Restoration of the hairline is the main purpose of the 1st hair transplantation session, while all other areas of the scalp are less aesthetically important. Since the hairline frames the face and is the “showcase” of hair transplantation, monotric are used, thin FUs in a dense arrangement. Transplantation to midscalp is the next section of the head, that is, the horizontal area of the scalp.
Transplantation to midscalp: Basic principles
Behind the hairline, and depending on the extent of hair loss, all other FUs, that is, those with 2, 3, 4 or more hair follicles, are used. Placing these FUs behind the hairline monochrome FUs gives the image even greater density and more natural coverage. The number of transplants that the donor site can yield is not sufficient to give a full density across the alopecia surface. The surgeon and the patient should concentrate on important and achievable goals, and the management of a “resource” such as the donor site hair follicles should be done with caution and artistic mastery. For this reason, in the midscalp area, Fus design and placement techniques are used to create the illusion of dense cover.
Differences with the hairline
The remaining hair growth in midscalp, whether it consists of finely or sparsely lined intermediate hair follicles, should be kept as intact as possible, in combination with the transplanted hair follicles, it will give multiplicity of density and coverage. For this reason it is important that FUs are implanted between the existing hair follicles in the recipient site and in a way to avoid their injury by following the angle and direction of hair growth.
In a study by Yagyu et al it has been proved that in most non-hair loss individuals the hair growth is straight to the direction of the hair, which follows an anterior-posterior direction with a slight swirl clockwise or rarely counter-clockwise as a continuation of peak turbulence. Occasionally, in patients who have maintained some anterior hair growth, it is preferable that the 1st hair transplantation session be done on the sparse midscalp. The advantages are that avoiding the “sudden” hair appearance at the most prominent point of hairline, the new hair can be combed forward and cover the finest hairline, while face-to-face encounter and front area will look dense, as it will have the “background” dense midscalp. Subsequent hair transplantation in the anterior region and hairline creation will look smoother with this strategy.
Transplantation to midscalp: Grafts distribution
As most people look at another person either directly or at a 45-60 ° angle, the overall image of density and coverage is determined by the anterior region. Since the hairline is only 2-3cm deep, it is not enough to give a full image in the anterior region unless it is co-administered by a high density area behind it. Because grafts are outnumbered, the creation of high density at one point will take the density from another. On the other hand, the density would leave the entire surface unfinished, as there would be surface coverage, but not a satisfactory “aesthetic cover”.
In particular, when a Stage VI patient undergoes a hair transplantation, at least 4,000 FUs are necessary to cover the hairline, anterior region and midscalp with an average density of 20FUs / cm2 (4,000 FUs = 8,000 hair follicles-hairs on a 200cm2 area), leaving the top empty. If this distribution was uniform, it would result in a density of 0.25 hairs / mm2 or more simply just 50% of the required density, which is about 0.5 hairs / mm2 in order to give a picture of normal density. However, if the 1,500 FUs are placed on a 60cm2 (hairline and frontal forelock) area, the density in this area will be 0.5 hair follicles / mm2 (100% of the ideal density) and 2500 FUs will remain for the rest 150cm2 area and they will yield a density of 0.3 hair follicles / mm2 or 60% of the required density.
The hair of the front areas with high density is combed backwards on the back and thinner hair and the overall image is evenly dense. This distribution is called forward weighting. Another method mainly used in hair loss patients is so-called “side weighting”, that is, the placement of the grafts with different densities gradually decreasing in front-back and side direction, in such a way that with the appropriate hairstyle the image will be full. As shown in the above images, high density, the use of monotonous FUs in dark areas, and the transplantation of thinner multicenter grafts behind them (light areas) can give a “step” image, but which is eliminated by the appropriate hairstyle, that is the coating of the weaker areas with hair of the densest one.
In the decision on the side where the dense zone will be placed, the patient’s preferences should be taken into account, but it is generally preferable for this zone to be on the left side and the hair to be rotated to the right and back.
Most men without hair loss choose to comb their hair in the above manner, so copying this technique after hair transplant will not attract attention, unlike right-to-left reverse hairstyle. The “hockey stick” technique is applied to patients in whom the donor site is within the limits of depletion by cuttings. Covering the front and side area as densely as possible, and spinal grafts that play the most important role in the rest of the scalp to keep the front hair back when it is combed.
Transplantation to midscalp is necessary both for the complete coverage and for the “support” of the hairline, since it will enhance the image of the aesthetic density, acting as a background for the anterior area. A dense hairline and a smartly designed midscalp with “artistic” graft distribution will give a full picture of coverage and if the hair is too long, it will reach the top. Call us today about hair transplantation prices, we will be happy to help you.