The Drawn Hairline Is Different From What Was Transplanted a Week Ago!

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

Hello. I recently got a hair transplant in Canada. I am a resident of the United States. I didn’t have severe loss, but my hairline has always bothered me. It was very unsymmetrical and missing temple points on an otherwise full head of hair. I had a procedure last week and the swelling has just subsided the last couple of days. Well, what the doctor drew in for my hairline is very different than what is now on my head. My temple points are extremely unsymmetrical now, more than before. When looking at me directly, one temple point can be seen and looks great, but the other one is further back the side of my face and can’t be seen from front view. One is lower than the other… The way it is now, is not what was drawn on my head prior to the surgery. The doctor took a picture of me before the transplant, but did not take a picture of me after the hairline was drawn or after the procedure.

My question is, how do I approach this situation.. Is it the doctors responsibility to fix this for me or am I bound to this agreement even though it was not what was discussed and agreed on prior to surgery? I have seen tons of pics on forums of people who have had temple work done, even from this doctor, and none of them look as unsymmetrical as mine. Should I have this fixed asap or wait till my results grow in and go have it fixed then… I mean, it is ridiculous how much I have paid and it was a fairly easy procedure from what I understand.

The good news is that you had a photograph taken before the surgery, hopefully outlining the hairline that was proposed. If the transplant was done in the last 5 days, it would be unlikely that you could undo the problem work. The best thing is to communicate with the doctor and address your concerns.

You trusted the doctor to perform your surgery after all. It is all about communication and having a trusting relationship. My answer may sound generic, but it is really as simple as that. Your doctor should be very concerned if the work is unbalanced. You can always get a second opinion. Keep taking good photos of your hairline and growth.

Tags: hairline, hair transplant, hairtransplant, doctor, physician, hairloss, hair loss

Does Normal Hairline Miniaturization Apply Only to the Center?

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

Hi you said that it is normal to have miniaturization where the hairline starts so my question is:does this only apply at the center of the hairline or it applies to all of the hairline including the temples?

Finer hairs in your hairline (front, corners, side, temples) are common, as it gives a fine, transitional appearance. This is not miniaturization… just fine hair. It is also mixed with fine vellus hairs.

Miniaturization should not extend far back (1 inch, for example), as that would indicate a receding or balding pattern, assuming that this 1 inch is not the movement towards a mature hairline.

Tags: hairloss, hair loss, vellus, fine hair, miniaturization

Triangle of Hair Missing in Middle of the Hairline

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

hi,what is it called when the hairline is kind of an inverse widow’s peak – when there’s a little spot (maybe triangle-ish) of hair missing right at the top?

i’ve been googling to no avail and it is rather worrying me as i am only 16 years of age ,male. i have very thin hair aswell but only because i have straightened it for the past 2 years so i am not sure as if that has somthing to do with it

Assuming that you have not damaged the hair from straightening it, some people have irregularities in the frontal hairline that is normal and genetic. These irregularities can be fixed with a transplant into them to reshape the hairline. At 16 years old, I am not sure that you are a candidate, but you should be examined by an expert if this is something that you want to do.

Tags: hairline, hair transplant, hairtransplant, hairloss, hair loss, teen

Propecia Effectiveness Statistics?

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

Hi Dr.,
I’m a 19 year old with a head full of thick hair. However, I have a slight recession that is following the pattern of my grandfathers. His hair receded into his early thirties and then stopped suddenly. I believe this is called a mature hairline, but it didn’t look like a mature hairline, it looked much worse. I really would prefer my hair not get like that. I think a hair transplant would be unwise this early, and getting one after the recession is finalized would kind of defeat the purpose of having one. Do you have any statistics on the effectiveness of Propecia, and would you recommend me taking this.

MerckIf it is a mature hairline, there isn’t much you can do. Medications may help, but I can’t say to what degree (each person is different and will react different to these drugs). At 19 years old and with very little (if any) male pattern baldness, you are definitely not a candidate for hair transplantation and any doctor that would do any surgery like that on you is taking you for a ride.

For Propecia stats, I’d say one of the the best places would be this page at the official site — Propecia.com – See the Proof — which is setup by the manufacturer, Merck. Although you may think that would be a terrible place for unbiased info, I should point out that Merck is heavily scrutinized by the FDA to make sure any claims, statistics, or other information provided is accurate.

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

Transplanting a Norwood Class 2 to a Class 1?

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

Thank you for all of your informative hard work! I am currently a Norwood 2 & may be progessing to a Norwood 3. I was curious to see if you could post any pictures of patients who’ve went (w/ the help of FUT or FUE) from a Norwood 3 to a Norwood 2 & some pics of those who’ve went from a Norwood 2 to a Norwood 1. Thanks in advance!

Norwood Class 2
Norwood Class 2
 
 
Norwood Class 1
Norwood Class 1

Most people who are young and have frontal recession are experiencing the maturing hairline and are not balding. I do not transplant the frontal hairline in these patients unless there is a reason that it has to be done. I remember an actor who had a lead role in a daytime soap opera TV series. As his hairline was maturing, he got indications that they were going to phase him out of the show because they wanted a person with a juvenile hairline, as the daytime women that watched the show apparently had fantasies about very young men (I’m not kidding). In that case, I did move him back to somewhere between a Norwood Class 1 and 2 and his million dollar a year income kept him secure.

I do transplant women routinely who have lost frontal hair and want their hairline back. Typically, a woman is a Norwood Class 1 and so to answer your question, I’d like to point you to a woman’s hairline reconstruction, which is now a Norwood Class 1. See Female Hairline Restoration After Brow Lift. There is essentially no difference in the process. Creating a female or Norwood Class 1 hairline is not an easy chore. The surgeon must be very experienced when creating it due to the direction of the hair in the corners. Look carefully at your wife, girlfriend, mother, or sister’s hairline and note the direction of the hair in the corners — it flows from the center of the hairline to the temple prominences. That growing process along with the transition from one part of the frontal hairline to another must be done right, or it will look awkward and artificial. If you are an actor or top line male model, I might consider bringing you back to a Norwood Class 1. In other words, I’ll do it, but it’s rare and we must have a meeting of the minds when embarking on this process.

Tags: actor, celebrity, hairloss, hair loss, hair transplant, hairtransplant, norwood, hairline

Mature Hairline Measurements

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

I have been reading about the mature hairline in this blog and you seem to state different measurements in each blog. The temples suppose to be up to 1.5inches receded but the frontal hairline is anywhere from 1-3cm on this blog. Isn’t 3cm too much? The reason I ask it seems that where my hairline is heading although it’s only 1cm up but I can see it’s thinning out to that length.

I agree that 3cm elevation for the mature hairline from the highest crease of the furrowed brow is high for the mid-line. I use my finger and generally see about one width of my index finger… and I don’t have fat hands. My index finger is 2/3rd of an inch wide.

There is no hard rule on measuring the mature hairline and each person is different, so this is a loose measurement.

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

Measuring the Mature Hairline

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

I know you explained how to measure the mature hairline with the wrinkled brow but you didn’t say how exactly. Do I need to put a ruler in the middle of my forehead and measure that way (this way it shows my corners are 2 inches receded) or can I put in highest corner of my temple and measure downwards if I do it that way I get 1 1/2 inches but my hairline is only 0.4inches away which is good. I believe I’m on a NW2.

Also around my temples I have a chunk of short hairs but there thickness is pretty much the same like other hairs. My hair is kinda longish you know. But what worries me that they will fall off and then my corners will be quite big. Is this all normal?

I’m almost 22 years old and my temples started to recede slowly since late 17s but in the past year just jumped up fast.

A maturing hairline is a generalization of how a young male will have a slight recession of his hairline in his teenage years or early 20’s. If you follow this “rule” (it is actually my rule) then there are three elements of it. A mature male hairline exists when:

  1. the middle of the hairline is about 1/2-2/3 inches above the highest crease of the furrowed brow
  2. the shape of the hairline is convex
  3. the sides of the hairline will rise about 1.5 – 2 times higher than the middle of the mature hairline

If you continue to recede beyond this area then there may be a genetic component of androgenic alopecia. This presence of genetic causation can be seen by mapping out the hair for miniaturization and looking for miniaturized hair substantially behind the leading edge of the mature hairline. And not to confuse anyone, but even though I call it a “rule”, there really is no specific rule to this. You cannot go by an exact set of measurements, such as 0.4 inches. If you are worried about this matter, I would see a doctor for a good microscopic examination (miniaturization study) of your hair to determine if there is a pattern developing.

Tags: mature hairline, maturing hairline, hairline, hair line, measurement, hairloss, hair loss

Does Dr Rassman Have MPB?

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

Dr. Rassman

If you were to judge from your own picture (the one shown on the website), would you say you have genetic hairloss? If so, to what degree?

I had a bald crown measuring about 3 inches round. This is classified as a pure vertex balding pattern. I originally made a mistake and had scalp reductions in the early 90s, which left me scarred. Since that time, I have had hair transplants and the scars and balding spot is largely gone. My hairline is natural.

Tags: rassman, hairloss, hair loss, hairline, crown, scalp reduction

Why Are Some Miniaturized Hairs Normal?

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

Why do people without baldness also have miniaturized hairs at the beginning of the hairline?

The hair that is present in the very front of the hairline either are vellus hairs or those that are naturally thinner than the hair behind and throughout the scalp.

Tags: miniaturized, vellus, hairline

Some Miniaturized Hairs Are Normal in the Hairline?

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

Hi,
i just have a question. I am almost 21, my hair looks good, but the thing that worries me is that I have a widows peak and in the widows peak I noticed that there are like some vellus hairs that are almost invisible between the terminal hairs. The rest of my hair is thick and healthy but the thing that worries me is that they can be miniaturized hairs. I also notices some very fine hairs that dont grow more than 0.5 cm in the very front of the hairline. Is this normal? You said that it is normal some miniaturization at the beginning of the hairline.

Yes, there are vellus hairs in the frontal hairline and that is normal. This is not necessarily miniaturization or balding, but if the miniaturization continues well beyond the front hairline (say 1/2 to 2/3rds inch back) there is reason to take notice. Keep having your hair mapped out for miniaturization at least once a year to see if there is the beginnings of genetic hair loss.

Tags: hairloss, hair loss, hairline, vellus, miniaturization

My Family Tree Shows No Signs of Hair Loss Anywhere, But My Hairline Changed At 20 Years Old

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

Hey doctor, thanks for keeping this blog.

I was just curious about genetics and hair loss… I’ve read multiple blog posts, but still confused.

About seven months ago I realized that my hairline had changed some. Since then, it hasn’t changed at all. Looking at a picture when I just turned 18 (I’m a 20 y/o male), my hairline looks similar in the front but not quite as high on the sides (I also have a naturally large forehead). However, as I said, for at least seven months my hairline has not changed at all.

My question for you is this: My father, mother, grandparents, great grandparents, uncles, cousins… all have full heads of hair. I’ve even asked my parents about their great grandparents, their cousins and uncles and aunts, and they all had full heads of hair as well. So, basically, in my entire family tree–both vertically across 4+ generations and laterally along each generation–there was no hair loss. I still have very thick hair on both the hairline and all around the scalp…people just tell me that I’m paranoid. Can I safely presume that my hairline is just maturing with my large forehead, and that I am not genetically predisposed? (Many in my mother’s family have large foreheads).

Thanks for your continued assistance.

I haven’t seen what you’re talking about, so I couldn’t tell you whether anything is safe to assume about your hair loss (or lack thereof). As you are in Beverly Hills, you could come by my office (no charge) and let me determine if you are really balding or just developing a mature male hairline. I will also perform a miniaturization mapping of your scalp hair to determine any possibility of early balding behind that frontal hairline.

Even if you were across the country… or across the planet, I would still suggest that you get such an opinion. If not from me, then from any competent doctor that is willing to examine your scalp.

Tags: hairloss, hair loss, family, genetic, hairline

My Doctor Doesn’t Do Miniaturization Mapping, But I Found a Non-Doctor That Does!

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

Hey Dr. Rassman, I am a male in his early twenties who has some questions about hair loss. My hairline has been receding for the last two years. I have seen a few specialists regarding my hairs future. One doctor is a very prominent hair doctor in the New England area. After seeing him he concluded that I had MPB, and put me on propecia and expensive luce laser treatments. After being skeptical for a little while and reading your blogs I saw that you stressed the importance of getting your hair mapped for miniaturization. This doctor does not have do miniaturization mapping and I became a little awry about that. Therefore I searched and found a hair specialist with the appropriate equipment to map my hair, he was not a doctor though. He looked at it and there wasn’t any signs of any miniaturized hairs. He told me I should stop the propecia and see what happens. Well I stopped and my hairline has slowly continued to recede, but its beginning to look like my fathers who has a full head of hair. Also, I saw the doctor again and he continues to tell me that I am losing my hair and didn’t think it was a good idea to stop the pills. I desperately need your advice because I have two different people telling me whats going on with my hair and I don’t know whose advice to take. It’s driving me crazy because I want to believe the doctor, but he totally disregarded the mapping of my hair when I brought it up. Your expert advice would be greatly appreciated. Thanks.

Reading a miniaturization mapping is not rocket science. I have some patients who purchased magnifying systems to determine if they had miniaturization and did not depend upon any doctor. If you really do not have miniaturization (and realizing that I am not your doctor) I would not take Propecia. Are you just developing a mature male hairline (see Maturation of a Hairline — Moving From Juvenile to Mature)?

I would personally not be a fan of any doctor who is critical of the information obtained from a good miniaturization study, and especially a doctor that would put you on hair loss treatment medication when you’re just developing a mature hairline (assuming that this fits you).

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

My Natural Hairline Is Too Low!

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

hi
i have a very low hairline and that makes impossible for me to have some great hair styles. is there any solution to my problem?? i want a higher hairline..

thanks

There is a surgical procedure called a brow lift (or forehead lift) which will elevate the hairline along with your eyebrows. If you are not too young (ideally you should be over 40) it may work for you, but you should seek out the services and opinions from plastic surgeons for this. Generally for the young man (in their 20s) this is something you will have to live with until you’re a candidate, but do talk to plastic surgeons about this.

Tags: browlift, brow lift, forehead, forehead lift, hairline, plastic surgeon, plastic surgery

What’s Up With Hair Transplant Surgeons That Make a Low, Straight Hairline?

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

Dr Rassman,

I have always been a fan of yr ‘Master Plan’ approach to dealing with hair transplant surgically. However, recently, through some hair transplant blogs, I managed to find a few patients undergoing ‘dense-packing’ method up front the hairline area and crown.

This very well-known and highly-regarded hair transplant surgeon seems to be a complete opposite of what you are doing. A look at this patient’s photo gallery, one can only be flabbergasted (more than impressed) by the transformation the patients went through. This is especially so in the hairline constructed – usually thick, low and virtually straight. Also, per hair line procedure, grafts from 1500 to up to 3150 grafts are usually used. Leaving only aother 2000-3000 grafts avaialble for future transplant. I am an advocate for careful hair transplant Master Plan, but seeing such amazing hairline done, one can only be moved and inclined to doing it with this surgeon.

Did you think this surgeon would have considered the impact of future hair loss in these patients or it is simply an amazing surgeon at work?

I can probably guess who this surgeon is, though I won’t do that here. If I am correct though, this surgeon basically does 3000 grafts on almost everyone that he sees (even those who are not balding very much). I would assume that he has loaded the very front of the hairline with very dense packing of the hair amongst other existing hairs that have not fallen out.

In my experience, some patients with fine hair just don’t get those densities. I would question if he’s cherry-picking the patients that he wishes to show. You are correct in your analysis, as many of these patients will not have much hair left after he finishes his first one or two sessions. Maybe there is a Master Plan, but it may not be in the interest of his patients.

Tags: hairtransplant, hair transplant, surgery, surgeon, hairloss, hair loss, hairline

Donald Trump’s Bad Hair Day

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

Donald TrumpUK’s Daily Mail has a new article up — A step-by-step guide to the gravity-defying Donald Trump combover — which includes some rather unflattering photos of The Donald’s infamous hair. And as everyone knows how bad his hair looks, that is really saying something!

The article hints that Mr. Trump’s combover is just hiding some balding, but I’d guess that he has had multiple poorly done hair transplants and is using this hairstyle to mask it as best he can. This is just rumor, though.

Tags: donald trump, trump, celebrity, billionaire, hairloss, hair loss, combover, comb-over, hairtransplant, hair transplant, hair plugs