#11-1. Female Hairline Restoration

▶ Previous Artlcle : #10-2. Hair Transplantation using a Transplanter

Unlike men, women often expose their forehead by wearing different hair styles, such as up style or a ponytail. However, these hair styles are not possible in women whose forehead is too broad or square shaped. Since a square or M-shaped hairline is often observed in men, women with these hairlines may look masculine or older than their actual age.

With the recent development of follicular unit transplantation, square or M-shaped hairline can be modified to a circular hairline that can be seen only in women, while naturally reducing the size of the forehead at the same time. The follicular unit (FU) may change depending on the site to perform transplantation. Along the boundary of the hairline, 1-FU is transplanted to allow dense packing and a natural look. 2-hair FU is used in the middle area, or slightly above the hairline, and 2- to 3-hair FU on the inside to increase the volume. As for the density of transplantation, 1-hair FU is applied to the boundary of hairline for dense packing at 60-70/cm², 2-hair FU at 30-40/cm² in the middle, and 2- to 3-hair FU at 20-25/cm² on the inside. When performing hairline restoration for women, the patient’s expectation should be weighed properly during consultation. It would be even necessary to hold the procedure off if the level of expectation is too high. The most common complaints of female patients following hairline restoration are the low density of transplantation, curliness of the transplanted hair and scar on the donor site. The patient’s level of expectation with regard to these three aspects should be clearly evaluated before determining whether or not to perform the procedure.

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First, the recipient site may appear less dense than normal. In my experience, female patients can be divided into the following three categories depending on their expectation on the density: 1) those who wish to have dense and full hair even when the bangs are put up, 2) those who desire a natural appearance while wearing the hair in a ponytail, and 3) those who do not necessarily need to expose their forehead but wish to have a smaller forehead when the forehead is exposed occasionally. In my experience, those in number 2 and 3 meet the indications of hair transplantation, but those in number 1 are rarely satisfied with the result and often require a second procedure. They should be well informed of such possibility and be cautious to decide on proceeding with the transplantation. When the hairline is too low (Figure 1) or the transplanted hair is not surviving well (Figure 2), the transplantation may result in an unnatural appearance. In my experience, patients are more satisfied when they have an M-shaped hairline, where only the margins are revised, than those with a broad forehead where the middle of the hairline should be drastically lowered.