KEY WORDS
Follicular unit transplantation - hair transplantation - male-pattern baldness - temporal
point marking - temporal triangle construction
INTRODUCTION
Asian population has more rounded face and head compared to the Western population.
The method of marking of temporal point practiced worldwide, described by Walter P.
Unger, does not help in marking temporal triangle border in Indian population. Hair
transplant is a commonly performed procedure nowadays in India. There are no specific
design guidelines in Asian population, So we follow guidelines for Western population
as described by Walter P. Unger. Hair transplant is more of art than science. We have
tried to modify the design of temporal triangle in this study.
Temporal recession in male-pattern baldness is common. Grades of temporal point recession[[1]] are as follows:
N = No thinning or recession of temporal point hair
T = Thinning and/or mild recession
P = Apex of recession is parallel to the anterior sideburn line
R = Recession has caused a reversed angle that is usually anteriorly convex, but is
now concave.
This straightforward classification uses letters N, T, P and R, which are added in
brackets after the usual Norwood classification in brackets like 4 T or 6 P.[[2]
[3]
[4]]
Patients with Class N or T usually require no augmentation. Classes P and R require
surgical augmentation [[Figures 1]
[2]
[3]
[4]].
Figure 1: Grade N
Figure 2: Grade T
Figure 3: Grade P
Figure 4: Grade R
The usual balance of temporal point with the frontal hairline is to place it where
the following two lines intersect. Line A is drawn from the most anterior part of
the hairline to the tip of the ear lobe. Line B is drawn from the tip of the nose,
over the centre of the pupil to the anterior temporal point.[[1]] In Indian population where the face is little more round and short than that of
Caucasian population, this new temporal line suits better.
Conventional line drawings for temporal point are depicted in [Figures 5]
[6].
Figure 5: Line A
Figure 6: Line B
Aims and objectives
The aims and objectives of the study were as follows:
-
To facilitate easy marking of temporal triangle
-
To define the temporal point more aesthetically
-
Mark lower border of the triangle easily.
MATERIALS AND METHODS
The study was carried out at author's private setup.
The new marking was applied on 126 patients from March 2014 to December 2017; they
were regularly followed up and results were observed.
Observation
The following is the new marking of the lower border of temporal triangle:
Line A: Drawn from the most anterior part of the hairline to the tragus of ear
Line B: Drawn from the tip of the nose, over the centre of the pupil to the anterior
temporal point.[[3]]
The new proposed temporal line is depicted in [Figure 7].
Figure 7: New marking and lower border of the temporal triangle in patient 1
The new line A compared to the old line A helps in forming the lower border of the
temporal triangle and helps in more aesthetic allocation of temporal point slightly
above the previous line [[Figures 8]
[9]
[10]
[11]
[12]].
Figure 8: New marking and lower border of the temporal triangle in patient 2
Figure 9: Post marking punching in patient 2
Figure 10: Punching with new marking in patient 3
Figure 11: Punching with new marking in Patient 4
Figure 12: Result in patient 4
Satisfactory results were obtained. With this method, the temporal point can be more
aesthetically placed and the lower border of the temporal triangle can be easily constructed
more aesthetically in Indian population [[Figures 13]
[14]
[15]
[16]].
Figure 13: Result in patient 2
Figure 14: Result of another patient with same marking principle
Figure 15: Result of another patient with same marking principle
Figure 16: Result in patient 3
DISCUSSION
The technique for temporal triangle reconstruction as mentioned by Walter P. Unger
is universally followed, and is aesthetically better in western population as they
have long face. While the technique mentioned in this study is aesthetically better
for Indian population, a slight higher shift of the lower border of temporal triangle
is aesthetically better in round face which is found in Asians.
In a study by Shapiro and Shapiro on hairline design and frontal hairline restoration,[[1]] the authors mentioned to keep the lower border of the temporal triangle slightly
above the line formed by drawing triangle but did not mention to change the point
from ear lobule to tragus. However, if we change the point from ear lobule to tragus,
the same line can be obtained.
CONCLUSION
With the new method of marking, we found that the lower border of temporal triangle
can be more aesthetically placed in Indian population.
Financial support and sponsorship
Nil.
