What is the consensus regarding a hair transplant patient’s decision to close the temples as in the example below? Is the hair behind it in the lateral region considered safe as it has receded so far?
I believe that the strategy of how a hair transplant surgeon approaches hairline design in terms of location and density is based on several key parameters – each of which must be factored into the final decision as to what should or should not be done with respect to designing the frontal hair restoration zone. Here are some of the key components that I factored into his plan.
A prediction as to the final hair loss pattern – Although there is no way to assess the definitive final pattern for many patients, an educated prognosis can often be made based on age, examination for presence or absence of miniaturization and family history. Analysis of these factors for this case suggested that his final pattern would support the long term aesthetic benefit of the restoration that was performed. Personally, I spend much more time trying to convince patients to be conservative with respect to hairline location and density as there seems to be more patients presenting to my office with the potential for progression to an advanced pattern on the Norwood Scale that would not support aggressive hairline restoration. Fortunately this patient appeared to have just the right combination of factors to allow for the restoration performed.
Stabilization therapy – This patient has been on stabilization therapy with Propecia (finasteride) for over 10 years. His examination showed advanced miniaturization confined to the frontal region and very limited miniaturization in the crown. He stated that he had maintained a good response over the treatment period and that he had no plans to alter the treatment regimen.
Donor site availability for future treatment – Careful assessment of graft availability within the donor site must be completed to generate a treatment plan that includes planning for any potential future grafting needs that may arise from progression of a balding pattern. This particular patient had ideal donor characteristics – excellent density, elasticity and healing characteristics. His graft “reserve” was factored into a treatment plan that should allow his overall long-term goals to be fulfilled if his pattern progress.
Patient goals – Both short-term and long-term goals need to be prioritized in developing such a grafting scheme. With the understanding that the donor site is finite and that a full head of thick hair is impossible for patients with advanced patterns, a discussion of what would be done in the event of pattern progression must be undertaken with all patients prior to committing to any hairline restoration plan. A patient who has no concern about crown restoration in the short-term or the long-term has the ability to do more in the frontal region than someone who prioritizes coverage from front to back. With respect to this case the front was defined as the highest priority from both a short-term and long-term perspective.
This patient had absolutely wonderful hair characteristics which contributed significantly to his final result.
Dr. Raymond Konior
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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