Hairline Restoration – Getting Back The Perfect Hairline

This ultimate guide will introduce the various treatment methods you can use to restore your hairline and regrow your hair permanently.

This will include a look at the most popular options in three categories:

1. Surgical
2. Pharmaceutical
3. Natural

What Causes Hair Loss?

As with various other medical conditions, hair loss can have many causes. Here is a look at seven of the most common.

Androgenetic Alopecia (AGA)

Androgenetic Alopecia (AGA), also known as Male-Pattern Baldness (MPB), is the most common cause of hair loss in men. However, it can also be present in women (known as Female-Pattern Hair Loss (FPHL)).

AGA is a genetic condition. Its exact mechanism is unknown, but it is believed to be related to the androgen hormone Dihydrotestosterone (DHT).

DHT is a byproduct of testosterone. It is produced when testosterone and 5AR (an enzyme) interact. DHT itself is not harmful. Instead, people with AGA have sensitive hair follicles that react negatively to DHT’s presence.

This ‘reaction’ leads to hair follicle miniaturization. In simplest terms, the follicle reacts by becoming inflamed. The inflammation slowly increases, which makes it difficult for new hair to grow. Eventually, the follicle is so inflamed that no hair can even reach the scalp.

If not treated, this can lead to permanent and irreversible hair loss.

Alopecia Areata (AA)

An autoimmune disorder, Alopecia Areata (AA) causes patchy hair loss on the scalp. It may also impact the face (Alopecia Totalis) or the entire body (Alopecia Universalis).

The exact cause is unknown but, in simplest terms, the immune system perceives the hair follicles are intruders. As such, it attacks them.

For most people with AA, the hair will regrow after a few months. This is known as remission. However, recurring hair loss is always possible.

Bacterial and Fungal Infections

Dandruff, seborrheic dermatitis, and scalp psoriasis – are a few of the most prevalent scalp conditions. And, while they all have their differences, they do have one thing in common – they are caused by bacteria or fungi.

If left untreated, these can cause redness, itching, and inflammation. This alone can lead to hair loss, but the scratching that occurs with these conditions can also dislodge hairs.

Illness and Medications

Our bodies, while adept at handling various levels of stress, are delicate in their own way. This is particularly true when you are dealing with illness or undergoing certain pharmaceutical therapies.

Many illnesses can lead to hair loss, including lupus and thyroid disease. Even long-term illnesses not typically associated with hair loss can cause it, especially if they put a large amount of stress on the body.

Even the medications you take to treat your illnesses can lead to thinning and hair recession. The most well-known includes chemotherapy, but mental health medications (such as trazodone) are also common culprits.

Physical and Emotional Stress

Stress is something that all humans deal with, but some more often than others. Depending on the severity of the situation, as well as how well you cope, you can experience negative side effects.

This stress, whether physical or emotional, can lead to lowered oxygen intake. As oxygen plays a vital role in hair health, this can lead to weak, unhealthy hair follicles and strands.

Learn more about stress, and what you can do to combat it, here.

Hormones

Hormones play a critical role in our health and well-being. Their presence is what makes it possible for men and women to sexually develop, and they can also regulate moods, insulin levels, and stress.

Unfortunately, a hormonal imbalance can cause many problems. These include acne, blood sugar control issues, and even hair loss.

The most common reasons for hormone-driven hair loss are medications (such as birth control) or medical conditions (including Polycystic Ovary Syndrome and thyroid disease).

If you are suffering from hair loss, this is one of the first places you should start. Your physician can easily run a blood panel to check hormone levels and, if imbalanced, provide proper support.

Nutritional Deficiencies

In the developed world, nutritional deficiencies are rarely the cause of hair loss. However, a medical condition or medication may make you more susceptible to the possibility than others.

There are many nutrients necessary for healthy hair growth, including iron, niacin, and biotin. A deficiency, even minor, can lead to poor scalp and hair health. This may cause breakage and shedding.

Who Is Susceptible to Hair Loss?

Men and women, young and old, black or white — all are susceptible to hair loss.

With so many causes, hair loss can affect anyone. It may be temporary, or it could be permanent, but the impact on your life is the same.

3 Signs of Hairline Recession

Are you unsure whether you are suffering from hair recession? Take a look at the most common symptoms below.

1. Your Hairline is Uneven

It is common for young men to wonder, “is my hairline maturing, or receding?”

After all, hairline maturation is normal. Recession, though, is not.

The best way to tell if your hairline is maturing or receding is by focusing on the way it is doing so. For example, if your entire hairline has slowly moved back, uniformly, then maturation is the likely cause. However, an uneven recession – where the temples are receding but the forehead line is not – can be a major symptom of a receding hairline.

2. Your Temple Hair is Thinning

When speaking of hairline recession, it can seem like a sudden occurrence. Instead, it takes place over some time.

In this period, the hair at your temple begins to thin. This means more hair is shedding than is growing in. As a result of this thinning, you will see the aforementioned uneven hair recession.

3. You Are Experiencing an Increase in Shedding

Shedding is a natural part of the hair growth cycle. On average, you should shed anywhere from 50 to 100 hairs per day. When the count starts to rise, though, is when you need to worry.

An increase in shedding is subtle at first. Perhaps you notice a bit of hair clogging the shower drain, or a few extra pieces on your pillow in the morning. Eventually, this increase builds and builds until the thinning is noticeable.

Surgical Hair Restoration Options

Hair Transplant

The most popular surgical intervention for hair loss, a hair transplant, literally transplants hair from another area on your scalp to the hairline. Let us look more closely at the various methods.

Mini/Micro Grafting

The procedure involves removing a slit of the scalp from the back of the head. This slit contains numerous hair follicles. Another slit is then cut on the hairline and the strip of hair follicles is then placed in it.

This procedure is quite outdated. It takes significant time to heal (compared to FUT and FUE), and this increases the risk of infection, scarring, and other side effects. This procedure can also look less-than-natural which is always a major concern for patients.

Follicular Unit Transplantation (FUT)

Follicular Unit Transplantation (FUT) is an interesting procedure, as it is an even split between mini/micro grafting and FUE.

Similar to mini/micro grafting, a strip of hair follicles is removed from the back of the scalp; but, this strip is not transplanted directly onto the frontal as is. Instead, the individual follicles are extracted from the strip and then placed onto the hairline.

Undergoing FUT means less healing and a more natural look than mini-micro grafting.

Follicular Unit Extraction (FUE)

Follicular Unit Extraction (FUE) is the most advanced hair transplantation method. It involves individual removal of the follicles from the back of the scalp and a similar style of transplantation.

This procedure is the best, both surgically and aesthetically. It mimics a more natural method of hair ‘growth’, and healing takes much less time than slit harvesting/transplantation.

Assuming the follicles placed on the frontal hairline are not impacted by AGA, the hair growth will continue as it should. However, you may experience hair fall in other areas of the scalp (i.e. areas that have not been transplanted).

To learn more about the different procedures, check out this full guide on hair transplants here.

Scalp Reduction

A less popular surgical restoration method, scalp reduction is just as it sounds. The size of the scalp is reduced by removing areas where hair loss is present, and then ‘stretching’ the healthier scalp to cover the area.

In theory, the ‘unhealthy’ hair follicles would be removed and healthier ones would take their place (through stretching).

This is a procedure that can be performed on its own, but it can also be done prior to hair transplantation. This reduces the area that requires transplantation, and it can make the transplant more effective as a result.

Non-Surgical Hairline Restoration Options

If you do not want to undergo a surgical procedure, then consider these pharmaceutical options.

Minoxidil (Rogaine)

Minoxidil is one of the most popular over-the-counter hair loss treatments.

The drug was first developed as a vasodilator, which is used in the treatment of high blood pressure (1). Doctors and patients soon saw one of its more unexpected side effects – hair growth – and it was rebranded and FDA approved under the brand name of Rogaine.

Interestingly, the exact mechanism of action is not understood. But, it has been proven to support hair follicles and reverse hair miniaturization. This has been shown time and again, both on animals (mice) and humans.

One such study, performed in 2014 by Aldhalimi et. al., studied the results of minoxidil on mice (2). More specifically, the researchers wanted to compare minoxidil’s effects to Ketoconazole and minoxidil with Tretinoin.

The mice (20 in all) were split into four groups. Each mouse had their dorsal hairs shaved and then dyed (to provide better visual results). The groups were split as such:

Group I: The control group, that received only a vehicle solution (95%) of ethanol alcohol, 0.1 mL.

Group II: The ketoconazole group, that received an application of Ketoconazole solution 2%, once daily for three weeks.

Group III: The minoxidil group, that received minoxidil solution 5%, once daily for three weeks.

Group IV: The minoxidil and tretinoin group, that received equal amounts of Minoxidil solution 5% + Tretinoin 0.1%, once daily for three weeks.

The mice were then observed and photographed each day for a total of 21 days. At the end of the three-week study, the groups were then compared.

As shown quite clearly, the minoxidil group beat out the other three groups:

There is no doubt that animal studies can be helpful, especially in the beginning stages of investigation. But how do humans respond to minoxidil treatment? Fortunately, this has also been studied.

In 1990, a years-long study was published in the Journal of the American Academy of Dermatology (3). The study consisted of 31 men — all of which had been diagnosed with AGA.

All 31 men had undergone minoxidil treatment (2% or 3%) for 4 ½ to 5 years.

According to the researchers, regrowth peaked at one year (on average). However, continued use maintained non-vellus hairs.

Minoxidil is a breakthrough treatment for millions of men and women worldwide. But, there are still many things to consider before using it to restore your hair.

Foremost, minoxidil only works as long as you continue to use it. This means you could be making a lifelong commitment when you choose minoxidil. It also contains some unpleasant side effects, including:

• Itching
• Rashes
• Increased heart rhythm
• Headaches
• Dizziness
• Lightheadedness
• Dark circles/bags under the eyes

These can make minoxidil a poor choice for many users.

Finasteride (Propecia)

A prescription medication, finasteride is a pill taken to treat hair loss. It works by inhibiting the enzyme 5-alpha reductase (5AR), which is directly involved in the production of DHT.

As with minoxidil, there have been many studies done on the drug.

One study, performed in 2005, consisted of 80 men (all diagnosed with AGA) (4). The study (and treatment) lasted for one year, and the men were split into two groups.

Group I: The experimental group, who received finasteride (1 mg) for one year.

Group II: The control group, who received a placebo pill for one year.

The researchers used four methods to determine results and effectively. They were:

1. Scalp hair count in a 2cm diameter.
2. The comparison of pre-treatment and post-treatment photographs.
3. The patients’ self-assessment via questionnaire.
4. Clinical assessment of scalp and hair.

The participants were examined every three months for a total of four examinations (excluding the pre-study evaluation). As expected, an increase in hair counts was seen in all four assessments for the finasteride group.

The control group, however, showed marked hair loss. This hair loss was present in 87.5% of control group participants but only 21.74% of finasteride-treatment group members.

Unlike minoxidil, which simply makes it possible for hair to grow in a hostile environment, finasteride actually lowers the body’s DHT levels. In the short term, this may not have any ill effects. But many patients do experience adverse effects, including:

• Low sex drive
• Inability to get/keep an erection
• Loss of ejaculatory volume
• Gynecomastia (the development of breasts)
• Anxiety
• Depression

In addition, the hair growth results you see will stop when you stop taking the medication.

Hair Cloning

In theory, hair cloning is similar to hair transplant surgery. The major difference, though, is that only a few follicles are removed from the scalp. Once the follicles are removed, they are isolated and cultivated. After they have multiplied, they are then injected back into the patient’s scalp.

Hair cloning is still in its earliest stages, and it is undergoing clinical trials.

Laser Therapy

Laser Therapy (LT), also referred to as Low-Level Laser Therapy (LLLT), is a treatment option growing in popularity among hair loss sufferers. It was only approved for the treatment of hair loss in 2007, so it is still relatively new.

LASER is an acronym that means Light Amplification by Stimulated Emission of Radiation. LLLT uses concentrated light beams to penetrate the hair follicles and interact with them on a cellular level.

The cells specifically targeted are called chromophores. As the name suggests (chromo = color), these cells love color. In fact, they can absorb specific color beams and even convert them into energy.

The energy is then used for numerous hair growth processes. For example, it can:

• Stimulate anagen re-entry in telogen hair follicles
• Prolong the duration of anagen phase
• Increase rates of proliferation in active anagen hair follicles
• Prevent premature catagen development

That is right — LLLT not only regrows hair, but it can even target follicles in the process of miniaturization and reverse it!

LLLT has already undergone quite a few studies, including two in-vitro, seven animal, and 12 clinical (5). However, there is still much to be learned about its true impact and longer-term effects.

Are Natural Techniques An Effective Way to Regrow Hair?

‘Natural’ is a term thrown around quite loosely these days. Before we proceed, let us define the term as used throughout this next section.

A “natural” technique is a hair regrowth technique that aims to use the body’s natural processes to facilitate hair growth. These techniques do not require pharmaceuticals.

Does “natural” mean that it is a better approach? Not necessarily. It is always important to weigh the benefits and risks. There are some natural approaches, such as the topical use of oils, which have very little scientific proof. There are others, though, which have been used for decades or even centuries with great results.

The techniques below are those which fall into the latter category. These techniques have been used by professionals for a myriad of reasons and have proper scientific evidence to back their claims. They can be combined with the techniques previously mentioned (such as surgery, or medication) or as a standalone treatment.

Mesotherapy (Microneedling)

Mesotherapy, more commonly known as microneedling, is a treatment that makes use of tiny needles. These needles puncture the scalp and begin a healing process that takes place in three stages:

1. Inflammation
2. Proliferation
3. Maturation (Remodeling)

This leads to the proliferation of ‘new’ hair follicles, which then stimulates hair growth.

In 2013, Indian researchers recruited 100 men with mild to moderate AGA (6). They were split into two groups. The first group received a twice-daily application of 5% minoxidil lotion AND weekly microneedling treatment. The second group received only 5% minoxidil lotion.

To properly assess efficacy, researchers narrowed their focus to three parameters: change from baseline hair count at 12 weeks, patient assessment of hair growth at 12 weeks, and investigator assessment of hair growth at 12 weeks.

First up, change from baseline hair count:

As shown in the table above, the minoxidil + microneedling group saw a significant increase in hair count over the minoxidil-only treatment group.

This same pattern is seen in the investigator assessments, who determined the minoxidil + microneedling group saw moderate – marked improvement.

And of course, the photographic evidence speaks for itself:

There are two main microneedling tools you can use at home: the dermaroller and the dermastamp.

The dermastamp can target areas of the scalp more efficiently, and there is also less risk of hair pulling from surrounding follicles.

Never share a microneedling tool. To learn more about the process check out my full guide on microneedling here.

Scalp Massages & Exercises

As evidenced by a few of the above treatments, blood flow is critical to the health of the scalp and hair follicles. After all, blood is the main transport mechanism for oxygen and nutrients. It also removes buildup, including DHT.

With a proper blood flow, the hair follicle can then build strong, healthy hair strands.

That is why scalp massages and exercises are an important addition to your hair care routine. You can perform them in as little as 10 minutes per day.

Are you not sure how to begin? Check out these in-depth demonstrations here.

Scalp Tension Reduction Devices

In addition to the scalp massages and exercises mentioned above, there is a device you can use for stimulating hair growth. It works to promote blood flow (just like massage and exercises), but it also reduces the mechanical tension of the scalp.

It is true that the androgen hormone DHT plays a role in hair loss. It has been believed for many years that DHT was the sole cause. The fact is, though, that mechanical tension plays a big part in the progression of pattern baldness.

Scalp tension is an acute or chronic tightening of the scalp’s muscles. This may be caused by physical injury, posture, stress, etc.

As the scalp’s muscle tense, the tension is then transmitted to surrounding tissues. This includes the various regions of the scalp, such as the frontal, temporal, parietal, and occipital.

If left untreated, scalp tension can become chronic. This results in inflammation of the hair follicles, as well as miniaturization.

It is believed that, as part of the inflammatory process, the androgen DHT is “called” to the site of tension. Why? Because DHT is actually an anti-inflammatory and, as such, it responds to inflammation (7).

In many individuals, the increased presence of DHT at the hair follicles is fine. But people with a genetic predisposition to pattern baldness suffer from androgen sensitivity. As a result, the presence of DHT can trigger an inflammatory process and push the follicles further into miniaturization.

The end result is the typical pattern of balding that is commonly seen in the hair loss community.

The solution to this problem is simple. To prevent pattern baldness, you must treat and reverse scalp tension. One way to do so is with a scalp tension reduction device.

A scalp tension reduction device is a device placed directly on the head. The device will have a headband that wraps around the scalp. The areas that the device specifically targets are those which are prone to tension. This includes just above the ears (occipital), the hairline (temporal and frontal), and the base of the skull (parietal).

With the device placed securely on the scalp, the headband will fill with air. As it does so, the scalp will be gently lifted up so as to remove pressure from the surrounding tissues.

The scalp tension reduction device has two major mechanisms.

1. It increases blood flow to the area. This is important for the delivery of oxygen and essential nutrients to the follicles.
2. It reduces chronic tension. With the scalp being lifted daily, the tissues can relax. This may help to combat inflammation, which will also reduce the presence of DHT.

And just like scalp massages and exercises, you only need to use the device for 10 minutes per day to begin seeing positive results in a few months.

Diet Overhaul

What you put into your body will have a direct effect on your body’s overall health. This extends to the health of your scalp and hair.

Before you go and make drastic changes to your diet, though, take a look at the tips below.

Rule Out Food Allergens

For some individuals, food allergies can be life-threatening. Consumption of that food, or even indirect contact, can cause an anaphylactic reaction.

Delayed reactions, on the other hand, are a non-fatal autoimmune response to the ingestion of an allergen. Some of the more common foods to cause such a reaction include gluten, eggs, and dairy.

When consumed, there are no obvious signs of an allergy. However, within your body, a storm is brewing. For men and women with AGA, this can lead to progressive hair loss.

When you eat an allergen such as those mentioned above, your autoimmune system goes into hyperdrive. It aims to protect itself at all costs.

We know that AGA is caused by a sensitivity to DHT. When your autoimmune system is already at high alert, the attacks can increase and worsen in severity. This includes the attack on your hair follicles.

As such, the consumption of allergens can cause the process of hair miniaturization to quicken.

This means you should remove allergens from your diet, even if they aren’t life-threatening.

An elimination diet is one of the best ways to find out your triggers. This means eliminating all major allergens from your diet, and slowly reintroducing them one by one. You can then check for non-obvious signs of an allergic reaction, ones that you may not have caught on to previously.

These include fatigue, irritability, weakness, anxiety, depression, and lethargy.

If the thought of eliminating all major allergens at once seems daunting, you can do them one at a time. You simply eliminate an allergen (dairy, for example) for two weeks. You then add it back into your diet and check for symptoms. But, it is not as effective as the other way.

Eat a Rich and Varied Diet

Once you have discovered the foods you must avoid, it is time to think about the foods you must include.

Malnutrition is a problem worldwide, though it is not always due to a lack of access to food. Instead, it can be due to a lack of a varied diet.

Lean meats, nuts and seeds, vegetables, fruits, and whole grains – all of these foods should make an appearance in your diet regularly. They contain the variety of nutrients and minerals your body needs to not only survive but thrive.

Does this mean that comfort foods and ‘junk’ foods are off-limits? While it would be best to avoid them entirely, that is not feasible for most people. That is where the 80/20 rule comes into play.

At the very least, you should aim to eat healthy, whole foods 80% of the time. This will not negate the foods you eat the other 20% of the time, but it will ensure you are at least getting your daily recommendation of vitamins and minerals.

What Can You Do In the Meantime?

No matter which treatment option you choose, results take time. If you have already started to experience a noticeable recession, this can be a devastating truth. Fortunately, there are ways to handle the recession until results are noticeable.

Get Your Hair Styled

Even with noticeable thinning and hair loss, the way you wear your hair can largely impact its appearance. With the help of an experienced hairstylist, you can find a style that suits your current predicament.

For example, an undercut is a great way to emphasize the length of the crown of the head, while also naturally covering the frontal recession. You may also want to consider a layered look, or even get ahead of the hair loss with a buzzcut.

Consider Hair Building Fibers

If you are looking for a short-term cosmetic solution to hair loss, hair-building fibers and powders may be the answer.

In short, hair-building fibers are products (typically consisting mainly of proteins) that stick to surrounding hair strands. This adds bulk to your hair, and it can provide a thicker, fuller appearance.

There are various brands to consider, including:

• Caboki
• Toppik
• Viviscal

Of course, these cannot be used with more advanced forms of hair loss. They need existing strands to stick to, and they will not stick to the scalp. However, they can be a good daily solution while you work on using the other techniques above.

Conclusion

There is no such thing as a one-size-fits-all hair loss solution. Similarly, there are not any miracle cures.

Above is simply a glance into the vast array of treatment options, ranging from surgical to pharmaceutical, to all-natural. The right choice, though, is the one that works best for you.

Consistency is key.

You have to work at making a change in your lifestyle, your diet, and your attitude towards hair growth. While the results will not appear overnight, they will come with time. Remember, this is just the beginning. It may take a few months to see results, and this is true for almost any option you choose.