Juvenile vs Mature Hairline — Am I Going Bald? (Photos)

Many of my younger readers of this blog are seeing changes in their hairlines and are worrying about becoming bald. The problem is made worse when there is balding in their family line. I have placed three diagrams taken from the Norwood Classification for hair loss. By conventional wisdom, the Class 1 pattern is proposed not to be balding, the Class 2 pattern suggests that this is the beginning of the balding pattern (it may actually be the beginning of the mature hairline, just not named as such), and the Class 3 pattern is thought of as early balding, possibly worthy of transplants in some men. The line between the Class 2 and 3 patterns are fuzzy, at best. The reality, however, is not quite as simple as I believe that Dr. O’Tar Norwood had documented. In most men (more so in Caucasians), the hairline of youth rises to a hairline of maturity. The mature hairline is about 1/2 to 3/4th inch higher in the middle than where the youthful hairline is and as one moves away from the midline to the corners of the hairline, the gap between the mature hairline location and the youthful hairline location is slightly over 1 inch, changing the overall shape of the hairline to its characteristic ‘V’ shape.

 

Norwood 1 Norwood 2 Norwood 3

 

You can tell where your youthful hairline is/was by lifting your eyebrows up so that you can see your forehead wrinkle. I call this the furrowed brow, and the wrinkles you see reflect a muscle below the skin (the frontalis muscle which is present in everyone). The youthful (juvenile) hairline touches the top of the highest wrinkle of the furrowed brow and has a concave frontal shape to it. This often persist until the early teens, possibly longer. In the mature hairline (with its almost convex frontal shape (V-Shape) that extends from the temple prominences), shows a gap where there are no wrinkles and no hair present. None of what I just wrote is male pattern balding, yet many of our young readers panic when they see the rise in this hairline and they look to the Norwood Chart to identify where they are in the progression of their hair loss. It is particularly bothersome to the young men when the change occurs slowly and asymmetrically. Asymmetrical hair loss is common It’s even worse when the change produces a ‘chewed’ look. This maturing process occurs between 17 and 29 years of age and it is not uncommon to find one side go up faster than the other side. Not all men get a mature hairline (for example, former US President Bill Clinton retained his juvenile hairline — see his photo below) and retention of the juvenile hairline is more common in non-Caucasians as seen in many people from Asia and the middle eastern region.

They say a picture is worth 1000 words, so look at the pictures and labels below for clarity of this. Women almost always retain their juvenile hairline through their entire lives, while 95% of Caucasian men develop a mature hairline.

Set 1 (below): Photo on the left is of a patient shown with the “mature” hairline drawn in. The photo in the middle on the right is of that same patient with the “juvenile” hairline drawn in (the lowest line paralleling the highest crease of the furrowed brow). Note the gap between the highest wrinkle and the proposed mature hairline. That ‘gap’ should not be transplanted. The photo on the below is of my hairline — a classic mature hairline. Click photos to enlarge.

 

Set 2 (below): Photos on the left (Korean) and on the right (Hispanic) non-transplanted hairline. The photo below this is of an adult female (Cambodian) hairline (non-transplanted). Mr. Clinton’s hairline (above) takes on the shape of the female hairline shown here. Female Hairline = Juvenile Male Hairline. Click photos to enlarge.

If the surgeon follows the rules set forth in this post, then the hairlines will be placed in a position exactly like it would have been had they never lost hair as shown in these two patient examples below. The man on the right saw his hairline go up from its normal mature position and the line drawn shows his normal mature position where the transplanted hairs were placed in a single session with these results. With the lower photo, this man had a Class 6 pattern of balding and this change in his look occurred in a single surgery. If the hairline was not placed in the correct mature position, he would not have looked normal. I call these hairlines “no hairline hairlines”.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weekend homework assignment: Check out the hairlines of your sibling, parents, spouse, neighbor, and meter maid. It’s worth looking at a variety of hairlines so that you can see what I’ve discussed above and determine the difference between a juvenile hairline and a mature hairline.

Actual limited frontal hair transplant post-op of 600 grafts at 4 days (photo)

The important take-away here is that within 4 days, with proper washing techniques, there is no scabbing present and nothing detectable short of a little tinge of pinkish color if you look close. All patients having a hair transplant should look like this within 4 days of the transplant. Some of the hairs that were placed already have shed so you can see why it is impossible to count the grafts after a few days.

How Do You Know What You Are Going to Look like When You Get a Hair Transplant? (From Reddit)

After a hair transplant, the grafts (hairs) go into a sleep phase which can last 1-4 months. Then, the new hairs sprout and start coming in waves and grow at a rate of 1/2 inch per month. The fullness you see by the 8th month reflects the density that the grafts (hairs) were put in by the surgeon. The greater the area of balding, the more grafts are needed. To help people like you judge what you will get, we hold Monthly Open House Events where prospective patients can meet many real patients who have had the procedure(s). They can look closely at the real patients’ results and speak with these former patients who often answer questions as you asked. I tell every prospective patient to demand to meet prior patients so they know what they are getting into. We want all of our patients to be educated and to develop realistic expectations.

A quick hair transplant question… from tressless


2019-02-14 11:49:57How Do You Know What You Are Going to Look like When You Get a Hair Transplant? (From Reddit)

Laser Clinic Claims a 95% Success Rate?

Hello,

I am 23 years old and already begin to thin around the crown of my head. Starting to notice hair on my pillow and when I shower. Thinning spot has been getting progressively more noticeable over the last 6 months. I have been using Rogaine for the last couple months without very much success. I am quite certain that stress and genetics are both major contributors to the early hairloss I am experiencing.

I have now begin to look at alternative treatment options and came across a laser therapy center claiming they have had 95% success rate over the last couple years. Laser therapy for a year was quoted just over $4000. That includes 15 mins under a laser helmet once a week for 12 months, a laser comb and topical solution for the 12 month timeframe. I have been advised that after the 12 months I would have to purchase topical solution for the rest of my life to avoid build up of DHT again which will progressively begin hair loss again. ($150/bottle every 7 months). According to the clinic they guarantee success or your money back (not something I would trust unless I see it in writing)

I would like to gain some insight into this type of treatment and see if anyone has had similar treatment with success. I am more than willing to spend the cash as my hair is an important part of my image and I have no desire to be bald by the time I am 30. Just want to make sure that the money is being well invested and that this is not a Scam.

Could you please provide me with some information on this type of hair loss therapy? Results? Studies? Success Stories? or anything else that can help in my decision. Thanks

I have written extensively about the use of lasers as a hair loss treatment — and simply stated, they do not work as claimed. To tell a client they have a 95% success rate — well, it depends on how they define “success”. If only 5% of their customers ask for a full refund, perhaps their judgment of success was that they were 95% successful in retaining your money. If they advertised a 95% success rate in regrowing hair, they’d probably be in violation of consumer fraud or advertising laws.

There was a recent case of a laser clinic in Chicago that was sued for refusing to honor their money-back guarantee when the laser treatment was found to be worthless, so just be sure to look out for these types of practices.

Here are some laser links worth reading:

  1. What Percentage of a Chance Do You Give Laser Treatment of Working?
  2. Reader Adds to the LaserComb / FDA Debate
  3. Reader Checks in with His Thoughts on the Latest LaserComb Study

After 3 Months of Propecia Use, I Can’t See My Scalp Under Harsh Lights Anymore!

Earlier this year I noticed my hair seemed thinner and a miniaturization exam revealed diffuse loss on the top of the scalp but not the sides or back. It was modest loss, only visible under harsh lights, but my hair definitely felt less dense.

Nearly three months later after consistent Propecia use, I could swear my hair feels thicker and I can’t see as much scalp in the mirror under harsh lights. Could this be a real effect or is it probably in my head? (No pun intended!)

This type of result seems like it might be too quick after just taking Propecia for 3 months, but I suppose it’s possible that you had a really great response, which we have seen in some men from time to time. It usually takes a few more months for most men to notice that much positive change, though. I’d keep taking the medication and keeping track of the gains.

Congratulations on the good fortune and better hair!

Left and Right handedness relates to finasteride side effects (article)

Apparently left handed dominant people have improved sexual function on fin rather than decreased sexual sides. I’ve been on fin for a short period of time now with the only side effect being a slight ball ache. I know this is a pretty tiny study but interesting to me nonetheless. What do you guys think? Article: https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2012.11580.x#ss7-title

This is a new one for me. I read the article and although the studies were relatively small, it is suggestive of the handedness issue. Thanks for the information


2020-04-19 08:55:38Left and Right handedness relates to finasteride side effects (article)

After taking finsteride and minoxidil

This man started a heavy shed after starting to take minoxidil and finasteride. This is not uncommon; however, is a dramatic change. I expect the hair he lost before the shed will return over the next few months. He has to stick to the program.


 

Lichen Planopilaris and Hair Transplantation

I am a 55 1/2 yr old female. I have been diagnosed with “lichen planopilaris”. I am tired of scalp injection. My doctor said the next step is probably 3 hair transplant. There seems to be no information on this disease. Is there anything else that can be done? In addition, I am on a generic rogaine formula. April will make 1 yr. on this product.

Any advice? Also, I know the cost for a transplant vary with different results.

See DermatologyChannel.net for more information on this disease. The problem with transplantation is that if the disease is active and is autoimmune in etiology, then a hair transplant may be doomed from the start. Inactivity of Lichen Planopilaris in the autoimmune arena must be determined before starting the costly hair transplantation process. If you and your doctor believe that it is under control and inactive now or sometime in the future, a test hair transplant with a limited number of grafts (about 10) taken with an FUE approach will tell you if a larger hair transplant procedure will work. Either these grafts will fail to grow (indicating that the disease is still active from an autoimmune perspective) or they will grow (indicating that the disease has become inactive). It should take 5-8 months to determine success or failure of the transplant. For those people who have an autoimmune cause, reactivation of the process is always an added risk.


2006-02-03 09:05:32Lichen Planopilaris and Hair Transplantation

Alcohol and Finasteride?

Hi doc,
First I appreciate you on providing expert level suggestions to people all around the world. I think it is really helpful for many patients. I am on Finax (Dr Reddys) for the past month taking daily 1mg at night. I have two questions:

1. I am very much tempted to take alcohol on weekend nights and skip the pills for those days to be on the safer side, and continue on the weekdays. I want to know whether I will get the benefit of the medication or it will slow down the effects?
2. Can I take the pills in the morning during breakfast even if I am on drinks in the nights, does it also effect the medication?

Please help me in understanding my concerns. Thanks in Advance!

I think you’re under the impression that alcohol cancels out the effects of finasteride, but that simply isn’t the case. There’s no adverse reaction to taking alcohol and taking finasteride on the same day. If you want to give in to your temptation of drinking alcohol on the weekend nights, it is not for me to judge or to advise you on. I wouldn’t down a bottle of booze with Propecia (or the generic Finax), but having both on the same day won’t make the finasteride ineffective.

I prefer to take the medication in the morning, but you can take the medication at any time of the day or night. Just take it every day.


2010-03-16 08:38:49Alcohol and Finasteride?