Georgia Ligda
MD, Plastic surgeon, Ph.D
hair transplantation expert

Importance of the HL

• The hairline (HL) is the very limit between the forehead and the scalp.
• The HL defines the human face as its upper limit.
• Generally, the HL changes over time in terms of shape, height and hair thickness, due to the aging process and the effect of various external factors.
• In the case of AGA, the HL recedes to various heights and its shape changes depending on the grade of the alopecia.

Importance of the HL restoration in the case of AndroGenetic Alopecia

• In the case of AGA, receding or absent HL is perceived as a sign of aging and people are considered to be older than their actual age.
• There is a significant negative psychological impact on these people as well as an impact on their personal and social life.
• Restoration of the HL is essential for the complete restoration of the face.
• Restoration of the HL has to be done in such a way as to maintain the patient’s natural facial features and appearance.

Detecting the limits of the forehead

• Underneath the forehead skin there is the frontalis muscle that raises the eyebrows and wrinkles the forehead when it contracts.
• There is an obvious difference in thickness between the skin of the scalp and the forehead skin because of this underlying muscle.
• When raising the eyebrows the upper limit of the forehead can be easily detected either by sight or by palpating the skin.
• The forehead skin moves and wrinkles with this movement but the skin of the scalp does not contract or move at all.

Restoring the HL

The HL restoration involves its shape and height.

The shape of the new HL should be consistent with its original one thus maintaining the patient’s natural facial appearance.

The height of the new HL depends on the patient’s age, the current AGA pattern and its likely progression over time as well as on the scalp hair restoration possibilities.

The restored HL is not absolutely necessary to be at its initial height as it may be at a height similar to that at a lower grade of alopecia than the current one.

Designing the HL/methodology

1. Ask the patient to raise the eyebrows thus to wrinkle the forehead.
2. Detect the limit between the forehead and the scalp.
3. Draw the very initial HL.
4. Design the new HL at a height appropriate to the patient’s case, while maintaining its original shape.

Practically the new HL will be designed at a specific height parallel to the initial HL.

Conclusion

Most patients with AGA are looking for a natural hair transplantation result that includes natural HL restoration.

Undoubtedly, maintaining natural appearance of the face is closely linked to the shape of the new HL.

The height of the new HL depends on certain factors however the decision is up to the surgeons and the personalised scalp hair restoration plan they have made for their patient.