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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:

This is a patient who I just performed a corrective procedure on. There were many mistakes made here in the past with his other doctors and I wanted to share those problems with you. Knowledge is power, and I hope this will teach you what to look out for so you can prevent them from happening to you. So let’s jump right in…

The Problem

First, let’s take a look at the “Before” photos (click to enlarge):

1. The patient had received around 3000 grafts total in three surgeries on the frontal hairline at another clinic.
2. The hairline is harsh, without single hair grafts in front of the larger grafts. Plus, these were not follicular units, but the old type of minigrafts of 3-5 hairs each.
3. The hairline was placed too low and too straight, creating an abnormal edge which made the transplants obvious to the patient.
4. The surgeon made incisions in the scalp that were not kept in the same place, so the patient had two scars rather than one (see arrows in photo above). The second and third surgeries should have been performed at the same location as the first surgery. The location of the upper scar was too high as well, so transplanting into the upper scar made sense to me.

The Solution

Here are the “After” photos, taken just moments after the completion of his surgery (click to enlarge):

1. I transplanted 1637 grafts total (1391 into the hairline and 246 into the upper scar in the donor area).
2. I built a wide transition zone with only one-hair grafts to break up the leading edge of the hairline so that it would not look transplanted.
3. I had to lower the hairline to get in front of the harsh hairline created by the other doctor. This brought the hairline almost back to its juvenile position, something that I rarely do, but was forced to in this situation.
4. Those 246 grafts transplanted into the upper scar (see arrows in the photo above) should almost completely wipe out its visibility, so he’ll have one scar in the back of his head instead of two.

I find it amazing that this happened recently by a surgeon not far from my office who does a great number of such cases. If this patient had asked to meet some of that doctor’s patients, I am sure that this is the type of work he would’ve seen. People just don’t know or think to ask a doctor to meet with other patients ‘one-on-one’. There is no substitute for meeting patients directly and talking to them about their overall satisfaction. We offer an Open House every month to allow prospective patients the chance to meet up to a dozen of our patients who had surgery. A detectable hair transplant is not what you want and it is easy to see the quality of a doctor’s work by engaging with one-on-one patient interviews.

This patient is the 3rd member of his family to receive a hair transplant from us. His older brother received approximately 9000 grafts in the early 90’s, and his father (a full Norwood Class 7) has had close to 10,000 grafts transplanted with one of the most remarkable results I’ve ever seen as he almost had a full head of hair. He still has reserves of hair for more transplants, which I do not believe he needs.

Of particular interest, all 3 family members had very high densities. In fact, the father and the older brother had the highest densities that I have ever recorded in the donor area: around 4 hairs per square mm. This sort of high density reflects a hair population on the head of approximately 200,000 hairs, when normal for a Caucasian is around 100,000. Along with the artistic skill of the surgeon, this is what enabled us to transplant so many grafts in a single session.

So now the youngest son has followed in his family’s footsteps with 3188 grafts — approximately 1400 grafts in and behind the frontal hairline, with the rest of the grafts transplanted into the crown. Despite being only 10 months out from his first and only hair transplant, this patient is already extremely pleased with the results he’s seeing. Click the photos to enlarge!

After one procedure of 3188 grafts:

Before:

Transplant area immediately after the procedure:

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Update: More info can be found here!

Hello Dr. Rassman,

Thanks for this Q&A forum! I have three questions as below and your response would be greatly appreciated!

1. As you can see in my picture [editor's note: see below!], which you can use on the forum with the response btw, seems like I have diffuse thinning. Im not sure what Norwood pattern this is, but does my pattern rule me out for a FUE hair transplant? I think I read somewhere that diffuse thinning candidates are not sutable for hair transplants. The hair in the back of head is pretty thick and looking at my dad and my older brother, I see no danger of losing hair in the back. It’s mostly crown thinning and almost bald on the top. I’m 39 years old

2. You mentioned that South Asians have less density than say those of European descent. I always thought it was the reverse? based on what I see in terms of density in the back of my head, looks like I should be able to get more drafts from my donor area??

3. Is there any way to reduce/eliminate shock loss from neighboring areas after a FUE transplant? Does one have to take propecia to eliminate shock loss? I tried finestaride (.25 mg) for a month and the side effects were frightening, so I stopped.

Thanks in advance!

Thanks for allowing me to post this photo. Click it to enlarge!

1. Looking at the only photo you sent, you look like you have LOTS of hair on your side and thinning hair on top. I have no idea how your hair looks like on the back (donor area) and what percentage of your hair are miniaturized in key areas. So in short, I cannot tell you if you really have diffuse thinning and I cannot give you a personalized diagnosis… but with little that I do see and what you described as mostly thinning at the top, I don’t think you have diffuse thinning. You most likely have an early Norwood Class 5 or 6 pattern. I would see a physician (hair transplant physician if possible) for a good diagnosis and a miniaturization study.
2. Asians have less hair density than their European counterpart, but much of the time Asian hair is thicker and coarser as compared to the European fine hair. This can make Asian hair look more full. I have no idea what your density is. Your guess is as good as mine (its only a guess) so go to a good doctor and have it measured.
3. Propecia (finasteride in 1mg strength) does not “eliminate” shock loss. It decreases the risk. There is no guarantee you will or will not have shock loss after a hair transplant surgery. Generally younger men in their early 20’s and men who are losing hair rapidly have more chance of shock loss.

Finally, I do not know what frightened you in to stopping finasteride. If you have side effects I would discuss them with your doctor to find out if it really is a side effect or something unrelated. Negative sexual side effects occurs in 1 to 2% of men who take the medication and they are reversible.

I’ve read that the average density of hair in the donor area is 2.0 hairs per square millimeter. I have a density of 2.2, which obviously is above average but how much? Is it slightly, moderate, or very high? Also, what’s the highest density you’ve ever seen on a patient?

The difference between a 2 or 2.2 density could be the normal variation around your scalp. High densities have ranged from 2.6-4.0. Let’s take a look at a patient with a density of 4.0, who has now had nearly 9200 grafts transplanted. Before on the left, after on the right (obviously). Click the photos to enlarge.

To see more photos of this this patient’s remarkable transformation, click on Patient ZU.

This patient was amazed by the results he saw from his single session hair transplant (2750 grafts). It’s been 3 and a half years since his procedure took place and in that time he’d forgotten what he started with. When he and his family member came in for a visit this week and saw his before pictures, neither of them believed that it was him. He’s allowed me to post these here so you can see why he was so pleased when comparing the before and after photos.

I used a hair band to keep his hair back when taking the after photos, since it has a tendency to fall forward on its own. His hair is fine so another session to thicken it up is indicated and is something we wants. The reason I only took out 2750 grafts, was because that was the maximum ’safe’ amount to remove. Any larger amount would have produced wound problems. His scalp is still slightly tight, so he will exercise his scalp for 3 months and then he should be loose enough to get out another 2500+ grafts. Click the photos to enlarge.

After hair transplant of 2750 grafts

Before