Abstract
BACKGROUND: A high and wide forehead is a common congenital facial characteristic among East Asian women, often resulting in an imbalanced mid-upper facial proportion, diminished three-dimensional contour, and reduced femininity. Although this facial morphology is often congenital, such features frequently lead to appearance-related anxiety, affecting patients' confidence and social interactions. OBJECTIVE: This study aimed to investigate how a personalized hairline design strategy using follicular unit extraction (FUE), tailored to East Asian facial proportions, can enhance mid-upper facial contours in women with high and wide foreheads. METHODS: A total of 60 female patients with high and wide foreheads were enrolled, with a mean age of 33.3 ± 7.1 years. Preoperative measurements showed a mean mid-frontal height of 7.48 ± 0.46 cm and a mean intertemporal width of 14.66 ± 0.65 cm. On average, 3243 ± 1038 follicular units were transplanted at a recipient density of 50-60 FUs/cm(2). Postoperative assessments included improvements in forehead contour, naturalness of the hairline, and documentation of adverse events. RESULTS: The average reduction in mid-frontal height was 1.33 ± 1.10 cm, and the intertemporal width was reduced by 1.47 ± 0.57 cm. On a 5-point Likert scale, the average satisfaction score for mid-upper facial contour improvement was 4.70, while the score for the overall hairline appearance was 4.52. Only minor postoperative discomfort was reported, with no severe complications observed. CONCLUSION: Hair transplantation via FUE is an effective approach for improving mid-upper facial proportions in East Asian women with high and wide foreheads, resulting in a softer and more three-dimensional forehead contour. Surgical design based on East Asian facial and hair characteristics yields high patient satisfaction and favorable safety outcomes, supporting its broader clinical application.