Hairlines are absolutely critical in completing a hair transplant. Because of the very few physicians who took time to study hairlines, i.e. Dr. Paul Rose the forefather, and others i.e. Dr. Cooley, Dr. Baumann and Dr. Harris, hairlines have become a standard in how they are templated. Even larger hair mills such as Bosley now take the time to use single hairs as the very front and then graduate to 2’s then 3’s and so on.
Another aspect to natural hairline appearance is the irregularity of the actual hairline itself. The picture below shows a typical hairline that has zero symmetry and even has “sentinal” single hairs shown by the blue arrows darting outside below the hairline. The red follows the natural hairline.
In my opinion the hallmarks of a natural hairline are macro-irregularity,
micro-irregularity (phrases coined by Shapiro I think), and no "extreme’
symmetry. These three factors allow a hairline to mimic a non-transplanted
hairline and avoid drawing attention to it because of a high degree of
linearity, regularity, or symmetry. The tendency is for observers eye’s to
"fill in the blanks so that even if a hairline isn’t dense, if the units are
too linear it still appears like a straight line.
Your photo shows all the qualities of a good hairline observing the 3
qualities above. The large concavity in the middle is the
"macro-irregularity", the small waves the “micro-irregularity,” and although
not shown in the photo the left side the hairline is not exactly level with
the right side.
The use of single hair FUG’s in the front allow for the gradual transition
from bald forehead to the hairline. FUE can also allow the use of finer
hairs from the area above the ear or lower in the neck to provide hairs of
smaller caliber to create an even finer look. You can also use them as the
"sentinel" hairs that you mention.
There was a cool discussion regarding hairline design in patients with very coarse donor hair. I have included some of my own comments below and hope this adds to your dicussion of hairlines. Interestingly, patients with coarse hair can challenge more established approaches to HT design.
"To me, a soft hairline is one with an irregular pattern of single-hair grafts on the leading edge, with increasing density (in terms of hairs/graft and grafts/cm2) moving into the frontal third. At this point, I think it goes without saying that single hair grouping are necessary for creating a natural hairline. But what about patients with very coarse hair? Can a SINGLE hair unit look pluggy on a patient with coarse hair? A single hair is in no way a “plug,” but in patients with coarse hair we do run the risk of a “surgical” looking hairline. The hairs can be too wiry for the front row and the exit points can stand out. What to do? The lovely feathered patterns and designs that are so natural looking for most patients can be difficult to pull off for those with coarse donor hair.
There are many ways to approach this issue, each with its benefits and drawbacks:
Graft Selection
Grafts need to be carefully examined and identified prior to placement. What may look like a single may actually be a double with a hair in the resting phase. We should assume the elite hair restoration clinics will use high magnification to identity and/or manufacture singles for the front row. Magnification also helps in sorting the singles best suited for the leading edge. Keen knowledge of the donor zone is necessary to locate the finest hairs for the front. It should be noted, however, that hairs cycle and appear differently at different times. This may present a challenge.
FUE
The extraction of nape hairs (or other hairs that tend to be softer than the clusters found in the traditional strip harvest zone) is a valid solution to the coarse hair dilemma. But we have all seen people with hair loss in the nape area or recessions in the posterior hairline. Therefore, these hairs should be considered transient for some. The patients at greatest risk for loosing nape hairs are those with the potential for extensive hair loss. In other words, the patients at greatest risk tend not to be the best candidates for HT in the first place.
Dense Packing
Placing grafts closer together on patients with very course hair is another possibility. Indeed, the coarse hairs that may have stood out with low density can be blended away in a lush carpet of tightly packed singles. The hairline should be undulating but dense enough so as not to draw the eye to any one hair. This is not exactly the transitional zone seen in nature but, in the absence of the perfect donor source, we can rely on the art of illusion.
Injuring grafts
Single hair grafts can be selectively injured to create a softer look up front. Since the object of hair restoration is to create the appearance of more hair with finite donor source, this approach should be utilized sparingly."
Dr. Umar did a great job reshaping my 1990s HT hairline with BHT.
There were singles there but believe it or not it was looking “surgical”, IMO.
He used leg hair to create a soft zone at the hairline and change its shape from something like this ) to this }.
Outside of us hair fanatics, I have never felt “spotted”, even by other patients.
I don’t understand why some top docs still produce very straight looking hairlines.
I much prefer the irregular hairline and a little peak in front can make a huge difference, IMO.
Peace.
This was my goal (although not as low a hairline).
I really like the shape of this model’s hairline.
Nice comparison photos. The stalky look of the older work is greatly improved with your new grafts. I think the staggered design looks good…you must be pleased
Rose Hair Restoration
I am not a physician. My opinions are not necessarily those of Dr. Rose. My advice is not medical advice.
“Stalky” is the perfect way to describe my old hairline.
“Pluggy” isn’t quite right and I never felt completely comfortable using that description.
Now, if I can maintain what hair I have, I’ll be very happy.
However, I am prepared for the reality that I may need more work in the coming years on top and in back. Also, I must be very careful about my donor supply after so many HT procedures dating back to 1992.
I see it as maintenance and well worth it as long as I don’t break the bank!
We have a baby and my wife would kill me if I told her I wanted to spend thousands more on my hair right now. Lol.
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