How our bone structure can impact on the graft numbers and design.

Genetics dictate the way we look, the bone structure of our face, hair characteristics and hair growth/loss patterning to a large extent.



A hair transplant is a cheat on nature; using nature’s reserves we have the ability to design a head of hair a person never had, create a hair line lower than even as a pubescent was not.

The NW scale is generic to give us an idea of the pattern hair loss can take in a male, but does not take into account the facial bone structure, and how this can change graft numbers and design. If we take two NW6 cases it is possible for there to be a vast difference in surface area maybe from 250 to almost 400 cm2 to cover due to bone structure.

Bone structure can result in the recipient area being larger than the donor area and this being the case it is not wise to design a low flat hair line either because it used to be or through desire but to design with the future loss in mind. It is important to restore facial balance, not just from the front elevation but sides and top.

By restoring just the frontal hairline you may create an unnatural facial proportion so the rounded wide design should be avoided at all cost.



The idea is to bring the hairline design until or before the curve of the forehead, when the hair grows longer it will give greater illusion of coverage and facial balance anyway and even short the design will be pleasing to the eye, naturally match the bone structure and blend with the temporal angles. The forehead bone structure could be more square, round, oval or triangular and the hairline design must match it to ensure facial/special awareness. The hairline is unique to a person’s bone structure and not a set template, or sometime not even to match the hair line from younger years as the facial expressions and bone structure change over the years.

Larger facial bone structure can be recognised with a broad forehead, flatter surface and a crown that drops twice, maybe three times. Larger or more pronounced bone structure can require maybe 30% more grafts to cover the average zone; if the hair line does not match the bone structure in relation to the patterning of hair loss this can result in a front loaded design, many grafts being used to restore an area and the creation of an unnatural pattern of hair growth, high frontal density and a design not fitting the patterning of hair loss behind the frontal.

This is an important topic as most people has a tendency to think faces are perfectly symmetrical.Check out the hairlines of your sibling, parents, spouse, neighbor, and people in the metro. It’s worth looking at a variety of hairlines so that you can see what we've discussed above and understand this very important topic.

Dr B