Female Hairline Restoration After Brow Lift (with Photos)

/by William Rassman, M.D./8 /, ,

I have had a higher hairline since I was a teenager. I always hated it. When I had a face and brow lift at the age of 49, the high hairline became even higher. Is there a simple way of lowering it? Is transplanting the only solution?

The photos below are of a 45 year old woman who, like you, had a high hairline compounded by a brow lift as well.

These first 3 photos are surgical pictures because they show what was missing, the deformities that were there and the problem that was tackled before (the middle and right photos were from immediately after surgery):




This next set of photos were taken after this lady’s 2nd procedure had grown in. The black hair and light skin are the most challenging contrast for hair transplant surgeons, explaining why it took two procedures to get the results you see here. She had a total of 3,508 grafts (in two procedures). Note that the side hair and temples were brought forward. In normal female hairlines the temple prominences often extend closer to the eyes than in men, narrowing the amount of forehead shown. Women’s hairlines, because they are rounded, not recessed, and the temples are important for accentuating femininity, make the work more difficult from an artistic vantage point.




The high hairline bothered her greatly after the brow lift and became unacceptable. The brow lift produced a wide scar behind the hairline (compounding the problem). In this situation, a hair transplant is the correct decision because lowering the hairline and filling in the scar behind the hairline can be accomplished with a single procedure in a person with blonde or white hair, and two procedures with someone with dark hair and light skin. The hairline was lowered by 3/4 inch and filling in the brow lift scar was also accomplished in the same procedure. A brow lift usually takes away the possibility of a hairline lowering procedure.

Does a Hair Transplant Increase the Forehead?

/by William Rassman, M.D./0 /

Your site is very helpful and is a great service to the community. I applaud your selflessness. I was motivated to check your site because I saw the Procede ads – thanks for setting us straight on that one.

I am curious, however, about Regenix and wonder if anything new in the way of clinical evidence has come your way to suggest how it works vs. something like Rogaine?

Also, is it true that hair transplant surgery, by borrowing from the back of the scalp, also serves to increase the forehead space? If so, is it advisable to have the transplants along the frontal hairline to lower the hairline and reduce this space?

Thanks for your help.

I have no information on Regenix in the way of clinical evidence (Tier 1 evidence) at the level of proven FDA approved treatments such as Minoxidil (Rogaine) or Finasteride (Propecia), nor are there any head-to-head trials comparing these sorts of treatments (who would pay for possibly proving someone else has a better treatment?). If someone tells me a certain treatment works for them, GREAT! Keep using it. However, I will not recommend treatments for which I do not have rigorous and incontrovertible scientific evidence.

As for the oft-asked question about a forehead lift from removing skin from the back of the head, I am happy to tell you that your forehead does not move, but your butt raises up two inches… I’m just kidding, you actually don’t have any change except for a little less excess skin at the back of your head because of the way the skin is attached to the skull it is loose. We have redundant tissue at the back of your head because your neck is actually a joint, like your elbow or your knee, so you need a little extra skin to allow for flexion. Thankfully for the hair surgeons, nature has provided a bit more skin there than is necessary, which is why we can take some out and not affect anything around it. Sorry for those of you who wanted a combination facelift/hair surgery!

Transplant Hair From My Back

/by William Rassman, M.D./0 /,

My question is about donor sites. I have a rather extensive amount of back hair and, if possible and practical, I would like to transplant said hair (in conjunction with hair from other, more typical, donor sites) as part of a transplant to correct my scalp baldness. While I still have hair on the sides and the back of my scalp, I do have a lot of baldness all across the top of my scalp, which I assume will require lots of grafts. Can back hair be considered donor hair?

Body hair is not a productive source for hair as traditional sources from the sides and back of your head. Unless you have significantly depleted the donor hair from the traditional source, I would not recommend hair from the body (an experimental procedure of questionable value). I have performed hair transplants on the baldest of men with great results. They have gotten hair from back and sides in each case. For example, see Class 7 Patient ZU from the NHI site.

Hair Transplant After Alopecia?

/by William Rassman, M.D./0 /, ,

I have several bald spots at the back of my head.I went to see an MD and a blood test was done all are normal and MD said that i am having alopecia. What is the approximate price of hair transplantation? i am only 26 years old / female and i don’t want to be bald this early in life. please respond. thanks

There are many types of alopecia. If you have one of the autoimmune causes of hair loss (that is what it sounds like), then hair transplantation does not work until the disease has burned out (generally you must wait for at least a couple of years and be certain that the autoimmune process has ended often requiring a biopsy). I need more information on the type of alopecia you have. See the Female Hair Loss category for the answers to your concerns that may have already been written.

The Value of Hair Transplant Experience

/by William Rassman, M.D./0 /, ,

Is hair transplantation an art form? Does one doctor really get better results than another? If it is only technicians putting grafts into holes in a head, how is it worth the money that you doctors charge?

Hair transplantation is a discipline that includes a sense of artistic balance, a sense of meticulous organizational skills, good judgments, and lots of experience. I know this because I see too many hair transplants that reflect failures of these elements. For example:

  1. Artistry: I can tell that a person had a hair transplant just by the location of the hairline. There is a range of normal locations, yet many doctors tend to place the hairline too high, in order to conserve hair, when the location is clearly not ‘right’. The eye catches something is not normal, and even when, on close inspection, the grafts meet the follicular unit golden standard for today, you know that something is wrong.
  2. Teamwork: Poor growth may reflect poor organizational skills and less than experienced staff. Many doctors use itinerant staff, brought in and paid by the hour. They were trained in different offices with different standards and learned habits and techniques that may not conform with the same standards as other team members. Many of the technicians who were terminated from NHI, now work as itinerant technicians who move from office to office. They bring with them the same bad habits that caused them to lose their job with me. Unless a doctor’s team has been working with that doctor for years and are self disciplined with a common focus using strict quality control processes, the team’s work will often reflect the weakest person working on the case. It is critical to recognize that today’s modern hair transplant standards are a team effort, not the output of a single individual, doctor or nurse.
  3. Judgment: The problem with balding people is that hair loss is a moving target, progressive over time. For the hair transplant surgeon it is also a matter of balancing supply of donor hair and the ‘moving’ demand of balding. A surgeon must work in the present time using what hair is reasonable to move today, while preserving hair for future hair loss so that the patients always looks normal. I have seen people who have had grafts placed in a 2 inch bald spot in the crown, which then advances to a 5 inch bald spot in the crown. They had an island of hair like an oasis in a bald desert. The same is true for frontal balding in the young man who has corner recession and gets them transplanted only to find that the corner recession advanced to full frontal balding. He comes to my office with ‘wings’ protruding out at the corners and a bald area around it. Both of these men looked freakish, so that any short term benefit they received was offset as their balding progressed. The unfortunate fact is that too many young men do not recognize that their bodies (and balding patterns) will change over time.
  4. Experience: I can not say that experience is king here, but I can say that experience means that mistakes should be minimized and #1, 2 and 3 above, have been incorporated into the routine of the transplant surgeon. I am fortunate to have become the doctor’s doctor in the Beverly Hills plastic surgeon community. These surgeons have had their transplants done by me or they have sent their patients to me and have seen the results we get. I have focused much of my professional career to publish the lessons I have learned over the years in the most prestigious medical journals and text books. Often I have had patients come to me saying that Dr. X told them that he invented ‘blah, blah and blah.’ I always tell the patient to have the doctor prove that they are the inventor and most of the time what they can’t get the information they are asking for. Falsely claiming authority or inventor status should not be taken lightly, as it is a measure of the fabric of the surgeon. Look up his/her credentials and experience and only believe what you can verify.

I can go on an on here, but to see what I am talking about, visit my website. There are over 200 patients with before and after photographs on the site and copies of much of what I have written and published is in the medical literature. Yes, hair transplantation is expensive, but would you want people to immediately say, “Nice hair transplant”? No one should even know.

Can I Have Thicker Hair After Transplant?

/by William Rassman, M.D./0 /

I am a young teenager who is not balding (yet.) I am worried about hairloss, because every male in my family is totally bald, except on the sides and back. I probably will have it by the time I turn 25 or 30(never asked anyone in my family when they started to lose hair, but I know my uncle started to lose hair at about 27 or 28.) But I have a question about my hair now. My hair has always had these various areas where there is really thin hair. They are like lines, not spots and seem very thin. I really don’t want to take pills or other applications to keep the hair I have, but am considering hair transplants when I do start to experience male pattern balding. If I do get hair transplants will there be an option to make my hair thicker? If not, will taking propecia after a hair transplant session make it thicker, or at least make the thin areas seem thicker? Please respond. Thank you for your time.

People use the word “thickness” to describe various contributors to ‘fullness’ that reflect very different aspects of hair; (a) the diameter of the hair shaft (i.e. the mass of the hair), (b) the density of the hair per square centimeter of scalp, (c) the character or wavy nature of the hair, (d) the color and contrast between hair and skin color (the lower the better). Propecia can improve the diameter of the hair shaft in a balding area, stop its eventual loss, or possibly make it regrow making the area thicker. Transplants can add donor hair (from the back) in between native hair (at the top or wherever the thinning area is) to increase the density of the hair in a particular area, also making it thicker. It is a little more complicated then this explanation, but not much. Doing both together (Propecia and Transplants), as you might imagine, will have an additive effect – that is, it will look even better. But doing both may not always be the right thing, if the anticipation of the results of Propecia alone may achieve the results without a hair transplsnt. Then you get the benefits without a surgery. That means that when you get evaluated by a doctor who can transplant your hair, you want a doctor with high integrity, one who will not recommend surgery if there is a reasonable possibility that Propecia alone will do the job.

As an aside, every male (and even some females) in my family also has some degree of hair loss, so I know where you are coming from. First and foremost, please get an assessment of miniaturization in order to detect when and if the genetic process started. A yearly check with a good doctor should show that to you. If and when you start balding, you may want to reconsider your decision not “to take pills or other applications to keep the hair I have.” Recent studies indicate that patients get the most improvement and are happiest when they keep the hair that they have, in addition to replacing what they have lost. As a surgeon I can tell you that nature does it a lot better than any doctor can – keeping what you’ve got is truly the best course of action overall.

Transplanting the Crown

/by William Rassman, M.D./0 /,

Greetings,
After seeing Steve Hartman of CBS/AM570 in person I am amazed at the process of his hair restoration. My situation is the typical male pattern baldness on the top and back of my head, not the front. How do you handle that?

Steve Hartman’s hair transplant procedure is what I like to refer to as the fast-track approach. With his situation, one surgery did the job he needed and if he stays on Propecia, hopefully he has seen the end of any more than this one surgery. For transplanting the crown, I have general reservations in the very young men (under 30) unless there is very good donor hair density and good laxity (looseness) of the scalp in the back of the head. Other elements of the supply/demand formulae must also be accounted for and those men with good quality hair and skin color tend to do better than those without either when the hair must be distribued to cover a wide balding crown. I am always worried that the crown will take all of the donor hair and when the front balds, then the patient may run out of donor hair. There are many times, however, that crown transplants are appropriate. In those men over 35 (for example) with a 3 Vertex balding pattern (frontal corners and crown only balding) or those with pure crown (vertex) balding in people like me. I had 1600 grafts into the crown and my frontal hairline is normal without any balding. I use Propecia to maintain any further hair loss and I have been stable for years since my transplants were done in the late 1990s.

Propecia is the mainstay for hair restoration in the top and crown (particularly for the younger men whose final pattern is not predictable), so you should first get assessed for miniaturization and then go on that drug if appropriate. Transplants rarely will be needed if you catch the top and crown loss early enough.

Transplanting to Thinning Areas

/by William Rassman, M.D./0 /

I am 21 and had wavy hair that is receding and thinning on top and in back. I worry that if I get this transplant procedure done to early that it will not look right. I am not bald but yet but the recede bothers me. How do you cope with filling in thin areas where hair is still falling out around it.

First, you need a diagnosis with a good mapping of your scalp for miniaturization to find out for sure that you have genetic hair loss. You are correct that surgery is not the first stop along the path to deal with your hair loss, but probably the last. There are effective medications. Please get a diagnosis first, then a master plan on what to do next.

Another Procedure to Thicken the Hairline

/by William Rassman, M.D./1 /, ,

Hi. I have a few questions for you that I hope you can help with.

First off, I have had multiple transplants so I would ask you not to insult me by sending me advertisement-type answers. I found you by Google searching so I don’t know much about you.

As I stated I have had multiple transplants. Dr. X and then Dr. Y were the two physicians I met with. Dr. Y’s scars from the donor area are rather large, Dr. X’s less so. But I did have a problem with one large graft falling out that essentially left a small ‘holish’ scar on my bald spot in the back of my head. Something I am not happy about but it is not that bad.

My hair is thin. It always has been. I am 39 years old now. I do not think I have much hair left to give from my donor areas without the back of my head starting to look bald too. I am right at the brink of what is acceptable re-distribution of the hair from the back of my head to the front of it.

It seems like you are strictly a hair transplant outfit but I thought I would ask for your opinion anyway. I do not think of myself with a full head of hair, I just want enough up front and even on the bald spot to have a stronger looking hairline overall. What would you recommend? Thank you for your time.

To address your question, you need to be evaluated directly. As you are local to Los Angeles, I ask you to please visit our open house on January 12 to meet some of the repair patients we have done. We have an open house event every month in our office if you can’t make this one. Read our repair articles published in respected medical journals, and get a private consultation to walk away educated with your options clearly defined. I will not insult you with propaganda and if you look at our website you will see that we are quite professional in the way we manage the medical hair restoration practice.

For more information about repairs, please read these articles:

Transplanting a Norwood Class 2

/by William Rassman, M.D./0 /,

Dr. Rassman,
I am 21 years old and I have been losing my hair since I was 16. I am now a solid norwood II and I am getting to the point where my hairloss is a cosmetic issue. I started using propecia, but I experienced the side effect of gynocomastia which fortunately subsided when I stopped using the product. Unable to use propecia, I feel a hair system or a transplant are my only options. Am I a candidate for a transplant considering that my hairloss will have to be chased across my head with multiple and frequent transplants? Thanks for your site. It offers a much needed service.

There is a need to establish a good solid relationship with a good doctor for someone like you. Having tried Propecia and developed a side effect, clearly you are doing the right things. A good baseline for miniaturization needs to be mapped on your head. Both you and your doctor must be able to command just what is happening to you and project what might happen and when. With that relationship in hand, you will be in a better position to analyze your situation. I personally think that if you start off with a hair piece, you will absolutely accelerate the hair loss process. Again, get a good doctor and work with him/her before undergoing something as radical as a hair transplant at your age. With that said, anything is possible if it is well planned out with a good Master Plan for your future in hand.

Burns to the Scalp

/by William Rassman, M.D./0 /,

I have researched your website and I am curious as to whether or not any of these procedures would work for me. I suffered from 3rd degree burns resulting from being trapped in a burning car after a MVA. My scalp was burned past the follicle in a large area ( mainly the top). I have been undergoing burn treatment for the past few years. My surgeon and have been using tissue expanders to restore my hair. I am concerned that this is a long process and involoves a few surgeries every 6-9 months. So I am looking for options and short-cuts. Any suggestions?

What you said sounds like your doctors know what they are doing and have developed a good, sound strategy. If you would like a second opinion, it would be very difficult to do it over a long distance. Sending photographs of good quality would help and I would be willing to take a look and verify the plan, but it sounds like you are in good hands. Why are you writing to me now? How far have you gone with your present medical team? Are they responsive to your questions and do you have confidence in them? These are basic questions that may speak to your overall comfort and the communications you have with your medical team. When you have the confidence in the team, then you should stay with the winning team. There are no shortcuts to problems of your type. Be sure that when transplants are the refining step, that your transplant surgeon knows how to manage a case like yours, as the transplant surgeon will frequently have different skills than the team of plastic surgeons who are managing your ’tissue expanders’.

Considering Future Hair Loss

/by William Rassman, M.D./0 /

i am 56/m, bald at the crown. with general thinning on the top and front. because my hair is still falling out i would expect to be compleatly bald in the norwood 6 area in 1 to 2 years. my hair is very fine. can i get a transplant that will also take into consideration my future hair loss, or will i have to repeat the process as my natural hair reduces to zero. if this is a stupid question please forgive my ignorance.

p.s. can you recommend a surgeon in the u.k. who is of your standard both ethically and medically. also i am a blue coller worker, so i would need a to get a loan, can you give me a estimate of a average price for a norward 6 transplant.

p.p.s. GREAT SITE.

At 56, it would be unlikely that you will complete your expected Class 6 pattern, because at your age, the hair loss is often very slow (almost to a stop) in most men. If you want to fill in the frontal and top areas, that would be the best place to start. The crown often takes a great deal of hair to fill in. With regard to a hair transplant surgeon in the UK, consider the physician search at ISHRS.org for a place to look and be sure to read The Truth About Cheap Hair Transplants as a buyer’s guide to selecting a doctor. Both the NHI site and my book also cover different aspects of the buyer’s challenge. Loans vary with the doctor, where some have arranged credit sources. Many of our patients put the hair transplant on a credit card.

What is Sufficient Donor Hair?

/by William Rassman, M.D./0 /

what do you mean by “sufficient donor hair” …any link where there is a pic differentating between “sufficient donor hair” and “insufficient donor hair”?

Hair transplantation requires that the supply of hair is more than adeqaute to meet the demand for hair. The smaller the balding area, the less will be the requirement for donor hair. There is also a ‘must’ where the donor hair must be in adequate quantities (density) and adequate quality (healthy). Low densities or poor quality of donor hair (the presence of Diffuse Unpatterned Alopecia, for example) means that the donor supply is insufficient to support a hair transplant.

Father and Son Hair Transplants (with Photos)

/by William Rassman, M.D./0 /,

The photos below are of a father and son duo that I treated. The father had advanced balding with fine hair, while the son had early balding. The father got a nice result, but because he lost about 50,000 hairs over his lifetime and got back about 10,000 hairs from me, he could never have the same head of hair like his son. The son started on Propecia and with his average weight hair, he has had wonderful results. Hopefully, with Propecia continuing for years to come, he will hold on to the hair that his father lost in the pictures shown below. Click the photos below to enlarge.

The son’s before photos are here (the first photo was taken immediately after surgery):



The son’s after photos, which were taken after one procedure of 1,295 grafts, are here:



With the son’s use of Propecia, I believe that he will not follow in has father’s foot steps with regard to his hair. Since the son is in the family business, now the new leadership will be hairier than the old one.

The father’s before photos are here:



The father’s after photos, which were taken after two procedures totalling 4,879 grafts, are here:



Since male balding is genetic, it is not unusual that I work on family members, in fact many of our patients are from these extended families. Once I had the privilege of performing hair transplants on three generations of individuals in the same family. Usually, one member starts it off and when they are satisfied, other family members follow. I have done 17 members from one overseas family who flew here every few months after the patriarch was satisfied with his results. Usually, the father has it done first, then the son, followed by the uncles and grandfathers. However, I remember one particular movie producer who sent his son in for a hair transplant ‘test’ and he watched the change occur over the next year. When he saw how great his son’s finial results were, he felt it was safe for him to have the transplant so he came to surgery with the confidence he apparantly needed. We do offer family pricing when they come together, extending the hairy appearance into the balding clans, a few patients at a time and hair by hair.

Hair Miniaturized on One Side — Should I Get a Transplant?

/by William Rassman, M.D./0 /,

First of all, thank you for the time you put into answering questions and posting them on your blog. I have found it a truly unique resource in the often troubling search for useful information on MPB and Hair Transplants. I am 27 years old and have been very slowly losing my hair since I was 20. All the loss has been in the form of a receding hairline and I am now probabaly only a norwood class 2 – 2.5. I have kept most of my hair most likely due to my use of propecia off and on for the past 5 years (2 years on and then 1 year off (like an idiot) and now 2 years back on). The outline of my hairline is now a normal mature hairline but it has slowly gotten thinner and thinner especially on one side while the other side has stayed relatively full. My question is two parts: Is it common to see significantly more miniaturization on one side of the hairline? Are there down sides to doing a hair transplant among those thin hairs to add density? Some might call me crazy for even considering such an option but the hair has gotten very thin and I would like to enjoy a full head of hair and not have to worry about covering up a balding area. I dont mind where my hairline stands but would really like to fill in the thinning area if there are not significant negative repercussions. My two biggest concerns are shock loss and what my hair might look like years down the road (will I have a small patch of transplanted hairs while everything else has thinned out or fallen out?). Thanks again for your time and this blog in general.

I am glad that you find my blog helpful. Thank you for your kind words.

It is not unusual for a person to show more hair loss on one side than the other. The reality is that the other side will catch up to the worse side eventually.

Transplantation may be an option, assuming that your hair loss extends beyond the class 2 pattern. If the miniaturization goes well into the existing hair, then a transplant AFTER you are on a course of Propecia, may be a reasonable option. Shock loss is rare if you are taking Propecia. Good planning with a good doctor will assure your best outcome concerning your final appearance and should prevent you from having islands of hair. This requires a master plan for your short and long term hair loss, because hair loss is a progressive process. Since you are in Los Angeles, you should call my office at 800-NEW-HAIR or visit the Request Additional Info page to setup a free consultation in our LA office, or better yet, come to one of our Open House events where you can see a patient surgery, meet many patients who had the transplants done by me and meet other patients who had surgery done by others so you can compare apples to apples.