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This is a Norwood 6 patient who had a hair transplant done at a clinic in Europe in the 1990s with the old pluggy technique. He wanted to shave his head, but the old hair transplant donor scar and the visible plugs were a problem for him.

This patient chose a combination of (1) SMP to camouflage his old scar, and (2) the surgical removal of his old plugs. The hairs that were in the plugs were redistributed into the crown. We also transplanted a few hundred FUE grafts taken from the donor area and used them on the top of the scalp. As he does not live in the United States, he will return at his convenience on another visit for the needed touch ups. He will likely go on to cover his entire head with SMP, may also undergo more FUE grafting into the frontal hairline, which will make it appear even more natural.

At the point I last saw him, the patient was very satisfied with removing his old plugs with FUE and having SMP done into the old scar. He can stop here if he is satisfied with the result, but I anticipate more work to be done. The after photo shows the temporary redness common just after surgery. We will keep you posted when he returns to the US.

The before (left) and after (right) photos show a work in progress. Click photos to enlarge.

Extending on a point you made answering a recent question, about a man who believed his hairloss would progress to a norwood 6/7 because he began showing signs at the age of 19, how accurate would this be as a way of estimating? For example, if I am actually experiencing male pattern baldness, then I have had this same hairline since I was at least 16 (no accurate pictures before) which includes no more than a little lobsided recession.

My progression has been extremely slow, even at a young age when people believe hair loss is much more aggressive. Is it possible that, even past the mature hairline point, a sufferer of hairloss can just stop at any point, say a norwood 3, or just a little overall thinning, and keep what they have left for the rest of their lives?

Hair loss can be aggressive and then stop forever if that is your genetically determined pattern. You need to see a doctor to get that diagnosis done. The doctor can check your miniaturization (if it is present) and your hair bulk, and between the two of those you can get an idea if you are balding. At 16 years old, I do not believe that you can predict a Norwood class 6/7 pattern, nor have I seen that pattern in a 16 year old.

I think a lot of times people write wanting comfort in knowing that simple math will tell them how much time they have to enjoy their hair. Unfortunately, there’s no chart to refer to and I can’t even give an estimate of that time table without an examination of some sort. There’s no way to predict your final hair loss pattern just based on when you started losing hair.

Dr. Rassman,

Thank you for this great blog. As you’ve pointed out several times in the past, you can’t believe everything you read on the internet about hair loss treatments like Propecia and Rogaine. My question today is about Rogaine. In your many years of treating patients, have you ever witnessed were Rogaine actually made the healthy hair fall out or become damaged? I’ve read where some individuals are claiming that Rogaine destroyed their hairline and damaged what healthy hair they had. Any experience with this in your own practice?

I’ve answered a similar question before.

I do not believe that Rogaine is bad for your healthy hair. If you have a full head of hair and you use Rogaine, there should be no impact on it… but then, why would someone do that? Apply the medication to the areas that have hair loss. And if you’re losing the hairline, applying minoxidil there most likely won’t show a lot of impact anyway.

I have compared my hairline situation to a previous description you posted of how a mature hairline should look. I seem to match up perfectly, both corners just settling at a little less than an inch above the centre of the hairline, which has not moved at all since the age of eleven. My hairline was already 3 and a half inches above my brow so I have been worried about going bald at a young age.

Anyway I was just wondering, will a receding hairline be identical to a mature hairline at SOME point of the recession, or will it move back in a different pattern? I’m just wondering because the right side seems to have been fairly stable for a couple of years, and the left has almost caught up. I’d be over the moon if this was just a mature hairline after worrying for so long.

You should read through this post, which should answer your question — Maturation of a Hairline. Yes, I suppose that some men in the balding process may go through a stage looking like a mature hairline and then continue receding.

I have a question about an actor’s hairline. The actor is named Robert Sheehan. After watching a few of his movies and shows, I looked him up and am quite curious of his hairline as he often sports a big curly afro. I am wondering if he is showing signs of a maturing hairline.

A few pictures of him are below:

Photo 1, photo 2, and photo 3.

I think most people outside of the UK are saying “Who?” in regards to this young Irish actor, but I looked up his career and he’s been on a few UK television series. For those curious, here’s his IMDB profile.

It’s difficult to tell what his hairline looks like, since those photos you linked to show his hairline corners covered. I don’t know if that’s a hairstyle used to cover his hairline on purpose or what, but he’s an actor, so it wouldn’t be uncommon to try to hide hair loss to prolong access to more youthful roles.

In the photo 3 (which is posted at right), it appears like he might have a high hairline or early loss, but I couldn’t say that with any certainty unless I saw some better photos or was able to examine this young man’s hairline in person.

During the course of hair loss, at what point should you stop using propecia. How do you know when you have lost 80%-90% of the hair you will lose during your lifetime?

Is this the time to consider a FUE procedure?

Maybe your doctor didn’t explain this to you, but in general it is recommended that you take Propecia indefinitely. I suppose if you eventually end up as Norwood 6 or 7 it wouldn’t make sense to continue the medication, but that’s something you should talk to your prescribing doctor about. If you had any significant side effects, then stopping the medication or reducing the dose might help with those.

As to when to consider a follicular unit extraction (FUE) procedure or any surgery at all, it is best discussed with your surgeon. You need realistic expectations as well as an understanding of the limitations of any surgery, along with the risks (more hair loss) versus the benefits. In other words, there is no simple answer.

I just had a transplant procedure done just over a week ago. I’m a pilot who wears a helmet to fly with. How long should I go before wearing my helmet again?

I don’t think you should have any issues with wearing a pilot’s helmet after one week. The grafts shouldn’t be an issue by this point, but the donor scar might be uncomfortable if there is a lot of pressure on your donor area from the helmet.

It really can depend on how large the surgical procedure is, so please talk with your surgeon. I would think your surgeon should be more accessible than me here on the Internet.

Do men who have low testosterone typically have better results with finasteride?

Male pattern baldness is really is not about testosterone levels, but rather, about your genetic predisposition. I don’t believe you can predict response to finasteride based on a hormone (testosterone) levels alone, but I really don’t know. It may be a good research topic.

Dear Dr. Rassman,
My eighteen year old son has been on propecia since march 2011 and has been using rogaine 5% since April 2011. He has had just about total regrowth starting with the month of June, his hairline is restored. The dermatologist was pretty sure it was MPB but left a stress issue on the table. My son had been through alot the past year. The Dr. never did any mapping etc. My question maybe he does not need the propecia, I don”t want to put him at any risk.

What do you recommend and is it unusual to have this success so quickly with these meds. Thank-you You are a voice of reason in all this confusion

I just answered a very similar question last week.

I have seen total regrowth (particularly in the hairline) on rare occasions, and when it occurs it usually happens in men under 22 years old or so. It’s been 5 months since he started on the medication, and although that does seem pretty quick to see so much success, it’s not improbable. Results can be seen anywhere from 3-12 months after starting Propecia. As this is a prescription drug, I’ll defer to the prescribing doctor as to whether or not your son needs the medication. He can always get a second opinion, of course.

Ideally, he will want to have a doctor who can check for miniaturization and hair bulk in a number of areas of the scalp to determine if he is balding. Hair transplant doctors know hair, so that would be a good place to start — not for surgery, but for the consultation. You can look for local doctors by using the physician search at ISHRS.org or if you’re planning to be in the Los Angeles area, he can see us.

I know you’re usually reluctant to prescribe Propecia in young men without visible balding beyond the mature hairline, even if they expect it to come soon. But isn’t the development of a mature hairline at a young age enough of an indicator? For example, if an 18 year old came to you with a fully mature hairline, 20% miniaturization in the problem areas, and an extensive family history of balding, would you still hold off in prescribing Propecia until he began to bald beyond the mature hairline or show more significant miniaturization?

I don’t prescribe Propecia as a preventive measure, and a mature hairline doesn’t necessarily indicate that you’re going to lose hair beyond that. Even family balding history doesn’t mean you’re destined to lose hair, as it can skip generations. Propecia works best with early genetic loss present, so upon examination I’d be able to make the determination of whether you’re a good candidate for this medication.

With bulk measurements, I can tell balding in anyone almost always. With significant miniaturization I can also sometimes (though not always) make the diagnosis.