BHR Clinic - Hairline or Crown - Which is the Hardest to Replicate?

[Raphael84]

Here is an interesting question that was recently asked to us, "What is the hardest aspect of a hair transplant?" "Is it the hairline or the crown?"
Both have challenges for different reasons and this video will help you to appreciate some of the intricacy and thought you need to take into account.
 

 

Edited March 22, 2021 by Raphael84

[Curious25]

Thanks for the video.

 

I know you mentioned it being important to avoid ‘front loading’, however does Dr Bisanga  believe the most aesthetic approach is to still have a denser hairline/frontal third, and then gradually decline in density toward the back of the head? 

[rob7331]

This was a great video! Really informative on a variety of topics. Thanks.

[TommyLucchese]

Great video - thank you.

I would be interested in a video explaining the sections that are marked out in pen before the surgery. For example that square box in the centre of the patient's hairline in this video. 

[Raphael84]

Thanks for the comments and questions guys.

On 3/22/2021 at 3:33 PM, qui bono said:

Its interesting you mentioned frontloading in this video (placing too many grafts in the hairline) ... if you had the time could you suggest some options of how a patient could correct this? 

 

This will depend on each patients personal situation. Front loading can occur due to an inappropriate hairline that was designed and placed too low or aggressively without thoroughly considering progressive loss behind and the demand on the patient´s limited donor area. This scenario is an example of the risks involved when operating on younger patients who desire lower hairlines and their progressive pattern may not be obviously evident.
Grafts can be removed/punched out, but in terms of frontal loading, if grafts are placed at density then it is not an easy approach to punch out a high amount of grafts and it may require several sessions as grafts that are adjacent to each another would not be removed in the same session due to the risk of the intermediate skin being compromised and the sites opening up that would require suturing and therefore potentially more impact and scarring on the skin tissue. 
 

On 3/22/2021 at 6:31 PM, Curious25 said:

I know you mentioned it being important to avoid ‘front loading’, however does Dr Bisanga  believe the most aesthetic approach is to still have a denser hairline/frontal third, and then gradually decline in density toward the back of the head? 

Higher density in the hairline and slowly dropping is the most appropriate approach to achieve the most aesthetically pleasing result. 
With the frontal hairline requiring single hair grafts in the initial rows, density is required to be higher to be able to achieve the necessary hair count to offer that visual of density. As we move back and are able to utilise double, triple and 4 hair grafts, then Dr. Bisanga is able to lower density whilst retaining the required hair count.
With hair restoration achieving the illusion of density, and mimicking nature with hair direction and angulation, as explained in the video, the crown will always allow light to reach the scalp due to the natural whorl pattern and so dense packing is not appropriate, whilst also considering that due to the constant change in direction of follicles and recipient sites not being made perpendicular to the scalp, then the angulation utilises more surface area meaning a lower density. Every patient´s donor area has their limitations and depending on extent of loss, restoring the crown at high density would not be possible in terms of graft availability for most patients. 
 

22 hours ago, TommyLucchese said:

Great video - thank you.

I would be interested in a video explaining the sections that are marked out in pen before the surgery. For example that square box in the centre of the patient's hairline in this video. 

Dr. Bisanga will utilise such markings to highlight the most effective area for larger follicular units. This is based on the bone structure of the patient, and the patient´s natural hair direction, and by focusing specific units in specific areas can optimise how light will (or will not) penetrate the transplanted hair and reflect from the scalp, as it is due to such penetration that the human eye will perceive thinning. By being methodical in this approach, the illusion of density is magnified.

Edited March 24, 2021 by Raphael84