Very frequently, patients ask for low, flat, aggressive hairline and frontal restorations. While there is nothing wrong with an aggressive approach in the right patient (and I've done them), it is often not the best long-term strategy and patients should be advised on a different course. Especially if I believe the design will not age well or look unnatural.
But what about the opposite? What happens when a patient is concerned that a drastic change from a transplant won't look proper and they request a "conservative" and subtle approach? Is it always okay to "go conservative?" Can a design be "too conservative?" And is it ever appropriate to advise a patient to take a more aggressive approach?
While this may seem strange to a lot of forum members, it is a request I receive on a somewhat frequent basis in the office. Patients fear that an age-appropriate hairline or dense packed frontal transplant will look like too big of a change. I can usually show patients examples, explain the growth/maturation timeline, and demonstrate that this will look natural. However, sometimes they still want a more subtle change.
The following is an example of this; a patient who truly wanted a conservative and subtle change. After seeing several examples of more aggressive approaches and reviewing surgical options, he opted for a more recessed and subtle frontal band procedure.
Norwood stage 2
There is a slight recession of the hairline around the temples. This is also known as an adult or mature hairline.