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MORE YOUTHFUL HAIRLINESSingle-scar, follicular unit hair transplantationBy Liz MeszarosContributing Editor  Pittsburgh, Pa. — Because of better technologies and improved results in hair transplantation, hairlines may be moving down, according to Dominic A. Brandy, M.D. Going against tradition, Dr. Brandy advocates that when doing follicular transplantation, surgeons can choose to divide the face into thirds to find the correct and natural place for the hairline for some patients. “What’s been taught over the years is that the hairline should always be higher in men you’re doing hair replacement on. The whole feeling was, in the early days, if you move the hairline down even two centimeters, you were using so many grafts,” said Dr. Brandy. He explained that using the old 4-mm punches limited surgeons to only about 600 hair grafts. By moving the hairline down even 1 inch, then, would probably use the majority of these. But with the advent and use of the “follicular unit,” this is no longer a problem in most patients, said Dr. Brandy, who has been doing hair transplantation for more than 20 years. In addition, the single donor scar technique makes more follicular units available, with less scarring.
One scar, more grafts“Today, you should always end up with one scar, so you can get a lot more hair grafts. So with the number of scars no longer a variable, it’s only the density of the hair that is important. You can get many grafts from a patient without making the back of the hair look like it’s thinning,” he explained. To determine the position of the anterior-most aspect of the frontal forelock, Dr. Brandy studied 20 men, aged 20 to 46 years, who had type III to V male pattern baldness, and evaluated distances between the chin to nose, nose to eyebrows, and eyebrows to frontal forelock. Importantly, he found that the distance form the eyebrows to the hairline was 33.4 percent of the whole. Mean distances included 6.96 cm from chin to nose; 6.55 cm from nose to eyebrows; and 6.8 cm from eyebrows to hairline. Therefore, Dr. Brandy explained, dividing the face into thirds when deciding where to place the hairline may be appropriate in some patients.Why thirds?Historically, there is good basis for this division of the face into thirds. In the past, the ideals of facial beauty have been dictated by many, including Leonardo da Vinci, who broke the face down mathematically, explained Dr. Brandy (See article, Beauty Trough the Ages, page 4.) According to his calculations, the ideal face consisted of one in which the distances from the chin to the bottom of the nose were equal to the distance from the bottom of the nose to the eyebrows, which were also equal to the distance from the eyebrows to the hairline. He does add, however, that there are certain instances in which he would not advocate this, such as in men with evolving type VII baldness. But this can usually be determined during patient assessment, he said.Patients satisfiedPatient satisfaction with the new hairline placement has been high in Dr. Brandy’s practice. “Patients like it when the hairline is obviously in a position where it harmonizes with the face. In the older days, many people complained about the high forehead. There seem to be more satisfaction now that I’ve gone to what seems to be more mathematically correct,” he told Cosmetic Surgery Times. With the advances made in both harvesting and achieving more refined results, Dr. Brandy said, there is no reason to always cling to the old ideal of the hair hairline in men undergoing transplantation. “Now we’re able to move those hairs and spread them out. It creates a thinner look, but coming down 1 inch doesn’t expend that many available hairs,” he said. “The techniques have changed; they’re more refined, and you don’t use that many hairs to create zones of hair. Therefore, you really can get a little more aggressive with where you place the hairline in some patients,” he concluded.
For more information • Brandy D. Dispelling the myth of the required high hairline in follicular unit hair transplantation. Derm Surg 2000 Sept 26 (9):844-847
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