Hair Restoration Blog

Dr. Mohebi,

You performed a hair transplant on me to make a female hair line as part of my male to female transgender process.  I recently decided to do a scalp surgery that may require a scalp advancing procedure.  My Dr. Will transplant hairs along the scar in hairline.  I am not convinced this will be enough, and we may need to do one final pass after all is done to be sure, possibly the middle of next year.  I’ll have to wait and see, money is also an issue.

A:

Good luck with your scalp advancement surgery. Please do your research and make sure your plastic surgeon does perform hair transplant on a regular basis before letting him place hair on your hairline.  It is especially important that he has experience with creating hairline for transgenders.

If he is not doing hair transplant on a regular basis as is the case for many cosmetic surgeons, it might still be OK to have him put the hair removed during the scalp advancement surgery on the top areas, where you still need more reinforcement.

Hairline is very meticulous specially for male to female trans gender patients.  We can easily repair the hairline in front of the scar of your scalp advancement surgery.  It will be more difficult if there is less than perfect transplanted hair on the hairline area.  that requires removing the hair grafts that are transplanted out of their normal locations and reuse them in the other areas.

We have answered many questions about hairline design on this blog in the past, however we continue to receive questions on hairlines from both men and women.  Since the hairline is one of the most important aspects of a hair restoration surgery, I thought I should still elaborate more on this subject.

We have to consider that hairline design is a dynamic task and has to do with several factors including the shape of a patient’s face, ethnic background, donor hair quality, skin tone and, of course, patient factor which should also be considered.  I think it is not right to judge a hairline only by seeing a patient’s picture from above the level of his or her eyebrows.  Of course, you may say whether a transplanted hairline is detectable or not, but to determining the location of a perfect hairline you need to consider the other factors as below:

Where should the location of a non balding hairline be?  There are several method to determine the location of a hairline in patients who have complete baldness in the frontal area.  I often encourage patients to bring their photos from before they became bald.  We generally spend plenty of time with every new patient to discuss the hairline so that it may be particularly suitable for every patient.  Let’s talk about the most important factors that should be taken into account when designing a hairline:

1. Donor hair quality is important in designing a hairline.  Only under certain circumstances can you place the hairline higher than its natural location.  I believe we can only give patients a significantly receded hairline when there is minimum contrast between the skin tone and hair color (blond, white and salt and pepper hair in fare skinned patients) or in patients with very fine donor hair shafts that could resemble a receded miniaturized hairline.  If the hair and skin quality does not match the above criteria, you should not bring the hairline higher than its normal position.  You may have seen patients with hair transplants with a detectable hairline that does not look natural only because of its location.  The reason is that we expect to see high lying hairlines with some degrees of miniaturization.  If the patient has thick hair, you can not put it higher than the normal non-balding position or it may look unnatural.
2. Hairline location also has to be proportionate in comparison to the other facial features.  You cannot design a hairline without considering its relationship to the other components of the face.  The rule of thirds is accurate in most patients except for the ones with a genetically very narrow forehead or the ones with a big lower face.
3. Availability of high quality donor hair is also important to decide whether or not you have the adequate number of grafts to be able to restore a large balding area without any need to bring a patient’s hairline any higher than where it belongs.
4. If a surgeon is planning for more than one surgery, hairline design should be done at the first hair transplant so it could be reinforced in the following surgery.
5. Another important factor that should not be ignored is the patient factor.  Many patients have done their homework prior to their hair restoration consultation and know exactly what they want.  Some patients have their own taste of hair style and, for example, don’t mind a thinner crown if they can have a perfect hairline.