Where Does the Hairline Belong?

There is an art and a science for placing hairlines. The normal midpoint of a mature male hairline lies 1.5-2cm above the highest crease of the furrowed brow. If you go to a mirror and lift your brow, you will see two things:

1. Where the hairline was when you were 8 years old (it hugs the crease)
2. By moving up 1.5-2cm above the crease, you will see where the central point of your hairline belongs

Some people do not raise their hairline to the 2cm point with a transplant, as they may go upward only 1cm as their hairline matures. But placing the hairline in the proper position is critical when the transplant is done and it is critical in your understanding of what constitutes balding versus the changes associated with a maturing hairline (which is not balding).

Here’s a patient’s hairline at 17 years old (left), and the same man at age 30 (right). Click the photos to enlarge:

My challenge was to help him select the proper location for his new hairline. I used the 1.5-2cm rule, and he was happy with what we drew. The photo here is just used to point out the change in his hairline over 13 years (an almost juvenile hairline to a balding Norwood Class 3 pattern). The actual hairline he chose was between the two lines (juvenile hairline and the highest receding point of his leading frontal edge). I could not help but wonder if he had taken Propecia when his hair loss began, would he have lost this much hair?

Earlier this week I saw director Oliver Stone interviewed on CNN. As you can see from the photo at right, his hairline is significantly higher than 2cm from the highest wrinkle. There’s a larger version here. The hairline is strong, and the combination of a strong hairline and a high location suggests that this is transplanted. Even when the hairline looks OK, placing it in the wrong position (too high) can make some one look just “not right”. When a normal hairline moves up as high as Mr. Stone’s, there is usually some erosion of the hairs at the leading edge… but Mr. Stone has no such erosion. I have seen this pattern appear on the heads of hair transplant patients who had surgeons that just did not understand what constitutes a normal hairline location.

Sometimes people ask to have their hairline located higher than the 2cm point (above the wrinkled brow) to save hair for an expanding or expanded hairline for future hair transplantation, however, that dooms the patient to detectability of the transplant no matter how good the procedure was. So placing a hairline requires the 1.5-2cm rule for most people. The new hairline can be placed lower than 1.5cm, even as low as the crease of the furrowed brow, and that may look normal for that particular patient, but I generally do not recommend that a person brings his hairline to his 8 year old location.

In the rare instance that I do agree to place the hairline at the highest crease (I have done this for a few actors), I always have this discussion with them. My hairline is 1.5cm above the highest crease and the hairline has never been transplanted, so I show our patients my hairline (see below) and ask them if they would like it for themselves. Nearly all patients given that challenge have agreed that they would take my hairline location. Click the photo of my hairline to enlarge.