Temple work

[Bubba]

I've had some work done to rebuild my hairline but don't feel it looks as natural as it should because my temples have receded and were untouched. So basically, I have a hairline that goes back to my ears.

I've spoken to one doctor who would not do temple work because it could potentially leave an odd patch of hair if further recession occurred. I've spoken to another doctor who seemed eager to do work on my temples because my transplant lacked balance. I feel like I really need some temple work but how risky is it to have work done in this area?

On another note, what is the best way to approach temple work. The hair on my temples is finer and grayer than the hair on the back of my head. I'm
worried that if I use hair from a strip for the temples, it won't look natural because the hair might be coarser and darker than my native temple hair. Can FUE be used to select finer and grayer hair from the sides of the head?

Also, which doctors are good for temple work?

[Dr Robert Reese]

I've had some work done to rebuild my hairline but don't feel it looks as natural as it should because my temples have receded and were untouched. So basically, I have a hairline that goes back to my ears.

I've spoken to one doctor who would not do temple work because it could potentially leave an odd patch of hair if further recession occurred. I've spoken to another doctor who seemed eager to do work on my temples because my transplant lacked balance. I feel like I really need some temple work but how risky is it to have work done in this area?

On another note, what is the best way to approach temple work. The hair on my temples is finer and grayer than the hair on the back of my head. I'm
worried that if I use hair from a strip for the temples, it won't look natural because the hair might be coarser and darker than my native temple hair. Can FUE be used to select finer and grayer hair from the sides of the head?

Also, which doctors are good for temple work?

Bubba:

Thank you for your question. I will attempt to answer your concerns as follows.

1) I am at a disadvantage without seeing photography of your current frontal-temporal hairline, therefore, I am not able to evaluate whether your concerns are "overblown", or your current hairline truly lacks "balance". But what I envision is that a "too strong" of a hairline was created in the first place for you. When you experienced temporal hairline loss, it exaggerated the imbalance between the frontal and temporal hairlines. The point is this. It is absolutely critical to stop ongoing hair loss in the first place with one or more of the FDA approved options available,(Propecia, Minoxidil, or Low Level Laser Therapy) especially if a "strong" hairline is going to be created for the patient. If stopping ongoing hair loss were a "cornerstone" of your treatment plan, then you wouldn't be facing this current dilemma. And just as important, an age appropriate conservative hairline is the "safest" option for most patients because if the patient does experience ongoing hair loss over time, they will still look "natural", just not as "thick/dense".

2) The creation of an individuals hairline is likely considered the most important component in quality hair restoration work. It must be created with a "vision" of the future, i.e. if the patient goes on to lose more hair, will the transplanted hairline continue to look appropriately balanced and natural? Thi s past year I transplanted an eleven year old girl who had been accidentally burned at two years of age. One of the most important factors in her excellent result was the time that was taken in developing a hairline that would look appropriate as she continues to age, since her facial structure/characteristics will also change.

The creation of a hairline for a patient can be difficult at times because there are patients who will pressure the surgeon into re-establishing a "John F. Kennedy, Jr." type of hairline when this could be completely inappropriate for them. Of course, the hair transplant surgeon should have the judgement and experience to inform the patient whether a hairline is appropriate for them or not. If the patient does not accept the surgeons recommendations, then the surgeon should not perform the procedure on them at all.

3) I agree that reconstruction of the temporal hairline is best achieved by using donor hair from the parietal, as opposed to the occipital scalp. The hair growing from the parietal scalp is typically finer caliber and will more appropriately resemble the hair found in the temporal hairline.

Generally, when I reconstruct a patients frontal-temporal hairline, (for an initial procedure) I will need 2,000 to 2,200 follicles. In your situation, it sounds like only the temporal hairline requires reconstruction, therefore, I estimate that you will need, (plus or minus) 1,000 follicles to achieve the result. Assuming that you have 7 0 to 80 follicles per centimeter squared of your donor scalp, you would need two temporal/parietal strips, (one on the right side, and one on the left side) about 7 cm in length x 1 cm in width to achieve the appropriate number of follicles. Notice that strip harvesting in these zones will provide you with the most appropriate quality of hair to match the hair found for temporal hairline reconstruction. If you were to consider the follicular unit extraction technique, the follicles would be harvested from a much more expanded donor zone, which would likely include occipital follicles that would grow a caliber of hair that might be inappropriate for temporal hairline reconstruction. So if I were you, I would only proceed with strip harvesting for your particular situation.

I wouldn't be overly concerned about losing more temporal hair since I've already lectured you on stopping hair loss with one of the three FDA approved options. Also, your surgeon will transplant into the existing temporal hairline so as to offset any possible exposed temporal scalp if some additional hair loss is experienced.

The creation of the recipient sites, (allowing for the transplanted follicles to grow in an infero-posterior direction) is paramount in creating excellent temporal hairlines. I recommend to my patients undergoing either temporal hairline or eyebrow reconstruction to use a little gel, (starting about two months post transplant) to "train" the hairs to lie flat. This "trick" leads to very natural looking temporal hairline and eyebrow results.

4) The hair restoration surgeons profiled on the International Alliance of Hair Restoration Surgeons web site are screened for both ethics in their practices, as well as being able to provide consistently excellent results. I would start the process there.

With Best Regards,

Robert J. Reese, DO

[gillenator]

I've had some work done to rebuild my hairline but don't feel it looks as natural as it should because my temples have receded and were untouched. So basically, I have a hairline that goes back to my ears.

I've spoken to one doctor who would not do temple work because it could potentially leave an odd patch of hair if further recession occurred. I've spoken to another doctor who seemed eager to do work on my temples because my transplant lacked balance. I feel like I really need some temple work but how risky is it to have work done in this area?

On another note, what is the best way to approach temple work. The hair on my temples is finer and grayer than the hair on the back of my head. I'm
worried that if I use hair from a strip for the temples, it won't look natural because the hair might be coarser and darker than my native temple hair. Can FUE be used to select finer and grayer hair from the sides of the head?

Also, which doctors are good for temple work?

Bubba,

Be very careful about this approach. First of all, we know nothing about your parietal zone which is typically called the rim in laymen's terms. Pics would help but that's your decision. Some men thin out in this area as they get older and find out that the hair on their sides are not terminal. And although the meds do work for a larger percent of the male population, you still don't know until you start them as prescribed. And I am primarily referring to finasteride (Propecia).

I am not a physician but let me inform you that I have seen some men over the past three decades who had either punch out grafts or small strips excised from their parietal areas. If your have continued thinning in that area, the scars can show very easily, and especially if they do any stretching. Trust me, you don't want that. Now clearly I am not stating this is the case for you, it's just that I am not in favor of it because you don't know what the future holds.

There are FUE surgeons who would potentially take extractions from that area but hand pick them. They can telescope the area to hand pick the best hair to use, not only softer in caliber, but hair that is not miniturizing. That's important. Now, even if you do end up thinning in your parietal areas, the healed FUE extraction sites may not be as apparent as several strip scars. Laxity is not an issue either. You don't have to be concerned about anything stretching.

One other thing. Yes the hair in the occiptal donor zone is usually a higher degree of coarseness or hair caliber but that's a plus in attaining visual coverage. IMHO, I think it's good to use that finer grade hair in the temporal points where the hairline commences, meaning the transition zone. But as your move away form the edge of the hairline, the hair caliber begins to increase. So having some higher caliber hair mixed in will ultimately produce more visual coverage with less hair. That's a benefit, not a detraction.

Talk to some reputable docs skilled in both FUE and strip and ask them how they prefer to harvest hair from the parietal zones. I think you'll be surprised.

[Bubba]

Thank you for both of your replies Dr. Reese and Gillenator.

I stopped taking propecia for a couple of years after my last transplant which accelerated the loss in my temples and mid scalp/crown. I've recently started back up again to try to slow things down. Now I'm trying to put together my next plan of attack. Both of you gave me a lot of good information to chew on.

[Dr. Glenn Charles]

The new era in hairline reconstruction is here. Temporal reconstruction is critical when attempting to restore a patients hairline. I have seen too many cases over the years where the doctor tried to restore the frontal hairline and did not address the temporal recession. This will draw the attention of others to this area. The reason is that you do not see men who only loose hair in the temporal area and have a normal strong lateral hairline. The only time the temporal area recedes is when the lateral hairline recedes also. So you should not attempt to restore the lateral hairline without addressing the temporal area. In my opinion!

[gillenator]

The new era in hairline reconstruction is here. Temporal reconstruction is critical when attempting to restore a patients hairline. I have seen too many cases over the years where the doctor tried to restore the frontal hairline and did not address the temporal recession. This will draw the attention of others to this area. The reason is that you do not see men who only loose hair in the temporal area and have a normal strong lateral hairline. The only time the temporal area recedes is when the lateral hairline recedes also. So you should not attempt to restore the lateral hairline without addressing the temporal area. In my opinion!

I could not agree more. The human eye is more apt to drift to an area that appears as an unnatural hairloss pattern.

On a side note, other unnatural hair attributes such as too much density can cause eye drift, especially as we get older. Every now and then I'll notice an older guy 60s plus with a mamouth level of density throughout his scalp and it's almost always an indication that he's wearing a system.

The goal in surgical hair restoration is not just to provide coverage, but to do it in a way that looks natural for each patient accomodating aging and that individual's hair characteristics.