The Stough Clinic  

The Feathering Zone Technique

You lost your hair one follicle at a time. That is the way we generally prefer to put it back. This way, the restoration process is gradual, natural looking, and cosmetically undetectable. Sound impossible? Please read on. The Feathering Zone Technique is the secret. It is the most important breakthrough in hair restoration since its invention in the 1960s. Why is it so important? Because this technique makes it possible to reconstruct the frontal hairline naturally and undetectably, as if it was never lost. Dr Stough has a different philosophy and a different technique.

What is The Feathering Zone Technique?

Hair from the back of the scalp does not emerge as single hairs; it grows as groups of hairs. These groupings generally contain one, two or three hairs, and rarely a four hair grouping can be found. The latest technology involves transferring hairs as they are found in natural groupings. At The Stough Clinic, hairs are transplanted according to their natural clusters and do not contain more than a single follicular unit. It may sound complicated, but is actually just simply the transfer of very small groups of one, two and three hairs. Only single hairs are placed in the frontal region. The old adage, "Mother Nature knows best," is an appropriate metaphor to describe this technology. The hairline should restore symmetry, harmony, and proportion to the face without ever being perceived as artificial or unnatural. Dr Stough achieves this by establishing a hairline that by its shape and location will appear natural over the course of decades.

Wht is this field of medicine so different?

For many individuals, having a hair transplant is the single most positive step they may take concerning their appearance. They are thrilled with the results and receive a very positive change in their appearance. These individuals cannot imagine why anyone who is distressed over their hair loss or lack of hair would not consider a transplant procedure. There are many factors, some of which are listed above, that determine whether or not you are a candidate. Everyone with hair loss is not a candidate for transplants. Men under 25 generally should be discouraged from transplants, although occasionally exceptions to this rule are made. Those men who are experiencing thinning of hair may not receive a positive benefit from transplants. On the other hand, a 40 year old man with well-defined baldness is a marvelous candidate. When you go to the dentist and he recommends a root canal, it is generally wise to take his recommendation and have the procedure. Hair transplantation is somewhat different. You need to be equipped with the knowledge of what you can expect from a hair transplant and if this will meet your goals. Education becomes mandatory.

Are you a candidate for a hair transplant?

The selection of patients for hair transplant surgery is an evolving area in hair restoration surgery. Everyone who walks in the door requesting treatment is not a surgical candidate. The newer method of selecting appropriate patients for hair restoration surgery is based on a combination of 1. procedural outcome assessment, 2. the amount of hair loss of the patient and 3. the patients goals. Additionally, specific characteristics of the patient must be considered such as the hair-to-skin color match, the size of the hair shaft caliber, the texture of the hair, the donor area density and the amount of curl.

Amount of Loss

The dominant factor in patient selection is the degree and pattern of loss. In general, the more severe the baldness, the happier the patient will be in the end. Facial framing will create a beneficial contrast between the way the patient looked before transplantation and the way the patient looks after transplantation. In other words, a more positive change in appearance is achieved with a well-defined pattern of baldness, as opposed to patients who are in slow constant evolution from one classification to the next. Patients with thinning hair often have what we refer to as a Óleaky bucketÓ because they are in an active phase of hair loss without any well defined areas of baldness. We make the analogy of trying to fill a bucket with water which is riddled with holes. If you have no baldness, it is difficult to ever thicken your hair. One thing many patients fail to realize is that the transplanted hair will be in place for the next 20+ years, but the NON-transplanted hair will continue to be affected by the process of loss.


Patient age is the second most important factor to consider and is inherently linked to the baldness classification pattern. Most patients under 30 years of age have thinning only and not well defined areas of baldness. In addition, younger patients tend to be unrealistic in their expectations and less accepting of conservative treatments which will bear positive, proven and predictable long-term results. Older patients tend to be more accepting of the limitations placed on all of us by the aging process.

Hair color vs. scalp color

Hair color as it contrasts with scalp color is an important consideration because the greater the contrast between these two, the more difficult it is to achieve a natural result. Strong contrast increases the risk of tufted, pluggy, unnatural appearance of some hair transplants. Jet-black hair in a lily-white individual is the most difficult situation in which to achieve a natural appearance. Gray, blond, and red hair tend to provide more natural results because these colors do not contrast strongly with the skin color of the scalp. The Feathering Zone Technique lends itself to the most natural result for these difficult cases.


Hair texture and caliber are other factors to consider. The thicker the caliber, the greater the surface area each hair covers. Small grafts need to be transplanted with thick caliber and coarse hair. Fine hair on the other hand provides natural-looking results, but due to the thin hair shaft, it is difficult if not impossible to achieve a thick, dense look. Fine hair is easy to style because it has less memory. In general, fine, soft hair is easier to transplant than thick, coarse hair, but achieving a dense look is much more difficult. We use the analogy of large, fat, redwood trees for coarse hair, versus slim pine trees for fine hair. The redwoods create a dense forest with fewer trees. The pine trees, no matter how closely planted, can never give the same density of forest. Thus, it is difficult to achieve a thick look with fine hair. That is not to say patients with fine hair are not good candidates, but the limitations must be discussed prior to transplantation


Hair curl is not as important as the other factors but it is an added benefit, as curly hair covers more area than straight hair. The curl adds volume and helps to hide the exit of the hair shaft from the scalp, giving a very natural look. Wavy hair also gives a thicker look than straight hair. High-density medium-coarse hair with curl is the most advantageous for transplantation.

Human satisfaction - a moving target

Regardless of these factors, successful candidate selection hinges on the patient and surgeon reaching an understanding on an objective goal, and agreeing on any compromises necessary to achieve the goal. Despite how well a candidate meets the surgeon's criteria and how well the transplant is performed, if the patient's goals are not met, he will not be satisfied. The surgeon must educate the potential patient on the lifelong progression of male pattern baldness, and therefore the limitations this continued process places on hair restoration procedures and results. Education for the patient will help transform ill-defined hopes into concrete expectations. Most problems with patient satisfaction stem from patient expectation and not surgical technique.

Facial fraiming - the key issue

A chief goal of surgery should be to restore facial framing by creating a permanent hairline, which will arrest the visual effects of continued hair loss. This return to facial framing has a tremendous positive impact on the patient's appearance by restoring familiarity, shortening the face, and directing the observer's focus to the central face. If facial framing has not been lost by the patient's balding pattern, then the surgeon needs to plainly and honestly convey to the patient what is realistically achievable over time and ask the patient if these goals will satisfy his needs. The patient must understand what can realistically be achieved and his expectations must be remolded until both the surgeon and patient are talking the same language and expecting similar long-term results from hair restoration.

The Feathering Zone Technique offers the best option for hairline restoration and facial framing. Patients, especially the younger ones, want the hairline placed low and round. We do not give in to these desires. The initial transplanted hairline can be modified downward at a later date should the need arise, or should the patient have sufficient donor hair ( and loss pattern) after the remainder of the transplant has been completed. On the other hand, surgically raising a low-transplanted hairline is time-consuming, expensive, and fraught with difficulty.

In creating the hairline, a surgeon must focus on the future, not on the past, and should not consider the patient's previous hairline. The patient may desire the hairline of his youth, but should have a hairline that will age well and meet the constraints of donor hair volume and quality.

There are many advantages to this mature, conservative pattern of a higher hairline. This pattern gives greater density and a more natural appearance than a low, round hairline. This hairline pattern is especially critical for patients with minimal donor hair. A high hairline with temporal recessions generally achieves an excellent life-long result which looks appropriate as one ages.

World Training Center for Single Hair Grafts

In the past 19 years, over 100's of physicians and technicians have traveled to The Stough Clinic to learn hair transplantation. Many of these physicians are starting out in the field, but even more are established surgeon's seeking to refine their technique. One of Dr. Stough's physicians, Dr. George Bondar, states: "I've visited hair transplant centers all over the world and the philosophy and meticulous attention to detail at The Stough Clinic is truly remarkable. Even more important, clients get straight answers. Dr. Stough is not afraid to say "No" to those who cannot benefit from his skill."


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