Two Norwood Class 7 Patients (with Photos)

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

Why is there such a difference between these two previous post’s photographs. They are both, by your report, Class 7 patients.

Norwood class 7 Thanks for asking this great, insightful question.

The rim of hair in a Class 7 balding pattern contains about 30,000-35,000 hairs. Considering that the normal total hair count of an adult is about 100,000 hairs, the only permanent hair that is never lost in any balding man, is the 3 inch high rim of hair schematically shown on the right (Norwood Class 7 pattern). The art of hair transplantation that I will show you below, reflects the way the surgeon redistributes these 30,000 (or less) hairs so that it looks like more than it is. The surgeon needs all of the help he/she can get from the characteristics of the hair on the patient’s head, including the quantity that can be safely moved.

The texture of the hair in these two patients is very different. The white/grey haired man (let’s call him ZU) has a hair shaft thickness that is easily three times the hair bulk (weight) as the blonde fellow (and for the sake of consistency, we’ll call him BF). The hair of ZU has a good character to it and holds a wave nicely, while BF has hair that lies limp and wimpy. Also, the donor supply of ZU is easily twice as good as BF and has a loose scalp which allows the surgeon to redistribute more hair from the permanent rim of hair around the sides and back. ZU received almost 10,000 grafts with easily 23,000 hairs in these grafts, while BF had only 4500 grafts (about 8,000 hairs). BF’s scalp was tight and his hair density was not as good as ZU. With that understanding, re-read the blog post titled Patient’s Guide — How Many Grafts Will I Need?, and it should be easy to see that we are not all created equal and the surgeon’s hands are ‘tied’ by patient’s hair characteristics (weight, texture, color, quantity) and therefore the hair transplant surgeon is not in control of every variable he/she needs. When putting the patient’s final results side-by-side, ZU has easily 8-9 times the amount of hair bulk (# of hairs and bulk) as BF. What is very important for you, the reader, to recognize here is that even BF is thrilled with his results. The thinly covered crown in BF (both men use a comb-back hair styling technique) is not of a concern for BF, because he looks at the man in the mirror and does not see his hair from behind. ZU also has a comb-back (which I showed in these photos by allowing the hair that is combed back to separate so you can see the scalp) with much better coverage of his crown area. ZU also had a considerable amount of hair transplanted into the crown, making his grooming easier and his crown looking fuller. From BF’s point of view, that man he sees in the mirror has a full head of groomable hair, just like ZU.

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Realistic Expectations of a Transplanted Hairline

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

I am trying to find great hairline work. The pictures on your site can’t get me excited. What can I do to get to a realistic expectation and become comfortable?

For the readers that are not familiar, the photos that are being referenced are located here — New Hair Institute – Patient Photo Galleries.

You are looking for a perfect hairline. I would love to know what your problems are with the posted photos. If it is that the density is not what it originally was, it is possible that we did not try to get to the original density (most patients require more area to be transplanted so achieving the original density is not in the cards). Some patients have their own mind made up as to what they want and I almost always do what they want, not what I think is best. I am not super selective on the patients I show on the site, for if I were, I would not show so many patients and only show those who had their original densities restored. All of the posted patients were happy with their hairlines and they allowed us to show off their photos (even for those that do not allow their face to show). I try not to pick out just the best of the best — I want to be honest and give a clear idea of what is possible. If the patients were not happy, they wouldn’t sign the photo release to allow us to show off their hair.

The posted photos may give you an idea of how a natural hairline looks after hair transplant, but the pictures lose the impact of the difference in hair textures that people have. There are a subset of patients who I would challenge anyone to detect anything but a natural appearing, non-transplanted hairline (even to the experienced eye), and some of these patients routinely show up at our open house events. They come to challenge even the most discriminating prospective patients who attend. If it is feasible for you, you can attend one of our monthly open house events at our Los Angeles office. This will give you the chance to meet with some of our previous patients and will allow you to examine our results very closely. I strongly suggest you do this, because pictures just don’t tell the whole story. It is not unusual for us to have 10+ patients show up to demonstrate their results in our Los Angeles open house.

If you have any other questions I will be glad to answer them by email or in person. I look forward to meeting you soon.

Tags: hairtransplant, hair transplant, hairline, nhi, open house, event

I Want My Hairline Lowered an Inch

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

(female)
I’m 16 years old born with a high hairline just about 3 inches. I’ve saved about $5,000 to get the procedure to lower my hairline and was wondering about how much would it be to take off half an inch to an inch. i have a widows peak and wonder if you can fix that too. what would be an estimate and could there be any payment plans. i’d love to have this procedure done before i turn 21.

The fee for a hairline lowering procedure is $8,000 (icludes all anesthesia and facility charges). The hairline lowering procedure is like a reverse brow lift and this is often the way women get a lower hairline. The widow’s peak would have to be assessed separately.

Alternatively, hair transplants could lower the hairline as well. This is, of course, what we do regularly with men and the fees are based upon how much hair is moved (price per graft). I would be happy to review your case confidentially if you send in a picture. Please reference this post if sending.

For more about hairline lowering, see Dr. Kabaker

Tags: kabaker, hairline lowering, hairloss, hair loss

Black Woman with High Hairline

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

I am a 20 year old black woman. I have an extended forehead that seems different form what other women have. Most women’s hair line is close to their face whereas mine is so back onto my head. It has never grown since childhood and i have a sister who has the same thing. I am thinking that maybe its hereditary but how can you be of any help to me? Would i be a good candidate for this procedure? and are there any tablets that i could take that might change it or foster the growth of hair there? Please help!!!!!

Women can have a hairline lowering procedure, which advances the hairline downward. If you are not a keloid former, you might be a good candidate for this. You need to be evaluated. There are no magic pills to fix this.

Tags: female, women, woman, hairline, keloid, african, black

When Does the Maturing Hairline Stop?

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

At what age should the maturing hairline process stop? I’m 33 and I’m getting a bit paranoid about my receding hairline not stopping. I’m at least at the 2nd stage in the Norwood pattern, but have no hairloss on the crown.

A maturing hairline usually stops around late twenties, but that rule is not followed by everyone. If you are concerned about hair loss and its progression, you should have your scalp hair measured for miniaturization and get someone who is an expert to let you know if you are actually balding (see Maturation of a Hairline — Moving From Juvenile to Mature).

Tags: mature, maturing, maturation, hairline, hairloss, hair loss

Hairline Lowering Questions

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

hi, i’m a female with a high forehead. I want to do a lower forehead surgery. I have some questions about the surgery.

  1. will it be local anesthesia or will i be put into sleep.
  2. how long will it take to look normal after the surgery.
  3. will the scar be obviou during the recovery period?
  4. will people notice that i did a surgery if i go out one week after the surgery?
  5. do you have any recommendation for doctors in toronto area?

Thank you very much for your time.

I will answer your questions as if you mean the hairline lowering procedure through excisional surgery, and not hair transplantation.

  1. This procedure is usually done under local anesthesia with some sedation.
  2. The effects are immediate, although there is swelling for up to a week. There is a scar at the hairline, so if you have bangs you should use them to cover the hairline scar. These scars are usually detectable for a few weeks. A small number of people will develop a white scar at the surgical site which can easily be treated with a limited hair transplant.
  3. Yes, the scar may be obvious while healing, but most patients can cover it pretty well with their existing hair.
  4. It depends on your art of styling that you use to cover the incision area and the lower hairline. As I said above, the use of bangs is a good idea because the new lower hairline should be introduced slowly so that the change will be more transparent. In a hair transplant, the change is so slow that no one usually notices it, but with this more radical surgery the final results of the new hairline is instantaneous. If you want to pull the hair back, the incision could be seen.
  5. No, unfortunately I do not have a recommendation in Toronto. Check with a good plastic surgeon in your area. Look for recommendations online, I suppose.
Tags: hairline lowering, hairloss, hair loss, hairline, surgery, hairtransplant, hair transplant

Surgical Camouflage of Pluggy Hair Transplants (with Photos)

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

This patient had 1414 grafts almost 12 years ago to camouflage the obvious grafts in his frontal hairline and in the process, bring down his hairline into its normal position. His old transplants were placed too high and looked too pluggy. This is a nice result and a good demonstration of the value of camouflage when used properly. The photo on the left is before I performed any transplants on him (note the plugs there on the close-up), and the photo on the right is over a decade later. The key to the camouflage was to create a feathering zone of one hair grafts irregularly placed and spaced apart in front of the plugs, then with two hair grafts placed closer together, the transition to the old plugs was so gentle that the plugs were hidden from view. The patient was thrilled with the results.

When we wrote the original articles on repairs for the medical journals, it was taken from experiences like this man had. Today, we can harvest hair from the big plugs (not shown in these photos) as well as use camouflage as we did here. When this repair was done in 1995, the unfortunate standard of care at the time was still the ‘plugs’ that produced the corn row deformities. Surgeons were trying to repair the rough work by putting even more large grafts in between the larger grafts, which only compounded the problem. Fortunately today, few of these pluggy procedures are done and much of what we published has become today’s standard of care for repairs. To see the original work we did on the subject and the publications, look at: NewHair.com – Repair (search).

Click the photos to enlarge.

Tags: hairloss, hair loss, hairtransplant, hair transplant, photos, repair, plugs

When Might an African American Mature Hairline Start?

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

I understand you say that the hairline matures at ages 17-29 depending on the person (race,genetics,etc.). when would u say african americans usually start to recede? i’m african american 18 yr whos temples began to recede a little and there is no balding on my mother side and receded hairlines on my father side.

Everyone varies. African hairlines are often flatter than northern European hairlines, so there is less a genetic propensity for the African hairline to behave as the photos show on the Maturation of a Hairline — Moving From Juvenile to Mature post. Still, although there are no absolute statistics, I believe that the mature hairline takes on a different appearance in people with African heritage. Where I believe than 96% of Caucasian males get the hairline shown in the above link, that number is substantially less in men with an African heritage. The mature African hairline, if it does undergo the changes shown above, should fall into the same age group. These hairline pattern also applies to Indians from India, many people from the Middle East and a large segment of men from Asian populations in China, Japan and Korea.

Good question!

Tags: mature, hairline, hairloss, hair loss, african, black, maturation

Balloon Expander Technique for Hairline Lowering

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

I am an 18 year old girl with a naturally high forehead (about 8 cm). I’ve heard of hairstyles you can have that don’t make your forehead look as high (such as getting bangs), however, it’s a bit hard for me since my hair is also thin and I don’t have a lot on the top of my head. I’ve read your responses to other people on lowering hairline options, such as the “balloon” technique. I’d simply like to know what the procedure is called, as I am in Australia. Also, is it safe and does it leave scars?

Generally there are two surgical options for hairline lowering for men and women with high foreheads. The first option is a traditional hair transplantation surgery. For a good example of this, please see: Female Hairline Restoration After Brow Lift.

The second option is a hairline lowering technique, a more extensive surgery like a brow lift (just in reverse). Balloons are usually not necessary to accomplish lowering the hairline, but when it is done, it requires putting a balloon in your head and expanding your skin over the course of few weeks or months to stretch your skin. The excess skin is pulled down to the desired forehead level. We will be doing one of these balloon expanders in the next few weeks on a patient.

Tags: hairline lowering, lower, hairloss, hair loss, balloon, expander

Why Do I Have a High Forehead?

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

hi i am a 16 year old male and for as long as i have known i have had a high forehead. my hairline is straight not receded but when i push up my eyebrows my highest wrinkle is just short of an inch below my hairline. i have never noticed any change of my hairline so what could be the problem.

We see wide variations in the construct of people’s faces. I remember a hairline that I put back which was less than an inch from the eyebrows. The man told me that it was his family mark and that he wanted to look like everyone else in the family. It would not have been my choice, but it was his. You can always move it if you do not like it, but at 16, I would want to get your parents involved in any and all decisions with regard to altering your hairline.

Tags: forehead, hairline, hairloss, hair loss

Forelocks and Widow’s Peaks (with Photos)

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

I am 21 years old and I think that I’m thinning. I have a prominent widow’s peak. My father (his white haired front view is shown here) and my grandfather both have balding (like the picture you showed of Dave Letterman on February 2nd, but the ‘pancake’ size area in the middle remains strong on both of them). I expect that I will keep my ‘pancake’ just like my father and my grandfather, but if I lost it, could it all be transplanted (including mywidow’s peak)? Can you tell me from my picture if I am losing my hair? I took a picture of it for you to see.

A widow’s peak can be created with a hair transplant. Many people (including me) think that it is a sexy look for people with narrow faces, and it works in a transplant when the surgeon is artistic. Some people have a widow’s peak with the hair direction pointing to the side instead of pointing front. This ‘cow lick’ in a widow’s peak is a bit more difficult to reproduce, but it can be done if the widow’s peak is eroding even with a ‘lick’. For an example of what I mean, see the photo below — click to enlarge.

 

The unusually good picture sent by this man (below) shows thinning behind the forelock and I took the liberty to create a zoomed version of the photo to show the difference in densities under magnification (click to enlarge).

 
His father’s hairline shows that the forelock is strong and I suspect the widow’s peak is a family trait (see photo below — click to enlarge).

 
Referring back to the son’s photo, I think that you can see this young man has reduced density and miniaturization when comparing the central part of the scalp (just behind his forelock) to the forelock. It looks like this young man will bald behind his forelock, possibly more balding than I think that his father shows now, but the strong forelock and widow’s peak may hold even if the hair around it falls out.

Tags: widowspeak, widows peak, hairline, forelock, hairloss, hair loss

Shouldn’t I See My Hair Receding If I Am Balding?

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

I have always had a high forehead, but I’ve had two comments in the last month saying I’m growing bald. My hairline has always definitely been higher by my temples, but I’m now unsure if it’s getting worse. When I lift my hair to show my hairline though, I don’t see any thinning. Shouldn’t this be a gradual process where I could actually see the hair receding or doesn’t it work that way? Also, my dad and all of his brothers are completely bald, but they all showed signs by the time they were 20. No one on my mom’s side is bald. Would that mean if I was balding, it would be in the same pattern as my dad and his family? I’m almost 26, should I be balding at the same age as then and same rate?

You need to determine if you are developing a maturing hairline. You should also get your hair mapped out for miniaturization to determine if you are really balding. Recession is different that maturing a hairline and you need to understand the difference. If you do not show miniaturization, the it would be safe to assume that you are not now presently balding.

Tags: hairline, hairloss, hair loss

Does Miniaturized Hair Imply a Form of Alopecia?

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

In this answer you stated; “it is normal to have some miniaturization or thinning in the very front edge of your hairline“.

and in this answer you stated: “The maturing hairline is as thick as the juvenile hairline, as long as there is no genetic hair loss in the actual hairline (no miniaturization). Sometimes, the mature hairline is thinner (at least it seems that way to me as I look at my mature hairline), but that is just a feeling.”

These two answers confuse me since it seems that you in your first answer suggests that it is normal with some thinning in the very front, but in the second answer, it is NOT normal with some thinning in the very front. If this is not a contradiction I suppose the juvenile hairline also have some normal thinning at the very front?

I would be really greatful if you could clear these things up…

Best Regards

Miniaturized hair means that the hair shaft is smaller than a normal (terminal hair) shaft. If you look at a follicular unit, you will see some vellus hairs (shorter and finer) and occasional thinner hair shafts, which when they are not present in substantial quantity, may be normal. As these smaller hair shafts are found all over the head, one must draw the line as to what may constitute a ‘medical condition’ that reflects genetic balding or other forms of alopecia. I have arbitrarily determined that any miniaturized count out of a population of normal hair shaft ‘terminal’ hairs, should be under 20%. When the thin (miniaturized) hair counts exceed 20%, I assume that this is a medical condition. In the frontal line, many people have thinner hairs, sometime exceeding 20% (in the first 1/2cm). If there is no miniaturization above 20% behind this first 1/2cm, then I would call this the soft look that God gave us to produce a transition from bare forehead to thick hair.

All hair shafts are not equal. In people with coarse hair, thicker hair shafts must be offset by finer frontal hair shafts and we actually see finer hair at the edge of a frontal hairline (first 1/2cm or so). The same is true for everyone, but the phenomenon I am talking about is most evident in the coarse hair person.

I hope this helps.

Tags: alopecia, hairloss, hair loss, miniaturization, thinning

I Think My Hair Transplant Was Placed Too Low

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

Hi Dr. Rassman, I recently had a HT with a “top doc” but I’m concerned that my hairline may have been placed too low. I’m 32 years old. My hairline sits 3 inches above my eyebrows and recedes about a 1/2 inch higher than that as it goes back. Where is the right stop for an adult hairline? any comments will be greatly appreciated.

If you look at the post Maturation of a Hairline, you will see where the adult hairline belongs. It should be one finger breadth above the highest crease of the wrinkled brow. There is not a fixed size for distance between the hairline and eyebrows; instead there are guidelines that could be used to determine where your natural hairline used to be and where it should be after a hair transplant.

One method is to measure the distance between the tip of the nose and the chin (let’s say in ‘Fred’ the distance is 7cm) and compare it to the distance between the upper bridge of the nose — Fred’s mature hairline should be found 7cm above the upper bridge of the nose. The other method is to use the highest crease of your forehead when you are looking upward and go about one finger breadth above it to determine where your natural mature hairline should start. I personally think that the second method is the best way to know where the mature hairline belongs.

Some patients do not follow these rules and may have a wide forehead or a bigger chin to start with. In these cases, old pictures from patients could be used as a guide. Nevertheless, the judgment of the surgeon and his/her artistic view is always crucial for the design of the most natural looking hairline. If you ended up with a too-low hairline, it can be a real problem, since as I’m sure you’re aware, hair transplants are permanent. Send me a photo with your eyebrows lifted high up and I will venture an opinion and keep your identity confidential, of course. Please reference this blog post when sending your photos.

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