Female Hairline preference among various layers of Korean population
Dear editor:
When designing a frontal hairline for hair transplantation, esthetic preference
should be considered as well as the progression of hair loss1. Considering
intact frontal hairline of female pattern hair loss, it is relatively free to create
frontal hairline in female patients compared to male patients2. Especially in
current female hair transplantation, as the majority of hairline restorations
are done not for cure in pattern hair loss but for cosmetic purpose, great
emphasis is placed on designing the hairline based on esthetic preference.3,4
In hairline transplantation, a frame of forehead shape of a patient is set by
designing frontal hairline. Here, overall shape and height of the hairline are
important points5. For a standard of forehead shape, a transplantation method
to a round shape has been proposed as an asian standard6. But, Lehman7
claimed that it should not be desirable to try to evaluate beauty with a one
unified standard, ignoring racial, ethnic characteristics, social atmosphere,
and personal preference. The public esthetic preference, furthermore, can be
affected by various factors, including gender, age, education, an economic
condition, and a residential district8.
The height of the hairline and the mid-lower face was defined to be from a
midpoint between the eyebrows to the lowest hairline, and to the lowest jaw
line, respectively. We get informed consent of using photo from the model
woman. Eight photographs for the survey were fabricated. First, as Jung et al9
proposed, Triangular, Round, Rectangular, and M-shaped frontal hairline
were fabricated(Fig. 1). And, we also investigated the preference of height of
hairline in round shape. Four photographs with different forehead height in
the round shape, were fabricated(Fig 2). Compared to the forehead height in
Figure 1(upper: mid-lower = 1: 2), one photograph with lower height, (upper:
mid-lower = 0.9: 2) and two with higher height (upper: mid-lower = 1.1: 2,
1.2: 2, each) were fabricated.
The survey had been carried out on 609 people who answered the email from
Nov.
3rd,
2011
to
Nov.
9th,
2011
by
an
internet
survey
site,
‘www.mysenic.com’. The respondents chose the most preferred one among
the four photographs in Figure 1, 2 each. 290 were male and 319 were female.
Raters who already have had hair transplantation were 14.
The results of the statistical evaluation of the preference are shown in table 1.
M-shaped hairline contour was the most preferred among 609 raters.
Rectangular was the second preferred, round was the third and triangular was
the least preferred. For the preference of the height of hairline in round
shape, Photograph F with lower and mid face to upper face ratio equal to 2 to
1 was the most preferred. Next, the photograph E that has the lowest
forehead was preferred, the next G, and the photograph H that has the
highest forehead was the least preferred.
The relationship between hairline contour and sex, age, marital status,
education, geographic location and history of hair loss, satisfaction to their
own hairline, history of hair loss treatment, desire to hair transplantation
showed no statistical significance. However, significant differences were
found among raters who have history of hair transplantation. They preferred
Triangular or, Round shape hairline.
Significant differences according to sex were found in forehead height. Males
preferred lower forehead height than females for the second preferred. And
significant differences were found among raters who have history of hair
transplantation. They preferred highest forehead. And, there was no
statistically significant difference in the relationship between forehead height
and the other factors.
In the group that had experienced hair transplantation, the opposed result to
the general preference aspect was obtained. In other words, triangular and
round shape forehead was preferred most. In forehead height preference, the
highest forehead is the most preferred. The two reasons of above results can
be described as follows. The first is the possibility that the people who have
preference to relatively narrow foreheads, i.e., Triangular and Round actually
undergo hair transplantation, and the second is the possibility that information
about hair transplantation from hospitals for marketing and some factors
during hair transplantation can cause changes in the preference aspect.
Clinically, the latter case should be considered significantly rather than the
former case.
General people get information about hairline mainly from homepages of the
hospitals where hair transplantation is performed. The information provided
by hospitals mainly introduces the transplantation to round type. An option for
hairlines is also limited during care process. Frontal hairline is designed on a
forehead of a patient before transplantation and the patient confirms it. But,
like actually done, only with lining the border with a pen, it is difficult for the
patient to imagine the final appearance with fully grown hairs. So patients
tend to accept the recommendations from the hospital.
This study suggests that the doctor have to have detailed access to a patient.
Rather than monotony procedure to Round shape, it is desirable to find out
more appropriate forehead shape for an individual. For this, image simulation
of various forehead shapes using the photograph of the patient can be an
alternative solution.
The survey is limited in confirming the sincerity of the respondents since it is
conducted through on-line at a long distance. Moreover, the survey targeted
to already determined panels. Also, the small size of the group that has hair
transplantation experience reduces the reliability. In future works, the large
size of the group have to be contained.
Figure legends
Figure 1. Hair line contours
A.
Triangular
B.
Round
C.
Rectangular
D.
M-shaped
Figure 2. Height of forehead
E.
Upper
:
Mid-
F.
low = 0.9 : 2
G.
Upper
:
Mid-
low = 1.1 : 2
Upper : Midlow =1 : 2
H.
Upper : Midlow = 1.2 : 2
Table 1. Scores for hair line contours and heights
Hairline contours
Frequency
Forehead height
Frequency
(Percent, %) (Upper : Mid-low) (Percent, %)
Triangular (A)
84 (13.8)
0.9 : 2 (E)
173 (28.4)
Round (B)
Rectangular (C)
M-Shaped (D)
Total
114 (18.7)
130 (21.3)
281 (46.1)
609 (100.0)
1 : 2 (F)
1.1 : 2 (G)
1.2 : 2 (H)
230 (37.8)
158 (25.9)
48 (7.9)
609 (100.0)
References
1. Michael Beehner. Hairline design in hair replacement surgery. Facial
plastic surgery 2008;24(4):389-403
2. Ralf Paus, Elise A. Olsen, Andrew G. Messenger. Hair growth disorders. In:
Klaus Wolff, Lowell A. Goldsmith, et al. Fitzpatrick’s dermatology in general
medicine. 7th ed. The McGrow-Hill Companies; 2008: 753-777
3. Nusbaum BP, Fuentefria S. Naturally occurring female hairline patterns.
Dermatol Surg 2009;35:907-13
4. Francisco Jimenez. Hair transplantation and female hairlines. Dermatol
Surg 2011:37:501-502
5. Sang-Hwan Koo, et al. A New Classification of male pattern baldness and a
clinical study of the anterior hairline. Aesth Plast Surg 2000;24:46-51
6. J Wong: Planning for ultra-refined follicular unit transplantation and the
hairline design. In: D. Pathomvanich, K. Imagawa(eds): Hair restoration
surgery in Asians. Springer P.39, 2010
7. Lehman JA Jr: Soft-tissue manifestations of aesthetic defects of the jaws:
diagnosis and treatment. Clin Plast Surg 14: 767, 1987
8. Nguyen DD, Turley PK. Changes in the Caucasian male facial profile as
depicted in fashion magazines during the twentieth century. Am J Orthod
Dentofacial Orthop. 1998; 114: 208-217
9. Jung JH, Rah DK, Yun IS. Classification of female hairline and refined
hairline correction techniques for Asian women. Derm Sur 2011;37:495-500
Female Hairline preference among various layers of Korean population
Inho Park, M.D.1, Chan Yl Bang, M.D.3, Min Ji Kang, M.D.3,
Jae Heon Jung, M.D.2, Ji Won Byun, M.D.3, Jeonghyun Shin, M.D.,Ph.D.3,
Gwang Seong Choi, M.D.,Ph.D3.
Inhers Dermatology, Pyeongtaek, Korea1
Gangnam Yonsei Aesthetic Plastic Surgical Clinic, Hair Transplantation
Center, Seoul, Korea2
Department of Dermatology, Inha University School of Medicine, Incheon,
Korea3
Department of Dermatology, Inha University School of Medicine,
27 Inhang-ro, Jung-gu, Incheon, 400-711, South Korea
Correspondance: GS Choi, M.D., Ph.D.
Tel: +82.32-890-2238, Fax: +82.32-890-2236
E-mail : garden@inha.ac.kr