3-D Organic Hairline Concept in Hair Restoration Surgery
By Arthur Tykocinski, MD
Tykocinski Medical Group, Sao Paulo, Brazil
Dr. Tykocinski is a dermatologist performing FUT’s since 1996 as well as dense packing follicular units since 2003. Dr. Tykocinski writes in this current article his 3-D Hair Line Concept. These are excerpts from his writings:
Since 2003 we have been using the coronal micro incisions to perform a hair restoration with densities around 40 FU/cm2. This represents not only moving from l.4mm to 0.7mm incision size in the hairline, but also the possibility to restore the hairline at once. This new technique/instruments allows a different approach that could take the hairline design to a new level of refinement. We realized that our standards should be modified. For many years, hair restoration hairline has been described in a two-dimension concept. But if you consider the temporal area, the spherical surface of the scalp with all bone structures and their irregularities, and also hair direction and angle, considering a tree-dimension perspective would be, maybe, more accurate. The hairline was first described as a simple line. Then comes the zigzag pattern and after that a multiple triangles design, with different sizes and connected with subtle variations bring artistry to the hairline design. But performing a detailed observation of the naturally occurring hairline a chaotic pattern could be noticed: instead off lines, sharp points or fixed patterns we can see gentle in irregular curves, with subtle variations, changing angles and direction. That pattern could be called organic and we based our study on it.
His objective is to combine the organic hairline design to a three-dimensional approach in the hairline design.
3-D organic hairline design and concepts
- Temporal restoration - The temporal area is an indivisible part of the hairline design for many reasons listed below. But it is especially important for patients with severe temporal recessions that loosed completely the temporal peak and have a flat temporal pattern. Performing a hair restoration without restoring the temporal area it will look: still bald, if we keep the hairline to high to accomplish that temporal recession or artificial, if we bring the hairline down but not restoring the temporal area, even with the best technique it will look bizarre, because you can't see in nature a person with such pattern. Restoring the temporal area using the coronal technique, that allows acute angles such 10-15° matching the natural temporal hair, should be considered in order to:
- Restore facial balance and harmony - If you restore just the frontal hairline you may create an artificial facial proportion that even the technique used was perfect the result could be not.
- Match the frontal and temporal hairlines with the same hair color, diameter and texture
- Facial rejuvenation
- Avoid the forehead with a "wide screen" unnatural aspect.
- Cover the temporal muscles - in some patients they are particularly prominent and unaesthetic.
- Treat future balding on that area, avoiding another hair transplant in the hairline too soon.
- Hairline design considering tree different levels:
a) Hairline with an organic shape, respecting bone landmarks (Level 1) - the design should be individualized according to the facial shape and forehead aspect. The forehead bone structures deserve special attention and should match the hairline. These bone convex structures over the forehead surface are often the true responsible for the "big forehead aspect". And unless we deal with such round elevations we won't be able to restore a balanced aspect. Probably the best solution is to bring the hairline design until the convex border of that forehead structure. When the hair grows it will camouflage it, bringing harmony to the face. The forehead itself could be more square, round, oval or triangular and the hairline design should match it and try to enhance the facial harmony. The hairline cannot be seen as a "standard template" for all patients. Instead off the should be individualized.
b) Outline flame pattern (Level 2) - the macro irregularities we would like to produce should mimic the natural aspect. Instead of a geometrical linear pattern, the hairline should have curves, with certain random micro variations. Creating flames varying from 4 to 5mm, bottom to top is an easy way to avoid an "obvious surgeon created hairline".
c) Density graduation using single hairs, decreasing towards the external border and with higher density while connecting the 2 hairs FUs zone (Level 3)
- Hair direction in arcs - instead of lines, arcs towards a converging point creates a better coverage. It is just the opposite of a fan pattern.
- Short hair preview (= 1,2cm) - helps surgeon controlling the hair angle, direction and density. It has the same basic advantages of the "long hair preview technique", not so dramatic, but equally effective and much easier to handle.
Changing the hairline concept from a two dimension (just frontal) and geometrical (lines, zigzag or triangles) to a tree dimension (frontal and temporal) organic concept (curves according to facial landmarks and the flame hairline pattern) it is possible to take the hairline design even closer to what is seen in nature.
|
