The patient has an absence of vellus hairs from the hairline

With no vellus hairs seen, this is a clear indication that there is some scalp and hair disease present (Frontal Fibrosing Alopecia, or Lichen planopilaris which typically presents as smooth white patches of scalp hair loss. No hair follicle openings can be seen in the areas of hair loss. At the edges of these patches, there may be scale and redness around each hair follicle. Hairs can be easily pulled out.  This condition is a contra-indication for a hair transplant. A scalp biopsy will help make the diagnosis.