What can go wrong when creating a new hairline

[Dr Bicer’s Consultant]

Hello everyone,

The hairline frames our face; it has such a large impact on how we look. Hairline position and design changes with ethnicity and genetics. However, there are some fundamentals that need to be followed to create a natural hairline. If any of the fundamentals are not followed it´s likely to result in an unnatural look.

Aspects such as -

Wrong Angles

Wrong Direction

Low Density

Wrong Placement

We will look at hair angles and direction/orientation, this can become complex when trying to recreate a cowslick hairline, as a result it´s not commonly tried. When placing the new hair at the correct angle and orientation is important to mimic a natural hairline, especially when there is surrounding native hair as they need to blend seamlessly. But even if there is no native hair, the natural parameters must be followed, with some leeway but not much.

A natural hairline hair angle is typically between 10° and 20°, as the hairline moves from the apex (middle of the hairline) to the temple the angle changes and becomes flatter. With the angles near the temple point around 3° - 5°. This varies with ethnicity, genetics and hair characteristics. The hair direction, the central hairline, most men's hair grows forward, toward the face, which provides natural lift when combed back off the face. Whereas male temple hair generally grows in a down and back direction. The direction and angles of hair growth changes behind the hairline around the head, such as higher hair angles and spiral direction of a crown.

If a doctor tries to buck the natural parameters an unnatural hairline will be created. Not only will it look unnatural it will greatly inhibit styling. Having hair growth growing "straight up" or in completely wrong directions such as growing backward at the frontal hairline, or perpendicular in the temple area is hard to camouflage. Being able to naturally style your hair is a fundamental consideration to creating a natural looking hair transplant. When the hair direction and angles are off it makes combing and styling harder, often having to use strong fixing sprays to keep the hair in constant position.

Fixing poor graft angles and direction needs to be performed by an experienced hair transplant repair doctor, it is time-consuming and can require multiple sessions. In some cases, more hair can be added with correct placement around the poorly placed hair. This can help to camouflage the bad hair grafts as they blend or get lost in the higher density with the new hair units, although it´s likely to still be problematic with some styling. If this is not a viable option, then the incorrectly placed grafts can be removed using a FUE punch, and if still intact re-implanted. A repair is not a good place to find yourself in, takes up more time, the inconvenience of it all, more money and in general can affect your well-being.

Often wrong angles and direction is accompanied with more issues that we´ll cover later. Unfortunately today, it is still possible to see too many poor hairlines. The lack of consideration to these aesthetic fundamentals shows incompetents on behalf of a doctor and demonstrates a total lack of care and understanding of anatomy and natural traits. Dr Bicer is a firm believer in informing her patients, allowing them to understand the pros and cons to hair restoration and that everyone´s plan is personal to them.

 

[Dr Bicer’s Consultant]

Here's an example of poor angles and orientation of hair along the immediate hairline repaired by Dr Bicer,

Also a video where he explains his situation and pulls his hair back, translated on the video from Portuguese.

 

[Dr Bicer’s Consultant]

Hello, the next two issues that can go wrong when restoring a hairline are wrong placement and low hair density.

Wrong placement can cover a variety of issues, but we will focus on the physical graft placement, to the graft distribution around the hairline. Poor graft placement can cause pitting or ridging, or a slight indent around the hair shaft or a small bump of hard scar tissue around the hair shaft. Both are unsightly and obvious, and hard to camouflage. Very visible when on the immediate front of the hairline. Caused by the incorrect placement of the follicular unit, depth, and lack of care by whoever is placing the graft.

Graft distribution along the hairline. The immediate hairline should only have single hair units in a slight jagged pattern over the first 2-3 mms depth along the immediate front. When grown out it will give a softer, natural look to the hairline. Using larger units along the immediate hairline, say 2 or 3 hairs units, while it may make it thicker, it will look pluggy, unnatural and not pleasing to the eye, again, while repairable, it complicates matters unnecessarily.

--------- The jagged edge along the immediate hairline and high hair density Dr Bicer patient-------

------ (same patient as above) grown out, a soft natural hairline with a build up in fullness ------​

Low hairline density, while it´s not possible to match like for like hair density of a natural full head of hair. The placed density must be enough to stop a see-through looking hairline, or a low density “gappy,” hairline of healthy, strong hair, and unnatural to the eye. Placing a lower density hairline can be due to not understanding physiology of a hairline or not having the skills to create the required hair density. Either way, the result is sub-par.

The required hair density varies dependent on the skin complexion and hair characteristics, such as the hair colour, thickness, and curl of the hair shaft. While it´s possible to repair, and place hair between the existing hair growth it is not ideal and adds complications with the slit making and placement, as well as the stress, inconvenience and added cost to the patient.

 

[Bigmac]

Great info. Thanks for sharing