Hair Restoration, Hair Transplant, Hair Loss Treatment Clinic

Apex and Temporal Point configuration with Anatomic Landmarks

The following is a group research study by Richard S. Keller, M.D., Jesse Smith, M.D., Jeffrey Rawnsley, M.D., and Gregory S. Keller, M.D. that was presented in the17th annual meeting of international society of hair restoration surgery in Amsterdam, Netherland.

The authors of the article describe that there are commonly accepted methods to identify the vertical positioning point of the frontal hairline in relation to the glabella when performing hair transplant surgery. While different authors recommend various landmarks and positions in relationship to head shapes (i.e.-" flat tops", "cone heads", etc.), most authors feel at ease with their methods of positioning the ideal vertical position of the frontal hairline in the midline.

Positioning the ideal apex is, however, an imperfect science, and has resulted either by determining a point from vectors taken from various anatomical landmarks or drawn from the surgeon's own "artistic" perspective. The temporal point position is similar. These methods are difficult to construct with reproducible accuracy.

It is their contention that the apex and temporal points are related to anatomic landmarks where hair naturally positions itself. The apex point was often palpable by sliding a cupped forefinger and thumb upward along the forehead until a depression was felt. This depression was above the pterion and marked the approximate position of the ideal apex. In an attempt to determine what the apex depression represented, a series of anatomical dissections were undertaken. The apex point and depression that marked it was noted on a series of five cadaver heads and needles placed with gentian violet to mark the position on the skull. A drilled area through the skin further delineated the area. In every instance the apex point was determined to lie at the point where the superior temporal line and the coronal suture met. The position of the apex was confirmed during live dissection and observation during a series of 10 face/brow lifts.

Over the last five years, the authors have used this position in finding the apex. Since the apex is not a point, but rather a small area of depression, a certain amount of persistent positioning must be performed to determine the apex. The ideal apex may also have to be adjusted after the hairline is created due to limited donor supply.

The temporal point is found with the finger tracing the temporal line diagonally downward until it stops at the vertical bony orbit. At this point, the temporal line with its underlying temporal muscle transitions to a vertical downward direction. This finger position marks the temporal point and represents a natural concept since temporal hair, in youth, generally lies over the temporal muscle and fascia. Again, dissection at both dadaverdissection and surgical face/brow lifting confirmed this location of the temporal point. Clinical experience has also demonstrated the utility of this landmark for the temporal point. Art follows anatomy and art can use artistic license to alter anatomy. These landmarks are reliable and once practiced, provide guidelines for the hair transplant surgeon to place the apex and temporal point within the limits of available donor hair.

These landmarks are not dependent or altered by head shape. This method of finding the apex and temporal point are valid, whether the head shape is reminiscent of a "cone head,” a "flat top,” or a normal-shaped head.