Recreating the Temporal Points

41 Recreating the Temporal Points

Melvin L. Mayer

Summary

The hair restoration surgeon must consider the balance of the entire frontal view of the hairline starting from the anterior edge of the sideburn, temporal points, temporal recessions, and frontal hairline and ending at the other sideburn. If the hairline is reconstructed and there has been significant thinning or complete loss of hair in the temporal point, serious consideration must be given to reconstructing this area to give a natural appearance. This chapter addresses principles to follow and surgical techniques needed in order to accomplish this in an aesthetic manner.

Keywords: temporal point temporal peak hairline temporal recession sideburn Mayer classification of temporal points Ahmad classification of temporal peaks

Key Points

•Transplanted hair must be placed at markedly acute angles, 10 to 15 degrees.

•The graft is rotated in the site so that any curl grows toward the skin.

•Be conservative and anticipate future loss; the shingling effect helps achieve a greater illusion of density than expected.

41.1 Introduction

Follicular unit (FU) grafting using smaller blades to create sites allows surgeons to be more aggressive in augmenting the temporal points and strengthening the frontotemporal recession. Smaller recipient sites facilitate the creation of acutely angled hair, which is crucial to rebuilding a natural appearing anterior temporal area.

When transplanting in this area, it is critical to make the correct decision regarding anticipated hair loss. One must always try to predict worst-case scenario by evaluating the patient’s age, family history of hair loss, and response or nonresponse to preventive modalities. Dampening the hair allows one to detect more accurately the areas with miniaturization that are affected by 5α-dihydrotestosterone (DHT). As with creating the hairline, conservative judgment is paramount.1^,²^,³^,⁴^,⁵^,⁶^,⁷^,⁸

41.2 Classification of Temporal Point Recession

To describe the temporal point status, it is useful to define the following four classes:

•N = Normal: No thinning or recession of temporal point hair (Fig. 41.1).

•T = Thinning and/or mild recession (Fig. 41.2).

•P = Apex of recession is parallel to the anterior sideburn line (Fig. 41.3).

•R = Recession has caused a reversed angle that is usually anteriorly convex, but is now concave (Fig. 41.4).

Fig. 41.1 Class N: normal.

Fig. 41.2 Class T: thinning.

Fig. 41.3 Class P: parallel to the anterior sideburn line.

Fig. 41.4 Class R: reversed angle, convex to the anterior sideburn line.

Patients in classes N and T usually require no augmentation. These patients should be encouraged to use finasteride, topical minoxidil, or photobiomodulation (low-level laser therapy) to help prevent further thinning. Platelet-rich plasma (PRP) has been advocated by some, but no significant controlled studies exist that would allow making a specific recommendation. These may be used individually or in combination. Classes P and R should be considered for surgical augmentation. In these two classes, the lower hairline placement increases the need to consider augmentation of the temporal points.4^,⁵

To create proper balance with the frontal hairline, the temporal point is placed where the following two lines intersect (Fig. 41.5): line I is drawn from the tip of the nose, over the center of the pupil (with the patient looking straight ahead) to the anterior tip of the temporal point. Line II is drawn from the most anterior point of the proposed frontal hairline to the tip of the ear lobe.