This insightful article was written by Dr. Bernard Nusbaum of Coral Gables, Florida. Dr. Nusbaum is a member of the Coalition of Independent Hair Restoration Physicians.
Hair transplantation for hairline reconstruction is gaining popularity among women with hair loss, thinning hair, high hairlines and those who have undergone cosmetic facial procedures which can alter the hairline, such as face and forehead lifts. While male hairline patterns have been described in the medical literature, these parameters, when applied to women, do not achieve appropriate facial framing and a “feminine” look.
There is a general lack of information describing natural hairline patterns in women. Most descriptions only address the height of the hairline by evaluating vertical facial proportions. In order to develop guidelines for female hairline restoration design, we studied 360 female volunteers at an informal hair salon setting and determined the most common features necessary to achieve a feminine, natural look. The average age of the subjects was 41 with a range of 16 to 70. This type of extensive survey has never been done before and we hope that with greater awareness of what occurs in nature, hair restoration results in women will improve. Below you will find the results.
A widow’s peak was present in 81%. Peaks or mounds on the sides of the hairline were seen in 98% of the subjects. 86% had these side mounds on both sides and 12% had a mound on one side only. Of those with mounds on both sides, 64% had a more prominent mound on the right. Of those with one mound, 83% had the mound located on the right. The average size of the widows peak and side mounds was determined. Hairline cowlicks were present in 64%; 61% had one cowlick, 3% had two cowlicks and one subject had three cowlicks. Of those with one cowlick (219 women), 70% had the cowlick on the left. It is interesting that brain development and right or left “handedness” has been associated with cowlick position and direction.
The precise locations of the hairline structures were measured and averages were determined. The average height of the center hairline, as measured from the middle of both eyebrows was 5.4 cm. Due to the large number of women studied, these averages are very accurate in determining the most common hairline shapes and locations.
The shape of the receding temples was concave triangular or concave oval in 87%. 99% of these women had fine hairs within the receding temples.
No correlation was found between age of the subjects and shape of the receding temples or height of the hairline, meaning that these features are most likely inherited and not age dependent.
Based on our findings, the following are proposed guidelines for designing the hairline in women via surgical hair replacement:
- Creation of a widow’s peak.
- Hairline 5.5 to 6 cm above the mid-eyebrow, taking into account the point at which the vertical forehead transitions to the horizontal frontal scalp.
- Creation of side peaks or mounds
- Concave triangular or concave oval temporal recessions with fine hairs within the recessions.
Since balding in men gets worse over time, receding hairline patterns are appropriate for male hairline restoration, while such patterns are inappropriate for female hair loss sufferers in achieving a “feminine” look.
Due to geographic location, the women in this study may represent a particular ethnic background and ethnic differences may exist.
Bernard P. Nusbaum, M.D.