The following are excerpts from the Question and Answer segments of Dr. Bernstein’s Open House Seminars. |
HAIR TRANSPLANT SEMINAR: PART 7
Designing a Hairline
Attendee: How do you know where to put the hairline, there must be an infinite number of possibilities?Dr. Bernstein: I think that there is really one best place to place the hairline in hair transplantation. When I draw a hairline at the consult, I photograph it and then when the patient comes the day of surgery, I draw a hairline again. I don't look – even though we photographed the hairline and put it in the chart, I generally don't look at it before I draw the line. I draw the hairline at the time of the hair restoration and then I look at the photo in the chart and they're almost always the same.
So there really is one correct way. There are some rules that govern this position. You should place the hairline a centimeter and a half above the upper brow crease, above the upper wrinkle. The frontalis muscles cause the forehead to wrinkle and in a teenager, the hair starts right above the muscle. If the hair grew over the muscle and you smiled, the hair would move. So we know it starts above the muscle as a teenage and in an adult, it moves further up about a centimeter and a half.
I just happen to have a finger that’s a centimeter and a half wide, so if I put my finger above the upper muscle; it usually sits just below the correct hairline for an adult. So raise your eyebrows all the way up so everyone can see the muscle wrinkle the skin. See, this is the ridge and this is where the hair in the mid-portion of the hairline should start – exactly a centimeter and a half above the upper brow crease.
My colleague Dr. Bill Rassman, a hair transplant surgeon in California, fist came up with this idea. In the old days, people used the rule of thirds, you know, from the proportions in Michelangelo’s sculptures. Basically there’s a third distance from the chin to the tip of the nose, a third from the tip of the nose to the eyebrows, and a third from the eyebrows to the hairline. But that's in the perfect proportions of someone that's not undergoing hair loss. That's a David. It's not in a mature adult male. So the rule of thirds is not a good one in designing an adult hairline for a hair transplant.
The way he got this was that he was thinking, "How can I come up with some kind of rule that works for everyone?" And he said, "Well, you know, since I'm doing hair transplants, I'm going to make hairlines of my own image.” So he went to the mirror, he wrinkled his eyebrows, he put his finger up on top of the wrinkle to measure the position of his hairline and he said, "Ah, it's a centimeter and a half. I am going to make everybody a centimeter and a half." And that's how that rule came in being. It’s a funny story, but the rule is extraordinarily helpful.
Attendee: But everybody has different size and shaped foreheads.
Dr. Bernstein: That's exactly right. And so the mid part of the hairline is going to start a centimeter and a half above the muscle. And people with different sized foreheads have different lengths of the frontalis muscle, so the positions will vary widely and that is precisely the point. It changes with each person. But that is not the whole story. There is a lot more to a hairline than just where it starts. It has to be properly shaped or tapered as is goes towards the temples, it must be feathered to look soft and natural and it can not be too symmetrical or it will look strange.
Hair Systems
Attendee: I heard that some companies attach hair. Is this OK?
Dr. Bernstein: Hair extensions are generally bad for your hair particularly if they are worn for extended periods of time because they accelerate hair loss. Anything that is permanently attached to the scalp – something that you must sleep with – can cause hair loss. Wigs sit on your head and you can remove them at night, so they are generally OK. But, any attachment that you sleep in, that constantly tugs on the hair, decreases the blood supply and eventually accelerates hair loss. And the hair loss can be permanent.
Attendee: I heard that if you wear wigs a lot, then that will cause hair loss.
Dr. Bernstein: If the wigs are loosely attached and taken off at night, they don't cause hair loss. Remember, hair doesn't breathe through the ambient air. It breathes through the blood supply. So you can't suffocate your head by wearing a wig.
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