This following article was written by recommended hair restoration physician Dr. William Lindsey and posted on our Hair Restoration Social Community and Discussion Forums.
Trichophytic incisions and closures were originally developed for forehead lifting, then adopted by many hair restoration surgeons. With forehead lifting, the standard coronal lift involves a cut about an inch and a half back in the hair. The forehead is lifted and a strip of hair-baring scalp is excised. This lifts the eyebrows, but also lifts the hairline: in my opinion, unnaturally. Most white women have high hairlines to begin with. Raise that hairline another inch and you start to look odd. I know, I’ve seen lots of those women up close over the years.
To counter that, doctors then put the cut in front of the hair. This avoids raising the hairline, but you see the scarline forever. Then in about the late 80s, doctors started cutting about 4 or 5 hairs behind the hairline, but angled the incision so as to cut ABOVE the roots of those 4 or 5 hairs. When forehead skin is lifted and cut off, again a bevel cut is made. Then when the angled forehead skin is placed down and sewn up, there are 4 or 5 rows of hair roots that will grow out in front of the scar.
Shown below is a young lady’s forehead that I closed with trichophytic closure last week. I took her sutures out on day 6 and the pictures are shown. Note that there are no hairs YET in front of the scar. It takes several months for them to grow in.
Also shown is another female patient on whom I performed a forehead lift. Now at 4.5 months, hair is showing in front of the scarline, which itself will continue to fade for about a year.
Ideally, this same result SHOULD occur with follicular unit transplantation (FUT) strips closed trichophytically. However, I think there is much more variability due to the thickness of the donor scalp being re-approximated during closure and scalp stretching with normal head and neck movements during the first several months post-op. Nevertheless, trichophytic closures are a valuable tool for the hair transplant surgeon.
William H. Lindsey, MD, FACS