Recognizing Fake Hairlines in Hair Transplants
I was at a conference two weeks ago in San Diego sitting next to a colleague of mine who deplored how fake hair transplants can be. I said that my results can look utterly natural even at close range and I showed him some of my photographic results. He was impressed. However, I challenged him and said, “I bet I can see more fake hairlines than you can.” He relented, “Probably, but I really can spot them out.” So I pointed over to a gentleman 3 seats away and I said, “Do you see that toupee?” He said, “Nooooooo!” I said, “Look at how his central hair combs down over the temple and how you can see a slight transition from his hairpiece to his natural hair in the back.” He admitted he could not see what I was talking about. Then I pointed to another gentleman sitting in the next row with an obvious transplant to me, and again he could not see what I was talking about. I explained, “Do you see how the hair that was transplanted on top is sparse with a recession along the sides of the head, and it does not match a natural hair pattern?” He admitted, “No.” I was in a fitness class with about a hundred people and I can guarantee that I was the only one to spot out the instructor had a hairpiece. I did not want to burst anyone’s bubble about this great hero of an instructor but it took me one second to see it when he entered the room.
The hairline above looks unnatural because it is too straight, does not match the temples, grafts are too large for the hairline, and the angles are too perpendicular. This has been corrected by softening the hairline, matching the temples, using finer 1-hair grafts in the hairline and breaking the hairline shape with a little widow’s peak.
The first few years in practice I could only see the obvious fake patterns but could not recognize the subtle ones. It takes years in the hair transplant business to start to see patterns that are unnatural that a regular Joe would completely miss on the street. My goal when I perform a hair transplant procedure is to make it almost impossible for another experienced surgeon in my business to recognize the hairline is fake even with those trained eyes. In this article, we will explore some concepts that can make a hairline and overall hair transplant result look fake but not obviously every single point can be covered in this short article:
- Hairline is too straight. This is a cardinal sin. When a hairline loses its micro jagged appearance then the pattern looks simply ridiculous. It should resemble a coastline in that there are little irregular jetties that on gross and close inspection look truly irregular.
- Hairline does not match the temples. When the hairline shape and degree of recession are not matched, the result can look truly unnatural. With today’s modern hairpieces (hair systems) that are woven it may be hard to detect that they are unnatural but what can be a telltale sign is that the hairline position does not match the degree of temple recession. The frontal hairline and the temple should unzip at the same rate. Rebuilding the temple to match the hairline can be an important part of a hair transplant procedure or at least not forcing the hairline too far anteriorly that would mismatch the degree of temple recession.
- The hairline has unnatural grafting performed. This one comment combines a host of technical problems that include using too large a graft in the front hairline, the angles of the grafts being improperly too high or splayed, pitting from placing the grafts too deep vis-à-vis the skin, compression where the grafts are squeezed down because the grafts do not fit the site, or hole, created, etc. These details would take an entire article if not more to cover. However, it is a big one that can lead to an obviously unnatural hairline.
- The shape, slope, and position of the hairline are off. When the shape of the hairline does not match the normal bell shape, or variation thereof, of a male hairline then that can be a dead giveaway that a transplant was done. In addition, if the position of the hairline is situated on the vertical plane of the head, i.e., the forehead, this can also prove to be a problem. Hairlines should rest almost entirely on the transition from the forehead to the scalp and not any lower than that limit. Finally, the slope of the hairline should taper superiorly as the hairline goes back from the central lowest point when viewed on profile. A mistake for the beginning surgeon is not to evaluate the hairline from the profile view as well. This slope can give away that the hairline is fake but you as an untrained viewer may not know why.
- The hairline does not match the degree of total hair loss. Sometimes the hairline can look totally fine but it does not match the degree of recession seen on the rest of the head. For example, a very low hairline may not match the degree of loss along the sides of the head where a portion of the head known as the lateral hump is dropping downward. Looking at the hairline as a component to the overall perspective of the head is a critical part of designing a hairline and should not be missed.
Hopefully, now when your eyes dart up to see a hairline that looks so obviously fake (don’t stare too long), you will have some tools to understand why that is the case. But remember it takes years of experience to begin to see things that you will not otherwise know are fake if you are just a passive observer and not a trained expert in the field.
Samuel M. Lam, MD, FACS is a board certified, hair restoration surgeon specializing in hairline design and hair transplant procedures for men and women. To schedule a consultation call 1-888-866-3388.