Direction is a Key Factor in Performing a Hair Transplant
Written by Male Pattern Baldness Writer on May 14th, 2010In the front and top part of the scalp, hair grows in a distinctly forward direction, changing to a radial pattern as it approaches the crown. The hair always emerges from the scalp at an acute angle, with the angle being most acute at the temples. In order for a hair transplant to look natural, the patient’s own hair direction must be closely followed. The one exception is that whorls — or licks — at the frontal hairline should not be duplicated if there is a good chance that the area will be lost because of balding. In this case, it is better to transplant the hair in the more neutral position, characteristic of the majority of men.
There has been a tendency for hair restoration surgeons to transplant larger grafts perpendicular to the skin. This is probably because the mechanics of the old plug procedures made sharp angling technically difficult and, if angled, resulted in more elevation and/or pitting when the grafts healed. Grafts often become slightly more perpendicular to the skin, compared to the way they were originally placed, as a result of the normal healing process. This perpendicular movement tends to magnify any errors in the transplant and is a phenomenon seen with grafts of all sizes. It is probably caused by the reorganization of collagen around the newly transplanted grafts.
The consequence of placing grafts perpendicular to the skin is most apparent when this mistake is made in the frontal hairline. A “Statue of Liberty” appearance results when the transplanted frontal area has hair pointing in radial directions. This makes combing the hair in any style problematic and invariably results in an unhappy patient.
Another problem with placing hair perpendicular to the scalp is that the viewer looks directly at the base of the hair shaft (i.e. where the hair inserts into the scalp). This contrasts with normal hair growth, or with a properly performed hair transplant, where the hair points forward. When a hair restoration surgeon plants hairs in a forward direction, the hair shaft bows presenting the convexity of the hair shaft to viewer. This makes the hair appear more soft and natural when groomed and gives a subtle fullness to the transplant.