Follicular anatomy of the anterior temporal hairline and implications for rhytidectomy.
BACKGROUND
Incisions made perpendicular to the hair follicles during anterior frontal hairline brow lifts or forehead shortening procedures help produce an inconspicuous forehead scar. The success of this "hidden" incision relies on the anteriorly directed frontal hairline follicles and their growth vector. The authors hypothesized that a similar incision could be made perpendicular to the hair follicles in the temple region during rhytidectomy. A well-designed anterior hairline beveled incision over the temple would allow for improved leverage during soft-tissue repositioning and a concealed hairline incision in the temple region.


METHODS
Anterior temporal hairline strips 4 cm in length at the level of the lateral canthus were excised from 16 fresh cadavers. Hairline follicles (n = 227) were assessed for direction and angle of growth after appropriate tissue preparation and staining (hematoxylin and eosin). The hair follicle angle was analyzed microscopically as it approached the epidermis.


RESULTS
The anterior temporal hairline follicles were oriented at a mean angle with the epidermis of 16 +/- 3 degrees anteriorly and inferiorly.


CONCLUSIONS
The anterior temporal hairline follicles of the scalp are oriented anteriorly and inferiorly with the epidermis, providing the surgical rational for using a beveled hairline incision angled 30 to 45 degrees to the external skin surface to undercut the distal flap. This incision is perpendicular to and transects the temporal hair follicles during rhytidectomy, permitting hair growth through and anterior to the scar. This modified anterior temporal hairline incision reduces visibility of the scar at the hairline for patients in whom scar show and hairstyle versatility are important concerns.
Mowlavi
Arian
A
Laguna Beach, Calif.; Cleveland, Ohio; and Springfield, Ill. From private practice, the Division Plastic and Reconstructive Surgery, Case Western Reserve University, and the Plastic Surgery Institute, Southern Illinois University, School of Medicine.
Majzoub
Ramsey K
RK
Cooney
Damon S
DS
Wilhelmi
Bradon J
BJ
Guyuron
Bahman
B
D001707:Biopsy, Needle; D002102:Cadaver; D005260:Female; D005546:Forehead / Q000601:surgery*; D018859:Hair Follicle / Q000033:anatomy & histology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D015361:Rhytidoplasty / Q000379:methods*; D012535:Scalp / Q000033:anatomy & histology*; D012680:Sensitivity and Specificity; D013701:Temporal Bone / Q000033:anatomy & histology