How Head and Face Shape Influences Hair Transplant Design

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey:

I seem to have a tall head. What is the distance one should have between the top (tallest) part of your head and your hairline if they were measured on a straight plane, e.g., standing against a wall put a ruler on the top of your head and point it straight out, then line one up with your hairline and point it straight out and measure the distance between the two. What should that be?

There are entire chapters in facial plastic texts written on the shape of the face and location of the hairline. In spite of all of the words one may find in those, two things are important and help me determine where a hairline “ought” to go.

1. The forehead comes up fairly vertically and at some point, it makes a sharp bend and becomes much more horizontal. When designing a hair transplant, that is where I initially plan to put the hairline.

2. We put a few dots to represent a hairline there, and stand back about 4 or 5 feet. If it looks reasonable, we’re pretty close. If it looks goofy, back to the drawing board.

Now for most folks that I see, that is how it’s done. There are 2 or 3 exceptions.

A. If someone has class 6 or 7 hair loss on the Norwood Scale, I push to put the hairline higher so we can cover a greater percentage of that bald skin. It’s all geometry. I can cover a palm sized area and start at the eyebrows and only make it to where the hairline should be, or I can start way back and viewers will never see the improvement. There is a happy medium that one can usually find to frame the face and give cosmetic coverage of a good area of bald skin.

B. Some people have just really tall foreheads and have had them all their lives. It can be a struggle to convince them not to bring their hairline down too much. Not because it’s not doable, but because it may change their appearance more than they anticipate and/or look goofy. Recall that textbooks and ratios are fine but we’re working on humans, not mathematical equations.

C. Some people have really low hairlines, but appear to be on the way to class 6 balding. I have seen numerous people from the India/Pakistan region with quite low hairlines, and a family of totally bald men and, other than some sparse hairline hairs that they see in the mirror, they have significant thinning all the way to the crown. I generally push a hairline behind the thin hairline they have so that they have reasonable coverage that looks age appropriate.

I hope this adds to the discussion.

Dr. William Lindsey

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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