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I am 20 years old and I was born with a very high hairline. I have always hated it. It makes my face look less feminine. Can you help me?

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Hairline location is a genetic factor. If you look at ethnicity and family patterns, you will see wide variations in hairline location. I have always noticed very low hairlines of women from the Indian sub-continent, and I have seen family patterns where the hairlines on men were just as low. My own daughter has complained about her very high hairline, but is not at the point of wanting to do something about it.

What is a high hairline and how do you know you have one that can be fixed? If you look at the profile of the forehead, you will see a vertical part of the forehead where it is perpendicular to the floor. A transition takes place as the skull curves back, changing from a vertical to more of a horizontal position. The hairline is located at the point where the transition zone occurs from vertical to ‘horizontal’. The hairline can be located at any point along this zone. The higher it is located with respect to its location in this transition zone, the larger is the forehead. I have seen foreheads where the hairlines are located on the horizontal (top, flat) side of the head. In women, this rarely reflects balding or natural recession and most women see this pattern throughout their youthful days. The hairline is part of their unique look.

There are two approaches to deal with the hairline, both producing outstanding results. These two approaches are to (1) put hair transplants into the bare forehead, essentially putting hair where it never existed before, bringing it lower to the more vertical part of the forehead, and (2) move the hairline down surgically by excising a portion of the upper part of the forehead. The two approaches are both surgical and they are distinctly different, but the end point is about the same.

Hair Transplants to Create a New Hairline Location:
The transplant approach is a slower approach, putting hair into the upper forhead and waiting until it grows out. Generally, I like to wait between 7-8 months before judging if the thickness is enough to meet the need for fullness. These transplants will look just like the normal hair. While waiting for the transplants to grow, most women will style the hair to cover the hairline until the results meet their needs. Sometimes a second procedure is necessary. Not much risk involved in this procedure, but I would suggest that those interested in the risks of hair transplant review my book (click here) for a very comprehensive overview of hair transplantation. Although much of the book reflects hair transplantation in men, there is little difference between the risks in men or women.

Lower the Hairline with Surgery:
Moving the hairline down is a reasonable goal if the scalp of the patient has some reasonable laxity (looseness) to it. People with tight scalps are generally not a good candidate for this type of surgery. The best part of this approach is that the end results are obtained at the end of the surgery (you do not have to wait for the hair to grow out) and within a week, much of the swelling and ‘black and blue’ from the surgery is gone. We call this ‘instant gratification’ which gives this approach a clear advantage over the transplant route. The surgery requires heavier anesthesia than the hair transplant approach, but it still can be done under local anesthesia. There is more numbness after the surgery than with hair transplants and the numbness can last 6 months or more. Eventually, most people return normal sensation to the hairline area.

Scars are treated with a type of incision called ‘trichophytic’ which tends to force hair to grow through the scar for camouflage purposes. The greatest risk of this surgery is the risk of scarring. Most people who have this surgery do not develop socially noticeable scars, but for a small number of people, the scar may be noticeable. If the scar becomes an annoyance, it can be covered with cosmetics and it could even be treated with hair transplantation, which is very effective to cover such scars. Any transplants that are desired to treat the scar would be relatively unnoticeable. Few people seek hair transplants for treating the scar.

Moving hairlines down in women is a very different process than moving them down in men. Women generally have a stable hairline. It is very rare for women to recede with age from genetic causes. In men, it is completely another story because in addition to a genetically high hairline which we see in boys and young men, genetics may create a progressive process of further recession. For this reason, lowering the hairline in men with a hairline advancement procedure is not a viable option, but transplants can follow a receding hairline as age and genetic factors force the hairline further back.

Framing the face is critical to beauty and balance. For those individuals with disproportionably high hairlines, the upper part of the frame is not proportionally balanced to the distance between the nose and the chin. Just like the man with a receding hairline, a disproportionably high hairline in the female impacts the youthful appearance and beauty in the western view of beauty. By moving the hairline to a position that is more proportional, the results can dramatically change the proportions of the face.


I just saw pictures of identical twins, one transplanted with 3000 grafts and the other not. The twin who had transplants, also took Propecia at less than the recommended dose, while the non-transplanted twin did not take Propecia at all. The difference between the two was dramatic, of course.

I have seen many identical twins over the years. In my video (you can get a copy from us by clicking here and requesting the “complete info” package), you will see donor hair removed from one and transplanted to the other. These two were done back in 1993, when one twin had 3300 grafts removed, and gave 800 of those grafts to his identical twin brother on that same day (on the house of course). The twin who had lost his hair had genetic MPB and wore a hair piece which pulled out most of his remaining hair and he became balder than the twin that had done nothing. Eventually, they both got transplants, and one more procedure was done where the recipient twin had to pay back the donor hair to his twin brother. The piece in the video is short, but you can see the dynamics between the two.

I also remember twins that had been done years apart. The first was done with the old plug technique elsewhere, and the second was done by me with FUT just 7 years ago. The one with the plugs does not like to talk about his hair transplant, while the patient who was done by me has been trying to get his brother to fix the old work. Unfortunately the “pluggy” twin has been gun-shy about surgery since he was plugged years ago and has not yet had repairs done.

From my experience, only a minority of twins go the transplant route. I wonder if it is because my focus is not to ‘sell’ hair transplants but to be a physician hair loss advisor and I do not exert pressure on my patients to go for the surgical solution.


I came into your office for a hair transplant in September of 2004. It was very successful and I now scheduled to come in for a second transplant to add density in a few weeks. When I came in for my first transplant I was surprised to hear that the doctor wanted to shave the recipient site of head to about 1/4″ in length. At the time it did not bother me, because I was able to wear a hat where I work. I am now coming in for a second session and things have changed. I need to be able to go back to work within four days of the surgery. I have spoken with several staff members at your office and they all have stated that there is no reason for the doctor to have to shave my head except in the donor area, but if my hair is long enough it will cover it up. I wanted to ask you personally if it is true that I don’t need to have the recipient site cut or shaved at all. My hair now is about 1 1/2″ long and I would like to leave it at that. If so I would also like to know why I had to do it the first time or was it just a personal preference of that doctor.

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The recipient area does not have to be shaved for a hair transplant, but there are some doctors that prefer to make the recipient sites in a shaved area. When I am the physician I do not have the recipient area shaved.


Hello Dr. Rassman.
Thank you for taking the time to respond. I also wanted to ask you about going on Avodart (Dutasteride) or it’s Generic Dutagen. I have been on Propecia since 1999, and I think it is no longer working. I read Merck’s official report on Propecia’s 5 year efficacy, and it looks like after 5 years Propecia stops growing any hair at all, and it’s ability to keep hair is weakened. Dutasteride appears to block 93% of DHT production, where Propecia can only block 38-45% DHT. Can I get a prescription form you or Dr. McClellan? I am noticing that my “own” non-transplanted hair is thinning, and hopefully the Dutasteride or it’s generic version can stop any more loss.

Also, I am using Nizoral shampoo (Ketoconazole) 2 times a week, and Head and Shoulders shampoo (Pyrithione Zinc) on the other days. Is it safe to mix the Ketoconazole and P. Zinc? A friend told me that the P. Zinc can cause miniaturization of the hair follicle, and mixing the 2 shampoos can have disastrous results. Then on the the other hand, many people on online hair loss forums are saying it is fine to mix the two shampoos. Only using Nizoral 2x a week does not stop my newly acquired incessant itching. It would be great if I knew it was safe to use Ketoconazole and P.Zinc.

Thank you so much for you time, I’m sure you hear all these worries all of the time. Now that I see my new hair sprouting, I want to keep it growing, and keep or grow more of my own.

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Here is a link to some of my other posts with my comments on Avodart. I will make a decision with regards to prescribing Avodart in early September, after I return from the International Society of Hair Restoration Surgery meetings in Sydney, Australia.

With regard to the various questions you had concerning the shampoos you mentioned, I really do not know the answer, as many people respond differently to each. Experiment with each and when you find something working, then stick to it. Mixing shampoos should not be a problem.


I’m a former NHI patient with a bothersome donor scar. Say I came in and it was determined a certain repair treatment was indicated — would you charge full freight as if I were from another clinic?

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Scars come from either the patient’s healing traits or the techniques used. For this reason, we have not charged any of ‘our’ past patients for a donor scar repair, providing that we did not have to transplant the scar. I believe that the new surgical techniques we have developed where scars can be removed, can improve scars that come about for failings of the older techniques. I believe that we should take care of our patients and that is part of our responsibility.

If we have to resort to an FUE for the repair, we have a charge between $1000-2000 per surgery (much less than our going rate) and most of these can be done in one or two sessions. In the past year, most of our patients have successfully improved their donor scars with this new technique and as a result we have not needed to do any FUE repairs in the past half year or so.


I started my research on the fue procedure about six months ago and have come accross an organization known as DHI. My cousin had an fue transplant from them last year and recommended their work, their website is full of info and they have numerous locations. BUT, until I stumbled upon your website, I didnt know half the things I know now, for example the fact that a Doctor is best trained to perform such procedures and that one should look for endorcements from pioneers in the field. While browsing their section on what doctors say about their procedures, I found that your name was listed. PLEASE could you tell me if DHI is a good choice for my procedure, as after studying your credentials I graetly value your opinion. If I dont go with DHI, your organization will be next on my list. I thank you for your time in advance and will greatly appreciate your proffessional advice.
Thank you.

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With regard to FUE, the field is still new and most of what I read/hear is through the advertising of particular doctors who promote FUE. From an insider point of view, I suspect some doctors who promote their skills in this area are not able to do a competent job at FUE, but I am not willing to name them because of possible slander issues and my lack of good solid information. This site is not put together to police the profession, but to give good advice to people like you on questions covering the entire range of subjects with regard to hair care. In searching out a doctor, you should always meet patients that they have done to be assured of the skills of that doctor. You would want to get good vibes on that doctor.

A while ago, I got a list of 500 patient references (source was a doctor who I knew was terrible and unethical). I picked up the phone and called the first 20 references that the doctor listed. Every one of the references (all had surgery with that medical group) told me horror story after horror story. I then realized that by publishing such a list, that particular doctor knew that few patients would make the effort to actually call these people and that the list of 500 references was enough to produce the credentials he wanted. This shows that when you do your research, you MUST follow the threads until you have clarity on the inquisition. This is a buyer’s market and as a buyer, please beware.

For information on FUE, please see:


34y/o female, on birth control, no visible medical conditions that I am aware. Started losing hair about 7 years ago once graduated from college and ended a three year engagemenet under stressful lconditions. Hair loss has progressedandrecentlynoticed the amount of thinning as I had a head full of thick hair. Now thinner, and every night shwer, there is always some hair in drain. Ihave tired multivitamins, Kevis, Advecia, and Hairgenesis….the vitamins helped but still falling out. I dont knowwha tto do….I am 5’2″, weight about 115-120 pounds. I was addicted to laxatives at one time but have since recovered. Could I have a vit. deficiancy? hormone problem dueto birth control? My thyroid checked out fine. I dont want to be 40 and bald. I have no children, no otehr medications.

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It is hard to know exactly what the cause and solutions might be via email without first meeting you. My suggestion would be to please read my many answers to women with hair loss. I discuss the medical work-up required for women, plus the causes for it. A good doctor to check you out and a good hair doctor will go along way to help you focusing upon your hair loss problem. I am sorry to sound evasive, but hair loss in women is a difficult differential diagnosis.


Dr Rassman
I have heard anecdotal reports that the use of Minoxidil for diffuse thinning in men can cause the good terminal hair one currently has to become Minoxidil dependent and change the “good hair” into a fuzzier Minoxidil produced hair—any truth to that? Thank you

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Minoxidil dependence does occur for the thinning hair associated with balding in both men and women. When it works, it can be dramatic, but the dependence is a reality that you must face, for if you stop the drug, you will lose all of the benefits including the hair that is preserved. Those men and women with normal hair do not have to worry about minoxidil dependence.


I want to have a widow’s peak like I did when I was younger. Can you transplant a widow’s peak?

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Yes, you can transplant the widow’s peak. People have different types of widow’s peaks, with some having different directions. Any of them can be made. Here’s a widow’s peak that is 100% man made, along with the entire frontal hairline. The “before” photo is on the left, followed by the “after” on the right. The “after” photo was taken after two sessions totalling 3,702 grafts. Click the images below to enlarge.

This patient is also featured on the NHI website:


I am consuming propecia for the past 6 month and i can see good results. My question is, i and my wife would like to have a baby. Is it safe to have a baby while i am on this medication because i have been told by a pharmacist that i should stop consuming propecia for at least 1 month before planning to do so. He said that it will probably do damage to a newly born child.

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The half life of Propecia is 4 hours. That means that in 4 hours, there is 50% of the dose remaining, in 8 hours 25% remaining, in 12 hours 12.5% remaining, in 16 hours 6% remaining, in 20 hours, 3% remaining and in 24 hours 1.6% remains in your system.

Now the official answer from Merck is that you can continue to take Propecia while you are trying to get you wife pregnant. Different opinions from different doctors who are generally skeptical, tell their patients the following:

  1. Stop taking the drug while you are trying to get your wife pregnant.
  2. Stop taking the drug while your wife is pregnant.
  3. Stop taking the drug the month you are trying to get your wife pregnant and when successful, go back on it.
  4. Stop taking the drug for the one week a month when your wife is in her fertile period.

Clearly, this is your decision. I tend to recommend #4, not because I believe it, but because it is reasonably safe and will minimize the time off the drug. I am always concerned about losing the benefits of the drug, and running the risk of a dramatic hair loss.


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