This is a photo of a female patient who had a hair line lowering and rounding hair transplant surgery. This is sometimes known as forehead reduction surgery.   Dr. Jae Pak performed the surgery at New Hair Institute Medical Group in Los Angeles.

female hair line lowering before after photo

*CLICK TO ENLARGE PHOTO

This patient did not like her square high forehead with receded corners.  She thought her hair line looked too masculine.  She considered a forehead reduction surgery to lower the hair line.  However, she was worried about the hair line incision scar.  She also wanted the hair line corners to be more rounded in appearance which a forehead reduction surgery could not achieve.

FOREHEAD REDUCTION Surgery:

Forehead reduction surgery for women with a high forehead has been popular since the late 1990s.  Dr Sheldon Kabaker  in Oakland California is a well known and prominent surgeon who has been offering female forehead reduction surgery for many years.  It sometimes requires the use of tissue expanders to drastically lower one’s hair line.   Since 2006 Dr. Gal Aharonov in Beverly Hills California has been offering a slightly modified approach to the forehead reduction surgery.  His method has gained great popularity from all over the world.  With third party review sites such as RealSelf.com, the hair transplant community saw a demand for women seeking an alternative to forehead reduction.  Potential problems of a forehead reduction surgery were the visibility of a scar along the hair line, and the limitations of creating an oval or rounded appearance.  While patients were happy with the drastic reduction in their forehead size, some were self conscious about their scar and would not wear their hair pulled back.  They addressed this with make up and sometimes a limited hair transplant procedure.

HAIR TRANSPLANT for hair line lowering:

An alternative for those women who did not want to undergo a forehead reduction surgery was a standard hair transplant procedure.  Hair transplant procedure involves harvesting donor hair from the back of the head to individually relocate single follicles to the front.  The limitations of a hair transplant procedure was that the results were not instantaneous. The transplanted hairs need to grow out from its roots. The advantage was a natural shaped hair line dictated by the artistry of the doctor creating the hair line.  There was no scarring along the hair line.

The results for this hair line lowering patient were achieved using Follicular Unit Strip Surgery (strip surgery) sometimes referred as Follicular Unit Transplant (FUT).   If Follicular Unit Extraction (FUE) method was used, it would have required shaving the back of the patient’s head.  This is something few women would accept. There is no shaving involved with the strip surgery and the incision around the donor area (back of head) is covered by the patient’s hair.  Even with the hair wet or hair up, the incision line (scar) will rarely, if ever be noticed.  This incision may be an issue for men who keep their hair very short.

FUE vs Strip scar on the day of surgery

If the incision is an issue for a patient, the alternative method of harvesting hair is known as Follicular Unit Extraction (FUE).  FUE harvesting is carried out manually by a highly trained surgeon or with an aid of the ARTAS robotic FUE instrument.  There are other machines available such as Dr. Harris’s SAFE system or the NeoGraft machine you may have seen advertised in airline magazines.  FUE method of donor hair harvesting may seem attractive for many patients because it is heavily marketed and advertised as a “no scar” surgery.  This is NOT an accurate statement and is shunned by doctors since FUE does leave thousands of permanent round scars.  Many patients have their FUE scars as well as strip scars camouflaged with Scalp MicroPigmentation.

Moth Eaten appearance of a FUE scar Before and After SMP

This reinforces the fact that the latest technology and fancy robots are not always the best choice. For most women, a small linear scar on the back of their head may be a better option than shaving their head for thousands of FUE “dot” scars.  Think of a C-section scar under long hair vs a moth eaten appearance on the back of a shaved head.

Talk to a doctor

Even if your hair is thin all over how likely is it that you can give an appearance of thicker hair by moving some hair from less noticeable locations to the front?

This question covers a lot of territory:

1- If there is generalized thinning over the entire head and you are a male and the thinning is in the side and back of your head as well, you might have a condition called Diffuse Unpatterned Alopecia (DUPA). This condition is not good news, and these patients can not undergo a hair transplant as there is a poor donor area and therefore the doctor can not move enough good quality hair to cover the thinning area. Scalp micropigmentation (SMP) on the other hand, may be a good alternative (see: scalpmicropigment.com).

2- If there is generalized thinning over the entire head and you are a female and the thinning is in the side and back of your head as well, you will not be a candidate for hair transplantation as the transplanted hair will have poor growth. Again as I said in #1 above, Scalp micropigmentation (SMP) on the other hand, may be a good alternative

3- If you are a male and you have thinning on the front, top and/or crown area and you are under 30 years old, the first treatment course we would be to try finasteride (Propecia) and give you a year to see if some of the hair thinning stabilizes or possibly reverses in some of these areas. If you stabilize or reverse the thinning process, hair transplants can be planned at that point in time if appropriate, however, you must work out the hair supply/demand issues with your doctor. Thinning in men evolves into balding and hair transplants do best in treating balding. When we perform a hair transplant on a young man, we advise the patient to use the drug finasteride to minimize any shock loss from the hair transplant surgery.

4- For women who do not bald but have thinning and a healthy donor area, the amount of hair that needs to be transplant may be limited by the size of the thinning area and the amount of hair one can transplant in a single session. If the thinning is great, the benefits of even a large hair transplant (say~ 2500 grafts) might not be enough to make an appreciable difference. In these situations, I might transplant a female in particular area (like the frontal area to strengthen the hairline or a central or right/left part to make the area look fuller). In this way there can be a partnership between styling and transplants. This is difficult to explain but worth a consultation with an expert in this field.

Most important, there is a balance between the demand for hair and the supply of hair as the doctor moves it around.

Can I have a Scalp Micropigmentation (SMP) and later a hair transplant surgery? What if I want to grow out my hair as well? I don’t want to always keep my hair shaved.

You ask a great question! We have been combining SMP with hair transplant surgeries using FUE or Strip FUT. After all we are a medical practice that specialize in all aspect of hair restoration!

This patient came to us with a old hair transplant surgery scar. He had a strip FUT surgery which didn’t really give him a full head of hair and he just gave up with the idea of having a full head of hair. But he had the strip scar which he couldn’t hide when he decided to cut his hair short. So he went to local doctor for FUE to the strip scar. As we tell all our patients, FUE to the strip scar doesn’t really give perfect results when you are looking to shave your head. So he ended up with MORE SCAR, many ‘punctate scars’ from the FUE surgery. Needless to say he was angry and was very skeptical when he came to see us. We didn’t blame him. He didn’t trust any doctors at this point. Although Dr. Pak thought he would be a great candidate for the SMP procedure, he actually turned him down because the patient’s expectations seemed unrealistic with a bad attitude.

Eventually, the patient came back for another consultation and even saw other SMP patients in person at our monthly Open House Seminars (where prospective patients can meet with former patients and see an actual SMP or Hair Transplant surgery taking place).

This patient eventually had SMP to the entire scalp and covered his FUE scar and strip scar with great results. In the process he came to know and befriend Dr. Pak to trust his work. So after about a year he came back to Dr. Pak for a FUE procedure (about 1500 graft) to add density to the top and soften (corrective surgery) his front hair line from the old transplant work.

While the FUE transplant didn’t give him the full density, the SMP provided a cosmetic benefit to provide a look of fullness. Now he has the option to shave or grow his hair out long.

Old FUE and FUT Strip Scar addressed with SMP Scalp Micropigmenation

SMP Scalp Micropigment for a shaved look

SMP Scalp Micropigment with FUE Hair Transplant for Fullness for Long Hair

I had diffuse hair loss all over my scalp at 30. My hairline was OK. My thinning was noticeable when separating my hair. But, when I combed it right, it was not very noticeable. I thought I would be completely bald and was worried. However, this year I turned 60 and have about as much hair now as I had at 30, and it looks pretty good. So, the point is that thinning does not mean balding. Some men thin out like a woman, and it just stops thinning. Instead of having their lifetime hairs in the back, they have them all over the scalp.

You’re right, but what you’re describing is seen in a minority of men. Some people have low hair density hair with a fine character, and this combination is particularly bad for a see-through appearance. Could this be you?

If we measure the bulk of your hair on top and compare it to the bulk of your hair on the back of your head, we can determine if your overall thinning was something that was always present versus a variant of the balding process, much like the presentation in women.

i have a 1 inch scar on my head just above temple. my hair surrounding the scar is thinner than the corresponding hair on the otherside.

i was wondering is it normal for hair to be thinner around a scar.

It may be just a perception of thinning hair, because you have less hair on the scarred area. I doubt that each individual hair strand diameter is thinner. In other words, when you got your scar you may have lost some surrounding hair contributing to less ‘bulk’ of hair in the region.

Hello Dr. Rassman,

Thank you so much for the service you provide the public with this site. It must be alot of extra uncompensated work for you, I appreciate it.

I got a 1300 hair graft about 9 months ago to the area that I roughly outlined in red (on both sides of my head of course, I am only showing one side). As you can see it is growing at nearly a 90 degree angle on my head whereas my natural hair falls forward. Even though I cut my hair at the same length, the transplanted area looks twice as long because it is growing directly ‘up’. My two questions are this: 1. Is this a lack of skill on the doctors part that it is growing at an unnatural angle? and 2) if I keep trying to comb it forward can you gradually adjust the natural angle of the hair so that it matches with the rest of my hair as to the angle that it grows (or will the transplanted area permanently be at odds with my natural hair growth angle)?

My doctor recommends a second procedure because as you can see the transplanted area looks quite thin. I am 26, do you see any concerns with having a second procedure done with this doctor, or do you sense a lack of skill and I should look elsewhere? I have minor thinning in the crown area as well, but I do not plan on transplanting anything to that area. I have been on propecia for 9 months, and while it has not totally regrown the crown area, I am hoping that it will prevent further loss in that area.

Many thanks, and feel free to post the picture.

Thank you for permission to post your photo. Please click the photo to enlarge.

You are correct. It seems your hair was transplanted at different angle than your native hair. The surgeon planning for the correct angle and direction of hair is a very important factor in a hair transplant procedure. Unfortunately, this is very difficult to correct and relatively impossible to reverse. Your transplanted hair will always grow in that unnatural direction. One of your options is to have another transplant procedure and make sure that the new transplants are in the correct direction to “blend” in with your hair.

With respect to a second surgery with the same doctor, you need to be able to trust the doctor before having any procedure. Doctors are human beings and they can make mistakes or misjudge the many decisions that are before them in a treatment plan. If you and your doctor have a good trusting relationship, I am sure he/she will see the difference in angle and your concerns and will be more than happy to accommodate accordingly. The key here is to directly discuss this with your doctor first, and then make decisions on the value of the doctor/patient relationship.

I am a 38 year old mail in good health and good physical condition, however like most men my hair has begun to thin. I saw the infomercial for “ScalpMed” and it looked promising, so I thought…what the heck, i’ll give it a try. Now, my question is this, it appears that I shed more hairs in the morning when I wash my hair (using a a ph balanced DHT reducing shampoo) after using this product. Can minoxidil cause one to shed more hair since I know this product contains this? If I don’t use scalpmed at night, the next morning when I wash my hair I have fewer hairs in the tub– about 14 without Scalpmed, and 20-40 with Scalpmed).

I also would like to make a comment to the medical industry. If one wants to try and find a cure for baldness, maybe they should research the italians or greek bloodline and see why the majority of those men have their hair way into their 40’s, 50’s, if not later years. Maybe they should research those genetics???

Thanks for your time and insight.

It is normal for one to lose 100 to 150 hairs a day. It is also normal for one to be concerned about hair loss and be proactive as you to try with products such as “ScalpMed”. Unfortunately there is no way to tell if these products actually work. That is why most are not sold as medications or FDA approved products. If ScalpMed is causing you to lose hair, I can not comment on it for there is no real information on the issues of safety or effectiveness.

Minoxidil has been studied as a topical treatment and shows good promise of hair growth in some individuals. To date, there are only two medically proven ways to treat male pattern baldness where it is not really ‘hit or miss’.

1. Hair transplant, which works 99.9% of the time
2. Propecia drug regimen (which may or may not work for you but it met strict FDA requirements) is more reliable, the earlier the hair loss is seen. In men under 30 with thinning and not recession, the reversal in my experience is significant. Reversal of a receding hairline, however, is highly unusual (even in the young man). The key to this drug is to start on it early if you have genetic balding and get to the hair while it is miniaturizing and before it falls out.

To more specifically answer your question, counting 14 vs 20 hairs lost per day seems insignificant (at least from a medical perspective). As stated, we normally lose on the average 100 to 150 hairs a day. ScalpMed may be contributing to the extra 6 hairs that you are losing, but there is no way to really tell.

Finally, the hair loss gene spans all races and cultures. The study of Italians and Greeks has already been done and there it still almost 50% of men in these ethnic patterns that have hair loss.