Treating Frontal Hair Loss

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

I have studied the norwood scale and have established that i am btween stages 2 and three – intial stages of rhair loss.

Reading through your articles , I have noted that propecia has limited results in treating hair loss towards the front of the head. are there any treatments which you have known to be effective in treating the front of the head?

many thanks

Men who think that they are balding may actually just be undergoing a change from a childhood hairline into an adult hairline. Many people who think that they are balding don’t realize that the Norwood Class 2 pattern is normal. For some people, the early part of the Norwood 4 may not even be balding at all. Get a good doctor and get yourself checked out for miniaturization before you obsess into believing that you are going bald.

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:

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.

Frontal Hair Loss and Propecia

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

Hello Doctor
Does Propecia help with the Frontal Hair loss. My Hair loss is more in the fronal top part of the forehead. My right and left side has no hair loss.

Propecia slows or stops hair loss throughout the head. In some cases, it will reverse the hair loss. These select cases are often younger men, but on occasion we see return of hair in older men, mostly in the crown.

In answer to your question about frontal hair loss, Propecia slows or stops hair loss everywhere you are impacted by the genetic balding process. The reversal is less frequent in the frontal areas, however. On occasion, I have seen complete reversal of hair loss in the front, top, and crown area in some young men.

For photos of Propecia’s regrowth results, see past blog entries:

Megasession Results (with Photos)

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

What does a 3000 graft operation look like in a person with a Class 6 Norwood balding pattern, fine hair and moderate contrast between hair and skin color?

The below patient is in his late 60s and had one hair transplant procedure of 3,164 grafts. The grafts were placed to cover the entire balding area. In helping you understand the issues related to fullness, the area covered placed about 6000 hairs (in 3,164 grafts) in an area that originally had 50,000 hairs. That means that what you are looking at about 12% of his original hair density (before he went bald). Clearly, the math points out that a return to his original fullness is not possible. Many times people ask me how many grafts one needs to get a full head of hair. The answer to that question depends upon the thickness of the hair shaft, the character of the hair (straight or wavy), the color contrast between hair and skin color (the lower the contrast the better) and the size of the bald area being treated. I have placed 3000 grafts into an area 1/4 the size of this man’s bald area and the results were a much fuller appearance.

There is a general misconception in the hair restoration community that one can tackle a man with this degree of balding and replace the fullness to his original look in one session with as few as 1500 grafts. Many unethical doctors make that representation and I find it difficult to ‘compete’ with a doctor who promises a full head of hair with half the number of grafts I showed here (probably at half the price because of fewer numbers and salesmen that promote such misconceptions). I try to show how important it is for today’s buyer to understand just what he is buying and what he can expect. Be careful when a doctor shows you just a single view of a result, places the photo in a shadow, and does not really cover the entire transplanted area. That is the reason we have open house events monthly and have been doing them for 14 years. Visitors can see and interview patients, examining just what they are going to get without tricks of photography or slick salesmen to tell you what you might want to hear, true or not. With that said, the man shown below felt transformed in just the one procedure. He wanted a second session to increase the fullness further and after these pictures were taken, a second procedure of 3000 more grafts were done with a similar distribution, though it is far too early to show the results of that procedure. Please click each photo to enlarge.

The 1st set (below) are the before photos.




 

The 2nd set (below), are the after photos, taken 10 months after one procedure.




Using FUE to Touch-Up Straight Hairline

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

Hi Dr. Rassman…
First of all, I want to thank you so much for creating balding blog, it gives us very valuable information from one of the top and best surgeon in the world. About five months ago, I had a 3000 graft transplant with Dr. XXXX in toronto to restore my hairline and part of my midscalp. growth is coming in good so far but I really dont like the hairline design. it is densly packed however the grafts follow and curve almost on a straight line letting everyone know its a transplant. I like the more jagged style where the hairline is kind distruped to give a more natural look like I have seen in some of NHI pictures. so I was wondering if you can probably FUE some areas on my hairline to give a more natural look, maybe 50-100 grafts depending on what you think is best just enough to distrupt the line pattern. Is there a minumum number of grafts needed for FUE procedures?? also is it okay to perform this procedure after six months of my initial transplant as I want to get this done ASAP. Thanks again Dr. Rassman

The problem with straight lines is that they are too orderly, like Count Dracula’s appearance in the movies of the 1930’s. They accentuate a hairline when the hairline should be a zone of transition from a bald forehead to a thick head of hair. I fix these types of hairlines all of the time. Depending upon the color of your hair, it usually takes between 200-600 grafts in the frontal hairline to build a good transition zone. I wasn’t 100% sure by your email if you’d already had an FUE procedure or just wanted to use FUE for some “touch-up” work. If you have already had a strip procedure, it would be less expensive to do it with another strip procedure. An FUE procedure will work as well, but at twice the cost.

Patients with Forward Hair Direction

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

Hi Dr. Rassman,
I was curious after looking through all the before/after pictures on your website, and also on some others, why I can’t find any pictures of people with hair direction going from back to front. They all seem to have either a comb over, or a slicked straight back look. Is there some aspect of transplantation that makes these hair styles “work” in an aesthetic sense while hair that falls forward (like mine which just falls forward when i comb through it) will not look as good after a transplant?
Thanks.

Hair normally grows forward and that is how it is transplanted. Patients use styling to accomplish their goals, whatever they are. I have seen men go from spiked styling to side combing all in a week. Some people feel that once their hairlines are fixed, they must show them off, so the photos that you see in our patient galleries reflect what the patient wants his hair to look like. Plus, when we photograph these patients, the hair is usually combed back just to show the status of the hairline.

9 Months After Hair Transplant (with Photos)

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

This patient is a Norwood Class 6 and had one hair transplant procedure of 3,206 grafts just 9 months ago at the New Hair Institute.

This is what he had to say…

No one ever knew that I had a hair transplant or that it was even me until I told them! I had to let the secret out of the bag, because people couldn’t recognize me.



Even after only one procedure, the change in his appearance is so remarkable, that I wanted to show off his results (with permission, of course). The photo on the left was taken just before hair transplantation, and the photo on the right was taken 9 months after. Click each image to see the full size photo. Forgive the quality of the “After” photo — there was a problem with the camera that wasn’t noticed right away.

Matthew McConaughey and Hair Transplants

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

Dr. Rassman, I am concerned that your post about Matthew McConaughey is misleading. Do you honestly believe he had transplants? Here are two reasons why I think it is unreasonable to think so. First, he had a full head of hair in movies before and directly after the picture (showing hairloss) was taken. The only way he could have had transplants is if his hairloss was sudden and his regrowth was extremely quick. Second, the results are be too good to be transplants even if used in conjuction with drugs or anything topical. I’m sure transplants can make make a big difference, but not that big of one. If he did have transplants then the pictures of your work appear to pale in comparison to the kind of work that can be done. I don’t think your work is substandard to anyone. I think he uses a hairpiece. Are you worried at all that passing his improvement off as a transplant will give people unrealistic expectations as to what hair transplants can do and perhaps unduly persuade people to get hair transplants. Also, do you think hair transplant doctors may be attributing Matthew’s results to hair tranplants in fear of losing people to the hairpiece business?
Sincerely,
Concerned

Just to be clear for the readers of this blog, your question is in reference to the post I made back in May regarding Regenix and the role it may have played in the hairline restoration of this actor.

I have no first hand knowledge of Matthew McConaughey. From photos I have seen of him, there is obviously a big change in his hairline between the older pictures and his current presentation. If the change reflected a hair system, then it is a good one. In the movies, this is done quite often for balding actors, and there are people primping and grooming the hair piece just before they are on film to achieve the best possible look. If the change reflected a hair transplant, then he had a good hair transplant surgeon. Photographs show us what the photographer wants us to see. A hair piece (a wig) would be instantaneous, while a hair transplant would take 8 months to grow out.

As far as expectations, look at the change a hair transplant made in broadcaster Steve Hartman, as featured on the NHI website. The results were at least as good as a great wig, but since it is his real hair growing from his head, he doesn’t have to worry about the costly maintenance or smell issues associated with hair pieces.

I’ve posted links to these photos before, but they are worth reposting to show the dramatic change in Mr. McConaughey’s hairline.

Hairline Receding on One Side More than Other

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

Hi Doctor Rassman, I’ve read your profile. You’ve made quite a lot of achievements. Congrats!
And now on to my question, I’m 19 years of age and my hairline is receding a lot towards the left than the right. My left side is roundish but the right side is still squared yet receding. I can actually feel the emptiness on the left side and that’s really freaking me out. I am also able to see through the hair…meaning that I’m seeing less hair up there but I dunno if it shrunk in diameter. Its like it went from jungle thick to like how a forest would look after a large fire. There’s also small bald gaps in my hairline. This is all very embarrasing for someone my age as it depicts an unhealthy aging teenager. I tend to wear tuques most of the time and I know I can’t do that all my life. I only work part time a few hours a week therefore I dont think I can afford Propecia. Are there any other drugs or methods you can suggest? Thanks.

Hair loss is often asymetrical. Usually, when one side becomes worse, the other side catches up with it. Eventaully, if you have male patterned genetic hair loss, you will continue the process. Propecia works well to stop it, slow it down, or reverse it, particularly in young men like you. You need to have your scalp mapped out for miniaturization and get a diagnosis first. Then a good doctor can treat you properly.

Transplanting Very Bald Patients

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

how much “coverage and density” can a norwood 6 patient actually achieve? All your photos of men with 6 or 7 norwood, all have “comb over” type hair styles? How come u never show any pics of the back of the finished product(or crown)?

A person with a Norwood Class 6 pattern will have lost 50-60% of his natural hair. A person with a Class 7 pattern will have lost between 70-80% of his natural hair. If you move half of the permanent zone of an average man, the most you can yield would be about 15,000-20,000 hairs (or 7,500/10,000 grafts in a series of about 3-4 surgeries). That would mean the coverage mathematics, of let’s say 60% of the total area of originally hairy scalp, can only receive maximally 20,000 hairs in an area that originally had 60,000. This is at best 1/3rd of the original density. In actuality, one rarely ge’s out that much and more likely 12,000-15,000 hairs is maximal. In the person with a Class 7 pattern and 80% hair loss by count, the maximum overall density in the recipient area is 80/12 or 15% of the total original density. We usually weight it to the front so that there is a comb-back effect, moving more density to the place where the greatest impact will occur. We could weight it to the front and sides, with a good comb-over produced (front to back or side to side). Either approach works. The crown is often sacrificed with the lowest densities placed there favoring the front or the sides, as the case may be. So you are correct, the densities in the less favored areas are ‘covered’ with some type of comb-over.

I posted these photos a few months ago here, but it is worth displaying them again to show that the results of weighting the frontal hairline can be very good, even though the crown is not as dense. Patient ZU is in his mid 60’s and had multiple procedures totalling 6,036 follicular unit grafts transplanted. “Before” is on the left, “after” is on the right. Click the photos to enlarge.



You can see more of his before and after photos on the NHI site: Patient ZU

Finer Hairs at Hairline

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

Hello Dr.Rassman,
I am a 29yr old caucasian male who has over the last few years been dealing with questions of hairloss. Thus far there is nothing dramatic to speak of – no noticably thinning or balding areas. There is however one thing that has led to a good deal of concern – it can best be described as light or whispy hair around the frontal hairline (from temple to temple). My hair has always been quite fine in nature and until a few years ago a light brown color rather than the dark brown it has become. In recent years I have grown my hair out quite long – opting for the ‘rocker’ look as friends call it. If I pull my hair back I dont notice any loss at all – it looks like a regular hairline – but the hairs that make up the first cm (rough estimate) are lighter in pigment and fine in composition compared with hairs deeper in the scalp. Aside from the minor difficulties this phenomenon creates when attempting to style my hair I’ve been wondering if this is an example of the ‘miniaturization’ process that you have described. I have no signs anywhere else of this phenomenon – just the fringe of the frontal hairline. No crown thinning, no overall diffuse thinning, no temple thinning – and that is what is driving me crazy! If it were more extreme I would be prone to take some action be it drugs, topicals or other treatments. With this said however the lack of action kills me just as much because I wonder if I’m not acting when I should be – nipping my possible hairloss in the bud so to speak. Please let me know if you feel this is an example of ‘miniaturization’ or not and any course of action I should consider taking. Thank-you.

To really answer your question directly, you should be examined and have your scalp mapping of your hair for miniaturization, which is best done under magnification with a visualizing high power microscopic tool, like our densitometer. Fine hairs often exist in the very front of the hairline, but in regards to what you refer to, I am not sure if you mean the mature hairline that has probably evolved from your child hairline (age 10 or so), which is often lower and thicker. I would want to see pictures and possibly meet with you in person to make such assessments. If you’d like to send photos, you can email them to the address on the Contact page.

Natural Looking Hairlines

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

Dr. William Rassman,
is it possible to restore the original hairline through hair transplant since my hairline had receded so much but not completely bald & its really affecting my self confidence. is it too early for me to undergo this procedure or should i go ahead? whats the best hair transplant method that gives a more natural looking hairline? thanks

You did not state your age and without a photo it is impossible to go into detail about whether a procedure is right for you or not. Hair transplantation today can be and should be undetectable and able to produce a completely natural hairline. The appropriateness of the surgery depends on the individual assessment of each person. There are hundreds of patient hairlines on our website, and you are invited to come to one of our open house events in Los Angeles and San Jose to meet patients directly, so you can see for yourself what can be achieved.

For a great example of what is possible in hair transplantation, please see the Steve Hartman feature on the NHI site. There are larger photos available on the previous blog entry, Where Are the Celebrity Transplant Photos?.

Hairline Myth

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

My frontal hair line is receding and i want to bring it back to a decent level. This is affecting my confidence. I have been advised to cut all my hair off with a blade finish to bring back my original hair line. Is this true will it work? Please suggest to me any form of medication that will quickly bring back my frontal hair line. Thank you.

Cutting or shaving your hair to make it grow faster, better, and stronger is a myth. Shaving your face, does not make your beard grow.

For the hairlines in Caucasian men, a change occurs sometime between 18-29 years of age when (in about 95% of men) it rises about 1/2 inch from the middle to about 1 1/4 inch on the sides. The higher corners make us take on the somewhat typical mature male look, which is distinctly different from the rounder corners found in the typical female hairline (or child’s hairline). You should have yourself evaluated by a good doctor to find out if you have genetic hair loss, do something about your problem and find out if it is real, or not.

On some movie stars and male models who need their youthful hairline, I have put it back where it was in their more youthful days. These men should also take Propecia to prevent more hair loss. It seems that their jobs (and their very high incomes) depend upon the very youthful look so transplanting it back is easy for a skilled hair transplant surgeon.

Looking Like Art Garfunkel

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

I am a 26 year old male, I’ve experienced rather quick hairloss (forehead line receeding, especially in the upper corners) over only 1 and 8 month period. It started when I began to get chest hair growing in. So I assume I’m experiencing genetic MPB due to testosterone changes. Its only getting worse. I’m new to all the drugs and treatments available. What course of action should i take? I dont want to look like Art Garfunkel.

You have just determined the absolute identifier for reaching the age where DHT kicks in. The appearance of chest hair is the biggest sign that DHT is now working on you. As you get even older you will see nose and ear hair as well; I should know, I am 63 years old. Propecia (finasteride) is a DHT blocker that will slow down the effects of DHT, but will not stop the chest hair completely. It will also probably slow down, stop, or reverse the hair loss. I recommend that you see a doctor and get on that medication. You need to have your hair and scalp analyzed for miniaturization so that good measurements will tell you where you are going to be as the treatment takes hold.

And for those too young to know who Art Garfunkel is, this is the hair style that the question-asker was referring to: Art Garfunkel.