EP 333: Understanding Frontal Fibrosing Alopecia: Hope, Treatments, and Hairline-Saving Strategies

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A creeping hairline can feel like a shrinking sense of self. When a longtime client whispered “something’s wrong,” we opened a conversation many people need but rarely get: how to recognize frontal fibrosing alopecia, why it’s not “just aging,” and what you can do right now to protect your hairline and your confidence. We unpack the early signs—smooth, pale bands at the front, thinning brows, scalp tightness—and explain why scarring alopecia demands quick, informed action instead of another round of growth serums.

With clarity and compassion, we walk through treatments dermatologists use to halt progression, from low‑dose oral minoxidil and dutasteride to topical or injectable steroids, plus when options like hydroxychloroquine, mycophenolate, or PRP make sense. You’ll hear how to build a supportive daily routine with gentle, fragrance‑free shampoos, minimal tension styling, and smart sun protection, along with practical product examples for sensitive scalps. We also talk timing for hair transplantation, setting true expectations around stabilization, and styling techniques—face‑framing cuts, soft fringe, nuanced color—that can restore balance while medicine does its job.

This conversation doesn’t shy away from the emotional side. Hair is identity, and losing it at the front is personal. We share a client story that moves from fear to a three‑year stable hairline through early diagnosis and an aligned plan between dermatologist and stylist. If your forehead seems to be “growing,” don’t wait—book a dermatologist, bring photos, ask about FFA, and focus on protecti

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Episode Transcript

SPEAKER_00 (00:00):
I'll never forget the day one of my longtime

(00:02):
clients, let's call her Anne.
She sat in my chair.
She ran her fingers over herhairline and said softly,
something's wrong.
My forehead feels bigger everymonth.
She'd just gone throughmenopause and the receding
thinning band at the front ofher hairline terrified her.

(00:22):
If this sounds familiar, you'renot alone.
Today we're talking about acondition that dermatologists
say is becoming more common.
It's called frontal fibrosinealopecia, or FFA.
Welcome to All About Hair, wherewe talk shop, share stories, and

(00:43):
spill the secrets behind greathair and a great career.
I'm your host, Denise Keilitz, aformer salon owner, educator,
and a lifelong hair crusader.
Whether you're a new stylistbuilding your book, or just
someone who loves learning aboutall things hair, you're in the
right place.

(01:08):
For many women, menopausealready brings hot flashes,
sleep changes, and shiftinghormones.
Add to that the heartbreak ofhair loss, especially when it's
right at the front hairline oreven in your eyebrows, and it
can deeply affect how you feelabout your appearance.
This isn't just about vanity.

(01:29):
Hair is part of our identity.
The hardest part?
FFA is tricky.
It's not the same as everydayshedding or genetic thinning.
It's an autoimmune scarringalopecia, meaning the body
attacks its own hair follicles,leading to permanent loss over

(01:50):
time.
Most women haven't even heard ofit.
It's often mistaken for amaturing hairline or normal
postmenopause shedding untilit's progressed.
I once had a guest who spentmonths trying growth serums and
scalp massages thinking shecould stimulate her hairline
back.
But with scarring alopecia,those things don't reverse the

(02:11):
process once follicles aredestroyed.
First things first, there isalways hope, especially when we
catch this early.
FFA is an inflammatory processwe still don't fully understand.
Some researchers suspecttriggers like certain sunscreens
and moisturizers and makeup orcontact allergens, but studies

(02:35):
are ongoing.
What we do know is this FFA isirreversible once scarring sets
in.
That's why early diagnosis andtreatment matter so much.
Dermatologists typically use acombination of tools to halt the
progression of this and protectthe remaining hair.
First off, there's medicaltreatments.

(02:56):
The most effective combinationsso far include oral monoxidil
and deustasteride.
I am not a medical person, guys,so forgive my pronunciation of
words, but doasteride.
I'll leave it in my show notes,so in case you want to look it
up.
So sometimes with topical orinjectable steroids, and this

(03:19):
helps to calm inflammation.
Other medications, such ashydrozychloroquine.
Sorry, I am not a medicalperson.
Mycophenolate.
I'm gonna leave these all in theshow notes.
I'm sorry, I'm slaughteringthem, slaughtering them.
And this is really importantinformation.

(03:41):
So I will leave all of these inthe show notes.
But anyway, there's othermedications that can be used.
Some clinics even add the PRP,which I can say, platelet-rich
plasma, to support scalp healthand encourage stronger growth
where follicles remain active.
There's also you want to havesupportive hair care.

(04:01):
Be gentle, avoid harsh styling,tight ponytails, or chemical
stress.
Protect your scalp from the sunwith hats or SPF.
And then also, also, you have tohave realistic expectations.
Regrowth is rare once folliclesscar, but stopping further loss

(04:22):
is possible.
If the disease stays stable for6 to 12 months, hair
transplantation can sometimeshelp restore the hairline.
You also want to usescalp-friendly products.
While they can't cure this,using products designed to
support scalp health and reduceinflammation can help keep the

(04:43):
area calm and maintain existinghair.
And also get emotional support.
Hair loss right at the face canfeel deeply personal.
I can tell you just from my ownexperience with hair loss and
having alopecia, I could hide itbecause it was on spots

(05:05):
underneath my hair, and I couldstyle my hair in such a way that
no one knew that I had alopecia.
But when it is right at yourhairline, and if you've never
heard of this, you might noteven know what I'm talking
about.
And so I will put a few links infor um pictures.
So if you are curious, you cango look.

(05:28):
But it's actually losing yourhair at your hairline, and your
hairline just gets further andfurther back.
And it could feel really, reallypersonal, and it could really
take a toll on yourself-confidence.
So just having a supportivehairstylist, seeing a
dermatologist early, and eventalking to a therapist can help

(05:50):
you feel more in control.
One of my clients, she came indevastated after noticing her
forehead kept creeping higherand higher.
She finally saw a dermatologist.
She started a prescriptiontreatment early, and we adjusted
her haircuts and her hair colorto frame her face.
So today her hairline has stayedstable for about three years,

(06:13):
and more importantly, she feelsempowered, not defeated.
Look, if you're postmenopausaland if you're noticing your
hairline changing, don't wait.
Just don't wait and hope it'sgoing to stop.
FFA cannot be reversed once thefollicles scar, but it can be
slowed down and it can bemanaged with the right care.

(06:36):
And even if regrowth isn'tpossible, there are beautiful
styling options and medicaltreatments to help you feel
confident again.
I would love to answer yourpersonal hair loss questions in
an upcoming episode.
After this episode, stay tunedbecause I'm going to answer some
that I've put together about FFAbecause I know people have asked

(07:01):
me about it.
But if you have any personalquestions about hair loss or any
hair questions, just send themto me.
You can email me or message meon my Instagram at all about
hair with Denise or DeniseKeiletz, and I might feature one
of your questions anonymously ifyou prefer on a future episode.
Let me start with somequestions.

(07:22):
How do I know if my recedinghairline is FFA or if it's just
normal aging?
That is a freaking terrificquestion.
So you see a normal maturinghairline changes slowly and it
doesn't cause redness oritching.
FFA often shows as a smooth,pale band of skin where hair

(07:44):
used to grow, sometimes withtiny little lonely hairs left
behind.
You may also see eyebrowthinning or feel scalp tightness
or tenderness.
If you notice these signs, seeyour dermatologist.
They can confirm with a scalpexam or a biopsy if needed.
Another question.

Another question (08:35):
are there gentle shampoos or ingredients
that won't irritate a sensitivescalp?
Absolutely.
Look for sulfate-free, siliconelight, and fragrance-free
shampoos.
Ingredients like aloe vera, oatextract can soothe irritation.
Brands such as Euphoras Nourish,Vanna Cream Free and Clear, or
the Rootus Densify Cleansers aregreat examples of these.

(08:58):
You want to avoid harshdetergents and heavy buildup
silicones.
I will leave all these links inmy show notes.
How soon should I see adermatologist if I'm worried
about my hairline?
Girl, right away.
FFA causes scarring.
Once follicles are gone, they donot grow back.

(09:19):
Early treatment can slow or evenstop progression.
So don't wait until you seesignificant change.
And finally, does stress or dietplay a role in triggering this?
No.
Stress doesn't directly causeFFA, but it can worsen
inflammation and contribute toother shedding types that make
FFA feel worse.
Diet matters because low iron,vitamin D, or protein can

(09:43):
compromise hair health, keepingnutrition balance supports in
any medical treatment you'reusing.
Alright, there you have it.
If this topic hits close tohome, know that you're not alone
and you're not helpless.
Start by seeing a dermatologistand being super gentle with your
hair and your scalp.

(10:04):
Knowledge and early action canhelp preserve the hair you have
and your confidence along withit.
For more education and support,always, always subscribe to my
channel, subscribe to my YouTubechannel, and wherever you listen
to podcasts, make sure youfollow, share this with anybody,
any of your friends who mightneed this information.
And don't forget to go grab myfree hair growth protocol sheet

(10:28):
over at deniseilets.com forwardslash thinning hair.
I'll leave the link in the shownotes.
And remember, when you knowbetter, you do better.
Thanks for tuning in to AllAbout Hair.
If you loved this episode, hitsubscribe, leave us a review,
and share it with a fellowstylist or hair loving friend.

(10:48):
You want more tips, tools, andbehind the scenes goodness?
Follow me on YouTube or head tomy website at deniseKeilitz.com.
Yes, I know it's hard to spell,so don't worry, the link is in
the show notes.
Until next time, keep learning,keep creating, and keep loving
what you do.