ISSUE OF NATURALNESS
Creating naturalness is the most important goal in hair transplantation. At SMG, we feel a hair transplant should be so natural that it is undetectable, even under close examination. With the skillful use of delicate Follicular Unit (FU) grafts, this degree of naturalness is possible. In the early days of hair transplantation, large punch grafts were used. It was these large grafts that created the “corn row” look associated with transplants from the past. These large grafts are outdated and no longer used. The desire to improve naturalness led to the development and use of progressively smaller grafts. Eventually, physicians observed that when studied under magnification, hair grows in tiny, natural groupings of 1-4 hairs called Follicular Units. With this observation came the practice of using microscopes to create grafts that kept these natural groupings together. By using these delicate 1-4 hair FU grafts, physicians now had the ability to transplant hair exactly as it grows in nature, creating totally natural results. Below are examples of natural hairlines created at SMG with FU grafts.
Totally Natural Transplanted Hairlines
It is important to point out that simply using FU grafts does not guarantee natural results. Equally important is knowledge of the patterns and distributions of hair found in nature. FU grafts must be placed with a deliberate attempt to reproduce these patterns. This is particularly important for the hairline area but holds for all areas where hair loss occurs (crown, midscalp, etc.).
FU grafts can be looked at as a very fine paint brush. Simply using this fine paintbrush is not enough. We also need to know how to paint. There are many individual characteristics of a normal hairline that work together to create a natural, undetectable look. Close observation of a natural hairline reveals that it initially appears soft and ill-defined but gradually take on more definition and substance as it moves posterior. The true fullness of a hairline begins slightly behind the most anterior boarder. In addition, the anterior border should be irregular and wavy. Creating too abrupt or straight of a hairline does not look natural and is a common mistake made by beginning transplant surgeons.
Another characteristic that has to be mimicked are the changes in direction and angle of the hair as it leaves the scalp. This is especially true around cowlicks, the crown, and in the temporal corners. These and many others work together to give a hairline its natural appearance. Understanding these characteristics, and being able to mimic them, are critical skills a surgeon must have if he/she wants to be able create the most natural hairline possible. Dr. Ron Shapiro has written what many consider to be the landmark article used to teach hairline design to physicians in the field today. Below are some diagrams taken from that article illustrating some of the principles natural hairlines.
NORMAL NON-TRANSPLANTED HAIRLINE
This is Dr. Ron Shapiro’s own hairline which has not been transplanted. Dr. Shapiro studied this and hundreds of other natural hairlines to understand recurrent characteristics that make a hairline look natural.
MICRO-IRREGULARITY ALONG ANTERIOR BOARDER
All hairlines have variable high, alternating with low, density spots along the anterior boarder of the hairline. This is called micro-irregularity.
MACRO-IRREGULARITY AND A WAVY ANTERIOR BOARDER
All hairlines have an undulating non-linear anterior boarder. This is called macro-irregularity. A straight line is abnormal and looks unnatural.
SOFT, ILL-DEFINED TRANSITION ZONE
All hairlines start soft and build density gradually over a few millimeters to a centimeter. A hairline that looks like a harsh wall is unnatural.
FOLLOWING THE NATURAL ANGLE AND DIRECTION OF HAIR
Hair changes direction and angle as it moves around the head. It is important to follow this natural angle and direction to create an undetectable look.
ILLUSTRATION OF PATTERNS
The temporal corners (yellow zone) have to be placed like a fan changing direction and angle around the corner. The transition zone should have micro- and macro-irregularity made up of 1-hair grafts that leads to a soft, wavy hairline. The hair behind this should become more dense using larger 2- and 3-hair grafts (red zone).
Examples of Natural Hairline Creation
SMG is considered one of the world leaders in hairline design and has the distinction of being asked to run the Hairline Workshop at the ISHRS annual meeting every year for the past 10 years.
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“Thank you very much for your attention. I am very happy with the results of the surgery. After 3 months only I already have full hair coverage in all the affected areas and don’t need to use the hair clips like I used to do for many years. Please give my beast regards to Dr. Shapiro and the team...”Read More