Maturation of a Hairline — Moving From Juvenile to Mature (with Photos)

Normal male hairline progression from a juvenile to a mature one typically occurs between 17 and 29 years of age. The lowest line in the photo below is the hairline this man had when he was about 12 years old. The second line is the hairline that will be his mature hairline if he is not balding. The area behind this second line has miniaturizing hairs and it should be his permanent hair, so this man is clearly developing frontal balding. This process of a maturing hairline might appear like balding to the person impacted by this change, but it is self limited and stops within a few years once the location of the maturing hairline is established. Many of my readers think that the development of a mature hairline is balding (they panic but should not because it is not balding). Performing a miniaturization study at the stage where the maturing hairline is starting to develop would show miniaturization (in only the blue area). In this patient the blue area is completely hair free. Behind the blue area, there should be no miniaturization (not the case in the photos here). I call the entire area we are looking at in the photos, the frontal hairline, not the temples (as so many of my young readers call it). Although the average age of a maturing hairline appears between ages 17 to 29, it could be seen before 17 or after 29.

If this man wanted a hair transplant, I would put him on Propecia (finasteride 1mg) to stabilize his progressive hair loss and then transplant him (about 1300 grafts). One might think that the proposed transplanted area would be easy to see, but he has enough hair to hide any transplant he would get with some creative forward combing style. The balding on the right side is as extensive as the balding on the left side, but the way the hair is styled, it hides the balding well. I would place his hairline just where the blue area starts and give him what he would have had if he was not balding. The entire red area would be filled with transplanted hair.

So just to summarize, these photographs are of a 31 year old patient with early hair loss beyond his mature hairline. The lowest line is the location of his juvenile hairline and the upper is the location of where his mature hairline would be (usually about 1/2 inch above the juvenile hairline in the midline and an inch in the corner of the frontal hairline). I’ve put up the original version and a color-highlighted version to show the areas I’m referring to. The blue section in the colored photos is the area between the juvenile and mature hairline, and the red section is the actual genetic hair loss which has miniaturized hair (behind the mature hairline). Please click the photos to enlarge.

Tags: hairloss, hair loss, hairline, miniaturization, juvenile, mature

Washing Scalp After Transplant

I am day 4 post op right now. I have been pouring shampoo-filled water on my head followed by a round of conditioner. I am not touching my scalp at all except for gently massaging around the donor area a couple of times. At what point should i change how i wash. Can you please detail how to wash my hair when it is time to change what i am doing now? Also I still have pain in the donor area. Is this normal? How long will this last? Lastly, are there any post-op products that promote scabs to fall off and protect against infection? Thank you for taking the time to read this and for your reply.

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For starters, you should be asking your transplant surgeon these question. Of course, I will do the best I can to help and will expand upon your question to supply other bits of information that may help my general readership.

Washing your head after a hair transplant has been arbitrary among hair transplant surgeons for years. The dilemma is that there is a risk of grafts dislodging in the first few days after surgery if the grafts get manipulated. On the other hand, washing reduces the chance of scab formation which gives you acceleration of the healing and normalcy of your scalp. Fortunately, this issue was studied recently (see this PDF file — Graft anchoring in hair transplantation). This study showed that presence of scabbing after surgery extends the interval that grafts are at risk of being dislodged. The study emphasizes that preventing scab formation would shorten the high risk period during which new grafts may fall out. I recommend frequent, but gentle hair washing in the first few days following you operation without rubbing or scratching in the recipient area. Professional hair washing for the first days after surgery is advisable and I personally offer this service to all of my patients during this time. Some products have been claimed to reduce the scabbing and infection after surgery with no documented evidence to support them.

Fortunately, infection is not a common complication after a hair transplant in healthy individuals, thanks to good blood supply of the scalp skin. As a general rule the donor and recipient wounds are almost completely sealed in within a few hours and certainly by the next day after a hair transplant. External factors should not cause infection in these areas beyond this time. If you do not learn to wash with some vigor, then the evidence of a hair transplant in its healing phase may take weeks to disappear rather than a day or two (crusts that are not washed away in the first or second day tend to linger for weeks). The actual details of how to wash should be obtained from your doctor. After a week, if the scabs are still there, you can wash your hair and then leave the shampoo on for 10 minutes or so, gently massaging the scabs after the 10 minute waiting period.

Folliculitis (a cyst in the recipient area which may become infected) is the most common cause of post operative infection in people who do not pick on their transplanted site. For those that pick, the infection risk rises. There are a number of factors that contribute to these cystic ‘pimples’ that appear after 4-6 weeks. Some people believe that these are caused by remnants of hair left behind from the grafts or are foreign body reactions to the glands of the hairs which may survive below the skin after the hair is shed. These glands (which lie along the hair shaft about 3 mm down from the skin) almost certainly produce sebum (a waxy secretion) which can not exit the skin, because it needs a hair shaft to find its way out. These cysts are best treated with warm soaks and frequent shampoos to promote their external drainage. When a doctor employs staff without extensive experience or with poor eyesight, grafts are put in one on top of another (piggybacking), which buries the first graft. These buried grafts causes cysts that frequently get infected and at times require antibiotics or even surgical drainage.

Pain in the donor area could persist for the first 2 or 3 days after surgery. Soreness continues to subside within the first week, and rarely require pain medications after the first day. Mild numbness in the donor area may persist for a few weeks.

Tags: hairtransplant, hair transplant, aftercare, wash, washing, scalp, graft

Propecia Success Rate vs Placebo

Dear Doctor,
Most of us would agree that wikipedia is one of the most common sources of information on the web. Looking at common hair loss treatments on wikipedia(http://en.wikipedia.org/wiki/Baldness_treatments) I found that the positive effects of propecia are not described sufficiently (as they are in your blog). Moreover, it says that “Propecia has a reported 29-68% success rate (vs. 17-45% in patients receiving a placebo)” whereas your posts report that almost all men have some positive effect. If possible, please clarify.

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Several studies were conducted on Propecia (finasteride 1mg) to compare its effect with placebo on hair loss or growth. To answer your question, I present the numbers of one study comparing the effect of finasteride with placebo in the growth of crown hair. In this study, hair growth was compared over a period of 5 years. In this experiment, initially investigators evaluated patients’ hair growth and came up with the below numbers:

  Finasteride Placebo
1 Year 65% 37%
2 Year 80% 47%
5 Year 77% 15%

The same study was repeated, but this time an independent team of investigators rated standardized photos in a blinded fashion (reviewers were not aware which patient took finasteride or placebo). The numbers were different, but still statistically significant as shown below:

  Finasteride Placebo
1 Year 48% 7%
2 Year 66% 7%
5 Year 48% 6%

There are some other studies looking at different aspects of hair growth and as a result you may see different numbers. In clinical studies, you may find different numbers presenting the same facts, but if you go to the detail of the study, you will notice that they are not necessarily concentrating on the same parameters. The difficult element not covered by these studies is the ability for finasteride to arrest the hair loss (stop or slow its rate of loss). I am personally certain (in my professional opinion) that finasteride reduces the rate of loss in all men with genetic hair loss.

The drug company (Merck) only report what was studied and can not guess or postulate on what they might logically conclude are probable outcomes in different situations. If it was not studied, Merck will be silent. Being under FDA regulations, they are tightly controlled as to any claims that are made. To get more information about a study, you need to look at the methodology of the study to understand what particular variables are being evaluated. Professionals like me, are allowed to voice their professional opinions and are not held to the same type of restrictions as Merck.

Tags: finasteride, propecia, hairloss, hair loss, placebo

Unlimited Donor Supply (or Follicular Unit Multiplication)

Hair multiplication has been a hot topic in hair restoration field in the last few years and many patients with severe hair loss hope that using this technique they can get back a full head of hair without worrying about donor supply limitation.

I think it would be helpful to review a recent article in the journal of dermatologic surgery on a similar subject: In Vivo Follicular Unit Multiplication: Is It Possible to Harvest an Unlimited Donor Supply? Ergin ER, MD, Melike Kulahaci, MD, and Emirali jamiloglu, MD 32:11:NOVEMBER 2006.

The article discusses a method for multiplication of hair follicles without a need to culture them. The authors have removed hair follicles using a FUE technique and cut them in different levels, trying to see if two hairs can be obtained out of one hair follicle. The researchers implanted the upper parts of these partial grafts in recipient area and the remnants back in donor site. The procedure was done on five male patients. Hair follicle counts and thickness analysis were performed after 1 year by a third party investigator.

Results of the hair count and thickness analysis showed that the growth could be seen in both the upper and lower parts of the cut follicle. From the grafts that were cut in upper one third, only 20 percent showed growth in the recipient site, while 84 percent of the remnant that were left behind, grew in the donor area. There was 29% growth rate in recipient area in the grafts, which were cut in halves vs. 68% growth of the remnants of these same grafts in donor area. Finally 41% of the grafts cut in upper two third grew hair in recipient area vs. 53% growth in the remnants of the same hair follicles in the donor area that they were taken from.

The authors concluded that hair follicle growth is complex and hair follicle contains stem cells in different levels, which could participate in the growth of new hairs. We know that stem cells are located in the bulb of hair follicles and in the outer sheath, in the middle of the hair shaft where the sebaceous gland is located. The authors assumed that each half of the follicle contains a stem cell reservoir that would potentially allow the growth of a new hair. The rate of the growth in a new hair follicle is reported to be 41 percent at best. All of the partial hair follicles grow thinner hair in comparison with intact hair follicles that were transplanted in the same patients.

The authors suggest that these sub-units of hair have value but they provide a lower yield than growth of hair from intact grafts both in numbers of viable hairs as well in the actual thickness of the hair that do grow. They also suggested that FUE is a promising technique is a mechanism to get the hairs for an eventual hair multiplication process once it is worked out, but it should be avoided if the transaction rate is higher than 10 percent.

Of course, this is not the only study on this subject and some other studies reported comparable results. As we have suggested in our previous publications over and over again, FUE is a great technique for the patients who have small donor area requirement, a limited balding area, a tight scalp and the ones with a contraindication for removing a strip. FUE should not replace strip technique in standard cases.

Tags: fue, hairtransplant, hair transpant, multiplication, donor

When Should I Be Concerned About My Female Hair Loss?

I am a healthy 25 year old female and recently I have noticed a great deal of hair loss. About 2 weeks ago, I started to notice an unusual large amount of hair in my hair brush and on my bathroom floor when I would get done styling my hair. I didn’t really think about it, until my boyfriend started pointing it out to me. He noticed that after I got out of the shower, there would be a clump or two of hair that had fallen out of my head. Is this something to be concerned about? I have no idea what would cause this.

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Just seeing hair coming out more than usual is not an indication of hair loss in women. If you have a long hair, you might be just going through normal hair cycling. If you noticed widening in parting of your hair, or if you could see your scalp more than usual, you should be alarmed and those might be indications that you are really losing hair. Hair loss in women as described in multiple posts in this site could have several treatable causes, like hormonal changes, medications, and medical conditions. If you have any of the above problems, you need to see a hair specialist and get your hair mapped for miniaturization.

Hair loss in women can sometimes be caused by underlying medical conditions, so it is important for you to be evaluated by your own physician. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone. The following laboratory tests are often useful if underlying problems are suspected: Estradiol, FSH, LH, SHBG, Prolactin, T4, TSH, ANA, Iron, TIBC, Ferritin, Free and Total Testosterone. It might help to print this page out and show this to your family physician.

Tags: female, women, woman, hairloss, hair loss

Is an FUE Procedure a Less Successful Hair Transplant?

What do you mean by saying “FUE can be done in one surgery (our group did as many as 2600 in a single patient in a single session) or it can be done multiple day surgeries”? You said that this does not mean that FUE produces viable hair, so does that mean that you see less success in FUE procedures???

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Anyone can claim that they are an expert at a procedure, but where is the credibility? The results of an FUE procedure in good hands will be as good as the standard strip procedure, but yet all FUE grafts are not equal. In our original article, we talked about the candidacy of patients, where some patients were better suited for FUE than others. Now the non-candidacy group is smaller, but the quality of the grafts may become an even more important issue.

For the future, we can look to the past, as Dr. Jae P. Pak’s engineering work led to a robotic application and a U.S. Patent granted for the FUE technique in 2003 (U.S. Patent 6,572,625). We can expect to see a robotic application coming out in a year or two.

In brief, Follicular Unit Extraction (FUE) can produce damage that range from transection (cutting) of the hair follicles to avulsion of vital elements of the graft. The percentage of such damage should be under 10 percent. When compared to the traditional strip surgery, the follicular units taken under the microscope from the strip excision are mostly perfect. The FUE procedure is not as time efficient as the strip either. Local damage to each individual follicular unit depends upon:

  1. the skill of the doctor
  2. the instruments and techniques used
  3. the tissue characteristics of the patient

Most doctors do not classify the quality of each individual FUE graft nor do they calculate the transection rate, so the integrity of the doctor in making this assessment is just as important as his/her skills. Please note that nothing is 100% and always be wary of doctors or salesmen promising you 100% success rates, or a willingness to take on any patient for an FUE, or flippant comments like ‘our grafts’ do not get damaged. Always ask the doctor how he/she knows. Look at the picture of the three grafts below. The graft on the left is a normal FUE three hair graft with good fat and fibrous tissue surrounding the follicular unit, the one in the middle shows transection of one out of two hairs (only one hair may grow, but it is denuded of skin so it may not grow to its full bulk), and the one that is on the right is a three hair follicular unit which shows that the follicles have been stretched and the surrounding supportive tissue has been stripped away (these grafts will ‘probably‘ grow, but they may not have their normal width when they grow out). If this patient had coarse hair normally, the graft on the left would be coarse when it grows (like his normal hair), the one in the middle might be less than coarse (less than his normal) and the one on the right may be ‘finer’ hair. A coarse hair has better bulk and better coverage for this patient than a ‘fine’ hair and the results of the fine hair graft when and if it grows will almost certainly disappoint the patient when compared to what it should have been. Click the photo to enlarge.


For further reading about the FUE process, please see What Doctors Don’t Want You to Know About FUE.

Tags: fue, follicular unit extraction, hairtransplant, hair transplant, hair loss, hairloss, success
Errors: https://baldingblog.com/photos/061214_fuegrafts.jpg is not accessible or supported filetype.

What Doctors Don’t Want You to Know About FUE

Follicular Unit Extraction (FUE) has been in vogue with hair transplantation surgeons in recent years. It is an elegant approach where one follicular unit is taken from a patient’s donor area, one at a time. There are no scalpels or the traditional linear scar. An FUE procedure requires a special 0.7 to 1 mm diameter tool that is used to harvest each hair follicle. All incisions and cuts leave a scar, but an FUE scar is barely visible to the naked eye because each FUE scar shrinks to less than 0.5mm.

There are many variables that contribute to the success or failure of an FUE. As one can imagine, harvesting a single hair follicle one at a time can be extremely tedious and fatiguing to the surgeon if he/she had to do it several hundred times for each procedure. More importantly, negotiating a 0.7 to 1 mm diameter tool to perfectly encompass a hair follicle is technically challenging even under magnification and requires a very steady hand and much experience doing it. Of course, one might ask how a doctor gets that experience and what the cost is to the patients from which that experience comes from.

There are also uncontrollable patient dependent physiologic variables as well, including:

  1. Hair characteristics such as color and thickness
  2. Skin characteristics such as hydration level, elasticity, degree of fatty tissue content
  3. Idiopathic variables (the unknown)

All the above variables contribute to what is called a transection rate. A transection of a hair follicle means that a portion or even the entire hair follicle was cut along its body and could be damaged, which may jeopardize its viability. A complete transected hair follicle will not grow hair when it is implanted.

A “successful” extraction of one hair follicle with the current FUE technique is a very relative term. To better illustrate this point we must understand the anatomy of a follicular unit with respect to the transection rate. One follicular unit can be a group of one, two, three, or four hairs. One patient may have a predominance of two-hair-grouped follicles and the other four-hair-grouped follicles. For example, when a surgeon extracts a four-hair-grouped follicle with an FUE technique and transects half the follicle, only two hairs will grow and the remaining two may be killed off, lost in never-never land. The way some doctors count, this is widely considered a successful FUE effort (not by me, of course), because this means only 50% of hair was harvested and 50% is lost forever! To make matters worse, the patients may be fully charged ($$) for that follicle even with the transection as long a one hair is viable (a shady process to say the least). What is even worse than that is that in a complete transection, that follicle is likely dead forever and even if the doctor did not charge for the complete transaction (as he/she should not charge for it) it would be considered by me to be negative value, reducing the person’s donor hair forever. One may argue that acceptable transection rate for a “successful” FUE is 10% or less, but this is not advertised and most patients (the consumers) do not have a clear understanding of this fact. Nothing in real life is 100%. Even the traditional hair transplant surgery with the donor strip incision has a 2 to 5% transection rate. From a historical point of view, it is interesting to note that New Hair Institute (NHI) was well aware of the possibility of transection rates in excess of 10% as early as 1997 before FUE was in vogue and four years prior to the landmark article published by Rassman, et. al. In conjunction with Dr. Jae Pak (with his mechanical engineering background) the two designed and built a prototype computerized video Follicular Extraction (FLEX) device which was patented by Dr. William Rassman (U.S. Patent 6,572,625). Even that device did not achieve did not consistently achieve the ideal ‘less than 10% transection’ in all patients and FUE can not match the 2 to 5% transection rate of the traditional donor strip incision. The transection rate by our NHI surgeons are still well within the 10% range for FUE and we make no pretenses that it is better than that routinely. Because of inherent limitations of FUE and uncontrollable patient variations, any claims of transection rate of less than 10% should be viewed as highly suspect. The automated process covered by the patent technology (above) is not commercially available… yet!

With the current state of technology, a surgeon may perfect his FUE technique, but the inherent patient variability will keep the FUE transection rate higher than the traditional donor strip incision technique. An informed patient should know the risks and benefits of any surgical procedure. The FUE procedure with its virtually non detectable scarring is an attractive alternative to the traditional donor strip incision and may be good when the amount of hair needed is small because the balding area being treated is not great, but its inherent transection potential may be a deterrent for the very bald patients who want the most hair possible from their donor site.

More information on the FUE technique:

Tags: hairtransplant, hair transplant, fue, follicular unit extraction, patent

Doctors Only Record Their Successes, Not Failures

Have you ever had any failures in your practice of transplanting hair? Not just you didn’t fill in a portion here or there. But someone who was devastated?. It seems everywhere I search, doctors only records their successes. I think it is great that HT is often successful and am fully considering one for myself, but am of course afraid that there are people who have gotten a HT from credible doctors, and it made their life miserable.

Any thoughts?

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There are no guarantees in medicine. A doctor can not expect 100% of patients who had transplants to succeed 100% of the time. I’ve met with many patients who have had transplant failures at other clinics and have come to me for help. Many times the failures are produced by doctors who did not have the necessary experienced teams or underestimated the jobs that they took on. Some of the failures are caused by a failure to properly set expectations and when doctors use salesmen to ‘sell’ the transplant, then expectations may not be met because they were set unrealistically high to make the sale and close the deal. In many of these patients, I see graft growth roughly proportional to the number of transplants that they received, but a disappointed patient still sees the process as a failure. We solve this problem by holding open house events monthly where setting expectations and patient education are central to my agenda.

In my practice I have seen a rare failure of grafts to grow. There are many causes of graft growth failure that are not caused by the doctor, some of which include:

  • severely atrophic skin in a very bald person
  • autoimmune diseases that were undiagnosed (a common cause)
  • chronic telogen effluvium and the presence of a variety of scarring alopecias
  • infection
  • severe diffuse unpatterned alopecia (DUPA)

DUPA is a relatively common cause of failures, because the condition is often not properly diagnosed, even though it is easy to diagnose when the donor area is mapped for miniaturization).

So yes, you are correct that doctors do not want to publicize failure. I don’t know of a doctor in any field of medicine that proudly shows off unsuccessful procedures. It is just never good for business. Could you imagine a breast cancer specialist telling how many of his patients died, or a psychiatrist tell his depressed patients how many of his patients committed suicide?

You ended your question with a suggestion that a hair transplant from a credible doctor would make their lives miserable. Modern hair transplants should not make anyone worse off. Even a theoretical complete failure should leave a person to where they were prior to the transplant (less whatever scar was in the donor area, which should be minimally detectable).

Tags: hairtransplant, hair transplant, doctor, failure, sucess

Hair and the Effects of Flat Irons

Hi I am 29 years old, male. Do flat irons cause permanent hair loss? My hair dresser started using a flat iron on my hair 3 years ago, since my hair was wavy, he showed me how I can make it straight. About 2 months after using it (usually once or twice a week) I noticed that my hair was drying out. I stopped, only to use it once in a while. Today I find that my hair is receding on the sides and my crown is thinning. Is this from the use of the flat iron? I’ve stopped using it for about 6 months now but I still find that my hair falls out everytime I wash and style it. I researching on the net about the side effects of flat irons but never found any concrete proof about the consequences of using them. I hope I didn’t ruin my hair for good! What can I do?

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Let’s think logically about this. When hair has grown beyond the scalp, it is no longer a living tissue. Only the hair organ below the skin is living. Hair is made of compressed fibers and a shingle type of structure made up of shed skin cells called cutin. These shed skin cells are in effect the same ‘stuff’ that produces the scales we see in dandruff and may reflect higher turnover of the skin on our scalps. As these shed cells are compressed above the fibers in the hair shaft, they form a layered array just like the shingles on a roof would form to keep out the water. But below the skin, the hair organ puts lipoproetin layers into these scales of cutin that give the hair the character that you have. The presence of fat on the outside of the hair shaft is what brings out ‘luster’ in the hair. Once the hair exits the skin as it grows , it enters the hostile environment of air, wind, weather, heat, etc… and it no longer is subject to what your body can do for it. As the hair exits the surface of the skin, the sebaceous glands secret a waxy sebum that may find its way onto the hair shaft, giving some people an oily hair.

When you iron your hair with heat, you do change the character of the hair and change the configuration of the varying layers of compacted cutin and the fibers that make up the structure of your hair. Heat takes away the luster (shine) from hair, burns away the waxy covering, may denature the lipoproteins on the surface of the hair shaft and it is this that protects the hair from the environment. Heat may damage the core of the fibers inside the hair as well. High heat applications can damage the hair so that it cracks, breaks, and even become fragile, producing broken ends from hair that breaks too easily. Take a look at this illustration of an enlarged hair shaft here (illustrated by Norm Nason). Note the layering of the cutin shingles. Look at the center of the shaft and see the fibers that form the backbone and the strength of the hair shaft. When these fibers are broken, or the shingled cutin is removed, damaged or burned, a pealing process may begin which would reflect the damage to the foundation of the hair shaft, and it can become permanent. When the hair is damaged, then gentle handling is critical to maintain and hold it on your head. You can, of course, cut it off and new hair coming from below the skin which should not grow out damaged, will eventually replace the weak hair. The hair exiting the skin is normal and undamaged so you can and should expect that once you cut off the damaged hair, the new hair will grow to whatever your normal should be. Good cosmetology can hydrate the hair and it might bring back some of its luster and strength. For those of you interested in high powered microscopic views of the hair system below the skin, see here.

So, if you have hair loss or thinning of new hair, it is possibly a new problem, and you need to have your hair analyzed by a doctor like me.

Tags: hairloss, hair loss, iron, character, heat, cutin, fiber

Juvenile vs Mature Hairline — Am I Going Bald? (with Photos)

Many of my younger readers of this blog are seeing changes in their hairlines and are worrying about becoming bald. The problem is made worse when there is balding in their family line. I have placed three diagrams taken from the Norwood Classification for hair loss. By conventional wisdom, the Class 1 pattern is proposed not to be balding, the Class 2 pattern suggests that this is the beginning of the balding pattern (it may actually be the beginning of the mature hairline, just not named as such), and the Class 3 pattern is thought of as early balding, possibly worthy of transplants in some men. The line between the Class 2 and 3 patterns are fuzzy, at best. The reality, however, is not quite as simple as I believe that Dr. O’Tar Norwood had documented. In most men (more so in Caucasians), the hairline of youth rises to a hairline of maturity. The mature hairline is about 1/2 to 3/4th inch higher in the middle than where the youthful hairline is and as one moves away from the midline to the corners of the hairline, the gap between the mature hairline location and the youthful hairline location is slightly over 1 inch, changing the overall shape of the hairline to its characteristic ‘V’ shape.

 

Norwood 1 Norwood 2 Norwood 3

 

Bill ClintonYou can tell where your youthful hairline is/was by lifting your eyebrows up so that you can see your forehead wrinkle. I call this the furrowed brow, and the wrinkles you see reflect a muscle below the skin (the frontalis muscle which is present in everyone). The youthful (juvenile) hairline touches the top of the highest wrinkle and has a concave frontal shape to it. In the mature hairline (with its almost convex frontal shape that extends from the temple prominences), shows a gap where there are no wrinkles and no hair present. None of what I just wrote is male pattern balding, yet many of our young readers panic when they see the rise in this hairline and they look to the Norwood Chart to identify where they are in the progression of their hair loss. It is particularly bothersome to the young men when the change occurs slowly and asymetrically. It is even worse when the change produces ‘chewed’ look. This maturing process occurs between 17 and 29 years of age and it is not uncommon to find one side go up faster than the other side. Not all men get a mature hairline (for example, former US President Bill Clinton retained his juvenile hairline — see photo at right) and retention of the juvenile hairline is more common on non-Caucasians as seen in many people from Asia and the middle eastern region.

They say a picture is worth 1000 words, so look at the pictures and labels below for clarity of this. Women almost always retain their juvenile hairline through their entire lives, while 95% of Caucasian men develop a mature hairline.

Set 1 (below): Photo on the left is of a patient with the “mature” hairline drawn in. The photo in the middle is of that same patient with the “juvenile” hairline drawn in (the lowest line). Note the gap between the highest wrinkle and the proposed mature hairline. That ‘gap’ should probably not be transplanted. The photo on the right is of my hairline — the mature hairline. Click photos to enlarge.

 

Set 2 (below): Photos on the left (Korean) and middle (Hispanic) are of adult males with the juvenile hairline (non-transplanted), photo on the right is of an adult female (Cambodian) hairline (non-transplanted). Mr. Clinton’s hairline takes on the shape of the female hairline shown here. Female Hairline = Juvenile Male Hairline. Click photos to enlarge.

 

Weekend homework assignment: Check out the hairlines of your sibling, parents, spouse, neighbor, and meter maid. It’s worth looking at a variety of hairlines so that you can see what I’ve discussed above and determine the difference between a juvenile hairline and a mature hairline.

Tags: hairline, mature, juvenile, photos, hairloss, hair loss