My Hairline Was Transplanted Too Straight

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

Hi Dr Rasman – many thanks for the very appreciated blog.

2 years ago I underwent an aggressive hairline FUE procedure – 3,000 grafts all in the hairline with temple closure.

I’ve recently started shaving my head and, despite the white-dotted donor area, I feel much better about myself. I’d love to continue shaving my head – the problem is the recipient area. My recipient hairs, though not particularly dense, are much thicker than the natural hair behind them and begin with a very sudden, ‘flat’ line. The texture of the skin is bumpy and *may* form a small ridge at the start of the hairline; it’s difficult to tell whether it’s scarring, or just hair follicles pushing up the skin.

If I were to remove the grafts, is there any hope of restoring a natural-looking, albeit bald area where my current transplanted hairline is? If so, what sort of treatments would you suggest?

Thanks again for the site

Oh wow! 3000 grafts to the hairline and temples does sound very aggressive, if not impossible from my personal experience. The bumpy skin texture you describe can be scarring from your surgery and if it is scarring there really is no treatment for it. I am not implying you had a bad surgery, but hair transplant surgery is not reversible. Hair transplant surgery is permanent and you need to have a good foundation and understanding of what you are getting yourself into, as well as the long term complication and issues (such as scarring and shaving) before you regret the decision.

There are doctors who do 3000 grafts routinely in a small area of the frontal line and I have seen the work. The hairlines I have seen are straight and many times I doubt that the patient actually got the 3000 grafts they paid for, which makes me question the integrity of the doctor. These hairlines can be repaired by creating a good transition zone in front of the harsh tight hairline, but that assumes that the hairline was not placed too low in the first place. Often in some of these patients the hairline is too low, making a good repair very difficult. Each case is different and I would love to see you either in consultation or good digital photographs of your frontal hairline.

Tags: hairline, hair transplant, hair restoration, hairloss, hair loss

Receding Hairline Corners — Is It Just a Mature Hairline? (With Photos)

/by William Rassman, M.D./4 /,

Dear Mr. Rassman,

First of all, thank you for your very informative and helpful site.

I am 30 years old, and lately, I started worrying about my temples. I have a feeling that I have receding temples and want to take action if this is the case. Unfortunately, I do not have old photos taken from the right angle to compare. Could you please tell me what you think and what my Norwood class is, according to the attached photos? I do not have any balding or thinning on top.

By the way, you can use my photos on your blog if you please.

Kind regards.

Click the photos to enlarge:

 

First of all, thanks for allowing me to publish these.

What I believe you’re talking about are the corners of the hairline, not the temples. The temples are below the corners (above the ear), and those look fine in the photos you provided. People seem to get the temples and corners confused all the time when labeling them.

It appears that your hairline is now convex in shape and the central area does meet the side areas, suggesting that the maturing hairline is locking into place. If there is no miniaturization present, I would do nothing other than observe your hairline yearly. This is a Norwood Class I or II.

Tags: hairline, hair loss, hairloss, corners, mature hairline

Finasteride Frontal Study

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

Hello;

I read your blog from time to time and I remember you saying that propecia doesn’t really work in the frontal area. As someone who is hoping for regrowth in the front that’s a gloomy assessment. However there are a few studies that offer hope, here is one and if you google search “finasteride frontal study” you’ll find more.

Finasteride in the treatment of men with frontal male pattern hair loss — “RESULTS: There was a significant increase in hair count in the frontal scalp of finasteride-treated patients”

From what I am understanding, it doesn’t work in on the temples but it’s common to see results in the frontal area as well as the back. As someone who is on 1/4 Proscar every other day I can tell you I am seeing some regrowth nearing month 3 now and I am hopeful that by month 6 I will have achieved even more. Also, for what it’s worth…not a single side effect.

I know that finasteride does slow or stop frontal hair loss. With regard to regrowth, in many men who have visual frontal balding, the degree of growth in my experience has been less than enough to produce hair that can be combed. I have had hundreds of patients on finasteride, and although a very small subset of them have grown enough hair to see a difference in the hairline, most have not. The drug will work the same on any hair follicle that is undergoing genetic hair loss, but the frontal area is often ahead in its balding (more so than the crown), so maybe the failure to see substantial grown in the frontal area reflects where the balding is by region. All I can report is what I see in my patient population and although I have seen remarkable frontal hair growth in some, the percentage of patients who show it is very small.

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

Propecia Isn’t Stopping My Hairline from Going NW1 to NW2!

/by William Rassman, M.D./2 /,

Hi Doc,
I started propecia 5 months ago for a receding hairline. My hairline appears to still be a norwood 1, but it is closing in on the second one very quickly. I don’t think the propecia has helped at all. I don’t even think the recession is slowing down. Is there any way the propecia could help from here on in, even if it hasn’t even slowed down the hair loss in 5 months?

Propecia (finasteride) will not stop the appearance of a mature hairline, as that is what it sounds like you’re describing to me. You should send me photos and I will give you a more definitive answer. Mature hairlines are convex in shape, while juvenile hairlines are concave.

Tags: propecia, mature hairline, hairloss, hair loss, finasteride

Did Writer Dean Koontz Have a Hair Transplant?

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

Hello Dr. Rassman! I am a big fan of horror writer Dean Koonz. According to his biography, he had a hair transplant because he was “tired of looking like G. Gordon Liddy.” His “before” picture is here and his “after” picture is here

I don’t know, I’m having trouble believing that those results are from a hair transplant. I’m thinking hairpiece but I thought I’d get an expert’s opinion. I see his picture on the book jacket every day and I can’t help but wonder!

Dean KoontzBased on the photos you sent (which I’ve cropped and shown at right), author Dean Koontz’s hairstyle sure is shaped like a bad hairpiece… but that reflects personal taste and maybe it does the trick for him. I don’t know any details about his procedure so I couldn’t really guess as to what is actually going on there. Former Illinois state governor Rod Blagojevich has a similar look and I do not believe that he has a hairpiece.

In the years that I have been involved in hair treatment, I have seen everything imaginable with regard to what the consumer wants his look to be like. It is not unusual for balding men to have facial hair and when many of them get their hair back, the facial hair goes away. With regard to hair pieces, almost nothing shocks me anymore!

Tags: writer, author, dean koontz, hair transplant, hairpiece, hair loss, hairloss

Transplanting Conservative Hairlines

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

On the NHI patient photos site, patient DTA has had a significantly improved hairline from his previous norwood 3 hairline. I was under the impression (from reading this blog) that your clinic took a more conservative approach to hairlines than other clinics but from the results it appears the hairline was significantly improved.

Could you please inform me on what type of method was used (FUE, strip or both), how many sessions such a hairline took to complete and how many grafts?

Thanks

Before
Before		 After
After

This patient had 4 procedures totaling 7390 grafts, all using the strip technique. The lack of graft and procedure count was an error on the NHI site that has since been corrected. He started getting transplanted before the FUE technique was available. Many times the patient just wants more fullness, so the graft count goes up.

As for the conservative hairlines, we create hairlines for men that frame the face and look masculine, like the patient above. I don’t understand why some doctors will transplant a straight line of hair for a 40 year old man (for example), when that type of hairline is usually seen only in children and women. See also: If I Get Transplants, I Want a Perfectly Straight Hairline.

Tags: hairline, hairloss, hair loss, hair transplant, new hair institute, nhi

Latino Males and Low Hairlines?

/by William Rassman, M.D./2 /

Why do many latino males have very low hair lines?

I’ve noticed that many Latino’s maintain a juvenile hairline for most of their life. You’ve mentioned in the past that Native Americans are genuinely different from any other race because of their genetics, they do not bald whatsoever. Is it possible that many Latino’s do not bald because many have these native american genes as well. Many Latino’s are what is known as “mestizo”, which means they have both European and Native ancestry. Does that explain why they have good hairlines?

I’m not a geneticist, but I believe you could be on to something. There are many Latinos who have concave shaped, strong hairlines. Your theory sounds good to me.

Tags: latino, hispanic, hairline, hair loss, hairloss

Does Telogen Effluvium Act Like This…?

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

Thanks a lot for this site, good sir. I have a question related to TE and MPB. I have diffuse thinning on the top of my head. While I haven’t been to a miniturization check, I would say some (though hardly all) of the hairs that fall of my dome are thin. I went through a 2 month phase where I lost very thick and dark hairs, but this has stopped (I guess they’re gone?)… I am possibly a NW 2, but I’ve always had a high forehead. The hairline has receded, but there are still hairs at the base of what is basically the original hairline. Basically what I’m explaining is a very unclean hairloss at the top of the head…the hairline is more of an abstract idea than a line, if you follow me…it’s very irregular and uneven.

Does TE ever “act” in this way? Or am I just kidding myself and it’s MPB? Father with hair, mother with hair, mother’s father with hair, father’s father with hair…

Cheers

I don’t think I quite understand what you are describing. I would be happy to examine you and then I will understand what you are talking about. As you state you have not gotten a miniaturization check, which could point to genetic balding. Moreover, it may be something very early, as you categorize yourself as a Norwood Class 2.

From what you describe, it sounds like you’re losing your hairline due to genetic causes and have a few remaining hairs that haven’t fallen out in the same area. A telogen effluvium likely won’t be focused at the hairline.

Tags: telogen effluvium, hairloss, hair loss, hairline

How to Measure a Mature Hairline?

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

this may be a strange question, but when one talks about measuring how much a hairline has receded, and says that a normal (“Mature”) hairline recedes a half inch in the front, and an inch and a half at the corners, how do you measure that? vertically, as if straight down the face to a point parallel to where the hairline initially was??

thanks!

The measurement of the mature hairline is essentially done with a drop string (gravity), from the leading edge of the hairline and to the highest wrinkle of the furrowed brow. Here’s a list of past posts that may help:

Tags: mature hairline, hairline, hairloss, ahir loss, measurement

If Miniaturization Occurs at the Hairline, Is It MPB and Not Maturing?

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

dr rassman,
i include in this question a quote you made in a recent post which i would appreciate if you could clarify:

“As hair in the maturing hairline undergoes apoptosis (cell death, possibly because the number of hair cycles in the juvenile hairline may be limited and reached), it could just fall out without going through miniaturization.”

Does this mean that if there is minaturization at the hairline change then this is MPB and not the natural development of the mature hairline? or can there be minaturization without MPB at the hairline? I would much appreciate it if you could comment further on this as this relates to the difficulties i have had in getting a professional opinion on my own hairline- as to whether its MPB or just the development of the mature hairline.

regards

If you have a maturing hairline, I would not expect to see miniaturization from the highest wrinkle of the furrowed brow. The leading edge of a maturing hairline, as a rule, does not show miniaturization. From the few cases I can reference (nephew and two of my sons), they lost their juvenile hairlines without miniaturization appearing, so I draw my conclusion based upon those three cases in my family.

Tags: hairloss, hair loss, mature hairline, miniaturization

How Fast Can a Mature Hairline Develop?

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

Hi,

I would firstly like to thankyou for your blog, i have found it extremely helpful. Recently i have noticed elevated hair loss accompanying a receding hairline. I am 20 years of age and therefore a little startled. It currently does not surpass your definition of a ‘mature’ hairline and i am hoping it will arrest soon. However it seems to have occurred very rapidly. In what sort of time scale does the ‘mature’ hairline tend to develop? and does it stop at a similarly prompt fashion?

Thanks very much

The appearance of the mature hairline may occur over a year or two, or it may take up to 10 years to complete. The key for genetic hair loss is to look for miniaturization beyond the confines of the juvenile hairline.

Tags: hairloss, hair loss, hairline, mature hairline

Lowering a Woman’s Hairline by Using Hair Transplants (with Photos)

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

This woman was born with a high hairline, which appears more common in women than in men. These women see it in their early teens and they have few alternatives to surgery. There are two approaches to the surgery:

  1. A hair transplant, which is performed like a typical man’s hair transplant when his hairline rises either by a high maturing hairline or just genetic balding (which almost always starts in the front).
  2. A surgical hairline lowering procedure (like a reverse brow lift) commonly done by plastic surgeons. The advantage of the hairline lowering procedure is that the results are instantaneous and once the swelling has gone away, the hairline is located in its new position. On occasion, a scar forms at the leading edge requiring a limited hair transplant to hide it.

The patient shown below opted for the 1st method (transplant) and had 1432 grafts about 18 months ago. She is quite pleased with the results of a single transplant session (performed by Dr. Jae Pak). Sometimes when a person has very fine dark hair and white skin, a second session is required to obtain the desired results. Click the photos below to enlarge.

After hair transplant of 1432 grafts

 

Before

 

Tags: hair loss, hairloss, hair transplant, surgery, hairline lowering, female hair transplant

Why Isn’t the Maturing Hairline Mentioned in Biology Classes?

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

If the maturing hair line is so common, why isn’t it discussed in high school or college biology or health classes especially when the genetics and human male anatomy sections are taught?

I really don’t know the answer to that question. It should be taught, just like “how to manage a checking account” or “practical economics,” but there are tremendous holes in our education if it’s just textbook learning. We are still fighting practical sex education in our schools and paying with lots of teen pregnancy. With all of our educational problems, defining the maturing hairline seems like a bit of information that may be only valuable to those impacted by the change and it rarely occurs in high school.

Tags: mature hairline, biology, school, hairloss, hair loss

Misdiagnosing MPB Due to Unsymmetrical Hairline Maturing?

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

hi dr rassman
i just had a question regarding asymetrical hairlines. if as a young child 12 or so you had a natural non symmetrical hairline and as time went on and your hairline matured, would it be possible to misdiagnose the patient as having androgenetic alopecia due to the unsymmetrical patterns produced by this condition?

thank you for your time

Early balding should show signs of miniaturization if your hair loss is genetic. Either see a doctor or take charge of your diagnosis by mapping your scalp. The choice is yours.

People with asymmetrical hairlines will develop maturing hairlines that may even out the symmetry (or they may not). Balding occurs in those with the genetic propensity for it, whether the hairline is symmetrical or asymmetrical.

As hair in the maturing hairline undergoes apoptosis (cell death, possibly because the number of hair cycles in the juvenile hairline may be limited and reached), it could just fall out without going through miniaturization. It could be an incremental fall-out, starting close to the leading edge of the hairline and then working its way back. I don’t get the opportunity to study the young man who matures his hairline and then keeps everything else without signs of balding, other than in my nephew as I watched his maturing hairline appear without miniaturization. One case study does not tell us the answers, so I look at these comments as academic.

Tags: hairline, miniaturization, hairloss, hair loss

Why Would Finasteride Discriminate Against Prohibiting DHT in the Hairline?

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

Dr. Rassman,

Why do some say that Finasteride does not work in the frontal area/hairline? If the drug simply prohibits DHT conversion, why would it discriminate against frontal hairs?

I believe your stance on the issue is that Finasteride does halt hair loss in the frontal area in some cases, but I’d like some clarification on the issue, as I’m sure most of the younger users of Finasteride are mostly concerned with halting early temple/hairline recession. Thank you.

No one knows. This is an observation that we have seen clinically. Its just the way things are! It may point to the fact that DHT is not the only culprit in male pattern baldness. Generally, frontal hair loss in men occurs faster than crown hair loss, so it might be that DHT blocking works earlier in the miniaturization process and many times when the patient gets to the doctor, the frontal balding is further into its progressive path. It also points out that blocking DHT may not be a cure for hair loss. There is no cure for hair loss yet.

Tags: dht, mpb, hairloss, hair loss, finasteride, hairline, propecia