Examples of Female Hairline Variations

There are many types of female hairlines that exist in nature. It is important for every serious hair-transplant surgeon to study these natural variations before considering to undertake a hair-transplant procedure on a woman to ensure that the result is natural and also appealing.  Some of the basic tenants of a female hairline is that it is shaped in an opposite fashion to a man’s hairline, i.e., the hairs typically aim in a circle, known as a cowlick, in the center and sometimes with hair shooting straight backwards in this region.  Also, the fronto-temporal region is more rounded and closed rather than receded like in a man’s hairline.  Besides these fundamental elements that describe most women’s hairlines, there can be variations obviously.

Female Hairline Variations (from Dr. Lam's textbook, Hair Transplant 360)

In the three examples taken from my textbook, Hair Transplant 360, you can see that all three have a central cowlick and closed fronto-temporal angles as described.  However, there are subtle but obvious differences as well.  In the image on the top right, there is a moderate widow’s peak and a squarer configuration to the overall hairline shape.  In the image to the top right, the entire hairline has a very closed off fronto-temporal region making the hairline appear much rounder.  In addition, the cowlick is further recessed without a very strong widow’s peak.  In the bottom left image, the widow’s peak is prominent and tightly packed with a less prominent cowlick.  In addition, there are finer hairs in the fronto-temporal region making the hairline look as if there is a slight fronto-temporal recession even though there is none.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To learn more about Dr. Lam’s female hair transplant procedures, female hair loss, female hairline lowering, 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 loss forum.

Most Common Reasons for Hair Loss in Women

Although it is more acceptable to see hair loss in men as normal, it is not considered so in women.  30% of women over the age of 30 lose hair to some extent but sometimes it is not a genetic condition but related to hormonal changes that should be investigated. I rarely perform surgery on a woman without at least this initial laboratory and/or scalp evaluation to rule out other conditions.  This article will not explore all the reasons for hair loss in women but will cover some of the most frequently encountered conditions.

In young women of childbearing age, perhaps the most common condition leading to hair loss is a low iron level because of menstruation.  If the physician can elicit from the woman, a history of significant menstrual blood flow, then this can trigger a laboratory evaluation to determine whether this is the culprit.  Iron replacement is an ideal way to help a woman restore hormonal balance but thereby aid with her hair loss condition.

The second most common condition that can lead to hair loss is a low thyroid level.  If a woman looks significantly overweight, then this can be either due to a hypothyroid state or to a condition known as polycystic ovary disease if it is not related to the just overeating.  Generally, the degree of hair shedding and hair loss is not as profound as in those women who have severe iron deficiency but it still can be in certain cases.  Appropriate thyroid replacement would obviously be the method of choice to correct the hair loss.  Of note, there can be thinning of hair in the outer portion of the eyebrows as further indication of a low thyroid condition.

Besides these two conditions, hormonal imbalances are another major reason that hair loss can occur in women.  A high testosterone and lower estrogen ratio can affect women, especially in the peri-menopausal and post-menopausal period of time.  Evaluating all women for hormonal imbalances and correcting that condition can be very important as part of a protocol for evaluating women with hair loss.  The type of hair loss that is evident in these types of women can resemble male pattern baldness with recession in the fronto-temporal region.

Besides these three reasons for hair loss in women, inflammatory hair loss conditions like lupus occupy the remaining types of non-genetic hair loss in women.  A workup evaluation in the suspected patient who may have scaly red patches or other skin issues should be considered.  With good clinical judgment, the physician can also rule out reasons for hair loss other than the above like post-pregnancy hair loss; hair loss related to stress or stressors like general anesthesia, major weight loss, etc.; and chemical or infectious damage to the scalp; among other types of problems that can lead to female hair loss.

Samuel M. Lam, MD, FACS, a board certified hair transplant specialist in Dallas, Texas. If you would like to to schedule a consultation please call 1-888-866-3388, or visit the following links to learn more about Dr Lam’s female hair restoration procedures and female hair loss conditions, or Ask Dr. Lam a question in our Hair Loss Forum.

The Female Hairline In Depth

One of my passions is female hairline reconstruction.  A large reason why is that it is one of the technically most challenging and artistically demanding parts of the head to do and to do right.  Unlike a male hairline in which all the hairs angle perfectly straight forward, the female hairline if done correctly goes in all different directions to make it appear as feminine and natural as possible.  In this article, we will discuss the two elements of a female hairline:  the macro hairline (overall shape) and the micro hairline (the details of how each of the angles are created when making recipient sites into which the hair grafts are placed).

The macro hairline, or overall hairline shape, in many respects is the exact opposite of a male hairline.  Men tend to have a more pronounced fronto-temporal recession with the curvature of the hairline aiming backward into these points of recessions.  A beautiful female hairline curves in the opposite direction with a rounded and closed fronto-temporal angle.  In addition, whereas it is important to create a conservative male hairline, a female hairline should potentially arc downward aggressively and be situated right at the forehead and scalp transition.  The goal is to create a rounded hairline to accentuate the beauty of a feminine face.

Female Hairline Restoration

Continuing on with the macro hairline, the hairline also consists of small protuberances that refine and break the linearity of the hairline itself.  In the midline a small widow’s peak will complement the female cowlick.  The design of the female cowlick will be reserved for the discussion of the micro hairline.  There can also be small protuberances approximately halfway between the cowlick and the end of the temporal hairline.  These are known as lateral mounds, a distinct entity found in many female hairlines.  These protuberances like the widow’s peak are only very slight:  take a look at women without high hairlines or without hair loss to observe what I am talking about.

The micro female hairline like the macro female hairline can be viewed almost as the opposite of the male hairline in many respects.  Whereas the male hairline typically is uni-directional, the female hairline is multi-directional.  Whereas the male hairline aims forward entirely, the female hairline principally sweeps to the side and back.  When designing a female hairline, the surgeon should look at ghost hairs (residual hairs that remain) as a guide or for female hairline lowering.  When there are no ghost hairs, the direction of the hairs behind the to-be-reconstructed hairline can be used as a guide for the design work.  In general, female hairlines sweep from the left to the right (in 70% of women) with the sweeping going in a whorl in the center of the scalp known as the cowlick.  The cowlick circles with the hair pointing backward toward the center of the scalp, which then must aim back forward as the hairs start to go back farther to the central-forelock region.  The hairs on either side of the central cowlick principally go to the side so for a left to right part the hairs from the left go across the hairline all the way from left to right and vice versa for the opposite design.  There are also less pronounced micro undulations in the female hairline as compared with the male hairline (what I termed the coastline effect in other blog articles.)  All of these nuances are important to remember as one designs a female hairline.  Matching experience with artistry is the key to creating both natural and feminine-appearing results.

Samuel M. Lam, MD, FACS is a board certified hair restoration surgeon specializing in female hair transplant procedures. To learn more about Dr Lam’s procedures please visit our website www.HairTX.com or call 1-888-866-3388 to schedule a consultation.

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.

Dallas hair transplant surgeon, Dr. Sam Lam, describes the nuances of a female hairline to better understand how to perform a natural female hair transplant using the principles outlined in this video.  The female hairline is completely different than a male hairline in that it is rounded and closed at the temples without any fronto-temporal recession at all.  This is almost universal across all races varying only in subtle but distinct ways based on facial shape of an individual.  In addition, there is a cowlick in the center of the hairline with a rotating element that is a strong attribute in the majority of female hairlines.  There can often be small peaks that jut out along the length of the hairline known as lateral mounds, which are also a distinct feminine feature.  Following a ghost of a hairline that already exists can be helpful if one is present.  If not, then the artistic element of designing one must be undertaken from scratch.

This video narrative can oftentimes convey more than any written text can so it is the preferred method of communication by Dr. Lam.  Along those lines, you are encouraged not just to hear Dr. Lam’s video lecture but to explore the multi-faceted videos on this site that show in great detail the hairline designs, recipient site creation, etc., that Dr. Lam has undertaken for female hair loss.  These meticulous close up videos can be very instructive in addition to reviewing the many before and after photographs on this Web site to understand better how these results can be consistently achieved.  Further, video testimonials and video close up results can further provide support for the quality of work performed at the Lam Institute for Hair Restoration as a prospective patient is deciding on the right surgeon to perform the procedure for herself.