When performing a hair transplant, one of the most important aspects is the hairline design. This is the hairline that will frame your patient’s face for a lifetime. Beyond the surgical techniques, there is artistry in the design. This artistry requires an aesthetic sensitivity and individual approach for each patient. The design must be aesthetically approached from all dimensions: the front, the back, the sides and the top.

When creating a natural hairline it is important that it does not draw attention to itself, and more importantly that it does not look like it has been transplanted.

The hairline should be a very subtle zone of transition leading into the central dense hair. The first line of hairs implanted should be placed in a zig-zag line (curvy line with curves of various shapes and heights) and not one after another in a row, in order to imitate nature. The hairline should not be perfect or absolutely symmetrical. It must be properly explained to the patient that small asymmetries or irregularities are acceptable, can be fully camouflaged by the grown hairs, and imitate Mother Nature more accurately. The tiny hair groupings are meticulously combined to create the illusion of a natural full scalp of hair.

The aging face and the forehead slope impact the design of the hairline. It is important that the patient have a hairline that is ageless. It must be appropriate for a twenty-year-old as well as a sixty five-year-old, and age with the patient. The placement of the hairline must take into consideration that natural aging process as well as the possible evolution of the patient’s androgenetic alopecia pattern.

When drawing a hairline, the mid-point (called the frontal hairline) should be placed at an appropriate height. The artist Leonardo Da Vinci, has described his method of determining this height by dividing the face into thirds:

- The lower third of the face was located from the chin to the tip of the nose.

- The middle third of the face was divided from the tip of the nose to the area between the eyes.

- The upper third was located from between the eyes to the hairline.

Unfortunately, this level for a hairline is more a reflection of a young man or woman. A mature hairline should be placed slightly above this point. The final height of the frontal hairline is always according to the age, the present Norwood scale of alopecia, and the family history on androgenetic alopecia of the patient. The outer borders of the frontal hair line that connect to the side fringe hair of the temple areas should usually occur in line with a vertical line drawn from the outer corners of the eyes.

Finally keep in mind that it is very important to define the joining points between the frontal and the temporal hairline in order to achieve the most natural result. In these terms it is important to define the limits between the recipient areas-zones in order to properly proceed with the implantation concerning direction, angle and density of the implanted follicles.

In summary the hairline placement is an important and integral part of hair transplantation. If in doubt as to the placement, place it high as it can always be brought forward later.