View Full Version : Cowlicks and transplants?

07-27-2009, 01:49 PM
Hey Guys,

I'm considering a transplant and currently researching doctors. I would like to know if transplants can be placed in the same direction as the cowlicks for a more natural look. Or if this even matters.

Here are some more questions: Is this a more difficult procedure? I had a cowlick on the front of my hairline and this area has completely receded. Will the cowlick come back if hair is transplanted there? What about my bald spot? Do the transplants have to be placed in a circular pattern to match the natural directional growth of my hair?

I have/had many cowlicks and this could play a huge role in my ultimate decision of going through with it, which doctor? method? etc...

When I was a kid, I could only wear my hair with a side part and combed in a specific direction. It's been so long since I've had long hair, I just realized this! I'm a norwood 3 and within a couple months of making a decision. Any info on this topic would be greatly appreciated! Thanks ahead of time.

07-28-2009, 06:18 AM
The directional growth of a transplanted hair is dependent on the direction of the incision and placement of that graft. Hairline incisions are made in the exact direction the hair at the frontal hairline naturally grows, which is angled. This will give a natural, undetected (as far as surgery goes) appearance. If the incisions were made straight up, you would have a manufactured look. I know you don't want that! The surgeon should be an artist, and be very methodical in the direction of each graft. Hair grows at different angles in various areas of the scalp, and it is up to the surgeon to angle the incision appropriately for each area. Hairline angle is different from temporal area, crown, etc. Placement of these grafts in the angled incision is paramount for a natural look.

To answer your question regarding grafting in the hairline area where you previously had a cowlick, once the new hair grows in, it will only grow in the direction the graft was surgically placed - it won't have a mind of its own and start growing in the old pattern. Some of our patients want to follow a circular pattern in their crown, and that can also be done, customized to the patient's preference. Again - the surgeon must follow the existing pattern of growth to blend in the new with the "old". Once new growth is estabalished, that vortex, or cowlick is full and all growing in the same circular direction. As a patient, it is a personal preference. Hope this answered your questions, and no, it isn't a difficult procedure at all...just customized.

B Stilwell, RN

Nurse for Dr. Mark Baxa

Robert True, MD
07-31-2009, 12:04 PM
Recreating a whorl or cowlick is some of the most technically precise work in hair transplantation. The most widely held opinion among hair restoration surgeons is that if a frontal cowlick has either completely receeded or nearly so, it should not be recreated. The hairline should be recreated with a uniform forward and gradually rotating angulation of the grafts to create the most dense and natural appearing result.

What to do when the cowlick is still present but thinning is a much different situation. If transplanting is done at this point the surgeon must follow the hair direction in the cowlick or the graft incisions will damage follicles in the area and the transplanted hair will grow in a different direction from the native hair in the cowlick - a bizarre look indeed. Recreating a cowlick is very careful and exacting work wherein every receptor incision is precisely angled around the spiral axis matching every subtle shift in angulation.

Anytime there is a whorl such as those that occur in the crown, more scalp shows through because of the natural separation of hairs. Thus when restoring a cowlick, higher density is required to hide the scalp than if the hairs are all transplanted in the same direction.

This all being said, cowlicks, undulations, and widows peaks are the "elegant" details of a handsome hairline, and when they are reproduced accurately some of the best looking hairlines results are achieved.

Here is a good example: