Frontal hair loss is probably the toughest hair loss problem a man has to deal with. It usually comes before crown hair loss or vertex hair loss and it's right out front for the world to see. The American Hair Loss Council estimates that 2 in 3 men will experience hair loss of some magnatitude and for nearly all men, some will experience frontal or temple hair loss.

In fact, mild hair loss in the temple regions is very common in men and it is more difficult to find a middle aged man without some form of temple hair loss. If you refer to the Norwood Classification Chart of Male Pattern Hair Loss below, you'll see that Class One represents the hair line of teenage male.

Class Two is what most men will become at some point in their lives whether it comes in their 20s, 30s, or even as late as their 40s. Hair loss is genetic about 95% of the time. Genetic hair loss is also known as “male pattern baldness,” or in medical terms, “androgenetic alopecia”. It is important to know that genetic factors are involved, as well as aging, and how male hormones trigger this "genetic hair loss."

Causes of Frontal Hair Loss

Genetic hair loss is caused by a male hormone called dihydrotesterone, DHT for short. When testosterone combines with an enzyme called 5 Alpha Reductase, DHT is produced. DHT then attacks hair follices and slowly shrinks them (over months or years) until they fall out and disappear completely, never to be replaced by another hair follicle.

To make matters worse, men can lose up to 50 percent of their frontal hair, before they even notice genetic hair loss is taking place.

Ninety-five percent of male hair loss is caused by DHT. Hair loss is not caused by clogged pores, poor circulation, or lack of oxygen as some scam hair loss treatment products claim.

Hair Loss Region Map

Fortunately, we live in a modern age where there are 4 medically established treatment options for frontal hair loss. But before we begin to discuss those treatment options, let's clear up some confusion regarding the definition of frontal hair loss.

Most dermatologists and hair transplant professionals do not necessarily classify the temple regions as frontal hair loss. To most dermatologists and hair transplant doctors, some temple hair loss is quite normal in a mature male hair line. See the chart below to understand the regions of your scalp.

Teenager Hairline vs Mature Hairline

Most hair transplant doctors are hesitant to implant hair grafts in the temple region to the extent that it would resemble a teenager's hairline illustrated in the Class One figure above. Most doctors will not rebuild the temple to such a degree that it would resemble a teenager hairline since this is inconsistent with a mature hair line one expects to see in a man 30 to 50 years old.

However, if you comb your hair to the side, doctors understand that more hair grafts are needed in the temple region to achieve your desired look and hair style - and will work with you to place more hair grafts in the temple region.

4 Treatment Options for Frontal Hair Loss

Men with frontal hair loss have four medically established, FDA approved treatment options. They include:

1. Hair Transplants
2. Finasteride (Propecia)
3. Minoxidil (Rogaine)
4. Flap Surgery

Hair Transplants

Over time, hair transplants are the most cost effective way to rebuild a receding hairline and frontal hair loss, as well as the most permanent solution to these problems. It is also the most aesthetically pleasing. Once new hair grafts are implanted, they have a 99 percent survival rate and are not susceptible to DHT hair loss (the donor hair is take from a DHT resistant region of the scalp).

Doctors rebuild the frontal hair line using 1-hair follicular unit hair grafts for the most natural and undetectable appearance. The best method for reproducing a frontal hairline is to implant these 1 hair grafts in an irregular, zig-zag pattern. These grafts will not be implanted or appear as a uniform line such as
. . . . . . or ________ But rather more like . - . - . - . - . - .

To see how a typical hair transplant procedure evolves, view this diagram. And don't forget to visit our frontal hair transplant photo gallery or locate a doctor that specializes in frontal hair transplants.

Minoxidil

For the longest time minoxidil was thought to be ineffective as a treatment for frontal hair loss. However, a 2003 manufacturer's study revealed that Rogaine (the brand name of minoxidil) was effective in treating frontal hair loss. However, as we indicated in the hair loss region map above, do not confuse the frontal hair growth claims with causing new hair to grow in the temple region as it will not grow new hair in the temple area.

"Results at 48 weeks (study conclusion) show that visible, photographically evident improvements were seen in the frontal scalp regions of 51 percent of men using 5 percent minoxidil, 42 percent using 2 percent minoxidil, and 13 percent of placebo users. Among these men, moderate to great increases in hair growth were seen in the frontal scalp regions of 19 percent of men using 5 percent minoxidil, 10 percent using 2 percent minoxidil, and 3 percent of placebo users." - Dermatology Times, 2003

Minoxidil requires a twice daily application. New hair growth will disappear if use is discontinued. Therefore, once you begin treatment, you will need to keep using the product for the rest of your life if you want to maintain any new hair growth that it achieves.

Finasteride

According to the front page of the Propecia website, "there is not sufficient evidence that PROPECIA works for receding hairlines at the temples." However, finasteride does bring assistance to hair loss in the frontal and mid-scalp anterior regions (see hairloss region map above). According to the study:

In summary, this study in men with hair loss in the anterior and/or mid areas for the scalp demonstrates that finasteride increases hair counts and results in - new scalp hair - noticable to the patient, investigator and an expert panel of dermatolotists reviewing global photographs. Improvents in the appearance of hair as well as slowing of hair loss were...observed.

Like minoxidil, finasteride requires a lifetime commitment if new hair growth is to be maintained. Dosage is usually 1mg per day sold under the brand name Propecia, which varies in cost between $60 and $150 per month.

Flap Surgery

Of all the methods to rebuild temple hair loss or a widow's peak, flap surgey might be the least desirable way to go about it. Although it has improved over the last decade, it still leaves an unnatural appearance with a straight edge hair line and hair growing in the wrong direction - making it difficult to style.

Flap surgery moves 10,000 hairs belonging to a strip of scalp adjacent to a bald area to that thinning or balding area by cutting it and rotating it forward. (see illustration below).

The strip is carefully removed and a small area of about 2 inches at one end is left attached to the scalp to allow continued blood flow in to that piece of skin and hair. Then the bald area of the same size as the flap is removed, and the flap is rotated into the place where the bald area was (usually in the front of the head).

HOWEVER, flap surgery can cause as many problems as it solves, consider the patient below who had a half flap or TPO flap procedure on HIS left and follicular grafts on the right side. Click on photos to enlarge.

The flap above gave a hair line that is too dense for a natural appearance. The hair line is also too defined, which is unnatural. Although not very visible in this photo, there is a very thin, white scar along the hair line.

Same individual as pictured above with a right side view his follicular units after 2 hair transplants. Note how the hair line is less dense and more broken up. This more accurately reflects a natural hair line appearance.

Summary:

While minoxidil and finasteride have been proven to be partly successful in growing new hair in the frontal region and mid-scalp anterior region, as well as maintaining hair count, these medications do not necessarily regrow hair in all patients nor do they regrow hair in the temple region which is sometimes referred to as the widow's peak. Flap surgery leaves an unnatural appearance with a thin, hairline scar and hair that grows in an unnatural direction.

Of all the treatment methods, 1 and 2 hair follicular unit hair grafts carefully implanted in the front and temple regions are 100 percent effective and more cost effective over time then medications. Hair transplants last a lifetime and do not need daily or monthly treatment methods.

At all costs, patients should avoid using Snake Oil products sold over the internet that promise new hair growth by working naturally. These "miracle hair loss cures" are not FDA approved, mostly sold from countries outside the jurisdication of the United States (which allows them to make outrageous claims) and have been proven to be hair loss treatment scams. See Hair Loss Treatment Scams for more information.