About     Contact     Archives     Videos     Events     Hair Transplant

Hi Doctor Rassman. I had a hair transplant a few years back by a very respectable doctor, and while I’m generally quite pleased with the results, my hairline is a bit asymmetrical. How normal is it for a natural hairline to be higher on one side?

Thanks!

In nature, the hairlines of non-balding males are usually symmetrical, but occasionally they are not. I do not have statistics on this. In the balding hairline that is receding, it is common for one side to recede higher and faster than the other side.

I have, even under the best of conditions, noticed the hairline slightly off balance after the transplant. I routinely draw the hairline and then have the patient (and if he’d like, his family and my surgical staff) provide input and between all of us, we usually hit it correctly. Just this week, I saw a patient who had the hairline higher by 1/8th inch on one side. Here’s his photos — click to enlarge:

Before (left) / After (right):

The after photo is 8 months since I did a single surgery of 2328 grafts. Upon seeing the slight unevenness, I offered to fix it the following day at no charge. He was visiting California from across the country and I wanted to address it before he went home. It took 249 grafts on the one side to balance it out. I won’t have photos of the final hairline for a while since the procedure was just done, but here is the area I’m talking about:

This patient is in his mid 20s and showed a Norwood class 3 pattern with additional recession in the temple area. The results posted below are after one procedure of 1733 grafts, with the photos taken only 8 months after surgery. I fully expect additional growth in the transplanted area with more time, but the patient is very excited with the way things have turned out so far. I hope to have updated photos to post in a few months when we get to the 1 year mark.

It’s worth noting that the patient styled his hair forward in the corners of the hairline, and the “after” photo is not a straight line as it may appear to some. Click the photos to enlarge:

After (1733 grafts):

Before:

Hey Dr. Rassman,

I must tell you that your blog has become an important part of my daily routine and can not thank you enough for your continual work on it. I know you probably have your reserves about this head tattoo procedure, but how about getting it done just on the scars from a HT procedure, it seems like a great way to cover up scars for people who want to shave their heads, especially on the sides and back, where you do not have to worry about losing hair. I am thinning on the top and receding and I am hesitant to get the procedure done on the top of my head in case i ever want to grow my hair out again and continue receding, but at least on my HT scar it makes sense? What are your thoughts? Thanks.

Tattoos can work if they are stippled so that they look like hair, but changes in color of the tattoo can be a real problem (imagine a green tattoo over time). As I understand it, most inks won’t change color, but from the few patients I’ve seen with a tattooed scalp that hasn’t been the case. Be sure to research the tattoo issue, as I’m not that informed about the various inks and methods.

I am not sure if you had a hair transplant and have a scar or if you’re considering a hair transplant and are worried about the scar. In either case, scars can be largely prevented most of the time, but if you have one, a revision of the scar (at least one attempt) should be made. Each case is different, so a good doctor is what you want to have. Ask your doctor about the frequency of scars and the sizes that he/she sees. Consider sending me a photo of your scar if you have one.

The photo below is a 4 year old scar after a single procedure of 2090 grafts done here with a trichophytic closure. There is a scar, but it is barely noticeable, typical of trichophytic closures in my hands. Click to enlarge.

Hi Dr Rassman,

Your blog is a gift so thank you for your efforts. After reading your blog and doing a bit of research I have decided to get some guts and visit my local doctor to start Propecia. I have been on it for two weeks so far with no major side effects – so any one reading scared off by all the internet hype out there - you will just have to suck it up and give it a go.

When reading your blog and looking at the Norword scale I am a little confused by my pattern, I am a 27 year old male and have progressed to the attached photo, its taken in high lighting conditions with a flash, in normal light it doesn’t look too bad and I can style it so its not very noticeable.

In January 2007 I had a full head of thick hair. I currently have many 1cm long thin miniaturised hair still left on the top of my head. I guess I was in denial for the last 2 years as I had a very difficult time plagued with family illnesses and stress. So my question is what balding do I have? Is it diffuse pattern which will end up as a Norwood 6 or 7? Or is it something else? I have a history of MPB in my family.

After much depression and why me’s!!! I have accepted the fact that I am going to be bald eventually.. On my course of Propecia what should I expect? Regards

[you have my permission to publish the photo]

I appreciate you allowing me to publish the photo (click to enlarge). Your hair is thinning in a Norwood Class 6 pattern, which means that you may lose all of the hair in the thinning area. So as a 27 year old man with what appears as miniaturization in the Class 6 pattern (this needs to be confirmed by microscopic assessment), you have a good chance at arresting the process or reversing it since it’s only been going on for 2 years. If you were over 35 years old, I would not be as optimistic. Diffuse unpatterned alopecia (DUPA) would have similar loss in the donor area, so a good mapping of your entire scalp would be warranted. Wait out the first full year on Propecia and then make a reassessment.

Get your scalp mapped out so that you can objectively put a number to the miniaturization and then compare those numbers after a year. What you see with your naked eye may be easily quantified with a good mapping of your scalp.

Thanks for the informative site! I’ve searched for similar questions and answers, you’ve addressed delayed and no growth from transplants before, so hopefully this isn’t repeating too much from others. I’m 29 and had a hair transplant with a reputable IAHRS doctor seven months ago. 2400 grafts total were used, placed in the front 1/3 of my scalp to thicken my front and fill up my hairline.

It’s been seven months and the only growth that has occurred are a couple or so dozen hairs that didn’t shed during the two weeks following surgery. Those started growing further at about 3 months and are still growing, but it looks as though nothing else has even begun to pop through. The only possible explanation I can think of is concerning ridding my transplanted area of scabs post-op. 14 days after surgery, the scabs started to raise up and I went through with the balls of my fingers and gently rubbed them off, in some cases gently picked them a bit to rub them off (a few also peeled like dead sking does). There was no sign of trauma and with the scabs came the small hairs. So I shed about 90% or so of the hairs at 14 days. I discussed this with my doctor and he said there shouldn’t have been graft damage and any grafts coming out would’ve been followed by bleeding.

Is there any explanation(s) for this delayed or potentially little growth from my transplant? I’ve read articles about some transplants having delayed growth for up to a year due to different types of hair cycles. Could the rubbing and slight picking off of scabs after 14 days taken the grafts out or traumatized them to lay dormant longer? I’m sending before and after photos. Thanks!

You sent a lot of photos, but unfortunately most of them were from a distance and poor quality, so they don’t help me see much. The two best photos are shown below (click to enlarge) — the left photo is from 1 day post, the right photo is from 7 months post surgery. There does not appear to be any growth and I would expect that something should have shown by now.

Sometimes transplanted hairs can take up to 12 months before it grows, but usually there is some growth by 7 months. You should see some results between 5-6 months post surgery. I would give it up to a few more months, but definitely follow up with your hair transplant surgeon. I really do not like the unusual zig-zag hairline the doctor placed, as evident in the 1 day post-procedure photo.

There are MANY factors that go into a successful hair transplant surgery. Each and every hair graft/follicle can easily dry up and die if not handled and transplanted by a professional medical team. That is why choosing the right doctor and the right medical group is very important. In other words, it is not like buying a car from a dealer who can get you the cheapest out the door price. Despite what the consumers may think, not all hair transplants are equal (even if they advertise the latest techniques).

Dear Doc,

I’m an 18 year old male and worried that my hairline’s begun to recede. I don’t have any particular family history of balding, both my grandfathers had most of their hair and so does my mother’s brother. Its only my father who is balding (he is 50 and has lost lots of his hair on the top of his head).

I’ve noticed that when I run my hands through my hair I occasionally lose one or two. Also when the hair is wet i tend to lose a few if I run my hand through my hair. I don’t see more than two or three on my pillow when I wake up.

I’ve always had a high hairline with temples higher than the rest of my hairline, but I think its starting to move back slowly.

I also have little red spots near the receding areas of my hairline, almost like acne (I have very little acne on the rest of my face). Looking at my pictures, would you say this is just a mature hairline or the start of the balding process. Also sorry for the long e-mail, but I’ve tried to list everything I can. I’d appreciate some advice on what I can do, as my hair is still very much part of my identity, and I don’t want to spend the next couple of years worrying and counting hairs.

Many thanks

While I thank you for permission to post these, usually I require a frontal view with the eyebrows lifted high so that the creases on the forehead show. You supplied two side views with the eyebrows lifted and a poor quality photo that requires me to guess. I’ll take a stab at it anyway. Click the photos to enlarge.

It does look like you are developing a mature hairline, but there is also a sign of some thinning that goes further back than just the leading edge, suggestive of miniaturization behind a maturing hairline.

You need to get your scalp mapped out for miniaturization and see if there is thinning behind the leading edge and how far back it goes. This is suggestive of early male pattern balding at a level where a drug like Propecia (finasteride) can stop it. See a doctor who cares about you and what may be early balding.

Hello Dr.Rassman. Your site is really informative and I really thank you for the work you do.

I’m a 24 year old male and over the past couple months the front (and to some degree various spots behind it) of my hairline have fallen out at a rapid pace. Now I’m not sure if this is due to stresses on my body (lost 50 pounds in 4 months) or just MPB (limited history of it in my family, or even a maturing hairline its hard for me to tell. I’ve already been to a dermatologist and she wasn’t sure and doesn’t check for miniaturization so while i search for one that does i would greatly appreciate your opinion.

I’ve included a couple pictures of the front and side. You may use these on your site if you wish, i don’t mind.

First of all, I appreciate allowing me to publish these photos. Click each photo to enlarge.

The thinning can be related to stressed induced by the rapid weight loss, a known cause of hair loss in both men and women. The short term loss may be reversible in your case if the miniaturization is extensive and the hairs are still there, just miniaturized. Stabilizing the weight situation (work that out with a good nutritionist) and taking Propecia (finasteride) might help. You won’t know for a good year or so, but you might see a slow reversal towards normal. It is worth a try. Get your hair and scalp mapped out for miniaturization so that you have a basic number for comparison a year from now.

Hello Doctor. I am a 22 y.o. male and my father and all his brothers are bald. My mother’s brothers all have their hair except for one. I have a few pictures here, I was wondering if you can take a look at them and tell me what I am on the Norwood scale, I mean exactly with decimals if you have to. Also, do you feel I should be taking any medications at this point?

Finally, is the hair on the sides of the head, I mean a couple inches above the ear to near above the eyebrow supposed to be thinner than the hair on top of the head?

Thank you very much. Here are the pics. Thanks!

There is a suggestion that you are a very early Norwood Class 3 balding pattern, because the corners look like that have moved upward… but without seeing you I can not tell much as there are no landmarks for me to base a judgment. Send me new photos that are taken closer than the ones you showed, and please lift your eyebrows on the frontal and side views so I can see landmarks that allow me to make the distinction between an early Class 3 pattern or just a maturing hairline. If you do not have miniaturization (difficult to tell in the photos provided), what you have would then appear to lean more to a maturing hairline. I couldn’t recommend hair medications at this stage without photographs that tell a better story.

If you are in California (we have two offices here), I’d recommend setting up a free consultation with us, and then you can walk out with a diagnosis and a treatment plan if it is needed.

I need to get your opinion on a photo I found. I was researching something unrelated to hair and I found a single photo with no info provided. I have no idea anything about this particular surgery, including doctor and graft count. But the hairline struck me as really weird looking. Why might a doctor transplant this odd shape? Just poor skill or is there a valid reason? I’ve had a successful hair transplant a few years ago so I’m familiar with how a transplant should look right after surgery, and this looks gross.

Here is the photo:

You can click the photo to enlarge, but note that this is NOT how a hair transplant should look. I have many criticisms of this work. The frontal line has a series of peaks that will appear like a picket fence when and if the hair grows in. Behind the leading edge, the grafts were placed in rows and that will show in the final result. The grafts appear to be large and elevated, which means that there will probably be pimple-like elevations from which the hair grows.

I would be interested in seeing the final result, but based on this photo I’d expect it to look awful. I’d love to know who the doctor is that performed this atrocity, so if anyone has more info please let me know.

This is a young woman with very bad see-through hair loss that recently visited my office for a consultation. She told me that it has had a devastating impact on everything about her life. In one visit to the office, we fixed up her hair with DermMatch with the result as shown below.

There was no surgery done here. Applying the DermMatch took just a few minutes. She felt reborn with what appeared to her as a full head of hair. Click the photos to enlarge: