The midscalp is the term used to describe anything behind the hairline zone, which in turn is defined as the first 2 to 3 centimeters in the front part of the transplant. The midscalp extends from behind the hairline zone all the way back to the crown. The area at which the midscalp turns into the crown is known as the vertex transition zone, or vertex transition point. It is much easier to understand the head like a box (see Figure) where the transition from the vertical front plane (the forehead) to the horizontal scalp is where the hairline is situated. The transition from the horizontal plane back to the vertical crown region is known as the vertex transition zone. Finally, the side limits of the midscalp are defined by the transition from the horizontal plane to the vertical plane of the temple area known as the lateral humps, an area to be discussed in the next article in this series. This side transition zone is known as the lateral crease.

Figure reprinted with permission from Hair Transplant 360, Volume 1 (Jaypee Brothers Medical Publishers, 2011), Samuel M. Lam MD

In the last article we discussed the central forelock and its importance in hair restoration. The midscalp technically can include the central forelock as a subpart of its area. Although less important than the central forelock and hairline in its total visual impact it plays a very important supporting role in many ways. If all the density were placed just in the central forelock and the hairline with very little grafting done in the midscalp, the area would look unnatural and also insufficiently dense. How is this the case? Well, hair loss is such that we typically lose hair from front to back (except when we lose hair in the crown area) so that it would appear unnatural if there were a wall of thick hair anteriorly and no hair behind it. The midscalp therefore plays an important albeit supporting role when creating a total hair transplant result. Second, the more hairs you put behind the central forelock the less see-through effect that you have. Consider rows of soldiers lined up behind rows of soldiers. The more soldiers you put behind the front rows the less you can see anything behind the initial rows.

Another important area of the midscalp is the lateral crease, the name for the transition from the midscalp to the lateral hump on the sides. This is especially the case on the side of the hair part where the splaying that occurs in this area can create more see-through and needs to be prioritized with hair grafts. Additionally, the hairs on the side of the part have a tremendous degree of travel distance (known as the cascade effect) because they travel from the part all the way over to the other side of the head so they are of prime visual importance, especially when compared with the other side that has little travel distance and is combed over with hair.

Samuel M. Lam, MD, FACS is a board certified, hair restoration surgeon specializing in hair transplant procedures for men and women. To learn more about Dr Lam’s hair restoration procedures please visit our website or call 972-312-8105 to schedule a consultation.