For a successful hair transplant surgery, creation of a natural hairline is one of the most important elements. While promoting their hair transplant centres, the surgeons tend to assure full and undetectable hairlines to the patients. Also patients nowadays expect an unappreciable and natural looking hairline with adequate hair density after a single session. With the advancement of technologies, good hair density can be achievable, but for designing a natural hairline artistic sense of a hair transplant surgeon is a pre-requisite.
How natural looking and untraceable hairline designing is possible at present?
Currently, it is possible to create hairlines which meet higher expectations of the patients. This has been possible by using more number of smaller and more natural looking follicular unit grafts (FUG) in the hairline. The FUGs are very similar to fine paint brushes which are used to create fine details in a painting. However, for designing a natural hairline, just using FUGs is not sufficient, the normal characteristics of the hairline should also be reproduced.
Zones of a Natural Hairline:
A natural hairline region can be divided into three zones,
- Transition Zone (TZ)
- Defined zone (DZ)
- Frontal Tuft (FT)
The general appearance of the hairline depends on the unique contribution from each zone.
Transition Zone (TZ): The initial 0.5-1 cm of the hairline is transition zone. The close by looks at transition zone depicts various specific factors which work together to create its definite look. At first, the TZ appears irregular and ill-defined but progressively gets more defined and dense as it approaches defined zone.
Defined zone (DZ): Posterior to transition zone lies a 2-3 cm wide zone namely Defined Zone. In this zone, the hairline develops a higher degree of definition and density. The increased density provides a fuller looking hairline by limiting the distance that can be seen past the transition zone.
Frontal Tuft Area(FT): It is a small oval area super-imposing the defined zone right behind the transition zone in the midline.Usually, this area is undetectable and has higher density of hairs than the rest of defined zone. This area is significantly important for aesthetic looks.
How a natural hairline is created?
Following are some of the key elements followed for designing a natural hairline: ·
- Undulated hairline: A normal hairline in a person without frontal alopecia is contoured with undulations. The hairline while extending across the forehead gradually flows inwards and outwards along the curved shape. Furthermore, each hair is seen to be diverging in any direction from few millimetres from the hairline. These factors provide characteristic appearance of natural hair growth, that is, random indentations and projections along the hairline. This formation should be followed while designing hairline during hair transplant procedure. There must be macro- and micro-irregularities in the hairline (Fig2).
- Fig 2: Macro- and micro-irregularities in the hairline
- Single-hair follicular units in first row: A follicular unit can be defined as a fundamental unit of a hair from where hair grows. One follicular unit can have1-4 hairs. For designing hairline which cannot be differentiated, single hair follicular units should be placed in the first few rows of hairline.
- Irregular Irregularity: At first look, the hairline appears to be even and uniform, however, on keen observation, this can be appreciated that the hairs along the hairline and scalp are placed randomly. The natural hairs grow at a variable distance from one another and are not placed randomly at equal distances. Additionally, the growth of natural hairs is in groups of one, two or three hairs, and these groups are also formed randomly. Thus, while designing a natural hairline in a hair transplant, the hairs should be grouped and spaced randomly.
- Different angles of hair: The hairs at different regions are growing at different angles. Similar pattern should be followed during hair transplant. The hair units should be implanted along the natural shifts in angulation of hairline. This method is followed to avoid “picket-fence” deformity which is quite unaesthetic.
- Setting of hairline according to facial profile: The facial profile, age and sex should be kept in mind during marking the hairline. It should not be too low to that it looks unaesthetic. For example, the shape of forehead and height above the eyebrows should be priory considered to mark the location of widow’s peak.It should not be marked too low.
- Different thickness of hairs at different zones: Along with providing undulation and irregular irregularity, the hairs with variable thickness should be implanted at different regions. For the center of hairline, coarse and thick hairs should be used, and fine hairs should be used in anterior and temporal regions. The variable density of hairs duplicates the natural hairline texture. If a surgeon fails to provide such appearance, the hairline will be easily noticeable to naked eye.
- Varying hair Density: The density of hairs on the scalp differs at each location.The hairs start getting dense as we move farther from the forehead. The initial hairs at the hairline appear to be spaced far and thin as compared to hairs behind the first row. On moving posteriorly, the hair density increases and is present more closely. For the creation of natural appearing hairline that is in harmony with rest of the scalp, the surgeon should gradually increase the density of hairs from anterior to posterior region.
- Random implantation of “Island Hairs”: Island hairs are referred to random dispersed hairs which are not related to hairline. Occasionally, island hairs depict the position of previous hairline. These island hairs in a hair transplant provide authentic look to the hairline. This can be done by implanting hairs scattered along the new hairline to provide hair growth similar to the natural hair growth.
- Angle between frontal hair and temple hairs: Care should be taken to avoid blunting of angle between front air and temple. Hair transplant surgeon should follow the natural alteration of direction of hairs in temples.
Conclusion: The principles for natural hairline designing discussed in this article are vital for creating a high degree of naturalness as expected by the patients. Selecting and using FUs appropriately combined with artistic and surgical skills of the surgeon to follow natures lead in designing natural appearing hairlines are critically required.