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Hello, Dr. Rassman. Why don’t you consider the small recession into the “mature hairline” to be hair loss? DHT causes this change, just like it causes the balding process. And intriguingly, the Dominican Republic pseudo-hermaphrodites did not show any amount of hairline recession into what you consider a “mature hairline.”

I would think if you are losing hair it could be considered “hair loss”, but the key is the cause of the hair loss, such as:

1. androgenic (also known as genetic)
2. mature hairline
3. stress related
4. infection related

I don’t think labeling something is that important. The important thing is looking at the big picture and understanding what is going on. The label “mature hairline” is qualified for a physiologic hair loss that is present in a substantial number of men who do not show any patterned balding.

do asians get a mature hairline? If yes. How does it then look like?

Everybody goes through some form of maturation of their hairline. It is not limited to race or ethnicity. It looks like any maturing hairline. In general, the hairline may recede about one fingerbreadth back, but the Asian hairline is flatter than the Caucasian hairline.

The patient photos shown here are of an Asian man in his 30s.

I know the subject of celebrity hairlines is somewhat like beating a dead horse, but I have a new one.

Would you say that actor Christopher Pine has a normal mature hairline? (The actor who played Captain Kirk in the new Star Trek Movie). My hairline looks a lot like his and so I am curious.

Based on the photos I’ve seen (the image to the right and a couple from Google Image Search — here and here), I’d say that Chris Pine is not balding, nor does he have a mature hairline. I suspect this is probably the same hairline he had when he was 12 years old.

Hi Doc, I have a question about the hairline maturation process. I’ve heard mixed things and I’m a little bit confused. Does the (non-balding) maturation process occur with or without miniaturization? Or can it be either/or? You have suggested that the hairs just fall out, but I’ve also read from you that they miniaturize. Can you please shed some light on this for me?

When you age from the teenage years to your twenties, your hair can recede a bit. This does not mean you are balding and you probably do not go through the miniaturization process. How this happens is not an exact science.

I would say your very front hairs will thin out over time as it miniaturizes and falls out if you have the balding process. In many of the young men who have come to see me and who appear to be developing a mature hairline let’s say half way up to the mature position, I rarely see miniaturization… while those men who eventually develop male pattern baldness will show miniaturization in the leading edge of the hairline.

The location of the mature hairline can be seen here.

I wonder how persistent the forelock is. My father - 55 now, has a receded hairline (V) shaped. It has thinned in the frontal region in recent years, but no real crown thinning.

My question: I’m 24, and already have a deep V shaped hairline, but I wonder how permanent it will remain? Or, whether the forelock can be expected to disappear as well.

Also, what extend does baldness proceed? Who makes it to a norwood 7 pattern?

You need a good diagnosis, including miniaturization mapping and a solid measurement of the hair bulk in the top and crown of your head. The same can be done for the forelock to let you know if you are actually losing hair in the forelock now. As a generality, if the forelock remains strong by the time you are 30 years old, then you may keep it into the years to come. As for percentages of men that make it to the advanced balding stages, see here.

At 24 years old, you need good metrics that should be repeated every year, and with what you report (your deep V hairline) you should consider finasteride. Talk to your doctor, as it is a prescription medication.

A prominent HT doctor recommends using transplanted nape hair at the hair line to soften the look of the hair transplant and make it look more natural. This seems to make sense as often hair transplants look like the hair strands are too thick where transplanted and not natural. You mentioned that nape hair is not permament. Does this mean it might fall out over time and even if it does is it still worth it for the cosmetic effect in creating a more natural hairline?

I recently saw a patient in my office who asked me this same question and asked about the doctor. In case you are the same person, my answer was as you correctly state — nape of the neck hairs are not permanent. Some patients actually come to have hair transplants to the nape of the neck, as they are completely bald from below the ear level.

Thus, your nape of the neck hairs that are transplanted elsewhere may fall out over time and it is not worth the surgery. More importantly, even with the FUE technique there will be scarring that may show at the neck with white pale dots if the nape hair falls out over time. If you are considering this type of surgery I would ask that doctor if you can meet with a patient who has had it done to see what it looks like. When the donor area is from the nape of the neck with strip surgery, most of the time the scars are prominent and wide. Scars like these are not amenable to repairs and even with FUEs placed into them, they can not really look normal.

If you want a softer hairline, regular donor hair should be sufficient if done right with single follicles that are finer and grow naturally that way. If the staff and the doctor are good, they will pick out the smaller caliber single follicles for the very front.

First off, I would like to say that I have learned so much from your wonderful blog–thank you. I am a 22 year old male with a receding hairline but there doesn’t appear to be miniaturization behind where the hairline currently is. I don’t see any crown thinning either. What do you think about this? Unfortunately, I had a high hairline to start with. I first noticed this in late 2009 so it has probably been occurring for over two years. Should I get on propecia? I do have mpb, right? I am severely depressed by this situation and I appreciate your help–I want to be proactive and treat it. (I will send pictures in a few minutes with my name as the subject. You may use them on your site)

Genetic history: Early cases of mpb have almost no precedent in my genetic history. My dad, his brother, and their father all had/have sharp but intact hairlines with crown thinning that didn’t start until their late 30s and stopped after about ten years leaving them with a nearly bald crown area. My mom has no brothers neither does my maternal grandfather but he and his father both kept full heads of hair their whole lives.

I have no way to know if you have MPB (particularly since you said you had a high hairline to start with, the hairline could just be maturing from the high starting point). I looked at the photos and your hairline appears strong. The key is that I don’t have any older photos or measurements to compare to your current hairline.

I couldn’t tell you to get on Propecia, as that is a prescription medication and I’m not your doctor. You should take photos with your eyebrows lifted high so that the forehead creases heavily. That will help me tell if this is a change in the maturing of your hairline or just recession.

I wouldn’t suggest being proactive when it comes to treating hair loss, as you could end up using medication that you don’t need. I’d see a physician in your area (you can check ISHRS.org to find a hair transplant surgeon — they know hair, just don’t rush yourself into surgery at 22 years old).

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Update March 10, 2011: Photos from reader added. Click to enlarge.

This patient is in his mid 40s and is thrilled with his results from taking Propecia daily for a little over a year. The corners of his hairline appear to be a little bit stronger and certainly there is noticeable regrowth in the crown area.

No surgery was performed on this patient, and I must note that the lines you see drawn in the before photos were where a hairline might’ve been placed if he elected to have surgery. Click the photos to enlarge.

AFTER PROPECIA (no surgery):

BEFORE PROPECIA:

You called it, doc! John Travolta was on vacation without his piece!

Link: E! News

John Travolta was in Hawaii celebrating his birthday and the paparazzi caught him in what appears to be his natural balding state. One of Hollywood’s worst kept secrets, I’m not sure that I can or want to take credit for calling it. In fact, there was a photo taken years ago of what was likely his real hairline, so I don’t know why the entertainment reporters are making a big deal out of this. And we did point out the hairpiece years before that. At any rate, I got a few emails about this “late-breaking” news already, some of which sent a variety of photos. Here’s one:

Hello Dr. Rassman,

How did the holidays treat you and your staff?

I had a question about keeping up with hair loss. Have you ever had a young or middle aged patient run out of donor hair? I saw this picture of Nicholas Cage and shuddered. I don’t mean to pile on the Cage/Hair issue but I think it helps illustrate what poor planning can lead to. He had some work done and now, despite his fame and fortune, he is a prisoner in his own body.

Will the equipment that NHI uses to calculate future hair loss (miniaturization mapping, hair bulk analyzer) pick up on advanced patterns like this one?

Thanks and enjoy your day!

There’s been rumors circulating for years in the gossip rags that Nicolas Cage had a hair transplant, but until he comes out and says one way or the other, it’s just speculation. I honestly don’t know when his loss started, how it progressed, or what his goals are/were. Actors will commonly have high end hairpieces/wigs used in their movies (depending on what the role calls for), so creating a timeline to note his hair loss progression is sketchy.

It may seem to you or others that his hair restoration process was due to poor planning, but to others and (himself) it may be what he wanted. Without good pictures, it is impossible to tell just where is hair loss is and what he had done. You also don’t realize maybe he may continue on with another hair transplant to seek more fullness. I do not know! It is all speculation.

Looking at the photo at right (full size here), his hairline is high… too high for a normal look. It should be located in the mature position, and if it were so located, it would not look transplanted.

As for the miniaturization mapping or bulk analyzer tool, neither will predict the future, but both do help us keep track of hair loss and the treatment progress. They’re just tools we use to come up with our Master Plan for each individual.

And to answer your first question… the holiday season was nice. Thanks for writing!