Thinner and Tighter Scalps in Balding Men

Over the years, I have read a number of articles and studies that discussed how balding men’s scalps are tighter and thinner than the scalps of non-balding men. In tandem with fibrosis, this leads to permanent hair loss once the male androgen hormones have started the damage.

Update: January 2020 — A new study from Taiwan concluded that androgenetic alopecia is associated with increased scalp hardness.

Scalp Fat Loss and Tightening in Hair Loss Sufferers

Even in 1954, there were already theories that perhaps fat loss on the scalp was to blame for hair loss. Maybe dihydrotestosterone (DHT) spurred androgenetic alopecia affected some people more than others? i.e. It depended on how susceptible individual scalps were to losing fat layers and fat cells and becoming thinner. Even further back, in 1942, Dr. Frederick Hoelzel postulated a baldness and calcification of the ivory dome theory.

Scalp Thickness Males Females
Scalp thickness differences in males and females. Epidermis, Galea, Dermis and Hypodermis. Source: Journal of Investigative Dermatology, June 1972.

Thinner Scalp Layers in Balding Men and Women

Another old study from 1972 concluded that in advanced stages of baldness, all skin layers of the scalp other than the galea exhibit significant thinning. In the image above from that study, the scalp thickness at different layers is shown in men versus women. The four main layers are the epidermis, galea, dermis and hypodermis.

Fibrosis, calcification, thinning and increased scalp tension are all part and parcel of male and female pattern hair loss. In addition, this entire inflammatory process can often lead to increased dandruff and skin flakes.

Kerastem, ADSC, AAPE and SVF

I have covered the issue of fat cells and hair growth numerous times on this blog in the past. Kerastem is perhaps the most important company in relation to this area of hair loss treatment. Stromal vascular fraction (SVF) enhanced adipose transplantation is the more technical name of this method of trying to regrow hair. In effect, you want to make thinner scalps thicker again.

Also make sure to read my posts on adipose derived stem cells (ADSC) and hair growth; and the related AAPE for hair growth. Sooner or later, I think that these technologies will become better and more reliable. They will probably never regrow hair on completely bald regions of the scalp. However, anything that can permanently maintain and strengthen existing hair is a huge success.

Could Botox Stop Further Scalp Thinning and Fibrosis?

After I wrote my last post on Botox and hair growth, I received an interesting email from a surgeon named “Gabriel P”. I am pasting it verbatim below, and hope to hear back from him in the next few months.

I wanted to share with you my story as a surgeon with hair loss maybe it could help our community.

Ok Hear me out.

Preface: Been losing hair for a number of years 10+. I am now 32 years old. I even went through a few hair transplants utilizing body hair and beard hair. I’m a surgeon myself so I tried everything I could in terms of medical literature defined what could help me with my hair loss. I didn’t want to try Propecia because of side effects and I like my sex life. So here’s what I’ve tried that has only marginally helped.

  • Metanx (prescription grade vitamin b12/ b6).
  • Nizoral (helps scalp inflammation in the very short term).
  • Hair transplant (my donor hair in the new transplanted areas also starts to thin so i transitioned to beard and body hair to some success).
  • Scalp massage using a cheap Wahl body massager (helps break down fibrosis in the scalp and promote blood flow).

That is about it. I’ve had this theory for a while now. With scalp hair loss and decreased blood flow.In a type lower extremity surgery I do, we bring blood flow to the legs utilizing an angio. The leg skin then goes from thin and shiny and no hair growth, to more malleable and better quality thicker skin.

If you look at patients with peripheral vascular disease, their skin on the legs will be very thin shiny and there will be almost no hair growth in the foot and ankle area.

The same goes for the balding scalp; most bald men in the Galea Aponeurosis area have thin and shiny skin and you can almost see the demarcation. people who aren’t bald don’t have this phenomenon on their scalps.

I thought to myself- “Why is it that my scalp itching started when my skin started getting shiny, thin and super tight- and why is it that when my blood pressure goes up my hair feels better? Or why my scalp itch goes away after a good nights rest when I’m in supine position, only to return during the day?”

The frontalis, temporal and occipital muscles all pull at the scalp and galea from different directions. We’ve had DHT pumping in our blood since puberty but my hair loss didn’t start then so whats the deal? I believe that as this skin gets tighter fibrosis occurs and the hair starts to miniaturize because the DHT or whatever it might be is not able to be washed out. This is only one factor, but I think its a key factor to fighting hair loss.

Back to botox: Botulinum toxin prevents muscle contraction for a very long time. To my knowledge there is only one study that studied the effectiveness of botox on the scalp- here it is:

Relatively small study, with good results. Apparently women have been using botox to keep their hair straight, but what I wanted to do was inject in the areas of the muscle tendon attachments to see if I can restore blood flow to the area as a result of loosening the scalp and the galea apopneurosis.

So I did. I have a plastic surgeon who I work with who I punted this idea to and we injected my scalp with botox loosely following the protocol in the paper. I wont go into the details, but its been a week so far and my scalp itch is COMPLETELY GONE. I cannot emphasize how this is NOT placebo and something definitely changed.

Whether it will last I will keep you updated. So far my scalp itch is gone and shedding has gone down a bit, but no regrowth bc its too soon for that. My hair feels significantly less limp as well. Botox lasts around 3 months so this should feel good for about the same time. I doubt I will get regrowth, but if I can keep what I have, its a win.

55 thoughts on “Thinner and Tighter Scalps in Balding Men”

  1. I like this doctors approach. He did his homework and made an educated decision to try something that has some validity. I thank him for reaching out to admin. Sir, please take plenty of pics asap and along the way. I hope that he keeps us posted and wish him the best!

  2. This sounds interesting.
    I wonder if someone else on the forum tried injecting botox into scalp. If so please share your story.

  3. Meanwhile Histogen at it again lol..CEO spouting some crap about potential partner and some Phase 1 for men ..LOL 12 yrs on, u couldn’t make it up

    1. Don’t get me wrong, Histogen made a lot of mistakes. But only business-wise, and legal-wise. They f***** up big time over and over again, Naughton is not an entrepreneur, she is a scientist. That’s why Pascoe is on board now, with Allergan in the background.

      The product is rock-solid. The pictures from 2012 were amazing, given that the new protocoll is even better and repeated treatments, it has the potential to be a cure.

      I believe in Histogen.

  4. Ask this “Gabriel P” to give you his full name, registration number, the University he graduated from, then phone the American Board of Surgery on 215-568-4000 to verify he is an actual surgeon, or equivalent if from a different country.

      1. There is no evidence whatsoever that muscle tension causes male pattern baldness.
        When Dr Gabriel generates it, we shall talk about it.

    1. I’m glad others have doubts about this “Doctor Gabriel”, I thought it was just me. I’m suspect of a doctor that states “I didn’t want to try Propecia because of side effects and I like my sex life.” A very biased statement that counters the data. Really, what kind of doctor would phrase concerns about side effects like that?

      1. Hey Admin, I noticed that all my comments go into “moderation” ever since we had a debate over sides from Dut, where previously they sailed right through. Hmmmm, interesting, did I say something out of hand? :-) I even watch the curse words as I know you don’t like those. If you prefer, I don’t comment so you can have a purified forum.

        1. Almost everyone’s comment goes to moderation first.

          In any case, any comments suggesting side effects are nil (or demeaning people who are getting sides) need to be tempered. Especially when it comes to Dutasteride, where there are some concerning new reports.

          I doubt that I have disapproved any of your comments recently, even if first in moderation queue.

          Regarding curse words, a lot of times the plugin I use sends comments with suspect words to the spam folder (which I rarely check). So it is a good idea not to use profanity anyway… irrespective of my preference.

            1. Hi Steve,

              My guess it that for every 10 studies that show few or negligible rates of side effects, there will be 1 that shows concerning rates of side effects. More so for Dutasteride than Finasteride for obvious reasons. I was trying not to scare people until there is more clarity and more studies come out.

              e.g., Read the below one fully, but do your own research to see how many others agree with the conclusions, or can replicate these findings:



              I have seen 3 recent studies from different countries (two of which I pasted last week in response to Yoda) that suggest a connection with 5 alpha inhibitors and increased liver fat, body fat, cholesterol, insulin etc… not too surprising, since changes in testosterone and estrogen affect a lot of things. Hopefully, most people will only see negligible increases in these negative factors.

              I am still planning to continue taking Dutasteride, but will be monitoring new studies on the subject and am not just assuming the best case scenario.

              1. Side effects are present for some user there is no denying that.
                I am using dutasteride for some time.
                At the beginning I had a slight loss of libido but after a while I don’t have that problem anymore.
                I guess since I workout a lot I don’t have some of the sexual related side effects that some users report.
                I think that people that are not physically active tend to have those side effects when using dutasteride.
                Also hair regrowth just kicked in these last days so I guess avodart started doing its job.

          1. Good to know, thanks Admin and for all the knowledge you bring to the table. I don’t think you’ve censored any of my comments, just found it odd that for a while I wasn’t being “moderated” and now I am. Also don’t believe I berated anyone who get’s sides but I do push back very hard on those who suggest that everyone who takes a drug will get sides and also those who claim sides that are not indicative to that particular drug, e.g. facial aging from topical minoxidil.

        2. For what it’s worth, my comments always go to moderation and I don’t believe that I’ve ever gotten in Admin’s bad side :)

          1. Yeah, I was always moderated but when I became a regular it went away, now it’s back. No big thang! BTW love the post name Dwight was awesome!

      2. A long time ago when Propecia came out I decided to give it a try, after a few months my libido was gone, like erased! Eventually I ended up divorcing my unfaithful wife, you do the math lol I spoke with a female pharmacist at the time and she told me that she knew several Propecia users (most of the users actually) who experienced the same side-effects, It took me years to regain a normal libido when some of her customers never got it back. If Propecia works for you, congrats man ! …if you’re just a troll paid by Big Pharma, there’s a special place for you in hell ;-)

        1. I’ve been using finasteride for over 15 years and I’ve never had any problems, I’m 46 years old and I’m still as horny as the devil. Most of the time when people have problems it’s all mental. I guess you and your ex wife didn’t get along…

          1. Lorence, for once we agree! I’m a longtime fin user (over 20 years) and Dut for now around 2 years. Sides on forums are overblown. Grant, I’ll let you know when big pharma sends me my check for hawking cheap, generic drugs…really dude?

    2. The registration number is actually an NPI number, and no I won’t give it to you Bc I value my privacy and the privacy of my patients. I will however update this follow up

  5. From the same researcher that brought you the study, “Air Pollution Causes Hair Loss”, comes the latest: Working Longer Hours Causes Hair Loss.

    “The study found that people who were in the much longer grouping — i.e. those working more than 52 hours a week — had nearly a 4% increase in alopecia. Specifically, twenty and thirty-somethings had twice the alopecia development rate as someone in the same age range working less than 40 hours a week, according to the study.”

  6. As a young guy I feel along with hair folicles more research should go into scalp and skin surrounding the hair folicle as the cure might be as easy as adding more fat cells to balding areas or atleast could be one of the cures as the thinning and balding scalps are generally drier and thinner. Hope this provides useful for research and a cure is there for all of us soon.

  7. If this matters but Aclaris is starting to come back thought for sure they were heading for bankruptcy. Instead it appears they are turning around fast. Maybe they have positive news?

    What I like about their potential cure is its simply a lotion to put on heads that should lead to a return of our natural hair, and hairline. The turnaround has been brought on by positive news on their warts product however if they stay in business they can continue the research on hairloss at least with existing research applications. Will it be in 2020? We are to know about the Increase in JAK trial results by early summer 2020 brace yourself.

    1. That’s a correlation.
      Correlation does NOT equate causation!

      If mechanical stress leads to androgen-mediated alopecia, our knees should suffer hair loss, too.

      Until evidence proves the causal relation between galea tendon tension and AGA, there is no point in discussing it, apart from ways whereby one could generate the necessary evidence.

  8. Admin,

    Since this blog is about a potential hairloss cure in 2020, is there any chance that you might do a post which summarises the current situation of the key hairloss companies?

    Of course, I’m not asking for a dissertation-sized post that lists every company working on a potential cure! I’m thinking about a brief-ish post that lists the top three (five?) companies, where they are (in terms of development), what we are waiting on (in terms of news, the next stage), and stuff like that.

    Hope this doesn’t sound cheeky! It is intended as a polite request / suggestion. Thanks again for all the good work.

    1. Paul, I would say that the only possible cure by the end of 2020 is Tsuji if he keeps to his word.

      For all others, the best thing to do is to check the category archives (see sample links below) for the last update.

      e.g., (though these guys now seem to be going back in time per recent update).

      1. Ya know admin, when you first started this blog I thought the 2020 aspect was a bit conservative. Now sadly it’s become a stretch. I don’t feel that it will be too much longer than that however I believe that it won’t be Tsuji, that will be years out as an accessible treatment, if it even comes to fruition.

  9. Gents,
    There is guy who made a comprehensive analysis and studied all these multi facet angels of hair loss.
    And came up with real objective evidence theory and solution for hair loss.
    I know how this sound like a cheap commercial but i read his book as a critique and couldn’t critique it.
    This is his website/book .
    Worth checking out.

      1. Haha sorry for jumping the gun then.
        I am glad that you also detected Rob under your radar would be really interested to see your comprehensive take on his theories.
        And thank you for all the time and effort you put into this forum.

      2. Wow I came here today just to ask you what you think of Robs latest ”peer reviewed study” and the phenomena of his scalp massages. I read his e-book and while a lot of his writing mostly signals a serious approach to science there are in my view some warning bells in the way he has chosen to set up his business. With the new study I was again curious if he is actually on to something though. Can’t wait to hear your take on it!

  10. He made a couple confusing and slightly contradictory points about blood pressure and hair loss. For instance, sleep lowers blood pressure, yet the doc reports it correlating with a subsided scalp itch (my itch also subsides with sleep), while at the same time saying when his blood pressure is higher the itch is also better. Blood pressure usually spikes during the middle of the day. Also meds like spironolactone and oral minoxidil lower blood pressure. Granted minoxidil being a vasodilator potentially improves blood flow to the scalp.

    The best point he made however that I think might have some validity is the comparison between the legs of vasculitis patients and the scalps of balding men. Thus blood flow being paramount for hair growth.

  11. If anyone with knowledge in biology/physiology etc could answer as I’ve searched for it a week ago and haven’t found and answer:

    (1) What happens to the injected botulinum toxin after ~3 months in the body? Does it somehow “disintegrates” and leaves the neurons’ receptors it binds to or rather does the body simply grow new neurons?

    (2) How could you explain the fact that people injecting it over many years report that as time goes by the time span required between injections gets longer (eg: 3 months, then 4 months, then 6 months…)?

    (3) If its effect should disappear with time as doctors advertise then how come one can have long-term side-effects from its use?
    – see article:
    – see study:

    I’m honestly interested about those questions so if someone have info please respond.

  12. Thanks, admin. For the record, I don’t think that we will have lots of cures next year! I was wondering about the current status of potential cures.

  13. Question Regarding Oral Minoxidiol:

    Recently, I asked my GP about oral minoxidil for diffuse thinning. He could see that I done some research, but he said that he couldn’t prescribe it to me. He was willing to refer me to a dermatologist, who might be able to.

    So, my question is this: How can I get a dermatologist to prescribe oral minoxidil? Are there any specific research papers I could show them? Are there any GPs I could contact for a referral of sorts?

    Any advice would be appreciated.

    1. My derm prescribed it, he’s a doc that’s fairly versed in hair loss and actually bought up some of the recent studies. I also send him info on coming treatments (some from this site, thanks admin!). I would search for a doc that has hair loss listed as one of their focus areas.

  14. Aclaris comes out with its High Dose JAK trial results in early summer. We have to wait for the results but it might not be much or it could be what we have all waited for. Aclaris has been incredible in sticking to their timelines.

  15. I got FUE 7 months ago, looks like it failed.. hair still stubble.

    What does this mean for me in future treatments like hair cloning? Will it not work for me?

    I need answers

    1. It depends. There are many factors that affect the result of fue so you wont know for sure what was cause for the weak result.
      Try using one of the big three or a combination of them and see what works for you.
      There is no definitive cure and there wont be one in the near future so try to at least maintain what you have.

  16. Hey guys just wanted to post a 5 week update and state that although my scalp is a bit looser than before, the MPB itch has returned and the hair loss has continued. There was a difference initially but the shed is severe now and I dont think botox for the scalp is a good answer.

    Thanks Admin for hearing me out. I am experimenting with EXOFLO (exosomes) on the scalp on Dec 5th

    1. Hi Gabriel, which doctor are you going to see for the exosome treatment? Maybe you can leave feedback in the actual post on exosomes that I wrote? Thanks and good luck!

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