Understanding Traction Alopecia and The Role of Hair Restoration

Traction alopecia refers to hair loss that arises from hair being pulled too tightly for too long causing permanent destruction to that hair.  Most typically, this condition is caused by tight hair braiding, as seen more commonly in African-American women.  Fortunately, this kind of hair loss is known as a non-scarring type of hair loss, i.e., the damage is only to the lost follicle and not to the surrounding skin.  Therefore, hair restoration for traction alopecia is highly successful.

Traction alopecia oftentimes affects the temple hair where a woman will tie back her hair causing loss of blood supply to this temple fringe.  In men who are Sikh, the hair loss can be circumferential around their head since their religion does not permit them to cut their hair and they must tie it up to be covered by a turban.  Accordingly, the tension is greatest to the hair around the periphery of the knot causing this unusual pattern.  Obviously, this is not a problem until they want to remove their turban when they abandon their religion.

Traction Alopecia Correction through Hair Transplant in an African-American Female

However, the most common indication still remains hair restoration for African-American women in the temple region.  Although donor hair density is typically low in Africans, the hair curl covers quite a bit of surface scalp distance.  Therefore, it is not as critical to dense pack the area when transplanting for traction alopecia.  I have found that transplantation for traction alopecia works very well with a high patient satisfaction.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To learn more about Dr Lam’s African hair restoration procedures and African hair loss disorders, or to schedule a consultation please call 1-888-866-3388, or visit www.HairTX.com for more info. To ask Dr Lam a question please visit our hair transplant forum.

Jamie Foxx:  Designing an African-shaped Hairline

Jamie Foxx’s hair transplant looks natural and appropriate for his ethnicity.  When designing hairlines for a person, it is important to consider that individual’s ethnicity and gender.  For African-American hairlines, the shape is oftentimes square even despite ongoing aging.  Clearly with hair loss, there is a blunting or loss at the fronto-temporal angles like in whites but an older African male can still have a pretty squared off frontal hairline and look completely natural and appropriate.

Jamie Foxx's Hair Transplant

When evaluating an African male for hair restoration, one must always weigh the alternative of shaving one’s head, that can look particularly good in African indivduals.  However, in a man without extensive hair loss that would permit an excellent hair restoration effort, not only can the frontal hairline be restored but it can be restored naturally with a more square profile.  I rarely perform this style of hairline in an aging white individual as it simply does not look natural if that person is requiring a hair transplant.  I think a large reason for this is that Africans have such curly hair that the hairline and head can be restored without needing tremendous packed in density since each hair follicle has so much surface travel.  However, in a white person no matter how much density you pack in, you are always worried that a squared-off, Norwood 1 type hairline will look unnatural when completed.  This is not the case with many African hairlines that look natural with a squared-off hairline.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To learn more about Dr Lam’s African hair transplant procedures, hairline design, or to schedule a African hair transplant consultation please call 1-888-866-3388, or visit www.HairTX.com for more info.

Tiger Woods:  Designing a New Hairline, Should It Be African or Asian in Design?

As everyone knows when they watch Tiger Woods play without a baseball cap, he is in serious need of a hair transplant.  Perhaps the media attention has focused on other aspects of his life that he seems to be losing control of more than his hairline but for the sake of this blog, let’s focus on his hairline.  The reason to talk about his hairline is to raise the question, what kind of hairline should he have?  Since Tiger Woods is part Asian and part African, which hairline would be more suitable for him?  Asian hairlines tend to be rounder and African hairlines tend to be straighter.  The answer is to design a more African hairline in design for the following three reasons.  First, his facial features appear more African than Asian.  Second, his hair appears to be more African (kinky and curly rather than straight).  Third, if you review photos of him as a child and as an adolescent teenager, you can see a hairline design that looks more African, i.e., straighter rather than curved.  When working on hairline designs in mixed raced individuals, it is important to take into consideration many cultural, ethnic, and individual factors that can influence how one creates a proper hairline and thereby attractive, natural and ethnically sensitive frame to the face.

Tige Woods' Hairline Young and Old

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. Please visit these links to learn more about Asian hair transplant and African hair transplant procedures.  If you would like to schedule a consultation please call 1-888-866-3388, or visit www.HairTX.com for more info.

Ethnic Hairline Designs for Hair Transplantation

When creating a hairline for a particular individual, it is important to consider many factors, one important element is ethnic sensitivity.  Hairlines differ based on gender, facial shape, and age as well, and these are starting points for any physician in his/her design work.  However, ethnic differences will be the focus of this article, as we explore how the shape of a hairline has certain general patterns based on one’s ethnicity.

We will start with Asian hairlines first, since I am Asian myself.  Asian faces tend to be broader and rounder than their Western counterparts, especially Chinese and Korean faces.  The hairline shape matches the face shape in that the hairline tends also to be broader and rounder in shape.  There tends to be less of a widow’s peak in the center but a subtle presence of one can serve to break up the roundness of the design.  The shape of the hairline also has less lateral suppression, i.e., it tends to stay rounder even toward the fronto-temporal region.  Because Asian hairs grow out straight and black, if the angles of the hair grafts are not kept very low vis-à-vis the scalp the result can look unnatural.  In addition, the novice surgeon is more prone to book leaf open i.e. create splaying of the recipient sites rather than aim them forward that can truly compromise density and create an unnatural result, especially in a very broad, round hairline design. (For more information view our Asian hair transplant page.)

For the African hairline, the shape tends to be straighter with very little to no fronto-temporal recession.  It can be almost a straight right angle at the fronto-temporal angle and still look very natural.  Depending on the degree of hair loss and the feasibility of creating this shape, the surgeon should consider creating a squared off frontal shape of the hairline.  Clearly, with more advanced hair loss the fronto-temporal angle will most likely need to be rounded to make the total result both attainable and also natural, which will also accommodate further hair loss as one ages.  Obviously, facial shape can influence the artistic design of the hairline but the above parameters can serve as a basis for one’s design work.  Fortunately because of the curly nature of the hair shaft, the travel distance to cover bald scalp for each hair follicle is good so that hair density can be more easily achieved with fewer total grafts used. (For more information view our African hair transplant page.)

The Hispanic hairline can be influenced more by the exact genetic makeup of the so-called Mestizo identity.  The White individual from Spain will have a hairline with a natural fronto-temporal recession like their White counterparts.  However, the person hailing from Central or South America may have a different ethnic makeup owing to centuries of intermarrying.  For instance, the sugar trade that brought African slaves over to the Caribbean may have individuals that look more African than other types of races.  The Dominican Republic and Haiti are good examples of a population that is primarily darker in aspect and in which hairlines would probably match more what was described above for African individuals.  The indigenous Indian populations of Central America have more an Asian appearance because originally they crossed over the Bering Straight through Alaska to arrive in Central America.  Therefore, some hairlines can resemble what I described above for Asian hairlines.  This Mestizo hairline therefore must be considered as an amalgam of different races and adjusted based on which race is the predominant presence in a particular individual. (For more information view our Hispanic hair transplant page.)

The Middle Eastern hairline also proves to be a bit elusive since there is considerable variability in the term “Middle Eastern”.  However, for simplicity’s sake, the facial shape and hairline design more closely matches that of the neighboring white, European hairlines, i.e., the typical fronto-temporal recession and suppressed lateral hairline shape.  Obviously, again it is important to overlay a considerable degree of artistic judgment marrying age, donor density, hair caliber/curl/color, and facial shape plus aesthetic desires of a patient (so long as they are reasonable).  Of note, the above hairline shapes are primarily focused on male-pattern baldness.  Women have an altogether different shape that is more universally rounder and closed off at the fronto-temporal angle and are outside of the discussion of this article. (See womens hair loss page for more info.)

With ever increasing rates of interracial couples, these hard and fast lines that were established above are beginning to blur.  I have managed many half black half white hairlines with some veering toward the black and some veering toward the white depending on the prevalence of their overall facial features and hair quality to influence my design work.   This is also true for mixed Asian individuals that I have worked on.  So the term “Mestizo” today really applies almost to all races owing to the intermarrying that is more prevalent today.  Using these basic guidelines is still a helpful starting point for any novice or skilled hair transplant surgeon.

Samuel M. Lam, MD, FACS is a board certified, hair restoration surgeon specializing in hairline design and ethnic hair transplant procedures for men and women. To schedule a consultation call 1-888-866-3388.

Dr. Sam Lam, Dallas hair transplant surgeon, lectures in St. Louis on ethnic hair restoration, encompassing African, Asian, Hispanic, and Middle Eastern hair restoration.

Part 1: African and Asian Hair Transplant

Part 2: Hispanic and Middle Eastern Hair Transplant