Frontal Fibrosing Alopecia and a Receding Hairline: Hairpiece Options for Women

Frontal fibrosing alopecia, usually shortened to FFA, is a scarring form of hair loss that causes the hairline at the front and sides of the scalp to recede, often together with the eyebrows. It mostly affects women after the menopause, and because the follicles it destroys cannot regrow, medical treatment focuses on slowing or halting it rather than restoring what has already gone. For the hair that has been lost, coverage works particularly well because FFA affects a defined band around the face: A frontal hairpiece recreates the hairline itself, a fringe piece can soften milder recession, and a half wig or full wig suits women whose hair loss extends further.

Key points include:

• What frontal fibrosing alopecia is and who it affects
• The early signs worth taking to your GP
• What treatment can and cannot achieve
• Why a receding hairline is harder to disguise than general thinning
• How a frontal hairpiece recreates a natural hairline
• When a fringe piece, topper or wig may suit you better
• Eyebrows, styling and everyday confidence
• What to expect from the hairpiece process

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Many of the women who come to us with frontal fibrosing alopecia have spent years being told that a receding hairline is simply part of getting older. By the time they have a diagnosis, they have usually tried every fringe, side parting and headband they own. What they want most is not more hair everywhere, but their hairline back, in exactly the place it used to be. This guide explains the condition and the coverage options that work.

WHAT IS FRONTAL FIBROSING ALOPECIA?

Frontal fibrosing alopecia is a type of scarring alopecia. Cells from the immune system cause inflammation around the hair follicles along the front of the scalp, and over time the follicles are destroyed and replaced by smooth skin. The hair margin above the ears and the eyebrows are often affected too, and some people notice hair loss elsewhere on the body. 

FFA occurs mostly in postmenopausal women, although it can also affect younger women and men. The cause is not yet understood. Genetics, immune activity and possibly hormones are all thought to play a part, and the condition appears to have become more common in recent decades. Researchers have looked closely at leave-on facial products, including sunscreen, after some observational studies found an association, but no direct cause has been established, so it is best not to change your skincare or sun protection without speaking to your dermatologist first.

THE EARLY SIGNS WORTH TAKING TO YOUR GP

The defining sign is a hairline that moves steadily backwards at the front and temples, sometimes over several years. Eyebrow thinning often appears alongside it, and in some women it comes first. The skin where hair used to grow may look paler, smoother or slightly shiny compared with the rest of the forehead, and there can be redness or flaking around the remaining hairs. Some people feel itching or burning in a band along the hairline, while others have no symptoms at all.

This is quite different from female pattern hair loss, where the hairline usually stays in place while the hair on top becomes less dense. The two can occur together, which is one reason a proper diagnosis matters. If you recognise these signs, ask your GP for a referral to a dermatologist, ideally one with an interest in hair, or a trichologist. Our guide to the main types of alopecia explains how the different conditions compare.

WHAT TREATMENT CAN AND CANNOT ACHIEVE

A dermatologist will usually examine the scalp closely and may take a small biopsy to confirm the diagnosis. Treatment aims to calm the inflammation and slow or halt the recession. According to the British Association of Dermatologists, options include steroid creams or lotions, steroid injections into the hairline, tacrolimus ointment, certain antibiotics used for their anti-inflammatory effect, hydroxychloroquine and other medicines that regulate the immune system. Where pattern thinning is also present, finasteride or dutasteride may be considered.

It is important to be realistic about what treatment can do. Results vary from person to person, some people do not find a treatment that works for them, and once a follicle has been lost it cannot produce hair again. The value of early treatment lies in protecting the hair you still have. Coverage and treatment work well together: Many of our clients wear a hairpiece while their dermatologist manages the condition. If you are weighing up longer-term routes, our comparison of wigs, hair transplants and medication sets out the differences.

WHY A RECEDING HAIRLINE IS HARDER TO DISGUISE

General thinning can often be helped with a good cut, volumising products or a change of parting. A receding hairline is different, because the hairline frames the face and is the first thing people notice. Styling a fringe forward can help in the early stages, but as the recession progresses there is less hair to work with, and the bare skin at the temples becomes harder to hide, particularly in wind or when hair is tied back.

Some women try hair extensions or tightly secured styles to fill the gap. These need care, because constant tension on fragile hair at the front can cause a separate type of hair loss called traction alopecia. A hair topper is not usually the answer either, as toppers are designed to add density across the top of the head rather than recreate the edge of the hairline. What is needed is something designed specifically for the front.

HOW A FRONTAL HAIRPIECE RECREATES A NATURAL HAIRLINE

Our Frontal Hairpieces were designed for exactly this situation. Rather than covering the whole head, a frontal hairpiece replaces only the hair that has been lost along the hairline and temples, so your own hair remains everywhere else. Each one is handmade on a wooden block shaped to a template of your head and your pattern of hair loss, using our super fine, lightweight foundation material. Fine European hair is then knotted into it strand by strand, following the direction of natural growth, so the new hairline looks as though it is growing from the scalp.

The hair is matched to your own in colour, texture, length, density and degree of curl, so it blends into the rest of your hair once it has been cut. Density is particularly important at the front: Too much hair looks just as unnatural as too little, and a softer, slightly irregular edge is what makes a hairline believable. Your frontal hairpiece is secured with a combination of double-sided medical tape and small clips, and we teach you how to attach, remove and style it yourself at home.

Seeing a finished hairline makes the result much easier to picture than any description, and our gallery shows the kind of natural finish we aim for. For a client’s own account of wearing a custom piece at the front, Mary Killen describes what she loved about our custom hairpieces.

WHEN A FRINGE PIECE, TOPPER OR WIG MAY SUIT YOU BETTER

Not everyone with FFA needs the same solution, and the right choice depends on how far the hair loss extends and how you like to wear your hair. Where the recession is mild and you are happy to wear a fringe, fringe pieces can be a lighter way to soften the front. Where FFA occurs alongside thinning on top, a hair topper may be combined with frontal coverage, or a single piece designed to cover both areas may work better.

If the hair loss has spread well beyond the hairline, or you would rather not have to blend a piece with your own hair each day, a half wig or full wig gives consistent coverage. A ReadyMade wig can be chosen, cut and styled in a single visit, while a Made to Measure wig is built around your own head shape, hairline and density. Our Swish lace front wigs offer a natural lace hairline at a wider range of price points. Our page on wigs for alopecia explains how we approach each stage of hair loss.

EYEBROWS, STYLING AND EVERYDAY CONFIDENCE

Eyebrow loss is one of the most noticeable features of FFA, and for many women it changes the face more than the hairline does. Brow pencils and powders, and for some people semi-permanent brow tattooing, can restore definition. We have written about why losing brows and lashes is more than cosmetic, and it is worth giving this as much thought as the hairline itself.

Day to day, the most common concerns are security and whether anyone will notice. A well-fitted frontal hairpiece is designed to stay in place through normal activity, and our guide to how secure a wig really is covers wind, rain and exercise in more detail. Because the skin at the hairline can be sensitive in FFA, it is worth mentioning any redness or irritation at your fittings so the attachment can be adjusted. A correctly fitted piece should not harm your own hair, as we explain in Do Wigs Cause Hair Loss?

WHAT TO EXPECT FROM THE HAIRPIECE PROCESS

A frontal hairpiece involves three visits to our London studio. At the first, we get to know you and your hair loss, explain how the process works and, if you would like to go ahead, create a template of your head shape and hair loss pattern and show you samples of natural European hair. At the second, we confirm the shape of the piece, adjust the hairline if needed and show you the hair we have sourced for your approval.

Once the hairpiece has been hand-knotted and finished, you return for a final fitting, where our stylists cut and dress it on your head so it blends seamlessly with your own hair. We then show you how to secure and care for it, and provide filmed tutorials you can watch at home. Clients with medical hair loss are VAT exempt, and your personalised price is given at the initial consultation.

HOW MANDEVILLE LONDON CAN HELP

For more than 50 years we have made handmade wigs and hairpieces for every kind of hair loss, and frontal fibrosing alopecia is a condition we see regularly. Our private Fulham studio is calm and unhurried, we see clients by appointment only and friends and family are welcome. Knowing what to expect from a wig consultation can make the first visit easier, and our price guide sets out costs openly. When you are ready, you can book a complimentary consultation and we will talk you through the options that suit your hairline.

FINAL THOUGHTS

A diagnosis of frontal fibrosing alopecia can feel final, because the hair it takes does not come back. What it does not take away is the possibility of a natural hairline. Seek dermatology care early to protect the hair you have, and know that a carefully made frontal hairpiece, fringe piece or wig can restore the frame around your face so that you recognise yourself in the mirror again.

FREQUENTLY ASKED QUESTIONS (FAQ)

What causes frontal fibrosing alopecia?

The exact cause is unknown. Immune cells cause inflammation that destroys the hair follicles along the hairline, and genetics, immune activity and possibly hormones are thought to play a part. It is not usually inherited.

Can hair grow back with frontal fibrosing alopecia?

Not in areas where the follicles have been completely lost, because FFA is a scarring alopecia. Treatment can slow or halt the hair loss in some people, which is why early dermatology care is important for protecting the hair you still have.

Does sunscreen cause frontal fibrosing alopecia?

Some observational studies have found an association between FFA and leave-on facial products, including sunscreen, but no direct cause has been proven. Speak to your dermatologist before changing your skincare or sun protection.

Is a hair topper suitable for frontal fibrosing alopecia?

Not usually on its own. Toppers add density across the top of the head, while FFA affects the hairline itself. A frontal hairpiece is designed specifically to recreate the hairline, although a topper can help where FFA occurs alongside thinning on top.

How is a frontal hairpiece attached?

Our frontal hairpieces are secured with a combination of double-sided medical tape and small clips. We teach you how to attach, remove and style the piece yourself, and the attachment can be adjusted if the skin at your hairline is sensitive.

How many appointments does a frontal hairpiece need?

Three. The first is a consultation and template fitting, the second confirms the shape and hair match, and the third is the final fitting, where the piece is cut and dressed on your head.

Can I wear a frontal hairpiece while I am having treatment?

Many clients do. It is sensible to let your dermatologist know, particularly if you are applying creams to the hairline, and to mention any redness or irritation at your fittings so the attachment can be adjusted.