Why Can’t We Move the Entire Permanent Zone to the Front?

Hi Doctor,

My understanding is that when you remove hair from the permanent zone, you want to leave enough so that the permanent zone does not look “thin.”

But what about sacrificing the permanent zone, especially in the back of the head?

Why not remove most of the hair there — so that the back may indeed look thin — while moving it to the top front and crown as desired by the patient?

I suppose you can do anything you want if you find a surgeon willing to cause you tremendous scarring in the back/sides of your head. I can’t say I know of any patients that would want to be the first candidate.

Doing what you suggest would leave a patient with a very wide and long scar on the back of the scalp as the scalp became tighter and tighter, stretching the scalp skin in the area of the excision. Even if the surgeon used follicular unit extraction (FUE), it would still not look natural, as the donor zone will be very depleted and look unhealthy (not to mention the tiny pinhole scars all over that may be visible). I have seen many patients with depleted donor hair, as too much hair was used by their surgeon for the front and top. These patients are not very happy with how their donor area (scalp) looks.

Keep in mind the entire point of doing any cosmetic surgery is to look natural (like there was no surgery done), meeting the enhancements and goals that the patient desires. Doing something extreme as you suggest is like an overly done facelift surgery, where it looks like someone is pulling one’s face back.