The Picket Fence Effect from Bad Recipient Angles in Hair Restoration
One of the most important concepts when designing recipient sites, i.e., the “holes” into which the hair grafts will be placed, is to make very low angled sites, especially near and at the hairline. What I like to call the “picket-fence” look is due to the fact that recipient sites are made almost 90 degrees to the scalp. This simply looks unnatural. In addition, you lose the ability to shingle the grafts like shingles on a roof when you make them too perpendicularly. Low angled sites cast a shadow effect on the bald scalp making baldness less visible. For all of these reasons, an experienced hair transplant surgeon should truly focus on keeping his angles for his recipient sites as low as possible when designing sites that go in the front of the scalp like the hairline and central forelock.
Picket fence bad hair transplant (from Dr. Lam’s textbook, Hair Transplant 360)