When you have a full head of hair you probably don't pay much attention to your hairline. Like your other facial features, it is just there—the place where your scalp hair borders your forehead and frames your face.
When you lose all or part of your hairline due to androgenetic alopecia or other cause, you lose a distinctive facial feature. One of the primary reasons for seeking medical or surgical hair restoration is to restore your appearance to the condition before hair loss. One of the most important esthetic considerations in hair restoration is the re-creation of your hairline, whether loss of the hairline has been partial or complete. The appearance of your hairline is a distinctive feature that confronts you in the mirror and a primary feature of the appearance you present to others.
Restoration of your hairline is something that both you and your physician hair restoration specialist will want to "get right". The best hairline recreated by transplantation or other hair restoration surgery is one that is "just there""—a facial feature that blends with your other facial features and does not call attention to itself as a unique facial feature. See Surgical Hair Restoration Treatements for a discussion of surgical techniques.
The surgical placement of a hairline by transplantation or other technique is an esthetic decision that you must make in consultation with your physician hair restoration specialist. The physician can be of great assistance in this decision because the physician's perspective is professional and three-dimensional. The physician sees you, and assesses your hair restoration need, in global perspective. Your view is primarily what you see in the mirror. While you may wish to recreate the hairline you are accustomed to seeing in the mirror, the physician may have other recommendations based upon such considerations as the likelihood of need for future procedures as your hair loss continues. It may be necessary to consider the need for future revisions in hairline to accommodate progressive hair loss.
In general, a frontal hairline should not be placed lower than your original hairline. A rule-of-thumb to follow is the "rule of thirds": the ideal face is divided into thirds—one-third from bottom of chin to bottom of nose, one-third from bottom of nose to arch or eyebrows, and one-third from arch of eyebrows to the "widow's peak" of the frontal hairline. When necessary, a hairline may be placed slightly higher than the original hairline—for example, if the availability of donor hair for future transplantation is in question due to rapidly progressive hair loss.
It is worthwhile to listen to the physician's advise regarding hairline placement. You should not try to push the physician to create a hairline with an unnatural configuration—for example, to attempt to create a hairline that resembles the hairline of a celebrity.
Re-creation of your hairline must also be considered in relation to the entire hair restoration program. Patterns of hair loss vary greatly and a hair restoration program must be designed to accommodate your individual needs. Before you proceed with a hair restoration procedure, you must be certain that you fully understand the physician's recommendations and that the physician understands your wishes and concerns. The best results of hair restoration require complete physician/patient understanding and agreement. This may entail the physician drawing lines on your scalp with a marker, to illustrate where the hairline is to be placed. Be sure you give thorough consideration to this discussion. Although a hairline can be revised surgically, it is always better to "get it right" in the beginning.
Mayer TG, Fleming RW. Aesthetic and Reconstructive Surgery of the Scalp. St. Louis: Mosby Year Book; 1992:65-73.
Unger WP. Hair Transplantation, 3rd ed. New York: Marcel Dekker, Inc.; 1995:110-121, 255-270.