There are two important situations in hair replacement surgery in which it is not wise to attempt to totally fill in the entire bald area of a man. The first is the young Man in his 20's, whose future balding pattern is totally unknown and could expand to what is termed a Norwood VII stage, which features the side hair fringes way down the sides of the head and the bald vertex/crown in back "scooping" very low in the back. The second is the man of mature age who has in fact reached a Norwood VII stage of hair loss, in whom there simply isn't enough donor hair to even think about filling in the whole bald area.

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                                                       49 year old male patient

           In the mid-1990's I first started researching and writing about the 'frontal forelock concept", and have authored over 12 journal articles and 3 textbook chapters on the subject, in addition to 20-plus lectures all over the world. I currently believe there are two design patterns that work best for almost every one who is a candidate for this approach. They are the "oval forelock" pattern and the "shield forelock" pattern. They are shown below. The oval pattern is used as the more conservative of the two, when the donor supply is really small in comparison to the needs of the recipient area. A 49 year old male patient who had two sessions with an oval forelock pattern are shown above from two views. The side view shows how the forelock creates a "mirror image" with the fringe hair, giving a very natural appearance.
                                             
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                                "oval forelock"                     "shield forelock"

         The Term "frontal forelock" probably isn't the best term for this pattern, but it is the one that has traditionally been used by hair surgeons. When one thinks of the frontal forelock, a small tuft of hair in the front center comes to mind, which doesn't actually look all that great. In hair transplantation, a "forelock pattern" refers to a pattern in which there is a gradient of density from the front-center, where it is densest, to the sides and back, where the density tails off and is sparser in a natural way. The goal is to capture a relatively early stage of hair loss that many men naturally go through on the way to losing their hair. By doing so, the man's hair doesn't draw any attention as looking unnatural by someone that would view it.

          The two areas that are usually not filled in with a forelock pattern are the fronto-temporal gulfs in front and the crown/vertex in back. In the case of the young man in his 20's, the crown will probably greatly enlarge in years to come and any attempt to presently fill it with grafts runs the risks of having a central area of hair some day surrounded by a large halo of bald skin. In the case of the mature aged man with an advanced stage of balding, there is barely enough donor hair to frame the face in front, and the prospect of filling in the large crown in unthinkable.

          The chief requirements for this type of pattern to be successful are an artistic surgeon and a patient with realistic expections. If those are present, there are actually very few men who can't be helped with hair transplantation with one pattern or another.