Designing of a natural hairline

Hair Transplant
1

While going through one of the sites, I went through a very interesting topic which i thought i will discuss with all the readers. In one of the comments they were discussing how a hairline should be designed by keeping a thinner transition zone infront of denser hair zone. I thought i’ll put my inputs to the topic.

For the construction of a natural looking hairline, first of all some of these points should be taken into consideration:

  1. Norwood level of patient.
  2. No. of available grafts
  3. Plan for future hairloss/ restoration
  4. Is the hairline area slick bald or it’s a case of thinning but identifiable hairline.
  5. Whether body hair will be used.
  6. Characteristics of body hair
  7. Number availability of body hair
  8. Patient preference
  9. Facial features of patient
  10. Will temples be closed
  11. Slope of forehead
  12. Whether it will be a hairline dominated HT or a crown dominated HT
  13. Preferred shape of hairline (angular, broad, rounded, U-shape etc.)
    etc…

After this, the doctor has to know about the most natural hair angles, hair directions, hairline variations, peaks etc., to design the hairline suitable to the patient.

There are a lot more things but that will become a long chapter by itself.

2

Dr. H,

On a different site you posted that you believe transition zones have its roots in plugs/minis/and micros era AND that you do not believe in transition zones. Your quote,

"PostPosted: Fri Dec 21, 2007 2:58 pm Post subject: Reply with quote
hairtech wrote:
I was disagreeing with the “no transitioning zone”. Let make sure I am reading you correctly. You believe in NO abrupt hairline… but you also don’t believe in a gradual transition zone???

BTW I have to call you sir.

Yes, you read it correct hairtech. No abrupt hairline, but no transition zone either. The concept of transition zone has its roots in a thankfully forgotten era of plugs. Aesthetic hairlines do not rely on transition zones.

If you wish to add titles, you may call me Dr. (Ms.) Harpreet. OK?

Dr. Harpreet (patient care counsellor, Dr. A’s Clinic).
If you have any queries, email them to hairadvise101@yahoo.com.
You may call us at +91 9810178062.
Online consults - contact by skype (hairadvise) or yahoomessenger, during working hours.

So I will post my response to that here so you can respond and so newbies or ghost readers are not confused about what transition zones are.

Dr. H,

Ok, will all due respect, I want you to read this concept and then maybe you can understand why HLC and myself, emphatically disagree in your statements of no transition zones:

Transition zones DO NOT have roots in plugs and minis/micros. In fact a transition zone was something a physician named Dr. Shapiro began to develop as so a hairline was not so abrupt. The concept of the transition zone come about AFTER the plug/mini/micro era. Just to give you an example in nature to what a transition zone is, take a look at a forest. If you were hiking on a flat piece of land, and you walked to the very edge of a forest… what is the most likely scenario of what you would see? Well you would not see a strong line of large trees in the front. You would see first some small bushes… then small trees, then medium trees then finally the large trees. By definition, a transition zone means a graduation to large trees from small to large. The same concept is applied in hair transplants. Dr. Shapiro and Dr. Rose for that matter, figured out that it looked unnatural to have huge grafts on the hairline (plugs, micros and minis), but in fact in nature hairlines start with fine single haired grafts in the front, then come naturally 2 haired grafts, then 3’s and 4’s, etc., etc. Not exactly on rows of 1’s, 2’s,3’s,4’s, but a mixture but definitely 1’s are first. If you don’t believe me, put on a pair of micrsocopic 6x loupes, go find someone, and study their hairline. Study different ones. A good hairline will in fact have a transition zone. This transition zone has its ROOTS from the beginning of man and in all races. Wink

3

» Dr. H,
»
» On a different site you posted that you believe transition zones have its
» roots in plugs/minis/and micros era AND that you do not believe in
» transition zones. Your quote,
»
» "PostPosted: Fri Dec 21, 2007 2:58 pm Post subject: Reply with quote
» hairtech wrote:
» I was disagreeing with the “no transitioning zone”. Let make sure I am
» reading you correctly. You believe in NO abrupt hairline… but you also
» don’t believe in a gradual transition zone???
»
» BTW I have to call you sir.
»
»
» Yes, you read it correct hairtech. No abrupt hairline, but no transition
» zone either. The concept of transition zone has its roots in a thankfully
» forgotten era of plugs. Aesthetic hairlines do not rely on transition
» zones.
»
» If you wish to add titles, you may call me Dr. (Ms.) Harpreet. OK?
» _________________
» Dr. Harpreet (patient care counsellor, Dr. A’s Clinic).
» If you have any queries, email them to hairadvise101@yahoo.com.
» You may call us at +91 9810178062.
» Online consults - contact by skype (hairadvise) or yahoomessenger, during
» working hours.
»
»
»
»
»
»
» So I will post my response to that here so you can respond and so newbies
» or ghost readers are not confused about what transition zones are.
»
» ____________________________________
»
» Dr. H,
»
» Ok, will all due respect, I want you to read this concept and then maybe
» you can understand why HLC and myself, emphatically disagree in your
» statements of no transition zones:
»
» Transition zones DO NOT have roots in plugs and minis/micros. In fact a
» transition zone was something a physician named Dr. Shapiro began to
» develop as so a hairline was not so abrupt. The concept of the transition
» zone come about AFTER the plug/mini/micro era. Just to give you an example
» in nature to what a transition zone is, take a look at a forest. If you
» were hiking on a flat piece of land, and you walked to the very edge of a
» forest… what is the most likely scenario of what you would see? Well you
» would not see a strong line of large trees in the front. You would see
» first some small bushes… then small trees, then medium trees then
» finally the large trees. By definition, a transition zone means a
» graduation to large trees from small to large. The same concept is applied
» in hair transplants. Dr. Shapiro and Dr. Rose for that matter, figured out
» that it looked unnatural to have huge grafts on the hairline (plugs,
» micros and minis), but in fact in nature hairlines start with fine single
» haired grafts in the front, then come naturally 2 haired grafts, then 3’s
» and 4’s, etc., etc. Not exactly on rows of 1’s, 2’s,3’s,4’s, but a mixture
» but definitely 1’s are first. If you don’t believe me, put on a pair of
» micrsocopic 6x loupes, go find someone, and study their hairline. Study
» different ones. A good hairline will in fact have a transition zone. This
» transition zone has its ROOTS from the beginning of man and in all races.
» Wink

You are impatient!. How do you manage to go from one site to the other so fast. I will have to learn that. Thanks for posting my comments anyway.

Lets talk hairlines. What is it you find difficult?!

4

The forefathers of natural hairline placement & Aesthetics were Lucas, Stough, Uebel, Griffin & Limmer and advances now-a-days owe much to them.

Aspects of artistic craftsmanship while designing a hairline were first discussed by Manfred Lucas.
Determination of appropriate hairline placement was first described & evaluated by Dow B.Stough & Dr.Carlos Uebel.

Coming to the transition zone, nature has not given us a thin uniform transition zone of low density hair infront of dense hair zone.
What nature has given is dense hair zone preceded by multiple large & small irregular peaks.

5

Ok I knew there was a language barrier or something. The irregular hairline is important. I agree with you on this and have discussed this before in different threads. But I thought we were talking about just the density part of a transition zone.

A good hairline will have both a transition zone as well as irregularity. A hairline will not be linear, however we still see clinics making a linear hairline.

And who first described irregular hairlines with transition zones is Shapiro and Rose.

Here is my own hairline for your review and below that is the thread I wrote concerning hairlines a while back.

Here is a post by Sofarsogood:

PostPosted: Fri Dec 21, 2007 6:31 pm Post subject: Reply with quote
Maybe there is a communication disconnect here.

A well built “transition zone” to the hairline can make all the difference sometimes in the naturalness of an HT, IMHO.

People with course donor hair and high skin-to-hair contrast often have an abrupt looking HT hairline, IMO.

In my case, FUs (even some singles) looked abrupt., IMO

BHT was used to create that “soft-zone” or “transition zone” and 3-peaks.

IMHO, it made a big difference in the naturalness of my HT.
If one isn’t comfortabe with BHT, perhaps nape hair could achieve the same effect.

The “soft-zone” only should be 2-3 mm tops otherwise the “unnatural” look may occur as the good doc suggested.

If we posted extreme close-ups of natural hairlines, I believe we would all see the value of the “transition zone”.

Check it out what BHT did to my HT hairline…

Here is a post by the BSPOT:

PostPosted: Sat Dec 22, 2007 2:49 am Post subject:

There is always a transition zone in every hairline.

It is paramount to achieving natural hairlines.

People often mistake “soft or natural” hairlines with low density which is untrue.

The idea or theory may have existed before Dr. Shapiro, but he wrote it, named it, and then perfected it-- it exists.

Take Care,
Jason

Here is a post by the hairloss cure:

PostPosted: Mon Dec 24, 2007 1:54 am Post subject: Reply with quote
Just to be clear, I wrote the following in my initial post: “Even people with luscious heads of hair will have a zone, even if it is only a few mm deep, where the leading edge is thinner, irregular, and undulating.”

“Thinner” refers to the use of exclusively single hair units. “Irregular and undulating” refers to many things, including irregular peaks.

I thought the statement was fair and rather inclusive. Furthermore, I believe it nicely describes many of the hairlines in the photos above.

Rose Hair Restoration

6

The problem I see with creating a natural hairline is that there doesn’t appear to be a single doctor in the world who can do so consistently. Sometimes I see photos of a hairline on a patient that looks absolutely fantastic. I have always been extremely reluctant to get a HT, but when I see the good work being done, I start to consider getting my hairline restored and waiting for HM in order to fill in the crown. So I surf over to the doctor’s website and, much to my dismay, discover one good-looking hairline, a few decent hairlines, and a bunch of crappy looking hairlines that I can’t believe people paid their hard-earned money to receive.

So it seems to me that building a good hairline is a lot more difficult than anybody here is making it out to be. I don’t know a lot about HT because I don’t pay much attention to it. So perhaps someone here can explain to me why no doctor in the world seems to be able to consistently build natural looking hairlines. I’ve been to the websites of the best doctors out there, and I continue to see inconsistent results. What I find the most concerning is that I am viewing the very best work these doctors have ever performed, and the bad results are being purposely withheld from my view.

I’m not trying to be critical here. Perhaps I’m what is referred to as “a patient with unrealistic expectations?” Before I pay over ten grand and commit to surgery, I ask for a guarantee that I will receive a hairline that looks non-surgical and looks like a god-given natural hairline. Is that not possible in this industry? I am a NW 3v with a hairline that probably needs a thousand grafts to restore. Can I seriously rely on anybody to restore my hairline or should I wait another five years for technology to continue to improve?

7

» The problem I see with creating a natural hairline is that there doesn’t
» appear to be a single doctor in the world who can do so consistently.
» Sometimes I see photos of a hairline on a patient that looks absolutely
» fantastic. I have always been extremely reluctant to get a HT, but when I
» see the good work being done, I start to consider getting my hairline
» restored and waiting for HM in order to fill in the crown. So I surf over
» to the doctor’s website and, much to my dismay, discover one good-looking
» hairline, a few decent hairlines, and a bunch of crappy looking hairlines
» that I can’t believe people paid their hard-earned money to receive.
»
» So it seems to me that building a good hairline is a lot more difficult
» than anybody here is making it out to be. I don’t know a lot about HT
» because I don’t pay much attention to it. So perhaps someone here can
» explain to me why no doctor in the world seems to be able to consistently
» build natural looking hairlines. I’ve been to the websites of the best
» doctors out there, and I continue to see inconsistent results. What I find
» the most concerning is that I am viewing the very best work these doctors
» have ever performed, and the bad results are being purposely withheld from
» my view.
»
» I’m not trying to be critical here. Perhaps I’m what is referred to as “a
» patient with unrealistic expectations?” Before I pay over ten grand and
» commit to surgery, I ask for a guarantee that I will receive a hairline
» that looks non-surgical and looks like a god-given natural hairline. Is
» that not possible in this industry? I am a NW 3v with a hairline that
» probably needs a thousand grafts to restore. Can I seriously rely on
» anybody to restore my hairline or should I wait another five years for
» technology to continue to improve?

Please, no sales pitches or clinic pumping. I’m looking for honest answers here.

8

Okay, looking back on my posts, I suspect people will think I am attacking the HT industry. That is not the case. I suspect what I am seeing is largely due to a limitation in donor hair. The worst HT’s appear to be on the guys who have a lot of baldness and had a lot of ground to cover. But I still see a lot of inconsistency among patients. I stand by my assertion that no doctor can consistently build high-end hairlines on their patients even if limited to low norwood level patients. I would like to hear an honest discussion of why this is. What variables are involved here that can lead to an excellent result vs. a good or marginal result? Is getting an excellent hairline result a matter of a coin flip? What are the odds and risk factors? I realize the answers will vary by clinic, but I am looking for general things a prospective patient can take away that will be of benefit when deciding whether or not to do the procedure.

9

Before giving any opinions i would be interested to know;

  1. Your current age,
  2. When did you first notice hairloss and how rapidly it has progressed,
  3. What is the current speed of your hairfall (rapid, moderate or slow)
  4. Are you currently, or have you previously, taken any medicines to help stabilise your hairfall,
  5. If yes to #4, then what was the results,
  6. Have you ever had any previous hair restoration surgery, if yes, the details thereof,
  7. Do you have any major medical or surgical condition/ illness that we should know about?
10

Dr. H,

I think we actually agree but our own wording is slightly different. For some reason I can see this but the culture difference is inhibiting you from seeing what I am trying to say and what you are trying to say. BTW, in nature there is a transition zone along with an undulating pattern. The tranzition zone does not necessarily mean the zone is 500cm wide until you reach the more dense regions. And there is no regularity to the transition zone, but there is a tranzition zone in nature.

Good posts.

11

» Dr. H,
»
» I think we actually agree but our own wording is slightly different. For
» some reason I can see this but the culture difference is inhibiting you
» from seeing what I am trying to say and what you are trying to say. BTW,

It does not seem like a “cultural difference” to me. The idea that Dr. H cannot see what SHE is seeing herself is a bit arrogant to say the least and sounds like your culture and education and knowledge of HT is better than hers. I am sure that is not what you are trying to say but it is what you said. Maybe YOUR cultural bias stops YOU from seeing this.:smiley:

What Dr. H is clearly saying is that the idea of a transition zone of smaller / finer hairs is outdated since all hairs used now are Fus so this “transition” which had it roots in the transition from single hairs to mini grafts is obsolete. It is more likely that your experience does not go back as far as Dr. Hs. The hairline now is defined by many criteria as outlined by Dr. H in the top of the thread.

12

So you also agree of “no transition zone”? Did you read everyone else’s posts? Maybe in your grand deciphering you tell me what you mean? Most folks agree with an undulating transition zone… not in eaxt in all individual however very important to the design of a hairline.

13

» So you also agree of “no transition zone”? Did you read everyone else’s
» posts? Maybe in your grand deciphering you tell me what you mean? Most
» folks agree with an undulating transition zone… not in eaxt in all
» individual however very important to the design of a hairline.

hairtec, I am not sure who this is directed at since your posts are usually not listed below the relevant part of the thread. I don’t know why that happens???

As Dr. H said the original definition of the transition zone came about along time before you were involved with Ht and related to cutting mini grafts into single hairs or smaller groups. Her problem was not a “cultural difference” as you put it. It is just that her background in HT seems to go back much longer than yours.

You have to admit, if you read some of this thread, that you sound quite derogatory to Dr. H as I said in my post. Just re-read and you will see. Personally I don’t think she deserved that and I felt it was quite / no very rude. That is my opinion. All the same Happy New year to you and your family.

14

It was just a debate … No rudeness. Chill out Marco. Happy New Year to you too.:wink:

15

» It was just a debate … No rudeness. Chill out Marco. Happy New Year to
» you too.:wink:

Each hairline will be different for each patient. Only the very top docs can frame each patients face properly.

16

» Each hairline will be different for each patient. Only the very top docs
» can frame each patients face properly.

Yes thats true.
Each patient should get a hairline which suits him the best.
Features considered in this regard are:

  1. Shape of the face
  2. Slope of forehead
  3. Height of forehead (Calculated by rule of third)
  4. Age of the patient
  5. Extent of hairloss/ plan for future hair restoration
  6. Availablility of donor hair (whether body or scalp hair)
17

And medical history… to rule out and pathological alopecias.:wink:

18

» And medical history… to rule out and pathological alopecias.:wink:

This is taken into consideration under point 5.

19

» Before giving any opinions i would be interested to know;
» 1. Your current age,
» 2. When did you first notice hairloss and how rapidly it has progressed,
» 3. What is the current speed of your hairfall (rapid, moderate or slow)
» 4. Are you currently, or have you previously, taken any medicines to help
» stabilise your hairfall,
» 5. If yes to #4, then what was the results,
» 6. Have you ever had any previous hair restoration surgery, if yes, the
» details thereof,
» 7. Do you have any major medical or surgical condition/ illness that we
» should know about?

I have no interest in getting a HT at your clinic at this time.

I have been performing an investigation into identifying hairline construction limitations and potential ways around them. I believe all HT surgeons could learn a lot from looking at closeups of naturally receded adult hairlines. I continually see compromises being made by HT surgeons that I don’t believe need to be made when creating hairlines. It is not enough to just move hair from the back of the head to the front. I believe the goal should be to make these moved hairs look like they grew there in the first place. IOW, coverage of baldness runs a very distant second place to natural placement. Not one hair should be moved from the back to the front unless it looks like it grew there from birth. Although what I’m saying might seem obvious, I question the depth and magnitude to which people understand this concept. It is better to be bald and look “naturally bald” than it is to have a thin coverage of hair on the head that looks transplanted.

The absolute worst thing you can do for a patient is to provide a hairline made up of thin coverage with placement that is a cross between a teenage hairline and an adult hairline. I’ve yet to see one that doesn’t stand out from a mile away and scream–surgery.

20

» » Each hairline will be different for each patient. Only the very top docs
» » can frame each patients face properly.
»
» Yes thats true.
» Each patient should get a hairline which suits him the best.
» Features considered in this regard are:
» 1. Shape of the face
» 2. Slope of forehead
» 3. Height of forehead (Calculated by rule of third)
» 4. Age of the patient
» 5. Extent of hairloss/ plan for future hair restoration
» 6. Availablility of donor hair (whether body or scalp hair)

That is easy to say, and sounds great. Unfortunately, very few doctors can produce a hairline that looks as natural as the hairline done by Dr. Cole in the advertisement video on the homepage of this site. From the photos I’ve seen on Dr. Cole’s site. Not even he can consistently perform work of this magnitude.

Thus, if we truly are going to talk about what to do and what not to do, it would be much more useful to provide photos so that the laymen (such as myself) can follow the thread and truly realize what factors bring about a natural looking hairline of outstanding quality. Otherwise, the thread starts to seem like nothing more than an advertisement for a particular clinic. If you truly are capable of creating a natural hairline, then show a photo and point out why it looks natural. Or show photos of hairlines not done by your clinic and comment on those. Either method would prove much more beneficial to the discussion than a short list of obvious factors that we all already know about.