HAIR and there!

Hairline designing plays an important role in a person’s aesthetic features. Dr Avinash Agrawal shares his experience with hairline design.

W illiam Shakespeare once wrote, ‘Beauty lies in the eyes of the beholder’. Here, the beholder is the patient who watches themselves in the mirror daily and is the best guide to their enhanced appearance with standard means. It is the correct guidance for the patient that mimics and reduces at least 10-15 years of the person’s face structure with a new hairline that suits their age, face, personality, and profession. Over the past decade, doctors have witnessed a significant shift in the age group of clients seeking hairline treatments. Those aged between 20s and mid-30 have grown in number in recent years as compared to those aged between 35 and 45 previously.

Designing a hairline is an art and aesthetic plays a major role. It is imperative for a surgeon to understand the racial, ethnicity, and facial structure to understand their patients better. This would help them mimic similar well-suited hairline with age in consideration.

Hairline frames one’s face and gives it a youthful appearance. The depth, direction, and angulation will not only make it more natural with micro and macro irregularity but will also soften the appearance by using for single hair follicle for 1-2 rows in the hairline. The new temple peaks and lateral hubs will enhance and make the face structure more mature and fuller.

The use of more grafts in the hairline, say up to 1 cm, with high density – approximately 55-65 graft per sq cm – and softening the appearance of single grafts will make the hairline more natural.

To follow the correct angle, use the posterior of the scalp where a few hair follicles are spread across sparingly to determine the extent of the hairline.

The direction of approximately 15° angle from perpendicular to forehead in the hairline to 65° to 80° that gradually makes the graft lay over one another in a crisscross fashion will give it a fuller appearance and create more volume with the use of limited donor hair.

How much is too much!

The concept of ‘how much is too much’ can be applied to donor usage and hairline density. There are multiple factors to consider.

• Check gross donor density and determine donor area (safe door zone).

• Check donor for future transplant.

• Use one-third capacity available for the best donor area cover.

• Take hair for temple peaks, from the nape of the neck or the fold below the occipital protuberance.

• Craft the density that is equivalent to the available donor density or at least two-thirds for the hairline cover.

• It is like creating a fortress wall beyond which no one can look further.

Density

The density depends on the method of implantation (using implanters [multi-implanter] or forceps [single or two forceps]), graft thickness (thin grafts with minimum tissue or thicker hair shaft), slit creation (sagittal or coronal slits with blades [steel/ sapphire] or needles).

In my opinion , for best results, use size 19 needle for sagittal slits for front two rows of hairline; sapphire blade 0.9 mm for closer placed slits; make three slits of 0.3 mm in 1 mm area for single hair follicle units in grid or crisscross pattern.

Angle

Follow the posterior hair angulation, progressively reducing towards the top area to the hairline from 55° to 15°. For temple areas and lateral hub hairline, enteral portion can be angulated to up to 50° to the forehead. Make temple peaks less dense for a softer appearance, with careful dissection of the larger 3 to 4 hair follicle units to create singles for the hairline.

Follow your heart, and do not give what you feel is not correct. You can always enhance the hairline in second session for better density and reduce it further if needed.

Hairline for the middle-aged

To make a standard hairline for the middle-aged, consider the frontalis muscle and stay above it (ask patient to frown or raise his eyebrows).

BEFORE

AFTER

• Check the sideburns (draw a line anterior to it perpendicular to the floor when patient is seated uprght looking forward upwards at the intersection from the frontalis muscle at the lateral hub).

• Two-third above and one-third below the line joining the eyebrow to the temple peaks, going at an angle to create this point of intersection.

• Draw soft curves for patient with a bulky face and round jaw.

• Draw a sharp angle for a pointed face with a lean and sharp jaw.

• Follow the frontal muscle extent and consider 1 cm above to make the rest of the line with micro and macro irregularities with U, V, and widow’s peak fashion at the front.

Last but not least, be considerate, hear the patient, and give them more time to decide and appreciate the hairline. Then take special consent for hairline design.

Number of grafts

A minimum of 1,800 grafts for 1 to 1.5 cm and an addition is temple peaks are created. The doctor can add more than 600- 700 grafts. A total of a maximum 2,500 or 3,300 for highter hair is sufficient for hairline design. Always consider a touch-up session (density session). Use all the care for growth including pre-op and post-op. You may consider using hair medicine cyclical therapy of nutrition and minoxidil until the grafts have grown. The patient who can carry and style well with planted hair will never have his hairline detected as artificial or made up.

Grow the hair length to up to 3 inches for better styling and a more aesthetically fuller-looking hairline. Newer modalities for camouflage such as scalp pigmentation can be considered in the hairline and temple area as well.

Patients in grade 7 with poor donor density can avail of hairline transplant and use fine nature hair toupee for the rest of the area for complete fullness for the entire scalp.

About the author: Dr Avinash Agrawal is the Director Partner at Acube Aesthetics Clinic. He is a renowned General Surgeon in Mumbai, and brings over 15 years of expertise in hair restoration surgeries. With a track record of over 3,500 successful procedures nationwide, he specialises in advanced techniques like FUT and FUE surgery, as well as scalp micropigmentation and eyebrow microblading, and training head at Masterstroke by Tejco Vision. He is also an associated surgeon at Hair Restore Clinic, in Mumbai and Hair Tree Clinic in Kochi, Thiruvananthapuram, Thrissur, and Kozhikode.