Hairline Design - Doubles, triples, and so on.

[Greg_Swanson]

Hi all,

What is everyone's opinions on the best hairline design? I've seen some posts saying there didn't like design 'x', as it has too many of a certain graft in it, and so on. 

Should the very front be mostly singles? Or does it depend on one's hair type?

Also, is it true that doing FUE potentially allows for a better "design", as the doctor can cherry pick the grafts so to speak? This didn't make heaps of sense to me, but maybe I am just uninformed.

Thanks all.

[haircrown123]

 Balding people regain their hairline with the help of a hair transplant. Follicular Unit Extraction (FUE) is the best and effective hair transplant method in which the doctor extracts the follicular units of hair, from the donor area of your head, one by one and implants into the bald area.  FUE method is a minimally invasive, long-term, natural-looking hair restoration treatment with assured results. 
 

[Greg_Swanson]

13 minutes ago, haircrown123 said:

 Balding people regain their hairline with the help of a hair transplant. Follicular Unit Extraction (FUE) is the best and effective hair transplant method in which the doctor extracts the follicular units of hair, from the donor area of your head, one by one and implants into the bald area.  FUE method is a minimally invasive, long-term, natural-looking hair restoration treatment with assured results. 
 

I know what the differences are, but FUE is not the best or the most effective method. 

Both methods are effective, and most people give FUT a very slight edge in efficacy. 

My question was regarding graft differentiation

[Bsmith_]

Single hairs in the hairline are most important for placement in the hairline for natural results. This is why physicians should have their medical staff evaluate the grafts under microscopes. 

I agree the yielded growth percentages are higher with the FUT than the FUE. One benefit of the FUE is you can choose the area where the grafts are extracted. Typically you have finer, single hair grafts closer to the nape of your neck. This can also be a con as much as it can be a benefit. Not many people talk about it but say for example you make extractions in nape area for the finer single hair follicles and later down the road, start to develop retrograde alopecia. You will most likely lose those follicles because you have started to thin in the area from where the extractions were harvested. 

IMO what separates good clinics from unexperienced clinics is graft trimming. When I say graft trimming I'm not meaning it in the sense of every graft being trimmed to say you got more grafts than the number of extractions made. I am meaning it in the manner of making sure you have enough single hair grafts you need to place in the hairline. With the FUT,  you do not have the luxury of defiantly knowing you are going to harvest the given number of single hair grafts needed to be placed in the hairline, so it would be optimal to take the given number of grafts you have harvested and only trim a set number of those grafts to give you the total amount of grafts (singles) that would be needed for the hairline. 

Why are single hair grafts important in the hairline? because who wants a 2 hair or 3 hair graft in the hairline that looks like a pluggy result! It doesn't look natural! As I mentioned earlier, microscopes are important!! A follicle might look like a single hair graft to the naked eye but without closely examining the follicle under a microscope, you could possibly mistake a 2 hair graft for a single. Quality control! This is not always practiced which is very unfortunate.

So I guess to answer your question, no, FUE does not allow for a better design in the hairline. A good physician will know how many single hair grafts are needed for the hairline and if they do not consider this to be important or needed, I would question their ethics. An experienced physician should be able to design a natural hairline regardless if it is a FUT or FUE procedure. 

That's my opinion on the matter! Hope it was helpful. 

 

[LaserCap]

Bsmith makes a lot of valid points, good read.  But design is far more than just choosing the type of graft.  It all starts with symmetry,  measurements, proportions, and age and even ethnicity.  Let's take age to begin.  An 18 year old comes in and has a hairline in the middle of his forehead. He is starting to mature his hairline and one of his temporal areas is starting to recede.  He is freaking out. The doctor fills it in.  At that precise moment the patient is thrilled.  What do you think will happen 20 years later when he now has a horn worth of hair on that particular area?  So first consideration is candidacy.

Symmetry, measurements, proportions, they all go together.  Some doctors use the 4 finger rule.  They'll just put their hand on the patient's forehead, starting at the brow line.  Others use the rule of 1/3. I know of many that also have a machine that projects a light.  The key here, from the part of the doctor, is to consider if this particular design will serve the patient well now and in the future.  An age appropriate hairline, despite of what the patient thinks, is important.  All it takes is education. If the patient, ultimately, is adamant about a hairline in the middle of his forehead, turn him away!  A few other things to consider. Will there be some recession on the corners? (Will depend depending on the sex of the patient.  If male, sure.  If a woman, corners will typically slope down).  Lastly, will there be staggering of the grafts?  This will typically add an element of naturalness to the work.

With regards to ethnicity, typically African Americans like a sharp edge with an inverted U design.  0 recession.  Typically no blunting is discussed.

Now grafts.  Yes, in the old days the nape was considered.  But back then it was just FUT.  So, if you see older guys with scars way low, you know that this was early 90's work.  FUE from there? Sure, but they retrograde comes into play.  Now must doctors get the finer grafts for hairline work from behind the ear.  So, shaft diameter is important.  This is where the clinical staff plays an important role in all of this.  The doctor can instruct, but an experienced staff is invaluable.

FUT or FUE?  Makes no difference.  An experienced outfit can play with all the elements.  They can trim, dissect, and even place grafts at different depths.  Opinion wise? FUT is typically a more robust graft and allows the staff more options.  The FUE, by definition, is already minute by definition.  How much more can it be modified? But ultimately how the patient decides to style his hair will help figure out how to move forward.

[RecessionProof]

Lots of great info in this thread. Didn’t consider the possibility that nape hair tends to thin later in life.

But agree that the concept of “cherry picking” is less of an advantage than it seems. I just had my hairline done and my strip produced way more doubles and triples, so I imagine some of those were split if necessary. 

Singles placed in the immediate front with a tasteful, natural “asymmetry” produce the best looking hairlines for sure.

[DrTBarghouthi]

Excellent answers by bsmith and lasercap. I would just like to add that a natural hairline is generally divided into a transition zone and a defined zone. The transition zone is usually where all single grafts should go and would have macro and micro irregularities or the zig zags that you generally see in pictures. This creates a natural transition between the forehead and the more dense defined zone which could have a dense combination of singles and multiples blending in with the transition zone. 

I also agree with the fact that microscope use is a must for inspecting grafts and making sure they are actually single hair grafts, but also to be able to trim more singles if needed.

5 hours ago, Bsmith_ said:

Single hairs in the hairline are most important for placement in the hairline for natural results. This is why physicians should have their medical staff evaluate the grafts under microscopes. 

I agree the yielded growth percentages are higher with the FUT than the FUE. One benefit of the FUE is you can choose the area where the grafts are extracted. Typically you have finer, single hair grafts closer to the nape of your neck. This can also be a con as much as it can be a benefit. Not many people talk about it but say for example you make extractions in nape area for the finer single hair follicles and later down the road, start to develop retrograde alopecia. You will most likely lose those follicles because you have started to thin in the area from where the extractions were harvested. 

IMO what separates good clinics from unexperienced clinics is graft trimming. When I say graft trimming I'm not meaning it in the sense of every graft being trimmed to say you got more grafts than the number of extractions made. I am meaning it in the manner of making sure you have enough single hair grafts you need to place in the hairline. With the FUT,  you do not have the luxury of defiantly knowing you are going to harvest the given number of single hair grafts needed to be placed in the hairline, so it would be optimal to take the given number of grafts you have harvested and only trim a set number of those grafts to give you the total amount of grafts (singles) that would be needed for the hairline. 

Why are single hair grafts important in the hairline? because who wants a 2 hair or 3 hair graft in the hairline that looks like a pluggy result! It doesn't look natural! As I mentioned earlier, microscopes are important!! A follicle might look like a single hair graft to the naked eye but without closely examining the follicle under a microscope, you could possibly mistake a 2 hair graft for a single. Quality control! This is not always practiced which is very unfortunate.

So I guess to answer your question, no, FUE does not allow for a better design in the hairline. A good physician will know how many single hair grafts are needed for the hairline and if they do not consider this to be important or needed, I would question their ethics. An experienced physician should be able to design a natural hairline regardless if it is a FUT or FUE procedure. 

That's my opinion on the matter! Hope it was helpful. 

 

 

4 hours ago, LaserCap said:

Bsmith makes a lot of valid points, good read.  But design is far more than just choosing the type of graft.  It all starts with symmetry,  measurements, proportions, and age and even ethnicity.  Let's take age to begin.  An 18 year old comes in and has a hairline in the middle of his forehead. He is starting to mature his hairline and one of his temporal areas is starting to recede.  He is freaking out. The doctor fills it in.  At that precise moment the patient is thrilled.  What do you think will happen 20 years later when he now has a horn worth of hair on that particular area?  So first consideration is candidacy.

Symmetry, measurements, proportions, they all go together.  Some doctors use the 4 finger rule.  They'll just put their hand on the patient's forehead, starting at the brow line.  Others use the rule of 1/3. I know of many that also have a machine that projects a light.  The key here, from the part of the doctor, is to consider if this particular design will serve the patient well now and in the future.  An age appropriate hairline, despite of what the patient thinks, is important.  All it takes is education. If the patient, ultimately, is adamant about a hairline in the middle of his forehead, turn him away!  A few other things to consider. Will there be some recession on the corners? (Will depend depending on the sex of the patient.  If male, sure.  If a woman, corners will typically slope down).  Lastly, will there be staggering of the grafts?  This will typically add an element of naturalness to the work.

With regards to ethnicity, typically African Americans like a sharp edge with an inverted U design.  0 recession.  Typically no blunting is discussed.

Now grafts.  Yes, in the old days the nape was considered.  But back then it was just FUT.  So, if you see older guys with scars way low, you know that this was early 90's work.  FUE from there? Sure, but they retrograde comes into play.  Now must doctors get the finer grafts for hairline work from behind the ear.  So, shaft diameter is important.  This is where the clinical staff plays an important role in all of this.  The doctor can instruct, but an experienced staff is invaluable.

FUT or FUE?  Makes no difference.  An experienced outfit can play with all the elements.  They can trim, dissect, and even place grafts at different depths.  Opinion wise? FUT is typically a more robust graft and allows the staff more options.  The FUE, by definition, is already minute by definition.  How much more can it be modified? But ultimately how the patient decides to style his hair will help figure out how to move forward.

 

Edited April 17, 2019 by DrTBarghouthi
Typos

[Dr Blake Bloxham]

Great answers. One thing I would add: when you visit a clinic for consultation, make sure they can show you examples of different types of hairlines. Hairlines are not a "one size fits all" type of thing. Just because a hairline looks amazing for one patient, does not mean it would look right for you. Hairlines must be customized for each patient. Things like: hair type, facial structure, forehead shape, level of hair loss, and overall goals must be taken into account.