Temple Point Restoration: When is it "safe" to do?

[John_in_NC]

I know many doctors are reluctant to touch temple points for fear of further receding and the "island" effect. My questions simple, although I knwo it may vary: when can one do a temple point restoration? At 30, 35, 40, 45 ?? At some point one has to say that a risk is worth taking...

 

Maybe I got the term wrong, but with temple points I mean the part in front of the ears, not the hairline one.

[Jotronic]

John,

 

I want to make sure I understand what you are referring to. When you say the part "in front of the ears" you are referring to the sides, where normally there is something of a triangular shape, yes? This is one of my favorite subjects cause I had it done myself.

 

Temple points are crucial to the overall effect of hair restoration. If you don't have them then you may as well have a wig on your head. Temple points balance the top with the sides and if you have too much on the top without enough on the sides then something just appears "off".

 

I believe that most anyone with hair loss should also have the sides addressed if they too are receded. Here is an example of what I had done.

 

You can see here that my sides were very weak before HT# 2 with Dr. Wong.

 

 

Here is Dr. Wong drawing the gameplan.

 

 

 

Grafts are being placed.

 

 

And here they are after placement.

 

 

Here they are grown out. Note, I had a bit more added in #3.

 

 

Had this not been performed then I know that the end result just would not have made me as happy as I am.

 

These areas do not require a lot of grafts compared to other areas but they are just as important.

Edited September 16, 2010 by Jotronic

[spoon]

Originally posted by Jotronic:

 

Temple points are crucial to the overall effect of hair restoration. If you don't have them then you may as well have a wig on your head. Temple points balance the top with the sides and if you have too much on the top without enough on the sides then something just appears "off".

 

I believe that most anyone with hair loss should also have the sides addressed if they too are receded.

 

Going back to the original question, though, how does one determine when it's safe to do it? Recession behind transplanted temple points is risky. I was really curious about this issue also, and am glad it was brought up.

 

As to the comment about 'may as well have a wig on your head', isn't that a bit much?

[the B spot]

Dammit Joe!!!!! You just want to show off the sexy mop again, you lucky dog!!!! just kidding......

Anyway, your temple points were done during your second HT right? My point is you took a conservative approach to them, but just those few grafts made a huge difference. It is an artform to restore temple points, as one of my friends found out the hard way. He is 35 with a 20yr old hairline and closed temples and full temple points, but is noticably thin behind it, without enough donor to cover. It is good advice to tell others to be carefull when doing these.......

[John_in_NC]

Joe,

I understand your point, but also it depends on how the hairline is designed. If you go for a 20 year old's, straight hairline, and don't touch the temples, you will obvioulsy look odd. But on the other hand, if having a mature hairline and your temples show no sings of receding or miniaturization (wall of thick hair,) that is is giveaway too, as that is not natural.

[no hair sux]

that third pic was hilarious. weird thing is, i never had those side temple areas and always wanted them. i'm worried, too, about having an unnatural island in the middle should i lose more O_O

[Dr. James DeYarman]

I feel that temple restoration is the most important area to transplant. It wasn't until the use of the lateral slit were we able to tranplant this area. Temple recessions will age a person more then crown loss. When someone argues that you will run out of hair it should be noted that you will not lose the hair on the sides completely. It is much easier to maintain the hair in this area then on top. I can always tell if a person has had a tranplant if their hairline is restored withount temple restoration.

Even Jotronic's profile shows sign of restoration because of the acute angle. If Jotronic gives me permission I will add hair to his photo to show what I mean.

[John_in_NC]

Even Jotronic's profile shows sign of restoration because of the acute angle. If Jotronic gives me permission I will add hair to his photo to show what I mean.

 

Dr.,

do you mean that it's too straight and too perfect with no blending in?

[Dr. James DeYarman]

Your orginal question had to do when can you do temple point restoration.

I feel that temple restoration will reverse the signs of aging. I have attached a photo of James Dean. He was only 21 when he made this movie and to make him appear older they grayed his hair and created deep temple recessions.

Lateral slits have made it possible to restore the temples. Therefore if a patient show signs of temple recession and loss of temporal peaks they can be restored at any age.

As far as any reply to question on Jotronic's hair transplants I am talking about design.

[DrBauman]

Originally posted by John_in_NC:

If you go for a 20 year old's, straight hairline, and don't touch the temples, you will obvioulsy look odd. But on the other hand, if having a mature hairline and your temples show no sings of receding or miniaturization (wall of thick hair,) that is is giveaway too, as that is not natural.

 

John, I couldn't agree more. On nearly every case, I'm addressing the temporal point to some degree--but it HAS to be in proportion to the hairline design. There has to be symmetry and balance to the hairline (frontal and temporal points) all the way around the frame of the face. Many surgeons ignore the temporal points and their results end up looking artificial, like a hairpiece: Too much hair in the front and deep recessions of the temporal point.

Here's a frontal hairline restoration (including the temples and temporal points) I performed recently on K.S., a 34 yr old...

He is about 10 months out from the single session of 2300+ grafts.

 

Here's a closeup of the right temple and temporal point before and 10 months after the procedure.

 

The hairs are lying very flat in the temporal point--this is critical. BTW, I have found that I don't need to use lateral slits to do this in most cases.

[PB]

Wow, K.S.'s temple points are 100% natural looking, I'm impressed.

[Guest Cousin_It]

Dr.Bauman...

 

Thank you for providing us with this exceptional photo. Though the amount of hairs required for this procedure are minimal, the results can be quite striking, considerably adding to the appearance of his transplant.

 

I must commend you on your artistic mastery of this procedure. Results like this were impossible a few short years ago, but due to the diligence of surgeons such as yourself, we can now have a totally imperceptible transplant.

[Bill - Seemiller]

Dr. Bauman,

 

I'll third the compliments. Do you have any immediately post op photos? Though we always appreciate doctor's input and display of excellent work, I hope to see more of your patients posting their results here during the surgery and recovery process to give us a step by step look at their journey and your work. To me, this is and always will be the best form of "advertising" if you will.

 

Bill

[Pat - Community Publisher]

Dr. Bauman,

 

Thanks for sharing these impressive results and pointing of the sutle but very important value of restoring the temporal points.

 

Pat

[DrBauman]

Originally posted by Bill:

Do you have any immediately post op photos?

Bill

Thank you for the kind words. Here's a patient whose scabs started flaking off in five days and was 'clean' in seven days. He used hyperbaric oxygen therapy, low level laser therapy as well as aggressive copper-peptide soaks all within the first few days:

He was looking for a similar hairline restoration to the example I posted above.

Looking at Joe's pictures, it looks like I prefer to 'round-out' the temple recessions a little more than Dr. Wong. I'll have to look back at some more photos, but I think I do it a little different for each patient.

--Dr. B.

[hairbank]

Thanks for the "birds-eye" view, Dr. Bauman. Would you mind sharing the number of grafts this patient received? Personally, I'm curious as I've toyed with doing something similar in upcoming years and just wanted to get an idea for coverage. Also, what would you guess the grafts per cm2 to be?

 

Thanks so much for the pics........the work looks great!

[DrBauman]

Originally posted by hairbank:

Would you mind sharing the number of grafts this patient received? Also, what would you guess the grafts per cm2 to be?

 

 

 

The first patient (KS) got around 2300, the second case (post-op healing) had over 2400 for sure. I have not measured the density in either case but I would estimate there to be a minimum of 40 fu/cm2 and probably more in some areas. Both hairline cases were done with 1mm incisions. I prefer to have a good variation in density across the hairline in a single pass and I like the central part of the hairline to have the highest density.

--Dr. B.

[no hair sux]

wow, thats the most impressive temple point restoration i have seen. very nice work, dr. bauman. that patient is having exactly the type of work i'm looking into. about how many grafts were added to each temple point?

[Jotronic]

Dr. B,

 

I don't thinks it's a matter of preference on how temples are addressed, it's a matter of the patient and what they bring to the table AND the doctor's preference. I had a lot more hair loss than the patient you posted did so to give me such an "aggressive" closure (at the time) may not have been wise. Both Dr. Hasson and Dr. Wong have many times rounded these areas to varying degrees, it just depends on what the patient brings to the table with regards to characteristics and supply/demand. I'm sure you recognize this. Having had my temple points reconstructed during round two and not knowing I'd be getting even more in round three I am in a better position to have more temple work should I ever be so inclined to move on to round four but as it stands I'm exhilarated with the balance that Dr. Wong achieved especially given where I started.

[DrBauman]

Originally posted by no hair sux:

wow, thats the most impressive temple point restoration i have seen. very nice work, dr. bauman. that patient is having exactly the type of work i'm looking into. about how many grafts were added to each temple point?

 

Glad you liked the photos. As I am sure you understand, every case is different. However, the typical TP (temporal point) restorations I perform use about 100-200 grafts per point. If you already have some hair there, you'll be on the lower side. If the TP's are totally gone, you'll obviously be needing more grafts. Probably the most important thing--in terms of design--is making sure that the TP is in proportion with the location/height of the frontal hairline and that it blends nicely into both the temple-recession and sideburn. The hair-directions in both of those areas change quickly over a relatively small area of space. Temporal Points are a huge 'bang for the buck' in terms of numbers of grafts required (relatively few), as well as what they add to the aesthetic value of the hairline restoration and 'frame of the face' (a lot). Here are some more photos of an aggressive TP restoration.

Patient "A.G."

One session, 2500+ fu's restoring the hairline, temples and TP's. ~8 months post-op.

 

 

For his age (20's), his extreme loss of the TP was somewhat unusual. Planning for his 'future-look,' with somewhat receded temples, was important.

 

--Dr. B.

[NervousNelly]

Great work doc. Much appreciated photos and all in similar lighting at same angles. This is exactly what we are looking for.

 

You're right, by not addressing his temporal angle you would have done him an injustice, especially if he ever decided to grow his hair longer. Awesome results.

[Guest Cousin_It]

Dr.Bauman...

 

Thank you again with providing us with an excellent example of your work. Obviously, temporal work can make a significant difference in the "realistic" look of a transplant.

 

I have always felt this way. Having seen many obvious transplants where this area was neglected, it never appeared to have a finished look. When I had mine done a few months back with Dr.Feller, I stressed the point of enhancing this area during the procedure. As a result of his artistic talents and obvious surgical skills, I was afforded the same "complete" look which you offer to your patients.

 

In light of the fact these pictures were only 8 months after the procedure, I am sure there will be an increase of growth and density in the upcoming months.

 

One question... due to the fact the temporal area appears to be a more delicate area than the rest of the scalp, did you find it necessary to use more refined scalpels for the procedure?

 

I look forward to seeing more examples of the fine work you perform. Thank you again for taking the time to educate members of this forum.

[Hair2day]

Dr Bauman:

 

Great work & photos.

 

How do you advise your patients to protect the temporal grafts in the immediate (1-5 day) post-op period? It seems like it would be easy to roll over on one's side during sleep and possibly disrupt the temporal grafts.

 

Thanks!

[DrBauman]

Originally posted by Hair2day:

Dr Bauman:

 

Great work & photos.

 

How do you advise your patients to protect the temporal grafts in the immediate (1-5 day) post-op period? It seems like it would be easy to roll over on one's side during sleep and possibly disrupt the temporal grafts.

 

Thanks!

 

After the grafts have been placed and checked, before the patient leaves the office, I usually place a very light and thin, but snug, bandage (almost like a jogging headband) around the temples and donor area. Between the grafts and bandage is a piece of non-adherent dressing material. (This is the same kind of material they use for burn patients in the hospital.) The patient is also given a special neck-pillow to use at night which helps prevent head movement, friction and accidental dislodging. Since these grafts are typically the first to be placed into position, the scabs are already quite 'solid' by the time the patient leaves the office. When the patient returns the next morning for the post-op scalp wash, the bandage is removed carefully by a member of the medical staff and the grafted area examined. Rarely, we might need to 'settle' some grafts that become elevated overnight. My staff and I examine the area quite carefully under magnification at that 24 hour visit. Unless the patient tries to remove the bandage, bumps or scratches his/her head, or is a very restless sleeper, there is little movement of the transplanted grafts. On the second day, the patient is already washing the transplanted and donor areas (no direct showerhead pressure, however) twice a day. I'll take a picture of the 'headband' and non-adherent dressings and post them here when I get the chance.

--Dr. B.

[Hair2day]

Dr Bauman:

 

Thanks for the explanation.

 

What is the neck pillow that you are referring to, to restrict nocturnal movement?