Settle the debate: When is it appropriate to lower the central hairline, if ever?

[Berik]

This is a very contentious topic with vastly different opinions from doctors on both sides of the argument. Some surgeons are very conservative and will almost never lower the central hairline once it has recessed and will only fill in the corners unless the hair loss is very stabilized and the patient is older. Even then, sometimes they will say that a "mature" hairline that is deeply recessed is more age appropriate and "natural."

Other surgeons seem to have no hesitation lowering the central hairline to its original, natural juvenile point, often creating a hairline that recedes into the corners more so the hairline resembles a norwood 2. 

Obviously, the approach to each case is unique and dependent on the patient's hair loss history, progression, and ultimate projection of where their hair loss will stabilize. 

 

Personally, I think that creating a central hairline far above the original point looks very bad for anyone under the age of ~50 and almost more unnatural some of the time. 


I'd love to hear others opinions on this. 

[Doron Harati]

When you loose around 3cm, then the surgeon can create zigzags for natural hairline, either you want "aggressive" or conservative result.

You can check many results here on our Instagram: 

https://instagram.com/doronhairadvisor_hdc?igshid=YmMyMTA2M2Y=

[mr_peanutbutter]

is it better when the whole hairline gets moved a bit forward including the middle? otherwise - in case of further recession - you have a receesed middle and prominent corners, sth thar cant be observed in nature, while an somehow intact hairline with a empty area behind is not that common but an unheard of natural balding pattern…

[Rafael Manelli]

It’s simply a matter of supply and demand vs aesthetics. There’s a roughly “ideal” hairline zone for each person. Anything more aggressive is a waste of grafts and produces an uglier result and so is pointless. Anything less aggressive produces a less appealing result, but saves grafts. Saving grafts means you can achieve better aesthetics for overall density or for the crown, or to insure against future thinning.

Most of us will have to compromise somewhere, either in the hairline position, the crown, the overall density or all three. Or you can demand full density with a low hairline and end up having to use lots of body hair, which is a gamble and a compromise on naturalism.

Anything above a norwoood 4 requires compromise on the vast majority of patients, no two ways about it. Even a young Norwood 2 must either compromise or take a gamble on future thinning, which is its own form of compromise.

I think most of us would secretly want our juvenile hairlines back, but would rather have a more mature Norwood 2 or 3 look and have enough grafts to cover the crown 

[ScottishGuy21]

The younger you are the bigger the risk.
 

If you only have mild hairloss and are north of 45 chances are things will remain pretty stable and it’s a calculated risk you could argue worth taking.

Below that I’d be dead against it. Aggressive recession could still hit and/or meds may start to weaken in effectiveness. You want to keep grafts in reserve for this scenario.
 

I doubt many of us want mature hairlines after a transplant but it’s the compromise we have to make in order to make it seem like we have a full head of hair!

[Rafael Manelli]

It's sort of a case where old guys get young guys hairline, while young guys get old guy hairline. 

[BaldReaper]

you can always lower your hairline, it depends on your donor and baldness level.