Author Bio: Dr. Sanusi Umar MD is the author of this article.
Last Updated on June 11, 2021 by Dr Sanusi Umar MD
The hairline is the edge of the area where the hair on your head grows. So it defines the edge in the front (Upper Forehead and temples), the back neck area hairline, and around the ears. However, in popular culture, the term “hairline” unless it is specified refers to the anterior hairline that defines the edge of the upper forehead. FUE hairline restoration offers the most advanced capabilities for hairline design compared to other hair transplant methods in the last 30 years. Without proper hairline placement, the forehead appears enlarged (or even too small), the face dis-proportioned and less flattering for the patient’s overall appearance. For many who struggle with hairline recession, the problem far surpasses cosmetic concern; it can lead to social withdrawal, low levels of confidence, and deep depression. Since the hairline has such an immense impact for male and female attractiveness, advanced tools and techniques are absolutely necessary for rendering the best possible outcome. With his propriety Dr.UGraft™ technology, Dr. Umar is able to recreate different hairline types, with almost no limitation on donor hair caliber, texture, or supply. This groundbreaking surgical advancement is the solution that so many men and women have been searching for: a way to restore the face-framing wall of hair that defines and balances the facial-skeletal aesthetic. It’s a way to reverse their receding hairline.
Developed over years of research and practice, Dr. Umar’s Dr.UPunch Rotor™ is able harvest from what is considered uncharted donor territory for most surgeons. He can safely source follicles from the nape, beard, and body. With such a wide selection of donor types , this device can facilitate the creation of natural looking hairlines in even the most extreme cases of recession and balding. Its revolutionary technology targets male pattern baldness and hairline restoration in female patients alike. Once harvested, the surgeon’s artistic expertise comes into play as they insert the grafts at specific angles and orientations to recreate true to life hair growth patterns on the head.
When is the Right Time for FUE Hairline Restoration?
The right time for FUE hairline restoration is really up to the patient–how severe his or her hair loss is, and how big an impact it’s having on their quality of life. There are also some generic guidelines with regard to aesthetics and patient candidacy that many surgeons follow.
Generally, hairline restoration arises from the following reasons:
- Hairline recession from androgenic alopecia
- Loss of hair from other factors: congenital issues, trauma, burns etc
- The need to reduce the appearance of a large forehead
Guided knowingly or unknowingly by the “Rule of Thirds,” it is possible for the naked eye to detect when a face is not correctly proportioned. We are innately aware that facial proportions should adhere, at least loosely, to this standard (see image below). If your hairline has receded to a point where the Rule of Thirds is drastically out of balance, this may be an indication that it’s time to start researching hairline design and hair transplant.
Age is also typically a factor when considering the right time for FUE hairline restoration. Many clinics will not perform hair transplant on patients (particularly men) under the age of 25 as a very general rule of thumb, due to the progressive nature of male pattern baldness. If a patient were to reverse his receding hairline too early, and become balder with time, the surgeon would then have to “chase” the patient’s hairline over many surgeries, continuing to fill in the ever-thinning hair. With Dr.UGraft™ technology, this issue is far less of a concern. Dr. Umar has successfully created natural looking hairlines based on long term strategies for patients in their early twenties. This may require using a smaller number of grafts inserted diffusely. Additionally, the actual graft supply can actually be augmented if needed. This is due to Dr. Umar’s ability to harvest follicles from other areas beyond the scalp.
If you’re unsure whether now is a good time for you to pursue FUE hairline restoration, contact Dr. Umar for a free consultation to discuss your hair loss and your transplant goals.
Male Pattern Baldness and FUE Hairline Restoration
Male pattern baldness (androgenic alopecia) affects over 40 million men in the United States. As the hair loss advances from Norwood Type I to Type VII, the first and most prominent area of loss is the hairline.
Aside from being an obvious area of thinning, it is also particularly difficult to surgically recreate this detail. This is due to the following reasons:
- Need for a softer caliber of hair
- The graduated thickness of hair that progresses from the front to the back
- The angulation/directional change in hair growth at the temple recesses and temple points.
For these reasons, it is important to pursue advanced surgery like FUE hairline restoration with Dr.UGraft™, wherein finer donors from the nape or legs can be used, and the surgeon is skilled in artistic vision and design.
Novice surgeons would struggle to create natural looking hairlines in men. Using thick donors from the SDA, they often create a sudden, dense wall of hair, or botch the temple recesses and temple points, or both. In some cases, they simply do not have the technology to rebuild the temple area and thus avoid it altogether. This creates a toupee-like effect on the final outcome.
The patient in the FUE hairline restoration before and after photo below had previously undergone 3 strip surgeries, which, by the standards for strip hair transplant results were good transplants. However, the patient was concerned about the uncomfortable stares directed at his hairline. Strip surgery is limited in the donor hair available to the traditional donor area on the back of the head, where hair is naturally thicker. Implanting these thick hairs on the hairline creates a harsh, toupee-like appearance.
Men who’ve already reached a later stage of pattern baldness may be tempted to forgo the hairline and fill in what seems like the baldest part–the crown. But keep in mind which area frames the face. Again, a toupee-like appearance will result if the surgeon does not properly reverse the receding hairline.
Hairline Design Hair Transplant for Toupee Integration
Some men may prefer to use a hairpiece to cover their baldness. However, hairpieces are limited in the extent of coverage and appearance of naturalness they can provide. The patient pictured below resorted to wearing a toupee after multiple old-fashioned hair surgeries at other clinics left him with extensive scarring and a severely depleted donor area. His lack of hairline and receded temple points, however, made the use of this hair piece look awkward, so he came Dr. U for a hairline design hair transplant to precede his hair piece.
Hairline Restoration in Female Patients
Female pattern baldness is also a common condition with the aging process, but occurs quite differently in men than in women. Androgenic alopecia in women manifests as a diffuse thinning across the scalp, creating the most noticeable loss along the line where the hair parts. Due to this widespread hair loss pattern and an insufficient donor area, women sufferers of androgenic alopecia are typically poor candidates for FUE hairline restoration.
There are, however, other reasons for women to require hairline design or hair transplant. They include:
- Traction alopecia
- Having a naturally high forehead
Hairline Restoration in Female Patients: Traction Alopecia
Traction alopecia is a loss of hair around the periphery of the scalp due to hairstyles that pull on the anterior and posterior hairlines. This includes tight braids, tight ponytails, weaves, and other types of hairpieces or hair accessories. The pulling eventually leads to scarring of the tissue and causes the hair to fall out. Depending on the stage of the condition, traction alopecia sufferers are typically good candidates for FUE hairline restoration in female patients.
Hairline Restoration in Female Patients: Fixing Large Foreheads and High Hairlines
Hairline lowering or forehead reduction is a cosmetic procedure that balances the facial aesthetic in people with naturally large foreheads. It is performed most commonly on women, but also occasionally on men. In these cases, hair loss or a thinning hairline was usually never a problem. However, the patient has often been unhappy with their appearance for some time. There are numerous types of surgery to achieve this (with FUE hairline restoration being the least invasive with the lowest potential for scarring). Regardless of the technique used, the creation of the most natural-looking hairlines should be the surgeon’s ultimate goal for each unique patient.
In the FUE hairline restoration before and after photos below, Dr. Umar lowers the hairline of the patients in order to reduce the size of the forehead.
Achieving Aesthetic and Natural Hairline Design through Hair Transplant
Surgically achieving natural-looking hairlines is a delicate, artistic pursuit, which requires a skillful artist with access to an array of “paintbrushes,” so to speak. Just as a painter would not create his masterpiece using a single thick brush, an FUE hairline restoration surgeon must have access to fine donor hairs in order to do justice to his work. This marks the difference between an outcome that appears natural and the ability to detect a hair transplant. Dr. UGraft™’s technology owes its extraordinary hairline creation to the use of nape or fine body hair (e.g. leg hair), which yields unmatched natural softness.
In addition to the artist’s tools, the artist himself must have the training, wisdom, vision, and talent to recreate different hairline types with the following considerations:
- Position of the hairline (again, the rule of thirds)
- The shape of the hairline
- The density of the hairline
- Caliber/texture of the hairline
Position of the Hairline
The position of the hairline refers back to the Rule of Thirds. The final placement of the patient’s hairline will need to strike a facial balance that is proportionally pleasing to the eye, or not. Guided loosely by the Rule of Thirds, the surgeon must be able to find that delicate balance for every type of face shape and structure, as it is not a perfect science.
The shape of the Hairline
In FUE hairline restoration, the shape of the hairline should be built to best complement the patient’s unique facial structure. A straight or rounded hairline? A widow’s peak? An M-shaped hairline? Sometimes, the hairline a person was born with does not best suit their appearance, and the surgeon is tasked with building a new shape to create the most cosmetically enhanced result. This requires paramount detail and big picture vision on the part of the surgeon; he or she must know how each and every graft will come into play to build the larger landscape of the hairline, including the temple recesses and temple points.
Often referred to as “M” shaped, this peaked hairline is better suited for angled, aquiline faces. The sharply angled temple recesses and temple points compliment the boldness of a male widow’s peak. Celebrity examples of this hairline shape include Stephen Colbert and Chris Hemsworth.
This broader, flatter hairline is more suited for round faces. The rounded temple recesses and temple points compliment the overall facial structure of softer lines. Round hairline celebrity examples include Brad Pitt and Leonardo DiCaprio.
Boxy, squared faces benefit from neutral hairlines, as the neutrally angled temple recesses and temple points present a balanced, symmetrical look. Celebrities such as Bradley Cooper and David Beckham are examples of individuals with neutral hairlines that suit their faces.
Videos of FUE Hairline Restoration Changing the Hairline Shape
In the video below, Dr. Umar built a different hairline than what the patient was born with. This new, slightly M-shaped hairline gives the illusion of a smaller forehead and is, therefore, more flattering.
In this second video, Dr. Umar was able to fill in the temple recesses to create a less dramatic widow’s peak. This more subtle widow’s peak gives the hairline a softer, more youthful look.
The density of the Hairline
Density of the hairline, or thickness, is perhaps the most delicate aspect of hairline design in hair transplant. The surgeon must not only take position and shape into account, but also the number of grafts per square centimeter. Hairlines are packed with less density than the crown or rear scalp, which makes for a soft, gradual, and very natural look. However, with every case being different–hairline position, overall scalp thickness, ethnicity of the patient–the prescribed density changes from patient to patient.
Caliber/Texture of the Hairline
Caliber, or texture, of the hairline refers back to the donor hair source. With FUE hairline restoration using Dr.UPunch Rotor™, Dr. Umar will select only the optimal donor hair in terms of caliber and long term viability. Under Dr. U’s care, hairline donors most often come from the nape, peri-auricular zone, chest, or legs. These hairs are naturally finer and lend a beautiful softness to hairline creation. Caliber of hair can be of particular importance in certain ethnic groups. For instance, in Asian patients (who have thicker individual follicles and less hair per square centimeter than other ethnicities), it is crucial to have the finest caliber donor for natural looking hairlines.
What Makes Dr.UGraft ™ the Master at FUE Hairline Restoration
While the single-punch nature of follicular unit extraction should give surgeons the freedom to expand beyond SDA donors (strip surgery is confined to this zone) many still do not, for the following reasons:
- Safe extraction of hair
- Long term viability of hair
Safe Extraction of Nape, Beard, and Body Hair Donors Using Dr.UPunch Rotor™
Despite the ideal caliber of nape, beard, and body hairs, they cannot be extracted safely without the proper tools. If the hair follicle grafts are damaged, they will not be able to grow new hair. The angulation of body hair growth differs from that of head hair, and most tools are not designed to bypass this obstacle. As such, standard FUE hairline restoration tools commonly damage nape follicles during harvest, rendering them useless. Dr. Umar specifically designed his Dr.UPunch Rotor™ to safely remove hair–even curly hair–from any area without damaging the follicle. With his revolutionary technology, angulation and texture no longer stand in the way of the most natural looking hairlines. Furthermore, scarring to the harvested regions is typically negligible and unnoticeable after healing.
Dr. U constructed a soft, natural looking hairline for this patient using 6,000 grafts from the head and beard. The results of the FUE hairline restoration are shown 2 years after surgery.*
Long Term Viability of Nape Hair Determined by Dr. Umar’s “FUE Shave Test”
Even when harvested with Dr.UGraft™ technology, nape hair that was viable at first may not always survive long term after transplant. The grounds for this are genetic and vary from patient to patient. By performing his “FUE Shave Test” (FST), Dr. Umar was able to determine good nape candidates from poor nape candidates. In shaving the occipital scalp of 128 patients, he could see who would advance to severe baldness via a clear line of demarcation in the shaved hair. It became clear that those without this line of demarcation had nape hair with long term viability, which also expanded their head donor area to an added ~3,000 grafts. In those who failed the shave test, Dr. Umar used donors from the chest or legs.
The patient below is shown 4 years after his nape hair-based FUE hairline restoration, proving that nape hair was long-lasting in this patient’s case.
Ultimately, nape hair is only viable in patients who pass the FUE SHAVE TEST defined by Dr U. For patients who fail the FST, the use of fine body hair offers an alternative source in most cases.
Dr. Umar’s Research in FUE Hairline Restoration
In addition to Dr. Umar’s development of the Dr.UPunch Rotor™, his work in hair transplant research continues to push the limits on what can be achieved. He has extensively tested new donor areas and widely published his findings, with a dedication to best serving the patient and delivering unmatched results. One such publication for Research Gate covers an in-depth case study on the use of leg hair. Another NY Times article discusses Dr. U’s work in FUE hairline restoration using non-traditional leg donor hairs.
Photos of FUE Hairline Restoration Before and After
The following patients sought FUE hairline restoration at Dr. U Clinic and were highly satisfied with the natural-looking hairlines he created.
Aggressive Hairline Versus Conservative Hairline Restoration
Some patients request an aggressive, densely packed hairline, while others are more comfortable with an age-appropriate, conservative hairline. When considering the aggressiveness of the hairline, it is important to also take into account the overall facial shape and framing of the patient. In the case of the patient below, Dr. U restored the patient’s temple points to compliment the hairline and facial frame, resulting in a more youthful appearance.
The patient below had undergone a previous strip surgery at another clinic, but was still at a Norwood 4 level of baldness and left with a linear scar on the back of his head. He wanted his hairline and crown restored conservatively, so Dr. U extracted 2,600 grafts from the head and nape with the Dr. UPunch Rotor in order to construct a more natural looking hairline.
Frequently Asked Questions – FUE Hairline Restoration
I know there are different hairline types. How do I know if I have a mature hairline versus a balding one before deciding on a hairline restoration?
A mature hairline will recede about 1-1.5cm past the juvenile hairline. On the other hand, hairline recession due to male pattern baldness will progress much greater than 1.5 cm. and will also affect the temples. If you are still unclear, it is best to seek the help of a hair restoration specialist who can provide you with the right diagnosis.
Is a hairline restoration performed for a female patient any different from a male patient?
The answer to this depends on the goals of the patient and the reasons for pursuing a hair transplant. In the case of classic hair loss, yes, hairline restoration performed for a female patient is different from a male patient. This is due to the varying considerations, including the diffuse pattern of loss in women as well as the length of hair being an issue with donor supply.
If the goal is hairline lowering or reshaping and rear scalp donor hair is plentiful, then hairline restoration in female patients is the same as in male patients.
In men, it may be necessary to perform a hairline restoration using donor grafts taken from other areas of the body, such as the facial region. This would occur if they have had past procedures which exhausted their head donor supply. However, since women typically don’t grow sufficient amounts of thick caliber body hair, a hair transplant procedure can only use grafts taken from the scalp area.
Is an FUE hairline restoration the best approach for achieving the most natural-looking hairlines?
An FUE hairline restoration is absolutely the best approach to achieve natural-looking hairlines. However, the surgeon must be able to safely pull from non-traditional donor areas, like nape hair, in order to create the softest aesthetic. Other types of surgery, including strip surgery and flap surgery, are either antiquated or produce harsh, subpar results.
Can I use Rogaine to reverse a receding hairline?
If used at the early onset of hair loss, Rogaine may work to reverse a receding hairline in some cases. However, according to clinical studies, Rogaine is intended to restore top and crown hair loss only, and has not been proven to work at the hairline.
If you’ve got more questions about FUE hair transplant surgery with Dr.UGraft, click the button below to ask the doctor himself:
Further Reading – FUE Hairline Restoration