shave the area that was below their newly created hairline. I am thinking this is not in the norm but better than too aggressive.

NN

 

[KennyDude]

I would be cautious if you`re considering a lower more youthful hairline, future loss may cause unforseen problems if the hairline is created too low.

 

[My WHTC Hair Talk]

I agree with all the other comments. It depends what the patient wants. The majority of doctors will not lower the hairline too low. It is always good to start with a high hairline you can always move down later. Most doctors take in consideration the patient €™s age, NW class, and family history of hairloss. The hairline is the most important part of a hair restoration so make sure you do a lot of research. Good Luck!

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