When I strategize to rebuild the head with transplanted grafts, I think globally and I think specifically. Thinking globally refers to how I distribute my grafts over a wide area of balding scalp based on priority. Thinking specifically means how do I think about smaller regions of the scalp for hair restoration. This blog article will focus on more global elements involved in hair restoration, discussing the three principle areas of the scalp minus the lateral humps and the temple region (that is the lateral portions of the scalp) that I contemplate when I perform a hair transplant procedure. These three regions are as illustrated: the forelock (or central forelock), the midscalp (or posterior midscalp), and the crown (or vertex).

The forelock is defined as the region that extends in front of the planned fronto-temporal recession (not the natural balding FTR but what is planned for reconstruction) and the anterior hairline. The forelock is the centerpiece of most hair-transplant procedures because it is the area that can make a man who is balding look bald. It also provides a good frame to the face. Hence, it typically is of highest priority to transplant when performing a hair transplant procedure.

The midscalp refers to the region of the scalp behind the forelock that takes a secondary concern to the forelock in terms of importance. However, it can still be very important if the baldness is extensive enough that there is involvement here. If all the hair is transplanted into the forelock and none are allocated to the midscalp the result can look artificial or not dense enough. This is especially true when the hair is wet and thins out accordingly. That is why during a transplant procedure, I wet the hair to determine the effect that doing so has on the midscalp region. If it looks sufficiently thin to create a mismatch with the forelock, I have to budget more grafts to be placed into this area. The midscalp is also the area that characteristically may require a second hair transplant procedure if most of the hair grafts were placed into the forelock or if the individual continues to recede back into the midscalp that was not previously transplanted.

The crown perhaps is self-explanatory. Nevertheless, it is an area that is worth discussing. The midscalp stops at the vertex transition point (or vertex transition zone) and that is where the crown starts. The vertex transition point refers to the area where the scalp goes from a horizontal to a vertical plane posteriorly. It is sometimes referred to as the posterior hairline for this reason. The crown is an area that requires a lot of grafts to do well; and that is why it is oftentimes separated out as an area dedicated for an entire hair transplant session. For more information on the crown, please review the other crown hair restoration blog posts on the crown to understand why it takes more grafts to accomplish an excellent result in this area.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To schedule a hair transplant consultation please call 972-312-8105, or visit hairtx.com for more info. To ask Dr Lam a question please visit our hair transplant forum.