Frontal Hair Line Creation and Recipient Site Preparation

The most important part of a hair transplant is the creation of the frontal hair line. The frontal hair line is noticed every day by both the patient and the rest of the world. If the frontal hair line looks natural, the rest of the hair transplant will look great. If the front looks bad, the quality of the rest of the hair replacement is irrelevant.

Temple Hair Loss Transplant
Creation of the frontal hair line should serve to frame the face. Due to the progressive nature of hair loss, a natural appearing hair line should be created that will appear natural throughout the lifetime of the person. Patients and novice hair transplant surgeons for that matter, will often desire a juvenile appearing hair line. This should be avoided. Remember that a juvenile hair line may make a 35 year old patient look younger, but will make a 55 year old patient look strange. Remember that every hair that is taken from the back and implanted into the front will stay forever. Every hair that is surrounding the transplanted hair might be soon be gone. Those designing the hair line must keep this principle in mind. When designing the hair line one needs to predict what will look natural at the time of the transplant and will continue to look natural for years and years to come. Remember, that hair loss is progressive and the continued loss must be predicted in order to keep it looking natural always. The hairline should begin somewhere around 7-8 cm from the eyebrows.

Frontal Hair Line Restoration
This point may also correlate with the junction point of the top of the head with the forehead. It is better to make it too high than to make it too low. The line extending from the front to the side should approximately parallel Frankfort’s Horizontal Line. Care should be taken to avoided blunting the natural temporal recession. This creates a juvenile hair line that will not look natural as the years pass.

The hair line, despite being called a “line” should not be straight. The natural hair line has peaks and valleys and is never straight. So, the newly designed hair line should also not be straight.

The angle created as the hair emerges from the scalp is important. In the front, the hair should exit angled forward and slightly outward. The created angle will, again, add to the natural appearance and should mimic the angle of hairs already in the area.

The density of hair in the frontal hair line should be somewhere around 30 hairs/cm2. The follicular units implanted should be mostly single hair units.

Finally, although this is a “surgery”, there is a certain amount of artistry to this part of the procedure. If the approach is “surgical” rather than “artistic”, then the results will look surgical and will not be natural. The first and foremost goal of anyone undergoing hair transplantation is to maintain a completely natural look that can not be detected. My approach is that an unnatural appearing hair transplant is worse than being bald. Click on the links below to see video of different aspects of the hairline creation and recipient site preparation.

Dr. Bitner is a member of the American Board of Facial Plastic and Reconstructive Surgery