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Some of the hairs on one side of my head, located at the hairline by a part, are shorter than other hairs on my head and do not seem to grow out to the same length. Are these hairs miniaturized, and I will lose them, or is this just the way those hairs are. They seem to be similar to the naked eye in every way except the length.

We all have different hair lengths because of hair cycling. It can, I suppose, be regional.

I’m pretty confused about the whole “propecia working on the frontal area/hairline” debate. It seems your various posts about the topic vary greatly in opinion of its efficacy. Let’s say I’m a 21 year-old male, Norwood 1.5 moving toward a 2 and my hair loss is undetectable to outsiders at this point. Would propecia be good to stop the hair loss at my hairline/front or could it reverse the thinner hairs? Or would I just absolutely be wasting my time with the drug? I also heard that frontal hair loss is caused by testosterone and propecia will have absolutely zero effect on it?

I’m quite confused and am getting tired of all the conflicts of interests/information. I’d say the miniaturization at my hairline is pretty mild at this point; the hairs almost look the same as the rest of the hairs on my head but I can just tell they are getting thinner. You say that if caught early enough, propecia works equally all over the head, but then you’ll say that it isn’t known to work on the hairline. For instance:

Why Is the Hairline Immune to Medication?
Could Propecia Shedding Be Cosmetically Significant?

What’s the deal??

I don’t know what conflict of interest you see, but I do see why you’re confused. In one post I said, “Propecia is not known to work on the hairline or reverse hair loss on the hairline (it happens in extremely rare cases).” In an older post I said, “Medication does work in the hairline, but I believe the hair loss has to be treated earlier.” It seems consistent to me, although perhaps a little ambiguous. Allow me to explain. Propecia (finasteride 1mg) isn’t reported in the literature to work at the juvenile hairline, which is the part that begins at the highest crease in the wrinkled brow and extends 2/3rds of an inch toward the back of the head. But I have seen rare cases of reversal of the leading edge of the mature hairline, which starts about 2/3rds of an inch above the highest crease in the wrinkled brow. One problem is that by the time the hair loss is noticed, it is too late for Propecia to do much good in the hairline. This is why I recommend mapping your scalp for miniaturization to be able to watch for this early loss. Hair loss has to be treated with finasteride just as it starts miniaturizing at the mature hairline if you want to try to halt the hairline from moving further back.

So what is the deal? This is the deal! I believe a Norwood Class 2 frontal loss reflects in most men, the loss of a juvenile hairline. I do not consider losing the juvenile hairline as balding. It is unknown if Propecia can impact the migration from a juvenile hairline to a mature hairline.

If you have miniaturization behind the juvenile hairline location, I would think that a DHT blocker like Propecia could reverse that balding, but I’d be more confident that it would slow down or halt the loss in most cases for a 21 year old. I say “most cases”, because I haven’t examined your scalp and I just don’t know if you are heading to a Class 7 pattern (see diagram at right), where taking Propecia when you’ve got massive miniaturization may not help much. I wouldn’t think you’re wasting your time with the drug, but it could end up being the case.

I just ran across a collection of photos on some celeb gossip site. I never realized Joel McHale from The Soup and Community had hair issues, but his hair looks good now. What do you think, did he have a hair transplant?

The change you see in the photo on the left (with an isolated forelock and hair loss around it) to the photo on the right (with a full frontal hairline) is often what I see when I do a hair transplant. I would think that he had a good transplant job done. Now it looks like a mature hairline as opposed to someone going through frontal hair loss. If I were the surgeon, I would have produced a slightly less concave shape bringing down the corners about another 1/4 inch.

Can you post a picture of a male who received a hairline lowering procedure? I can’t find any only females. Thank you!

I have never done a hairline lowering procedure on a man because of the risk of further balding, but there would be no difference in the technique between this procedure on a male or on a female.

On Dr. Sheldon Kabaker’s site, he’s got just 2 male patients out of 32 patients shown, likely because it isn’t as common of a procedure in men. The male hairline lowering patients he’s posted can be found here and here.

Hi Dr Rassman,

I am mixed race chinese-caucasian 25 year old and have noticed some frontal recession behind the hairline and while it is very minor at this point unnoticible unless under bright light (which I am combating with propecia)… if my hairline were to recede… which hairline do you recommend when getting a transplant, the flatter asian one or the more pointed caucasian one? Which one will allow me to use less hair for the hairline in order to save my donor hair for other parts in case I need it? Did you give Jon Gosselin (great job on him by the way) a caucasian hairline? Which do most people choose who are in this situation? I have brown caucasian hair fairly thick hair shafts, but a flat asian hairline in my case.

The basic difference between the Asian and Caucasian hairline shape is, as you point out, that Asians have a flatter hairline. This is not always the case, though. The convex Caucasian hairline works well in most men and that is what we did for Jon Gosselin. Sometimes, we lower the corners slightly in the Asian hairline reconstruction.

Hi Dr Rassman, i have spoken to you before and cannot decide between scalp advancement or hair transplants. I spoke to beverly hills institute and they told me dr mayer and dr fleming are the ones who started scalp advancement and having hair transplants will not look as good and that i will only be disappointed…i am now confused because i thought dr kabaker initiated this procedure. Also the doctor i went and saw suggested 2000 grafts however he seems to think a scalp advancement may be a better option….why is this so it seems so extreme as i have a young family i am scared …thanks for listening

You have every right to question the things that are unknown to you. It is a surgery on YOUR body that you will carry for the rest of your life. Different doctors will have their own opinions, as doctors are human and they tend to ’sell’ what they do best. My point is that there is no clear and definite answer to your question. You need to do your due diligence and research and speak with former patients. You need to try to see the before and after results (not just pictures) of the doctors and procedures you’re researching. This may be easier said than done, but not for our hair transplant practice, as we do this all of the time. We do this in our monthly Open House events where my prospective patients have an opportunity to meet my past patients who have had the surgery, so they can see the results for themselves.

To clarify some facts: Dr. Kabaker is well known to perform hairline lowering procedures. He is not the only one that does this, as many plastic surgeons who do browlifts can easily do hairline lowering procedures. Dr Fleming is well known for his scalp reductions and flap procedures, not for hair transplants and therefore they will sell what they do best. Scalp reduction is different than hairline lowering.

If you have a hairline lowering procedure you may need a small hair transplant procedure to hide the inevitable scar at the frontal edge, but the procedure is literally instantaneous while you must wait for 6+ months for the hair transplants to grow out. If you have a hair transplant procedure you many need a second hair transplant procedure to meet the density goal that you desire no matter what anyone tells you. Just remember that if it sounds too good to be true… well, you know the rest.

hi doc

i’ve got a general question about maturing hairline. while a hairline is maturing, can the total volume of scalp hair diminish? is that possible?

If the hairline and the hair that disappears reflects 2% of your total hair count, then the reduction will be 2% of your hair (total volume measurement). While it is maturing, the impact (if you do not have genetic balding) will not affect you anywhere other than the first 1/2 inch of hairline. In other words, if you’re losing hair beyond the hairline it isn’t just a mature hairline.

Hi Dr. Rassman

I am an African American female with a congenital high hair line. I have always hated the vastness of my forehead and am limited to hairstyles with bangs. I would like to have have my hairline lowered. Because of keloid risks I would probably opt for transplants instead of surgery.

My questions are; do you know of any good or great surgeons in NYC or surrounding area who have experience in this type of surgery? Everything I see is in Beverly Hills or Oakland Ca. And also, if I choose to have implants do I have to go to a surgeon who does implants or can I go to a hair restoration institute? Thanks for your time.

I can’t say for sure either way about the keloids or whether you’re a candidate for surgery, but I do know that Dr. Robert Bernstein in Manhattan would be the person to see in New York. I have worked with him for more than 10 years and we co-authored Hair Loss and Replacement for Dummies.

I am 19 years old and I have fine, straight hair. The hair growing on the right side of my head is significantly thinner than the left side. I don’t remember having this problem as a child, but I have had it for awhile. I used to have such pretty hair, so it’s really upsetting. I think I have had this problem since I was about 11 or 12 years old, which is a pretty young age for hair loss. I remember getting my hair pulled really hard on the right side by a girl when I was in 7th grade, but I don’t know if that is the cause.

Also, I used to wash my hair everyday since about 12 years of age until earlier this year. I stopped after I realized how bad it is for your hair. I’ve been eating pretty healthy for the past 2 years(mostly fruits, veggies, and fish) and I take vitamins. Will that help at all? I switched to an all natural brand of shampoo and conditioner that is made of aloe vera, and I’ve stopped using harsh chemicals, however I still have problems with dry, irritated scalp. I have pretty low self esteem because of this, and I just don’t know what to do. I’m going to see a dermatologist soon, but according to this information, what do you think the cause is and can it be reversed?

Also, do you know of any good hair specialists in my area (Austin, TX)?

I am assuming that you are a male, since you didn’t specify…

Your diet won’t help regrow your hairline, but a healthy diet is always good practice anyway. First, as always, you need a diagnosis. This is likely your genetics, but you are doing the right thing by seeing a dermatologist, particularly with your irritated scalp condition. The genetic balding problem may play a role in the asymmetry, which is common in those going through male patterned hair loss. I don’t have referrals in Austin at this point, but you can review ISHRS.org to find a doctor in your area.

At 19 years old, I wouldn’t rush into a hair transplant surgery to balance out the hairline, but for those readers with a similar problem (that are a bit older than this young man), hairlines that are out-of-balance in men can be easily fixed with hair transplants.

hey dr rassman,
thanks for answering all my questions. first off, my question today is about temporal hair loss and its relation to the maturing hair line process. is this loss (temporal) related to the maturing of the hairline? can one lose his temples and have his hairline only mature and not be considered genetic balding? or is the temporal loss due to more recession to come in the future?

thank you

The maturing hairline is as seen here. If the hairline goes up further, then it is most probably genetic balding. The appearance of a mature hairline has nothing to do with male patterned genetic balding and temporal loss doesn’t necessarily indicate future loss.