The Art Of Restoring the Lost Hairline

Restoring the Lost Hairline

When mapping out a hair restoration surgery, an experienced surgeon will take into account a number of different factors. This allows the surgeon to design a hairline that looks natural and undetectable. Each hairline should be unique for every individual and is as much about a surgeon’s artistic aesthetic sensibilities as it is about being an expert surgeon. This is a critical component in restoring the lost hairline.

Only a physician with years of dedicated practice can discern all of the characteristics and intricate nuances required to ensure that a surgical hair restoration is able to mimic nature.

Restoring the Lost Hairline of one of Dr Gabel's patients

The before and after photos of a patient with a restored hairline can be quite dramatic

The Importance of the Hairline

Most patients wish to restore a resemblance of the hairline they once had before experiencing hair loss. Past photographs of patients can serve as an excellent tool to help a surgeon realize a patient’s former appearance.

Creating a new hairline using the lost hairline as a blueprint is often possible if the donor area is sufficient.  The design must also be capable of taking into account future hair loss considerations.

Patients often bring in photographs of hairlines they would like to have, be it from celebrities or magazines, which if factors permit, can also be taken into account as a possibility when designing a restored hairline.

Age and Ethnicity Considerations

An age appropriate hairline is crucial for creating a natural result.

Because of the progressive nature of hair loss, poor planning can lead to patients having a hairline that looks less than natural later on in life. Keeping this in mind, juvenile hairlines will never be designed for a patient as a teenage hairline is not found in nature on a mature or aging face.

Additionally, limitations in donor supply may limit how aggressive a doctor can be with hairline placement and density. More importantly, the physician must be able to take into account the limitations of a patient’s donor resources.

A person’s ethnic background and facial structure can have some bearing on the straightness, shape, and position of their hairline.

For people of African descent, the look of a straight hairline will generally work better. However, it may be more suitable for people of Asian heritage with a broader and rounder hairline . The shape of the head of all ethnicities will likely determine the placement of a hairline along the forehead.

The ideal hairline design for every patient should seek to complement their specific facial shape.

Realistic Expectations

Managing expectations is part of hairline design, patients must realize the limitations of their donor supply. They should also know the age appropriateness of what they want.

But with realistic goals, a patient and doctor can capably set out to create an aesthetically significant hairline that reframes the face and brings a more youthful appearance to an individual.

The impact of a well designed hairline can be profound, not just as a cosmetic change in appearance, but as a morale boost to a patient that has suffered from the frustrations of losing their hair.

Contact The Gabel Center

To learn more about hair loss, the latest medications and the latest techniques in hair restoration and surgery, contact Dr. Gabel’s Hair Transplant Oregon office. Our team at the Gabel Center look forward to your visit and discussing these matters with you in greater detail.


Best Natural Remedies & Ingredients for Hair Loss

Although we highly recommend hair transplant’s as the hands down, most effective way to restore your hair, we would be remiss to at least mention some of the ingredients in some of the more natural remedies for Hair loss. In fact, if you aren’t giving your hair the support of nutrients such as protein, iron, omega 3s and vitamin B , you may be hurting your hair’s chances of recovery rather than helping. The following ingredients, though they have been used for hair loss in the past, may or may not work, but it won’t hurt to be taking these too.
Other factors also come into play, such as nutrition, not just for your hair, but for your overall health too.


Biotin is one of the best natural remedies for hair loss. It is water soluble, and is a B-complex vitamin that helps to convert nutrients into energy. Biotin also improves the protein infrastructure in hair, skin, and nails. Certain studies of women who have taken marine protein supplements did notice hair growth in affected areas, and less hair loss overall. An easy way to get more Biotin into your system is by adding these foods into your diet:

Tomatoes are a great source of Biotin - Natural Remedies

Tomatoes are a great source of Biotin


  • Organ meats, such as liver or kidney
  • Egg yolks
  • Certain nuts, such as almonds, and walnuts
  • Legumes such as soybeans or peanuts
  • Whole grains
  • Bananas
  • Cauliflower
  • Mushrooms

Flax-Seed Oil

Another excellent natural remedy for hair loss is Flax-seed. Flax-seed oil contains omega-3 fatty acids, and contain Vitamin E, which have strong antioxidant properties. This will keep your hair follicles protected and can also help to stop scalp damage. Flax-seed also helps improve the efficiency of the capillaries, and increases blood circulation. The omega-3s nourish your follicles and hair shafts, and increases their

strength and resistance to damage. Flax seed can be added to many meals as a supplement or topping including adding to:

Flax-Seed contains Omega-3s which benefit hair health - Natural Remedies

Flax-Seed contains Omega-3s which can benefit hair health

  • Oatmeal
  • Smoothies
  • Baked goods
  • Milk
  • Yogurt

Folic Acid

One of the most underrated natural remedies for hair loss is Folic acid. It is a known fact that Insufficient folic acid in the diet can result in hair loss. It is also known as Vitamin B9, though rarely called that. Folic acid aids in tissue regrowth and will improve circulation, which in turn helps your hair follicles function correctly. Folic acid also helps transport nutrients to the hair and improves cell division around your hair follicles. You can increase folic acids simply by adding:

Folic Acid foods for Hair restoration and health Natural Remedies

Folic Acid, another necessary ingredient to hair health

  • Oranges, grapefruits and other citrus
  • Dark leafy green vegetables such as spinach or Kale
  • Cereals, and breads
  • Rice
  • Pasta

Vitamin A

Vitamin A through Papaya for Hair Restoration - Natural Remedies

Papaya is one good source for Vitamin A – though too much Vitamin A can actually harm hair health

Vitamin A is critical for many functions of the body, including the reproduction of cells, and is an antioxidant, which can protect your hair follicles from damage from free radicals. In addition it can keep the scalp moist and elastic. Unfortunately, taking in too much Vitamin A can cause their follicles to reach the end of their growth cycle too quickly, causing them to fall out. If there aren’t new hairs to replace those that have fallen out, baldness can occur.

Vitamin C

Vitamin C through citrus fruits - Natural Remedies

Citrus such as Oranges, grapefruit, lemons, imes and kiwi are all great sources for Vitamin C which aids in fighting hair loss.

Since hair loss is directly affected by Dihydrotestosterone, and having high levels of this male hormone can cause male patten baldness, it’s good to have Vitamin C as a way to combat balding. BY adding more vitamin C to the diet, scientists found that the DKK-1 “baldness’ protein would completely stop. Besides this, it can help the body produce sebum, the natural oil that protects your hair and strengthens it.


Oysters for Zinc and hair health - Natural Remedies

Oysters are a great and tasty source for Zinc

It can help with DNA & RNA production, critical for These trace minerals are important for maintaining scalp health through cell reproduction, tissue growth, and repair. Zinc can also help to balance the body’s hormones, and in some studies helped reverse gray hair back to the original coloration.


Lobster and selenium for hair loss - Natural Remedies

Lobsters and other shellfish are excellent sources for Selenium, necessary to combat hair loss

Selenium is an antioxidant and trace element/ mineral that helps to kill free radicals in the body. It also activates an enzyme in the body that helps other free radical killers, like vitamin c. This can further assist in the fight against baldness, including both male and female pattern baldness. Unfortunately lately many people hinder the effectiveness of Selenium in the body by smoking, drinking excess alcohol or taking birth controls pills.


more natural remedies for hair loss

It’s always best to not rely solely upon articles on the internet to self diagnose, but leave the questions to a professional like Dr. Gabel. He’ll give give honest feedback about what the best course of action is for you. In addition, he may have a more tailored plan including other natural remedies for hair loss besides those listed here. Dr Gabel’s office can be reached at 503-693-1118

Finasteride (Propecia): Important Information to Understand

Dr. Steven Gabel offers his patients many treatment options for hair restoration and strives to stay on the cutting edge of modern medicine. Finasteride is an important medication to learn about.

One of the most common medications for treating male pattern baldness is the use of the medication finasteride, known better by the brand names Propecia (1-mg tablet) and Propecia (5-mg tablet).  It is the only FDA approved oral medication that is proven to effectively treat male pattern baldness (androgenetic alopecia).

Finasteride requires a physician’s prescription and only a thorough consultation with a qualified doctor can determine your best course of action for pursuing a medical treatment for your hair loss.

The Root of Male Pattern Baldness

Male pattern baldness is the most common cause of hair loss in men. Since male pattern baldness behaves in a progressive fashion, about a quarter of the men who have this condition will begin noticing hair loss as early as their teens, even before they reach 21.

As men age, 1 in 4 will notice thinning or baldness by the time they reach the age of 30. And by age 40 studies indicate that up to half of all men will notice cosmetically apparent hair loss.

Men who have male pattern baldness will lose their hair in a predictable pattern, typically defined on the Norwood Scale, beginning with the recession of the temples and then advancing over time to form a typical “M” shape as the hair line further recedes back and thins. Hair loss can also involve the crown, gradually advancing until the entire front, top, and crown are bald or very thin.

Male pattern baldness is caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible hair follicles located in the front, top, and crown of the scalp. People with male pattern baldness are genetically predisposed to the DHT hormone that causes the miniaturization of their susceptible hair follicles, which shrink in size, both in diameter and length. As a result, the miniaturized follicle eventually produces a small, unpigmented vellus hair rather than the usual pigmented, normal terminal hair.

DHT also shortens the susceptible follicle’s growth (anagen) phase. These two effects cause the hair to become progressively shorter and finer until it eventually disappears to the naked eye and is no longer viable.

How Finasteride Works in The Body

Normally in men, the hormone testosterone is converted to the hormone DHT by the enzyme 5-alpha reductase.


Normal hormone pathway to make DHT


Finasteride works by blocking an enzyme 5-alpha reductase thereby significantly reducing the amount of DHT that the body produces. By blocking this enzyme, a patient can effectively lower the DHT in their body and spare their hair from the effects of DHT. This results in hair that maintains its shape effectively reducing miniaturization of the hairs. Finasteride causes a significant drop in both the scalp and the blood levels of DHT. Finasteride 1-mg/day decreases serum DHT levels by almost 70%.


Production of DHT is inhibited by Propecia (finasteride)


Clinical Studies of Finasteride

Controlled studies have shown that after five years of treatment, 90% of men taking finasteride experienced either a growth of new hair or a halt to their hair loss. Specifically, after five years, 48% of men demonstrated an increase in hair growth, 42% were rated as having no new hair loss while the remaining 10% were rated as having lost hair.

In contrast, 6% of men treated with a placebo demonstrated an increase in hair growth, 19% were rated as having no new hair loss while the remaining 75% were rated as having lost hair.

In the “Hair Count Clinical Study,” hair counts showed an average gain of 277 hairs per one-inch circle at the end of five years of observation. These hairs were significantly larger than the fine, miniaturized hair characteristic of balding men.

In the “Hair Weight Clinical Study,” a 34% increase in hair weight was observed between finasteride and the placebo after 96 weeks of clinical observation. By increasing hair weight, that effectively gives patients more volume, and ultimately a fuller appearance of hair.

Can Finasteride Help Preserve the Frontal Scalp?

Finasteride is often used to protect hair on the crown and top of the head from DHT’s effects, with some claiming it is less effective at preserving the frontal scalp and hairline from hair loss. However, there is published data from a controlled clinical trial of men with frontal hair loss that demonstrates improvement in the frontal region of the scalp. The efficacy of finasteride to retard or slow down hair loss is universal to all areas of the scalp so long as there is some hair in the area.

Although their mechanisms for promoting hair growth are different, both finasteride and minoxidil act to thicken miniaturized hair regardless of where it is on the scalp.

How Soon Can I See Results?

Finasteride should be taken once daily. Patients must commit to taking finasteride for one year or longer before its effects in preventing hair loss and re-growing hair can be accurately assessed. Finasteride takes up to a year or more to show its full effects in both preventing hair loss and in re-growing hair. During the first six months you may note some unwelcome thinning of your existing hair. This may be due to either progression of your hair loss before starting a finasteride regimen or some shedding of miniaturized hair that makes way for the new healthy anagen hair to grow.

It is important to be absolutely patient during this period of time. You should continue the medication for at least one year before you and your doctor can assess its benefits. If finasteride is able to benefit you in stalling or even stopping your hair loss, it will require a lifetime commitment to taking finasteride to maintain the results.

What Are Potential Side Effects?

Side effects from finasteride at the recommended 1-mg dose are uncommon, but ultimately reversible if they should occur. The one-year drug related side effects were 1.5% greater than in the control group. The compiled data showed that 3.8% of men taking finasteride 1mg experienced some form of sexual dysfunction verses 2.1% in men treated with a placebo. The five-year side effects profile included: decreased libido (0.3%), erectile dysfunction (0.3%), and decreased volume of ejaculate (0.0%).

Most cases of sexual dysfunction occurred soon after starting the medication, but there have been reports of sexual dysfunction that have occurred at later points in time. The sexual side effects were reversed in those who discontinued the medication, and in 58% of those who continued treatment the sexual dysfunction was overcome. After the medication is stopped, side effects generally disappear within a few weeks. Anecdotal reports exist where side effects have persisted after discontinuation of therapy, but no clinical trials confirm the claims. This had been referred to as “Post-finasteride syndrome.”

When finasteride is discontinued, all of the hair that had been gained or preserved by the medication is soon lost in the coming weeks or months. In effect, the patient returns to the level of balding where he would have been had he never used the medication in the first place.

Finasteride is not known to cause complications with any other drugs of clinical importance.

Finasteride may decrease fertility in some men, studies are not conclusive in the matter at this time. The effects may be due to changes in the composition of ejaculate and/or a reduction in sperm count. The effects appear to be reversible by simply discontinuing the medication.

What Are the Long-Term Benefits?

The positive effects of finasteride are seen in areas of the scalp that are thinning, but where there is still some hair present. In other words, finasteride does not reverse complete baldness.

It can not promote hair growth in areas that are completely bald. Although it can regrow hair in thin areas, the major benefit of finasteride seems to be in its ability to slow down or halt hair loss. Positive results typically peak around one year after beginning a finasteride regimen.

Results remain stable in the second year or show an almost negligible decrease. Although the long-term ability of finasteride to maintain one’s hair is not fully known, the majority of men find that after 5 years the medication is still maintaining their hair from further thinning or baldness.

The benefits of finasteride will stop if the medication is ever discontinued. Over the 2-6 months following discontinuation, the hair loss pattern will generally return to the state that it would have been if the medication had never been used.

If a patient ever discontinues the medication for extended periods they should be aware that they may forfeit whatever gains were made by having used the medication.

Should I Use Finasteride After A Hair Transplantation?

Absolutely, finasteride has shown itself to be useful in complementing a hair transplant for the following reasons:

Finasteride works best in younger patients who may not yet be a candidate for hair transplantation and need to preserve as much hair as they can until they’ve stabilized their hair loss and are old enough to consider a surgical approach.

Finasteride is less effective in the front part of the scalp than it is at protecting the crown. The lion’s share of surgical hair restoration is used to offer a cosmetic benefit to the frontal scalp and hairline.

Finasteride can re-grow hair, or at least stabilize hair loss, in the back part of the scalp and effectively make future hair restoration to the back of the head unwarranted even if hair loss exists in the frontal scalp.

For those who choose not to take finasteride because they fear potential side effects, or who cannot take it due to being in the minority of people who experience the side effects, then surgical hair restoration is still highly effective. The only difference is that medications can prevent further hair loss whereas surgery cannot.

Medications are not needed for a hair transplant to be successful or the transplanted hair to grow and be permanent.

But medications exist as preventative treatment, mitigating the need for restoration procedures in the future.

 Can I Use Generic Finasteride Instead of Name Brands?

Finasteride 5mg (Proscar) and 1mg (Propecia) are available in generic formulations and are much more cost effective. For those wanting to pursue the most inexpensive route, it is recommended to buy a pill cutter taking ¼ of a 5mg tablet every day.

Most generic brands are just as effective as the name brands; but, if you have consumer confidence issues in your pharmacy’s generics then consider using name brands to ensure the integrity of your finasteride’s effectiveness.

Contact The Gabel Center

To learn more about hair loss and the latest medications and the latest techniques in hair restoration and hair transplant surgery, contact our Portland hair transplant surgery center today.  Our team at the Gabel Center look forward to your visit and discussing these matters with you in greater detail.

Learn About Follicular Unit Extraction (FUE)

Dr. Steven Gabel offers his patients a wide array of hair restoration treatment options and strives to stay on the cutting edge of modern medicine while doing so. One of the most sought after surgeries in the field is follicular unit extraction (FUE), which can cosmetically benefit many patients suffering from hair loss or hair thinning.

Our goal here is to cover the basics about FUE and which patients can benefit the most from having the procedure. It is important to remember that each individual patient is unique and not every case should or can be treated exactly like another. Only a thorough consultation with a qualified doctor can determine your best course of action for having a hair restoration procedure.

What Is Follicular Unit Extraction (FUE)?

Follicular unit extraction, or FUE for short, is the technique where individual follicular units are removed from the scalp one at a time using a tiny, round instrument. The result are small tiny, round scars in the scalp where each follicular unit was extracted. FUE stands in contrast to follicular unit transplantation (FUT), also known as the “strip” method, where an elliptical incision is made in the back of the scalp and all the follicular units are removed at once. The result is a linear scar in the back of the head where the strip was removed.

Each follicular unit graft contains 1, 2, 3, and sometimes 4 hairs. The advantage that FUE has over traditional strip surgery is that while patients will develop scars with either procedure, the FUE method allows patients to keep their hair shorter without noticing the scars, while patients who had strip surgery may need to keep their hair a little longer to hide the scar. Also, some patients do not like the idea of having a long incision and scar in the back of their head – these patients are also ideal candidates for the FUE technique.

The goal from both procedures is a natural appearing result.

Who Is An Ideal Candidate For Follicular Unit Extraction (FUE)?

The ideal candidates for FUE are prospective patients who have good density in their remaining hair at the back of the head and like to keep their hair short. They should have stabilized their hair loss (usually with help from medications, vitamins, or low light laser therapy which Dr. Gabel goes over during his comprehensive evaluations) by the time they choose to undergo surgery. It’s important that patients have realistic expectations about the surgery and what it can achieve, as well as the results.

It is not unusual for FUE procedures to be smaller sessions than FUT (strip) procedures, and it may require more sessions than FUT to achieve the desired cosmetic results.

Is Scalp Laxity An Issue With Follicular Unit Extraction (FUE)?

Some patients have very tight, non-mobile scalps which makes it very difficult to remove the hair via the strip procedure. These patients are ideal for the FUE technique since as the follicular units are removed individually irrespective of how tight a scalp is.

Is Follicular Unit Extraction (FUE) Useful To Correct Scalp Scarring?

Absolutely, FUE tends to be an ideal surgery for people who have scalp scarring from prior procedures. In these specific cases, Dr. Gabel is able to extract several hundred grafts and insert them into a prior strip scar to hide it. Additionally, FUE is often called upon to help blend in hair transplant procedures such as mini grafts and plugs.

Contact The Gabel Center

To learn more about what’s best for your individual case as a hair loss sufferer, please reach out for a FREE consultation with Dr. Gabel. The staff at the Gabel Hair Restoration Center are experienced medical professionals committed to providing each patient with a positive, personalized experience to achieve the best possible results.

Hair Transplant Growth Timeline

Day 0:  Day of hair transplant.

Days 1 – 5:  The first 2 weeks following a hair transplant are the most critical.  Dr. Gabel provides his patients with detailed instruction booklets on exactly how to care for the newly transplanted grafts.  During the first 5 days, patients will experience swelling of the forehead and at the back of the head, which is the donor area.  The skin may also look red at the areas where all the tiny incisions were made for the newly transplanted hairs.  This redness usually resolves after the first week or 2.  After only a few days, the donor area is no longer tender.

Days 6 – 10:  At this point, patients no longer experience any swelling and the redness should only be faint or completely gone.  For each follicular unit transplanted, a “crust” will form which is the attached skin layer drying out.  During this time, Dr. Gabel will have his patients gently remove the crusts by thoroughly soaking the grafts, and then gently rubbing them with a finger.  By day 10, all the crusting should be gone and the transplanted hairs will appear like a “crew-cut” haircut.  Lastly, around day 10, the sutures or staples will be removed.

Continue reading

Watch a Patient’s Real-Time Growth after 3439 Grafts

Day of hair Transplant

I am presenting this patient who had surgery on September 3, 2014, and will display her results every month on this thread to document the progression of growth in hair restoration surgery. This patient had 3439 grafts placed in the frontal hairline and temples to augment and bring down her hairline.

She has graciously volunteered to return each month to my office for the next year so we will be able to present her photographs in real-time. I feel this is instructive for patients inquiring about the progression of hair restoration surgery and how they may look each month.


Continue reading

What is a graft?

A graft simply refers to a follicular unit, which may be a 1-hair, 2-hair, 3-hair, 4-hair, or even a 5-hair follicular unit graft. When hair transplants are performed, the single hair grafts (or follicular units) are inserted into the frontal hairline. Just behind the hairline, the 2-hair follicular unit grafts are placed to add density to the hairline, and behind these are the larger grafts to ultimately add density to the entire scalp and hair restoration procedure. The following diagram shows a close up of 1-hair, 2-hair, and 3-hair follicular unit grafts. Continue reading

Follicular Units

Follicular units are naturally occurring groupings of hairs. They are sometimes referred to as “grafts“. When hairs are examined using a high powered microscope, hairs exit the scalp and skin in “families” of 1, 2, 3, 4, or 5 hairs bundled together. These usually exit the skin at one central location and then fan out over the skin. Not infrequently, one may see 2 hairs exit and a single hair exit very close it each other – this is considered a 3-haired follicular unit. As shown in the photo below of a close up photograph of the scalp, there are distinct groups of hair that are exiting the scalp. When Dr. Gabel and his team perform surgery at his Portland hair transplant office, we refer to the follicular units as grafts. Continue reading

Will I have scar from a hair transplant procedure?

There are many causes of scarring, and scarring can be divided into two categories:  external surgical factors and inherent patient factors.  The most important concept to understand is that anytime an incision is made, whether it is a linear incision, or a small round circular incision, a scar will be formed.  Our hope at the Gabel Center is that every scar is minimal.  Some of the surgical factors that cause increase scarring is poor surgical technique, taking too wide of a strip, making too large of a circular punch, or operating in a prior area of scar.  On the other side of the coin, some patients are  more prone to forming a scar then others because of their genetic makeup and collagen strength.  When assessing patients at our Oregon hair transplant clinic, Dr. Gabel will obtain a detailed history on each patient to determine how they have healed in the past with surgical procedures.  There are also some physical characteristics that predispose patients to scarring.  When Dr. Gabel examines his patients, he will discuss the risk of scarring prior to any hair transplant procedure.

FUE, FUT, and the strip method?

FUE is an abbreviation for follicular unit extraction and FUT is an abbreviation for follicular unit transplantation. You may also see FUT called the strip method.

FUE is a method in which a small punch- like device is used to remove individual follicular units from the donor area. With FUT or the strip method a piece of hair bearing scalp is removed from the donor area. The wound is then stitched or stapled closed.