temporal peaks triangle

[jacksonbrowne]

Why isn't more emphasis placed on the temporal peaks/triangle in HT's? my uniformed opinion is that temporal peak restoration helps balance out weak transplanted hairlines with minimal grafts necessary.

 

My temporal peaks/triangles have always been thinner than the hair surrounding it. Sure there is a chance it could recede back, but from what i've gathered, it takes about 200 grafts to fill in the peaks and 400 to resculpt them.

 

How come more docs don't emphasize it?

[jacksonbrowne]

At the risk of being criticized, i'm growing increasingly frustrated by the lack of input to my questions.

 

Before posting a thread, I search these forums to avoid duplicate posts/threads and answer my own questions. Also, i've generally scoured the existing literature available on the internet. I've tried my best at maintaining etiquette on these forums, but so far have not been satisfied with the answers.

 

Because opinions vary greatly amongst the medical field on Ht restoration guidlines I seek out opinions from HT specialists.

 

Perhaps the mods/community can tell me how to best attract answers to my questions without directly resorting to PM'ing indivuals.

[Sean]

I always thought more grafts were needed to work with temporal angles? Not 200-400 but around 700grafts?

 

But I guess it depends if you want to lower your hairline and add density? I have seen a lot of results from various clinics that incorporated them into a hair restoration procedure. I guess each doc is different, some may use less, some more? You are right it does frame the face really well. I guess it depends if you are going for a conservative look or youthful look.

[wb280]

browne, actually u raised a very valid point. The temples are the ones that make or break your HT IMHO. Even if your hairline is restored, once the temples are done improperly, others will still say, hey it seems u r balding. Also, u r right to say that it does not take too many grafts to restore temples

 

However, here's the rub. I would reckon its not that the docs do not place emphasis but too much placement of grafts on the temples would shout HT One of the first signs of MPB is temporal recession and remember, HT is about creating an illusion of density. Once the temples are unnatural, it makes the whole hair line very very unnatural and must be avoided at all costs IMHO

[mattj]

Temple points are an important area which isn't discussed very often. Mine were never strong, even before I had any hairloss, and I remember it bothered me. They help with framing the face and the forehead looks bigger without them.

 

They may play some part in helping to give a natural appearance as part of a transplant, but I think that above that, they're simply aesthetically pleasing. They work with the temples to give a nice angle which is very masculine.

 

So it's worth having temple points built as part of a transplant, especially as they often require just a couple of hundred grafts per side. They may require more though. Just like the hair up top, it'll depend on how much you're missing. More grafts will be needed if the whole side going up to the hairline needs to be created, which is sometimes the case.

[Dr. Glenn Charles]

I agree that the temporal peaks/triangles are often critical to establishing a natural hairline. Sometimes patients do not have any real recession in the temporal areas and do not require any work done in those areas when having other hairline work done. However, if a patient does have recession in the temporal areas and hairline work id done where the temporal areas are not addressed it actually can make the situation more noticable. So to answer your question all patients who have hair loss in the hairline area and are considering hair transplantation should be evaluated for temporal recession and this should be included in the surgical hair restoration plan.

[Cam Simmons MD ABHRS]

Why isn't more emphasis placed on the temporal peaks/triangle in HT's? my uniformed opinion is that temporal peak restoration helps balance out weak transplanted hairlines with minimal grafts necessary.

 

My temporal peaks/triangles have always been thinner than the hair surrounding it. Sure there is a chance it could recede back, but from what i've gathered, it takes about 200 grafts to fill in the peaks and 400 to resculpt them.

 

How come more docs don't emphasize it?

 

JacksonBrowne

 

It seems that you are talking about your "temporal points" and others have replied accordingly.

 

I have had some patients contacting me about temporal triangles or temporal peaks that are talking about "temporal points" and others that are talking about "frontotemporal (FT) recessions." Temporal Points are usually triangular and project forward from the hairline on the sides. FT recessions are the usually triangular corners projecting backward that are made between the frontal hairline and temporal (side) hairlines.

 

Temporal points help frame the face but it is even more important that the frontal and temporal hairlines balance each other. People with naturally low, full hairlines tend to have strong temporal points and people with natural higher hairlines tend to have weaker temporal points. A low, full hairline without temporal points can look like a wig that has slipped forward. Strong temporal points make a receded frontal hairline look more receded and can look unnatural if there is little hair on top.

 

Dr. Mel Mayer has classified temporal hair loss as N= Normal, T = Thinning, P = Parallel (to the sideburn), or R = Reversed (concave backward above the sideburn).

 

The first 2 questions, hair transplant doctors will ask you are "Can you send photos?" and "How old are you?" Your current status and your age are the two most important predictors for your future hair loss. The younger you are now the harder it is to predict how much more hair you could lose.

 

It may not take a lot of grafts to transplant a young man's temporal points now but it could commit him to transplanting a lot more grafts later to maintain a balanced look. Usually for very young men, whose future hair loss is harder to predict, we start with a higher, more receded frontal hairline and leave N,T, or P temporal hairlines alone. If someone is older and their future hair loss is easier to predict, transplanting their temporal points to balance their frontal hairline can be a very good idea.

Edited September 6, 2010 by Dr. Cam Simmons

[Surfarosa]

Dr. Simmons - at what age do you feel that you can start making the "call" on predicting the extent to which a patient will lose their hair? I know this is a question that can have many answers with the usual caveats but you intimate above that it becomes easier to make a prediction thus you must have something in mind.

 

I have been losing my hair since my late teens, been on meds for 10+ years and feel at 36 I should be able to have an idea of where I'm destined. In my early 20s my fear was that I would follow my father's advanced MPB route. However, as I have not (he was completely bald by my age) I often wonder where I might end up or when I might have a pretty darn good idea.

[hairthere]

I actually just had my TPs restored via FUE (200 to each side). Go to patient results section to see pics.

[Cam Simmons MD ABHRS]

Dr. Simmons - at what age do you feel that you can start making the "call" on predicting the extent to which a patient will lose their hair? I know this is a question that can have many answers with the usual caveats but you intimate above that it becomes easier to make a prediction thus you must have something in mind.

 

I have been losing my hair since my late teens, been on meds for 10+ years and feel at 36 I should be able to have an idea of where I'm destined. In my early 20s my fear was that I would follow my father's advanced MPB route. However, as I have not (he was completely bald by my age) I often wonder where I might end up or when I might have a pretty darn good idea.

 

Surfarosa

 

Great question. I can't give you a simple answer.

 

Without medications, it is easier to predict the future for someone in their 40s than in their 20s. If there is mild to moderate loss at 36, someone could still progress to as far as a Norwood 6 but very likely wouldn't get to a Norwood 7 pattern. Norwood 6 patients are much easier to treat than Norwood 7 patients, of course.

 

Medications can be great at slowing hair loss and can therefore make prediction harder. I always design hair transplantation as if patients won't keep taking medications while encouraging them to continue taking them. We can never know exactly how you would look now if you hadn't used meds for 10+ years but it would make sense that you would probably have much less hair. Sometimes patients only learn how much the medications helped after they stop them.

 

The genetics of hair loss are very complicated so you can't look at one family member and expect to follow in their footsteps. The fact that you could notice hair loss in your late teens, which is earlier than a lot of men, is a warning sign that you could have developed advanced MPB and it is good that you and your doctor started meds to slow your loss when you did.

 

To get your best estimate at your future progression, you would need a close personal exam to look for miniaturized hair where the hair currently looks thick. You would then have to add a measure of caution because you have been using medications.

 

Sorry the answer is a bit wishy-washy but its the best I can do.

[Cam Simmons MD ABHRS]

I actually just had my TPs restored via FUE (200 to each side). Go to patient results section to see pics.

 

Hairthere

 

Thanks for directing us to your photos. You seem to have good growth at 5 months. The hair directions and angles look good. Dr. Feller has transplanted a small number of grafts well so that your temporal points are still subtle but create a nice balance with your transplanted frontal hairline.

Edited September 7, 2010 by Dr. Cam Simmons
didn't actually give a link

[Surfarosa]

Hairthere - how do I get to the pictures you are referring to ?

 

Thanks

[Cam Simmons MD ABHRS]

Hairthere - how do I get to the pictures you are referring to ?

 

Thanks

 

If you are still on-line hairthere, I hope you don't mind me stepping in. Surfarosa, I found this link by clicking on hairthere's name then looking for recent posts.

 

http://www.hairrestorationnetwork.com/eve/157589-temple-point-update.html#post2243326

 

Good night all.

[Surfarosa]

Thanks for your answer Dr. Simmons I will contact you via your website as I am really interested in a proper evaluation. I have never been satisfied with the evaluations I have had - including from several coalition doctors.

[hairthere]

No problem Dr. Simmons, thanks for helping surfarosa out. The TPs, in my opinion, were essential to making my hairline restoration a success.

[Cam Simmons MD ABHRS]

Surfarosa

 

I should also mention that bringing old photos to a consultation can help. Instead of seeing a snapshot of your current condition we can get a "movie" of your hair loss progression.

[mattj]

Strong temporal points make a receded frontal hairline look more receded and can look unnatural if there is little hair on top.

 

This is an important observation. The temporal points project forward, and this can give the effect of making temple recession appear deeper. Like more hair has been 'scooped away'.

 

But it is possible to give more definition to the temporal points without making them project forward too much.

[jacksonbrowne]

Thanks everyone for rallying and giving some great answers. I've developed a bit of an obsession with temple points and have noticed that great hair and strong temple points go hand in hand.

 

MattJ brought up an interesting point, but from looking at photos and people iMO, strong temple points look good regardless of deep recession. Look at Jude Law vs. Phil Collins. The criminal Whitey Bulger.

 

Look at Kevin Spacey who is in dire need of some temple point. Personally, I feel that the 'cove' effect like seen on Jude Law looks stronger than w/o.

 

 

[jacksonbrowne]

I'd like to reference this post where Bauman shares his thoughts and postulates (in 2007) that he prefers 'rounds out' the temple points more than Hasson & Wong.

 

Some good work in this one. I guess it's a bit of negotiation with the hair doc but i'd definitely take a higher hairline with stronger temple points.

 

I've observed many people in class, public and on the train to the point of being stared back and have found that I prefer a higher hairline with stronger temples than a lower hairline w/weak temples.

 

 

 

 

http://www.hairrestorationnetwork.com/eve/154445-temple-point-restoration-when-%22safe%22-do.html

[hairthere]

jackson, I agree with you 100%. I never noticed temple points until mine had receded and now I look at them all the time. We just look odd without them and a bald guy with strong tps versus a guy with no tps and a strong hairline almost looks better.

[mattj]

 

MattJ brought up an interesting point, but from looking at photos and people iMO, strong temple points look good regardless of deep recession. Look at Jude Law vs. Phil Collins. The criminal Whitey Bulger.

 

 

 

Oh, I agree with you. They do look better. I'm just saying that they can exaggerate recession. The further forward they are, the further back the recessed temples will appear to go. It's probably only an issue in mild MPB cases really, and may not be of much importance to most men.

[StuPitt1]

First post here. IMO, the reason why most people don't have their temple points addressed by the doctor is because it's the hardest area to make "natural looking" I have yet to see good, not great, but good temple point work done.

 

Today's HT doctors have mastered the best techniques on the top of the head, hopefully they will start spending more time on the sides.

[Megatron]

It may not take a lot of grafts to transplant a young man's temporal points now but it could commit him to transplanting a lot more grafts later to maintain a balanced look.

 

I think that's a very, very important point Dr. Simmons makes. IMHO too many guys are willing to disregard the long term implications for immediate satisfaction.

[Cam Simmons MD ABHRS]

First post here. IMO, the reason why most people don't have their temple points addressed by the doctor is because it's the hardest area to make "natural looking" I have yet to see good, not great, but good temple point work done.

 

Today's HT doctors have mastered the best techniques on the top of the head, hopefully they will start spending more time on the sides.

 

StuPitt

 

You are right. Temporal points are one of the more challenging areas. The angle and direction of the hair are critical. The very flat angles required means we can't put the grafts as close together as we could on the top. The transplanted hair is directed away from the incision so the bases of the grafts near the incisions are visible whereas in the front, you see the tips of the hairs first. Even if you brush the frontal hair back, you see the bend in the hair and not the base. Larger grafts can stand out like a sore thumb in the temples so we will not get as much density when we are using 1s and 2s. I think most hair transplant doctors would rather achieve the look of thinning natural-looking temporal points than having denser less natural-looking temporal points. Subtle temporal points can make a difference even if they aren't dense.

 

Temporal points are still the icing on the cake for most patients. Usually we have to focus on the cake first.

 

Hopefully, you will consider this "good, not great, but good" temporal point transplantation: http://www.hairrestorationnetwork.com/eve/158034-dr-cam-simmons-%96-norwood-3v-man-%96-part-2-2295-grafts-better-frame.html

[Tom60]

i never knew that temporal points were the hardest. but now that i think about it, i have seen some pretty bad hts in that area.

 

great posts.