eugenix Female Hair Transplantation at Eugenix/ 1500 Grafts/1 year post op

[Abhinay Singh]

Female Hairline

Introduction:
Female  hairline is relatively more complex than male hairline.
Each female has a specific hairline in mind depending on their own perceptions of beauty. The doctors can definitely give inputs regarding what would look more natural and aesthetic. 
   The donor availability is also an issue in the females. Since females have a very limited donor, i.e., the back scalp only, it is vital that the donor density is properly evaluated and the available grafts are used to their optimum capacity.

Indications of Female Hair Transplantation:

1. Naturally high hairline:
   Sometimes women do not fancy their naturally high hairlines. They turn to hair transplantation for lowering their hairlines.
2. Androgenetic Alopecia:
   Women can experience baldness with the increase in sensitivity to dihydrotestosterone. This can happen due to a hormonal imbalance in young women and after menopause in women who are in their late middle ages.
3. Traction Alopecia:
   Constant pull/tension in the hair due to tying them tight can cause permanent loss of hair.
4. LPP (Lichen Plano Pilaris) and other scarring alopecias: 
    In these conditions, the body's own immune system can eat up the hair causing hair loss.
5. Cosmetic surgeries:
   Surgeries like an eyebrow lift among many others can cause the hairline to get elevated.
   The distance of the hairline from the glabella is also different in males and females. When it is 8 to 9 cms for the males, for the females it is only 5 to 6 cms. In females, the hairline has many micro and macro irregularities.
   Additional elements in the female hair line: Widows peak, lateral mounds, cowlick, shape of fronto-temporal recession, size of temporal peak, width of sideburns and the distance from the tragus are determined to the last dot for precision and perfection. This is what helps to balance the different proportions.
   
Creating Recipient sites:
   The slits in the midline zone (middle  1/3rd or middle 3 finger width) are directed anteriorly and the hair is also directed towards the right side from the left side.
   The tactile sensation during site creation can provide feedback as to whether the direction and angle is correct: As the blade enters, there should be a very smooth sensation; if the surgeon feels something gritty or crunchy, the angle is most likely incorrect.
   Lateral mounds are described as protrusions along the frontal hairline, on average 3.75 to 4.0 cm from the widow’s peak or center of the hairline. Lateral mounds are larger and more lateral than in men, and occur with a higher frequency. It is very important to incorporate the lateral mounds into the female hairline to impart a more feminine look.
   Another difference is that cowlicks were more prevalent in women with 64% of women having some type of cowlick pattern. In patients with a strong whorl, the direction of the transplanted hairs should match those of the cowlick.
   Many women do have a frontotemporal recession, it is less prominent than in men. If the patient previously had a concave triangle or concave oval shape, this shape can be maintained in an advanced position. These temporal recess show miniaturised hair, and so grafting with fine sentinel hair, as well as single hair grafts (with thin calibre, slow growing and less colour), should be used at the anterior portion of the recess to create a natural appearance.
We usually under correct the recess while maintaining the concavity  to create a more straight/slightly concave hairline  of the fronto-temporal recess in such cases. Attention should be paid to hairline-temple balance in such cases as sometimes temple & temporal points need to be enhanced to balance the augmented fronto-temporal recess.

   The suitable donor area for the frontotemporal area (FT), temple peak (TP), and sideburns (SB) are the nape/ just behind the ear/front of ear. However, hair shaft diameter in the FT, TP, and SB were smaller than in the donor areas of the temporal, parietal, occipital, and neck regions according to our study.
The “baby hair” on the hairline zone are characterised by 1) slow growing, 2) thinner in caliber and 3) lighter in colour.
It is very very important that these kind of hair are strategically picked up from the donor area and planted on the hairline zone to create the natural looks in females (though it is also important in males)!

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Edited March 6, 2020 by Abhinay Singh