Repeat From Archive

We have been getting a great number of questions about hairline hair loss. Basically the questions relate to the slow appearance of the mature male hairline. The pictures in this post show a young man in transition between his juvenile hairline and his mature hairline. Note that the corners are moving up and that there is some thinning of the leading edge of the hairline. What you see here is not balding, just maturing the hairline.

Please note that we do not generally diagnose hair line questions. However due to the increasing daily emails with photos of young men concerned about their hair line, we will soon be rolling out a new website where you can submit your photos and have others rate the hair loss. Stay tuned!

Hey doc, there is a new hair laser on the market. What do you think?

This space age design and the small case “i” in-front of the name does not add value. The FDA clearance means that it is safe. I really do not understand the FDA as effectiveness has not been proven in the one example mentioned in the article. I have not seen any definitive clinical research that proves that these lasers have any value at regrowing hair. Even the recent article in the Dermatology journal stated “further study is needed”.

What Is The Best Way To Diagnose Hair Loss?

We addressed this question before HERE

I personally believe that the HAIRCHECK instrument is a great instrument to put numbers (an objective measurement) to the balding process. When repeated yearly, you will know how your hair loss is standing up to treatment such as Propecia (finasteride) or just the normal progress balding men experience routinely. We perform HAIRCHECK measurements and MINIATURIZATION MEASUREMENTS (with a microscope) on most of our patients who are balding and those who go on the drugs so we can see gains or losses over time. The measurements are limited in certain cases when the hair is too short.

I am scared to death that I would have a hair transplant and everyone would know because it would be so obvious. What do people do to hide it? Do they live in a hat?

I could write a book about this subject. Many years ago when larger grafts were used, it was impossible to hide a hair transplant because the wounds were large (between 3 and 5 mm). Large wounds, are obvious and at the time that these were done (late 1980s and early 1990s) the typical patient had to use a hat (baseball hat most common). When I innovated the small 1mm grafts in the early 1990s (I started doing hair transplants in 1992), I focused on this problem. There are two parts to this problem. The first reflects the post surgical period of a few weeks. The small 1mm grafts healed rapidly and with good post-operative washing, the surgery could be undetectable within a few days. Swelling was also a problem immediately after a hair transplant, one we solved with the judicious use of corticosteroids which reduced the post-operative swelling plaguing our patients. In the early 1990s as the number of grafts in my practice rose into the thousands (2000, 3000, 4000 and 5000 grafts), careful focus on post-operative washing and the use of single large doses of steroids brought undetectability within a week or so. Most patients were able to go out into the public within a week, once we mastered the post-operative care.

The second concern was how did a man go from a completely bald look (Class 6 or 7 patient) to a hairy look. Here I have many stories and I will mention only a couple of them here. A Class 7 patient of Indian decent, let his beard grow out just before the hair transplant. To his and my surprise, his beard was white so everyone he knew laughed at his ‘Santa Clause’ appearance, but no one, observed his hair transplant or the change in his look from bald to hairy. He shaved off his beard and no longer paid attention to his hair. Like grass growing, you never see it grow. The second patient was a 55 year old male with a Class 5A pattern. His hair was prematurely white and his balding pattern was very obvious. His post operative care paid attention to his wounds and in a few days, his hair transplant was barely seen. He has rapid growth of the hair, an unusual rapid course. At Christmas, his daughter who knew her balding father, picked up the new hair on first meeting after a year of not seeing him. She said, dad, take off that silly wig. He told her that it was not a wig. Then she reached up to his hair and tried to pull off the wig. Of course, it did not come off because it was his own naturally growing hair. “Come-on Dad” she said, Yoy never had hair before. Where did it come from? He remained silent and then she said, Is that Rogaine that you used? He smile and acknowledged her comment. As a nurse, she followed, “that is the most amazing result of Rogaine I ever saw”. There was little else to say.

Even FUE procedure where you shave your head can be easily hidden in a few days

Immediately AFTER FUE surgery

5 DAYS After FUE surgery!

According to the Wall Street Journal (9/15/14) There was a 39% increase risk of developing aggressive prostate cancer when compared to non-balding men. This was the result of a questionnaire given to 39,000 men and fom this reason, the patients actually determined their balding pattern and their perception of the aggressiveness of the cancers. The conclusions expressed here should be evaluated with a more scientific clinical study; however because prostate cancer in the #1 leading cause of cancer in men, it may be worth taking note of this possible association. It seemed that the greatest risk may be with those men with frontal balding (what we call a Norwood Class 3V pattern) however, since this was done by self diagnosis, one can not be sure about the association. The American Cancer Society estimates that a man’s lifetime risk of developing prostate cancer is 15.3% and it carries a death risk of 2.7%. The article was written by Peter Loftus.

We reported a similar finding here
In another post on baldingblog, we wrote about a somewhat controversial article which contradicts the Wall Street Journal article is here

We have seen well documented associations between crown (vertex) balding and heart disease which we reported here

What is clear between the two subject article is that nothing is clear.

NHI Eyebrow Transplant Immediately after 300+ grafts

NHI Eyebrow Transplant Immediately after 300+ grafts

NHI Eyebrow Transplant  7 DAYS after 300+ grafts

NHI Eyebrow Transplant 7 DAYS after 300+ grafts

NHI Eyebrow Transplant  7 DAYS after 300+ grafts

NHI Eyebrow Transplant 7 DAYS after 300+ grafts

This is an Asian patient who wanted to enhance her eyebrows.
She was worried about how it may look after the surgery, especially going back to work!
She didn’t see many before after photos on-line of how it looked IMMEDIATELY AFTER SURGERY so she gave us permission to use her photos.
Hopefully it can help those considering an eyebrow hair transplant surgery.
We’ll keep you posted as the eyebrows start to grow out in the next coming months..

In your before and after pictures, few patients show their face. Why is that? If I could afford a hair transplant and had a great result, I would show my face and feel proud of it.

First, with regard to costs, the costs have dropped significantly over the past decade because of better techniques and more competition. Second, cost is a relative term. What may seem “expensive” to one person may be “priceless” to another. In absolute terms hair transplants can typically cost under $10,000 and it depends on the number of grafts you need.

With respect to patients showing their face, this is a private matter for each individual. Some patients have no issue with letting the world know of their transformation. Some rather remain anonymous. We respect the wishes of each individual. In fact most patients rather not have photos published (even when it does not show the face). Some of our best work at New Hair Institute will never be published and go unnoticed to the public. There were a few of our patients on stage and in the audience during the recent Oscars for the world to see but their results will never be published on our site. Each patient has to sign a written consent form giving us permission to publish any photos (even if it doesn’t show their face).

Before hair transplant

After 2400 grafts


Do all twins with a balding gene lose hair at the same time? Is it possible for one twin to not have the balding gene? Or is it possible for one twin to bald at a different rate if they were at a different stress level ?

We have seen many identical twins (same genes) over our 23 years at NHI but they do not bald or lose hair at the same time. Maybe several months to years apart. This may suggest some outside influence. For example one set of twins twin used anabolic steroid and lost his hair fast while his twin did not. Another twin used a hair piece and developed traction alopecia from the tapes and glues. The twin with more hair, at one point, was a donor for his brother who needed the extra hair.

I have seen twins without hair loss, but have not followed one of a pair with hair loss. I would imagine that stress might cause one twin to have accelerated hair loss if they had the genes for balding.


How do you undo a bad hair transplant? I see many of them on men in stores and at work.

Hair transplant has been referred to as “plugs” and still carry that negative connotation because the transplanted hairs actually looked like “plugs”. These type of surgery were pre 1990’s work when doctors were not transplanting follicular units. Those big plugs are still around on the heads of thousands if not millions of patients. We’ve (New Hair Institute) been correcting or fixing the “bad work” for over 23 years since we opened. Instead of a lengthy explanation of how it is done, the flowing before and after photos reviews the corrective hair transplant surgeries performed by New Hair Institute over the years.
You can also see them here

Repair of Hair Transplant Plugs: The old plugs that created his unnatural looking hairline were cut out and then transplanted back in a more natural looking pattern. A total of 1212 grafts were placed in this repair surgery.

Repair of Hair Transplant Plugs: In the repair phase, the large grafts were dissected into their individual follicular units and re-implanted. One procedure of FUT provided excellent camouflage. A second session will be considered to increase fullness.

Repair of Hair Transplant Plugs: Mr. AQ had old plugs that failed to grow hair. Note the visible white scars produced by the hairless plugs. After the repair with one procedure of Follicular Unit Transplantation, the scarring was undetectable and the patient let his hair grow naturally gray.

Repair of hair Transplant Plugs: Patient JG had extensive scarring from a sew-on hairpiece and 3 hair transplant sessions using plugs, many of which didn’t grow well. Luckily, the patient had salt & pepper hair, ideal hair for a repair. Dramatic improvement was accomplished with just one session, although JG planned a second session. One problem that we could not correct was the very low hairline.

Repair of Hair Transplant Plugs: This patient had very noticeable plugs done earlier in his life and he was unhappy with the way they looked. Being a Norwood 5A, he also had very thin hair all over his head as you can see from the top-down photos we took. After three procedures totaling 5405 grafts, we were able to not only hide the plugs that he had, but we were also able to achieve a very full looking head of hair from nearly any viewing angle.

Mr. AS had a very pluggy frontal hairline from the old plug technique. A slight Widow’s Peak was created to break up the straight-line appearance of the hairline and to camouflage the plugs. This repair was accomplished with just one session of Follicular Unit Transplantation. A second session will make it perfect.

Repair of Hair Transplant Plugs: Plugs placed within patient’s old hairline by another transplant center were not too noticeable at first. However, with further hair loss, the poorly planned transplant became very unnatural. Fortunately for the patient, the old plugs were located high enough so that a dramatic camouflage was achieved with just one session of Follicular Unit Transplantation.

Repair of Hair Transplant Plugs: This patient is a 37 year-old man who had three procedures performed at another clinic. He was dissatisfied with the pluggy results. We transplanted 1,947 follicular grafts to camouflage the old plugs.

Repair of Hair Transplant Plugs: A 38 year-old man came to NHI dissatisfied with a hair transplant he had at another clinic. In his first surgery at NHI, he had his pluggy hairline removed, re-dissected, and re-transplanted. During his second surgery, his remaining plugs (not in the hairline) were removed. In his third surgery, he received 1,696 follicular units, and his results were great, but are still not complete.

Repair of Hair Transplant Plugs: Patient BII has medium weight hair of above average density (2.5/mm2). Two original sessions of large mini-grafts resulted in a hairline that was lopsided and pluggy. The patient was treated at NHI with two sessions of Follicular Unit Transplantation after some of the larges mini-grafts in the very front were removed. The hair from those grafts were subdivided under the microscope and re-implanted. We always use every single follicle!

Repair of Hair Transplant Plugs: Joe Penny came to our office a few years back to fix a bad hair transplant that utilized the old plug technique. As you can see, his three sessions totaling 3811 grafts turned out quite well.

About a year ago, I noticed a receding hairline. Hair would fall out during a shower, or even I would see some strands on my pillow. My dad and his dad started balding at my age, so it is most likely genetics. It is really embarrassing. I told my parents about it and they won’t take me anywhere. They feel like I am exaggerating. Plus, i do not think we have insurance, so that is also a reason why I haven’t seen any doctors. That is also the reason why I haven’t been to any doctor/dentist in well over 5 years. People are starting to notice a receding hairline and it is really stressing me out, thus more hair falls out, thus more stressing. Please help

The best help I can offer you is to go see your doctor. If not for the hair, but for a general check up. You are under 18 years old and a minor. You should have insurance through your parents or the state that provide free health insurance. The most common cause of hair loss in men after puberty is genetic male pattern balding (MPB) or androgenic alopecia. At your age there is a good option in medications. You can also see a hair transplant doctor but you will need a parent to accompany you to be able to address the situation if the examination confirms your suspicion.

Even if your hair is thin all over how likely is it that you can give an appearance of thicker hair by moving some hair from less noticeable locations to the front?

This question covers a lot of territory:

1- If there is generalized thinning over the entire head and you are a male and the thinning is in the side and back of your head as well, you might have a condition called Diffuse Unpatterned Alopecia (DUPA). This condition is not good news, and these patients can not undergo a hair transplant as there is a poor donor area and therefore the doctor can not move enough good quality hair to cover the thinning area. Scalp micropigmentation (SMP) on the other hand, may be a good alternative (see:

2- If there is generalized thinning over the entire head and you are a female and the thinning is in the side and back of your head as well, you will not be a candidate for hair transplantation as the transplanted hair will have poor growth. Again as I said in #1 above, Scalp micropigmentation (SMP) on the other hand, may be a good alternative

3- If you are a male and you have thinning on the front, top and/or crown area and you are under 30 years old, the first treatment course we would be to try finasteride (Propecia) and give you a year to see if some of the hair thinning stabilizes or possibly reverses in some of these areas. If you stabilize or reverse the thinning process, hair transplants can be planned at that point in time if appropriate, however, you must work out the hair supply/demand issues with your doctor. Thinning in men evolves into balding and hair transplants do best in treating balding. When we perform a hair transplant on a young man, we advise the patient to use the drug finasteride to minimize any shock loss from the hair transplant surgery.

4- For women who do not bald but have thinning and a healthy donor area, the amount of hair that needs to be transplant may be limited by the size of the thinning area and the amount of hair one can transplant in a single session. If the thinning is great, the benefits of even a large hair transplant (say~ 2500 grafts) might not be enough to make an appreciable difference. In these situations, I might transplant a female in particular area (like the frontal area to strengthen the hairline or a central or right/left part to make the area look fuller). In this way there can be a partnership between styling and transplants. This is difficult to explain but worth a consultation with an expert in this field.

Most important, there is a balance between the demand for hair and the supply of hair as the doctor moves it around.

Can I Swim After I Have SMP?

You have to wait about 3 days before you go swimming (ocean, lake); however, if there is chlorine in the water (typical swimming pool) you should wait at least 30 days to be sure there is no connection between the pigment and the water. When SMP is properly done, the pigment settles below the epidermis within 30 days, so the chlorine from the swimming pool can not reach the pigment. Chlorine can bleach the pigment and change its color. Ocean or lake water should be fine.

I saw a website from a ‘company’ in the field of hair restoration, where the doctors were advertising several types of lasers for the treatment of hair loss saying that their devices are FDA approved. Does this mean that these devices have been tested by the FDA and actually work?

We addressed the subject of FDA regulation with hair lasers many years ago here and here. The FDA never really approves such a device confirming that it grows hair, but in this case they cleared it to be safe for sale. It is unfortunate that some doctors seem to promote the idea that such devices are ‘approved’ by the FDA for certain hair loss treatments. The FDA does not actually test these devices on its claims of growing hair, but place the burden on the seller or manufacturer to demonstrate safety and effectiveness. In this situation, the FDA clearance for use of terminology for Low Level Light Laser Therapy seems to have faltered.

Tags: laser hair loss, hair loss FDA approval, FDA laser hair treatment status

I am 21 years old and my hair is everything to me. I don’t want to lose it, even when I grow older. Is there a mature female hairline like the mature male hairlines you write about that I should worry about?

Unlike the male’s mature hairline which is V shaped, the female hairlines are usually rounded. The rounded hairline may move upward and in most women who are under 40, the upward movement does not change the rounded shape. If by chance you do not follow this rule of thumb, you can always have hair transplants to restore your rounded hairline. Check it out with a doctor who understands the female patterns of hair loss.

The body of a supercentenarian expands science’s appreciation for the physiological limits of aging.

This article was Published in The Scientist:

Two interviewers chatted with the now 113-year-old van Andel-Schipper back in 2003. The interview was also repeated at age 111 (neuroscientist Gert Holstege) and again at 113. She was amazing with memories going back to the details of a soccer game in 1898 when she predicted that her favorite soccer team was not going to be successful and she was right.

“She knew exactly what was going on in politics, in sports,” recalls Holstege”… “She could explain … exactly what happened in 1898 when Wilhelmina became queen [of the Netherlands].” She remembered the details of the parties she’d gone to with Dutch soldiers as WW1 began in 1914. “She was completely alert.” She died at age 115.

I (Rassman) had a great grandmother who lived to 114 years of age and I remember her well. Like Andel-Schipper, her brain functioned reasonably well, but unlike her, she was not in a nursing home. She lived with her daughter (my grandmother). Every Sunday, the family would get together with her. She was born before Lincoln became president and was alive when I went to medical school. She gave me the following advice. “Marry a rich woman until you get established and she puts you on your feet. Then get a divorce and marry for love the second time.” It could be modern day advice for many of our peers.