Designing a Temporal Point in Hair Restoration: Why, In Whom, and How?
The temporal point has become a much-vaulted point of discussion in many of the recent International Society of Hair Restoration Surgery (ISHRS) meetings. When discussing the temporal point, the conversation is reserved here for men, as women typically do not have a pronounced temporal point (but still have one to a lesser effect). A strong temporal point can be a very aesthetically pleasing and strongly masculinizing feature for men who choose to undergo a male hair restoration procedure. It also allows a more aggressive anterior hairline design since the temporal point matches the hairline design and keeps it natural. We talk about the concept of the “lid effect” which in short means if the anterior hairline is designed aggressively but the temples are not adequately rebuilt the result looks like a toupee, or hair system, because the two lines do not resemble a natural hairline. Said another way: no person has a very low hairline and a very receded temple except someone who is wearing a hairpiece, a typically bad one at that. Therefore, understanding how, why and in whom to build a temporal point is an important undertaking.
Temporal Point Reconstruction
Let’s begin with the very strong word of caution that anyone in his first 5 years in practice performing hair restoration should probably not be creating temporal points. They are the hardest areas to do right and to create a natural result. It is one of the most telltale signs of a bad hair transplant, and a novice hair-transplant surgeon will almost invariably make a bad one. When I teach surgeons how to do temporal points, I reserve this only for advanced students who have mastered the art of basic hair-transplant procedures first. Why is the temporal point so difficult to do right? In one word, angles. The angles of the recipient sites have to be very very very low and flush flat with the surrounding skin. This also makes it much harder for inexperienced graft placers to place into without problems. Therefore, to create good temporal points, you have to have both an experienced surgeon and an experienced team of assistants.
Besides the angle of the recipient sites, their direction is also important. In addition to having very low and flat angles, the sweep of the hair (the direction) must match that of a temporal point. It tends to run at about a 30 degree angle backward and downward except at the peak of the point itself where it runs straight back and along the bottom portion that tends to run almost straight down. These directional changes are subtle but must be maintained as well besides the low angle vis-à-vis the scalp to ensure a natural result.
Besides technique, a surgeon must find the right candidate. The temporal points can require very few hair grafts or can expend quite a few of hair grafts depending on the degree of hair loss and the degree of desired restoration. That being said, there must be correct judgment of who gets a temporal point and who should not get one. A very young individual such as perhaps early 30s with significant hair loss would be the worst candidate. The reason is that someone young and who has a lot of hair loss may run out of donor hair to cover the temporal loss that can ensue in other parts of the head that would later suffer hair loss. Although a result can look natural today, it must be able to be maintained over a person’s lifetime. That is something that a surgeon must always be mindful of when deciding to perform a hair transplant on a prospective patient. Oftentimes surgeries are done on patients who are not good candidates either due to unethical business practice or lack of knowledge on the part of the surgeon. My goal in these articles is to shed light to a patient on these critical judgment issues that inform every good hair-transplant result.
Samuel M. Lam, MD, FACS is a board certified hair restoration surgeon in Dallas, Texas. To learn more about Dr Lam’s hair transplant procedures please visit our website hairtx.com or call 1-888-866-3388 to schedule a consultation.