NY Hair Transplant Surgery and Hair Replacement Surgery

Additional Topics:

-	Limited role of scalp reductions
-	Use of Propecia/Rogaine
-	Transition from a hairpiece to hair transplants
-	Temple area transplantation
-	Trans-gender Transplantation
-	About Donor Scars

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60 Railroad Place Suite 102 Saratoga Springs, NY 12866
Phone: 518-581-1872 Toll Free: 1-800-281-9198
e-mail: saratogahair@spa.net

The Importance of the Front Hairline

The importance of creating a natural front hairline cannot be over-emphasized. This one area of the transplant will be the overriding factor, above all others, by which you judge the quality of your hair transplant result.

There are Four key aspects involved with creating the front hairline which deserve special mention and are the essence of a hair surgeon’s sense of artistry.

a) The height of the hairline
b) The contour of the hairline
c) The “micro-contouring” of the hairline
d) Acute angling of hairs and the absence of “pitting”

(to see enlarged view of transplant patients click the desired photo)
Before HT	4 sessions, 8 years later
For additional examples of our work visit Photo Gallery I, PhotoGallery II and Photo Gallery III for men.

Height of the Hairline:

The first of these is simply the height at which the hairline is placed. Many young men in their 20’s will often pressure the surgeon into placing it in the same position it was at age 15, and, unfortunately, sometimes the surgeon, in his eagerness to please the patient, complies with the patient’s request and places the hairline there, unaware that, when he is 50 years old, this hairline will look foolish and draw unwanted attention to itself. In deciding where to best place the hairline, we take into account four factors:

1) The anatomy of the patient’s forehead and skull. Most often, the proper place to place a hairline is at the exact halfway point between the vertical plane of the forehead and the horizontal plane of the top of the head. Some men have long tall foreheads, and others have short ones. Some men have wide, “squat” shaped heads, and others have long, vertical ones. For each person, the height of the hairline will be different and cannot simply be put at a point X number of centimeters above the eyebrow.

(to see enlarged view of transplant patients click the desired photo)
Before HT	After 4 HT sessions
For additional examples of our work visit Photo Gallery I, PhotoGallery II and Photo Gallery III for men.

2) The position of the side “temple” hair. If this hair is positioned way back near the ears, then a low hairline will look very unnatural, almost akin to a “lid” hanging way out, with nothing to hold it up. It draws attention to itself in the same way some hairpieces do. For such men, placing the hairline a little higher is the proper thing to do. For some men, who are in their 40’s or older, and who have temple hairlines that are set pretty far forward, then the hairline can be set at a much lower position and still look natural, providing it isn’t placed way down on the vertical plane of the forehead. In most cases, the surgeon has to take into consideration the age of the patient and the present position of the temple hair, and then project where it is likely to recede to. This latter task calls for a good deal of experience and judgment. For some men over 35, it is possible to actually transplant the temple area at the same time, which then allows the surgeon to be able to place the hairline lower .

3) The age of the patient. This obviously goes along with some of the above comments. In a younger patient (20’s and early 30’s), the “crystal ball” is often very cloudy as to his future, eventual final hair loss pattern. Therefore, if a surgeon does decide to go ahead and transplant a younger man, it is best to set the hairline at a slightly higher, more conservative height –to allow for the possibility of any “worst case scenario” later on down the road of his life.

4) The wishes of the patient. Some patients want their hairline a little higher, and others will push for it to be as low as possible. Given the restraints and limits that the above three points might impose, there is usually still a small, acceptable range within which the hairline can be placed, and the patient’s wishes in this regard play an important role.

(to see enlarged view of transplant patients click the desired photo)
35 year old male before HT	Close-up after 3 HT sessions
With hair pulled up and exposed (side temple areas also transplanted)
For additional examples of our work visit Photo Gallery I, PhotoGallery II and Photo Gallery III for men.

The Contour of the Hairline:

Apart from the “micro-contouring” of the hairline, which is discussed below, there is a certain overall sweep and shape to the hairline’s shape that is critical in its appearing natural later on. We find that a gently flared contour works best in most men. In women, we try to have the receded front-temporal angle be shallower than in men, and then complete the sweep of the hairline down into the temple areas as well. A hairline that is too “flat” or too perfectly round, like a “cereal bowl,” looks very unnatural in our opinion. Each of our hairlines is shown to the patient for approval prior to starting the first procedure.

The “Micro-contouring” of the Hairline:

Obviously, if the hair surgeon does a poor job in choosing the height or the shape of the hairline, no amount of naturalness at the hairline’s edge will make up for either of these two mistakes. But, assuming that most hair surgeons are capable of choosing a reasonable and acceptable height and contour for a given patient’s hairline, the most important artistic challenge, and the task which distinguishes a great hair transplant from an ordinary or poor one, lies in the way the hairs in the front half-inch breadth of the hairline are aligned and spaced.

Much of this ability can be learned by repeatedly studying the direction and spacing of the hairs that naturally exist on men’s heads. On close observation it can be noted that a natural hairline is not a “line” at all, but a totally erratic arrangement of hairs, which are spaced more sparsely at the front edge – with several “sentinel hairs” way out front – all of which impart a natural appearance. There also is an unmistakable “gradation” of density from the very front and inwards over that front one-half inch of hairline depth. It is possible to mimic this same distribution and appearance by blending in 1-hair follicular unit grafts at the very front with 2-hair FU’s just behind them, followed by 3-hair FU’s deeper into the hairline zone. All of these grafts are cut under the microscope and are placed in the smallest possible needle hole, so that they can be placed relatively close to one another when required. We generally place around 400-500 FU grafts at the front hairline in every procedure.

(to see enlarged view of transplant patients click the desired photo)
40 y/o male, before HT	Hairline, after 3 sessions
For additional examples of our work visit Photo Gallery I, PhotoGallery II and Photo Gallery III for men.

Besides the spatial relationship of the hairs to one another, there are two other critical aspects to having the hairline look totally natural: They are the angle at which the hairs are placed and the absence of “pitting.” Hairs should be placed at a fairly acute angle in order to mimic nature and to “overlap” one another to give the best appearance of density. Hairs placed at an acute angle also are easier to style and sweep naturally in whichever direction the patient chooses. Obviously, if there are significant numbers of pre-existing natural hairs in the frontal region, then the surgeon simply has to faithfully follow the same direction for the newly transplanted hairs. In the many “corrective” cases we do, in which the patient is unhappy with the unnaturalness of the work he has had, the two commonest mistakes that we see are that the grafts have been placed too perpendicular to the skin, as if they were coming straight out of the head like a tree growing up from the ground, - and that there are too many grafts with a pitted appearance.

“Pitting” of grafts occurs when the tiny amount of skin that surrounds the hairs of the FU graft is placed deeper than the surrounding scalp skin(see photo below). When this occurs, there will be a slightly dark, “pitted” appearance to the exit site of the hair, as if there was a small dark line drawn around the hair where it comes out. If you multiply this effect times several hundred grafts, you will immediately look at such a hairline and declare it to be very unnatural in appearance. We avoid pitting in three ways: The recipient sites are made with a “limited depth” apparatus, so that the hole isn’t even deep enough for a graft to sink down too low. Secondly, as the assistants (and Dr. Beehner) place the grafts, we are careful to have the skin of the graft even with, or slightly higher than, the surrounding skin. And third, at the end of the procedure after all the grafts are placed, Dr. Beehner puts on a magnifying lens and inspects each graft, to make sure that none have dropped below the skin level. He lifts up any such grafts if this has occurred.

(to see enlarged view of transplant patients click the desired photo)
29 y/o male, pattern drawn	Hairline, after 2 HT sessions

Several examples of natural appearing hairlines created at our clinic are demonstrated in this section, to give you a sense of our artistic abilities in this important area of transplantation.

For additional examples of our work visit
Photo Gallery I, PhotoGallery II and Photo Gallery III for men.