The art of frontal hairline and temple point design

[George Clooney]

What follows is a summary of a number of articles I've come across in the literature about the aesthetics of frontal hairline design and determining location. Images were taken from Shapiro et al "Hairline Design and Frontal Hairline Restoration" (2013) and Garg et al. Decoding Facial Esthetics: A Method Which Includes Forehead Curvature (2017).

This discussion may seem a little heady for people new to hair loss research, but if you can be patient with the terminology I think you might find some insight to have a more nuanced discussion with your surgeon about your procedure. Particularly if you're going to a clinic that is less well recognized or with younger surgeons, this might help seeing if they've done their homework.

Temple points can be difficult. I thought this article was very interesting in terms of its discussion of graft orientation and how to distribute multis vs single units of hair.

The other subtlety that I've struggled with is knowing where I would want to place my frontal hairline. Many people describe Da Vinci's "Rule of 1/3rds" - forehead to glabella is 1/3, glabella to base of nose is 1/3, base of nose to chin is 1/3:

This is where placement should go for a young hairline or in a patient that has relatively minimal loss, but probably too aggressive for someone with limited donor or a high Norwood. Another approach is determining the mid frontal point (MFP) and assessing where the middle of the curve is between the dome and face in the horizontal and vertical planes:

There is about 3 cm of leeway with this approach -- 7 cm for aggressive hairlines, 10 cm for conservative. This is assuming you have an "average" head size. A lot of intuition and experience come into play here, it's not carved in stone, so to speak.

Regarding temporal points, Shapiro discusses what he feels are unnatural transplanted hairlines as well:

Determining temporal point placement is difficult. Every temple point is a triangle made by the junction of frontal and temporal hairlines. If a surgeon places a frontal hairline that goes into the patients native temples without reconstruction, you can end up with an unnaturally wide and rectangular forehead. There are certain surgeons that are known for this approach. It also seems like FUE specific surgeries involve less bulking of temple points than strips, but perhaps that's because style preferences of surgeons have changed over time. For aggressive lower hairlines, temple points should generally be sharper and for those with more recession there is a natural smoothing/curvature at the apex of the point that happens over time. FTA = frontotemporal angle and LEL = lateral epicanthal line (from the outside of your eyebrow).

 

There is a lot more to hairline creation than described here but this might be a good place to start for those that are struggling to understand which clinic is the right one for them.

Most important is not to rush your surgery. The techniques will only get better with time and the longer you wait the more opportunity you'll have to see how your native hairs will evolve, particularly if you're taking medication. My crown continued to bulk up from finasteride for years after I began the medication, for example, to the point where I no longer needed crown work. Your face is your calling card and it can be impossible to recover from a botched surgery. Don't fall in love with marketing and don't let people accuse you of analysis paralysis.  Patience is paramount.

I really appreciate this forum, the hard work Melvin puts into it and the humility and honesty of everyone who's willing to put their case out there. There is something really special going on here and I think open spaces like this are future of cosmetic medicine (and probably medicine as a whole).

I hope you all found this helpful!

Edited February 9, 2022 by George Clooney

[Melvin- Admin]

Thanks for creating this awesome thread, very informative and great points 👏🏼👏🏼

[NARMAK]

Thanks for sharing. 

I think there's some very solid points regarding what sort of temple point designs should be used based on hair loss and age. 

Personally i think there's become a "standard" design many clinics tend to use but i think there's got to be scope for a holistic tweak. 

Personally i don't know if waiting any further than what we have today and the principles of temple point restoration will actually lead to a better outcome. I would say perhaps we need more capable and numerous options for temple point reconstruction but i think and i have no way to prove this. The majority of people don't require a full temple point reconstruction. They need a small booster/augment or they sometimes have strong temple points and only need to have the corner temporal areas lowered. 

[George Clooney]

2 hours ago, NARMAK said:

Personally i think there's become a "standard" design many clinics tend to use but i think there's got to be scope for a holistic tweak. 

Personally i don't know if waiting any further than what we have today and the principles of temple point restoration will actually lead to a better outcome. I would say perhaps we need more capable and numerous options for temple point reconstruction but i think and i have no way to prove this. The majority of people don't require a full temple point reconstruction. They need a small booster/augment or they sometimes have strong temple points and only need to have the corner temporal areas lowered. 

I think every surgeon has his "signature" look for temples. You can ask them to adjust or modify slightly, but it's usually a minor variant of their baseline.

That's why this place is so invaluable, with people showing their immediate post op results and hairline design, it gives us an opportunity to understand the thought process that went into the procedure.

It does seem like we've been in a period of refinement of previously known techniques, but one thing I enjoy about hair restoration is that there always seems to be something interesting around the corner.

Your point is well taken though; hoping for some miracle cure probably isn't that wise of an approach. Do your research, find your guy, and when it's time it's time.