The planning of the hairline is one of the most important steps I air transplantation. The quality of work of a surgeon is often judged by the quality of the hairline. Single grafts are often used to create a natural hairline. To locate the ideal hairline in a bald patient, it is necessary to divide the face into 3 equal segments. In the midline, the hair starts atleast 8 cms from the glabella and sweeps along the lateral sides of the forehead from the center. At this point, the sides of the hairline should be oriented parallel to the curve when the subject is looking straight ahead. The lateral hairlines are usually 9.5 to 11.5 cms above the lateral canthus of the eyes. The temporal angles should form relatively sharp right angles or acute right angles in most men, but these and angles should be more rounded in women. The hairline should vary according to the shape of the face round, oval or triangular. The patient’s desires or constrains are other factors that can affect the hairline. Usually 250 – 300 single hair or micro grafts will be required to create the hairline in an individual. The micrografts in the hairline would be placed in an irregular sawtooth pattern, macro and micro irregularities to create a natural appearance. Behind the hairline. Behind the hairline two and a half follicular unit grafts are used to provide a new hairline. 3 or 4 hair units are used just behind. The less ideal is the hair and the skin characteristics. The more important is to use the smaller grafts. To give good density in alopecic recipient areas, some surgeons use punch grafts that are 1, 1.25 and 1.5 mms in diameter behind the hairline. The punch grafts have the advantage of removing the circular area of bald tissue where the grafts would be placed. These punch grafts would not be used in areas where the hair is already present as it would punch out the existing hair and the surgery would be counter productive. The punch grafts are useful in areas of total baldness.
