a method for evaluating and treating the temporal peak region
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A method for evaluating and treating the temporal peak region

Male pattern baldness occurs due to three factors: age, genetics and hormone levels and seen occurring in both men and a few women. Generally the age related baldness is psychologically less disturbing. However, genetic and hormonal factors that cause baldness early in the lives of men in their 20s and 30s is a psychological and also of aesthetic concern. To disguise hair loss, cosmetic changes such as usage of wigs or hair transplant is very common. Hair transplantation is a better option as the cosmetic appeal is natural. Hair surgeons have help at hand by way of different hair transplantation techniques all of which is achieved by transplanting hair follicles on the bald regions of the head.

The hair transplant procedure is not just harvesting follicles and transplanting them. To give a natural look to the pate, it is necessary that the surgeon have and consider aestheticism in his work.

Male pattern baldness has been classified by Dr. John Hamilton and subsequently by Norwood into 7 categories starting from very little signs of baldness categorized as Type I to an advanced stage of baldness falling in Type VII category. Their classification known as the Hamilton-Norwood classification has been based on examining 1000 men divided into different age groups. It is seen in both their classifications that during the process of aging, balding from Type III onwards is a steady process and men in their 70s, 80s and 90s show significant signs of Type V, VI and VII baldness patterns.

In Type IV pattern, the hair is seen to recede from the front leaving a band of hair in the top of the head. During this stage, the area just above the ear has a triangular tuft of hair. This stage of baldness is referred to as the temporal peak baldness. And treating the thinning of hair at this stage is of significance as the whole transplant can be very effective when this region is treated early along with the crown treatment.

The temporal peak baldness is graded into four categories depending on the thinning pattern. A hair surgeon is able to evaluate the pattern and thinning areas by soaking the hair with alcohol or water or by the use of densitometer. In Grade A, there is very little thinning observed. In Grade B, the small triangular areas of hair just behind the temples show signs of thinning. Wetting the hair displays the areas of probable future thinning. In Grade C the crown hair has significantly thinned down. Grade D stage is the stage when the top hair is fully gone and some fine hair called the vellus hair is left behind. This stage is the actual bald pate stage.

Most often hair surgeons do not work with temporal peak baldness while restoring hair on the top of the head. Hence the transplant gives the face value a distorted image and the person who has undergone such a hair transplant is perceived to be wearing a wig although he isn’t. Hence a thorough evaluation of the probable thinning pattern needs be established to achieve good results.

How does the hair transplant surgeon evaluate a patient’s balding condition?

First the surgeon marks the actual hairline of the patient. As already mentioned in the grading of temporal peak baldness, it is necessary that the hair surgeon determine the pattern of future balding areas by use of water or alcohol. Once this is done, he marks the already bald region so that he can determine the amount of hair required for transplantation. Then he measures the distance between the eyebrow and the temporal peaks on either side to maintain symmetry. He also determines the hair donor region before he can actually start the surgical procedure.

The surgical procedure -

a) After the initial paper work completed, the patient is given medication orally as well as intramuscular injections.

b) From the selected donor site, the hair follicles are harvested and separated into single hair follicles under a stereomicroscope. Single hair follicles are carefully teased out to give a fine finish in the temporal region. The donor site is selected by the surgeon that comprises of soft fine hair and never coarse hair. When fine hair is unavailable, the pattern of hair transplants is slightly changed by way of increasing the eyebrow to peak ratio.

c) In the meantime, the surgeon readies the regions for transplant by making dots 1 cm apart on the temporal peaks. Using a microscope [loupe magnification] he makes 1.0 mm incisions between the already existing hair follicles. This stage of the surgical procedure is the most critical in achieving excellent final result. 20 such incisions are made per square cm which means 20 individual hair follicles are transplanted per square cm all through the temporal peak.

d) The hair graft is carried out and the region is dressed. The dressing is removed the next day and his head is washed.

This procedure may be carried out a couple of more times depending on the need of the patient. This way the natural flow of hair and its aesthetic balance is maintained.

A method for evaluating and treating the temporal peak region references

  • Brandy DA. A method for evaluating and treating the temporal peak region in patients with male pattern baldness. Dermatol Surg. 2002 May;28(5):394-400; discussion 401. PMID: 12030871
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