Dr Bloxham and Dr Feller asked me to post this presentation for them.
Temple Point Hair Transplant: Sometimes, Always, or Never? Feller & Bloxham, Great Neck, NY
Recently, “temple point” hair transplants have been discussed heavily on the forums. This isn’t a new topic, but it is usually a somewhat passionate and opinioned one. I’ve always had my own thoughts on the issue of restoring the temple points or “temporal triangles,” but didn’t participate in the recent discussions.
At the same time, I had a patient send me an update of his own 7 month temple point hair transplant results, and thought it would be an interesting opportunity to share the case and discuss the issue a bit.
First, the case:
The patient is a man in his 40s who underwent a number of hair transplant procedures at other clinics in the past. These were focused on the frontal-third and mid-scalp, and they worked well. But despite the coverage on the top, he continued receding and ended up thinning in the temple regions. And although he was covered well with the transplants, he wanted a more youthful framing to his face and didn’t feel like his transplant journey was “complete” without more defined temples.
Here is how he looked before the surgery and an outline of our surgical plan:
After multiple other FUT procedures, Dr Feller and I had to evaluate the donor carefully and determine if he had the grafts to do another small procedure and how we should extract them. We determined he had the laxity for one more small strip, and that the FUT technique was a best way to extract them.
I was able to obtain 750 grafts via a strip and utilized the grafts strategically to rebuild the temple points. Attention was paid to recreate the natural flow, direction, and angle of the temple hairs, but also to match the density and appearance of the other transplants, and to look appropriate on someone his age (IE not excessively rigid or unnatural symmetrical).
7 months later, he sent in the following images:
Here’s a video:
These were sent by the patient, so I did my best to match them up to the pre-ops but obviously not a perfect comparison. And he’s only 7 months and will continue maturing. But the procedure achieved the desired effect -- more defined and youthful framing via temple point restoration.
So why do temple point hair transplantation in this patient? And by extension, when should temple point restoration be done? When should it not be done? Almost always? Almost never? Or sometimes?
Good indications and patients for temple restoration (“Almost Always”/ Sometimes):
1) Patients with significant loss in the temple regions in general.
Now, this does not necessarily mean people who used to have slightly more defined temporal points and now they are a little more blunted or less dense. But for people who truly have thinning in this region. There is actually a scale for those who thin in a particular part of the temple region. It’s not necessarily the “temporal points” per say, but more the “superior temporal hairline” or the most anterior portion of the parietal hump.
Here’s a picture of the scale:
As you can see, these patients have thinning in the upper portion of the temple region and transplanting other areas of the scalp without addressing these regions may create a less natural appearance. This is what some people refer to the “toupee” look.
In these patients, addressing the temple areas with or without transplanting other areas of the scalp is important for a natural appearance.
2) Patients with minimal loss who will not need extensive grafting in other areas of the scalp.
3) Patients with “softer” hair characteristics, finer hairs, and minimal contrast between the coloration of the skin and hair.
4) Somewhat older patients with more stable and predictable loss.
Poor indications and patients for temple restoration (“Almost Never”):
1) Young patients with unstable loss who may need a significant number of grafts in more important “foundation” regions up the road.
2) Patients who aren’t suited by a more aggressive and immature hairline design.
3) Patients/cases with recession in the fronto-temporal “angles.”
If a patient has a significant amount of recession in the corners, rebuilding the temple points can actually accentuate this recession and make the corners look further back in comparison to the temple points that are now further forward
4) Patients with thick, coarse, dark hair and a more noticeable contrast between hair and skin tone.
The temple hairs, particularly those in the very front parts of the temple, are very fine. Even with an appropriate amount of singles, coarse, dark, hairs may stand out and look somewhat artificial in the temple triangles.
So, comparing the patient in the case to the above list: he was a man of an appropriate age with stable hair loss, transplants in the foundation regions of the scalp, recession in the temple regions, and fairly favorable hair and skin characteristics. We felt he was an appropriate candidate and I think it went well.
What do you think? Good criteria for when to do and when to reconsider temple point transplants? Or should they be attempted more often? Less often?
Discuss! And I hope you enjoyed.