What is classic hairline lowering?

Hairline lowering (also called a scalp advancement or forehead reduction) is a surgical technique that allows patients to have their frontal hairline advanced certain distances depending on variables such as pre-operative hairline height, scalp laxity and patient preference. The alternative treatment would be hair transplantation.

Advantages

Compared to hair transplantation, there are a few advantages:

  • Hair density will be the same as on the rest of the hairy skull which gives a very natural looking result.
  • Immediate result.

Disadvantages

  • Surgical procedure is necessary.
  • Scar that can vary from almost invisible to very visible depending on the skills of the surgeon, the preferred hair style of the patient and sometimes the scarring tendency of the patient.

What can hairline lowering do for you?

This procedure can be performed to address a congenitally high hairline or sometimes a hairline that has recessed from hair loss. It is performed mostly on women. The normal attractive female hairline midpoint is usually 6 – 6.5 cm above a point between the eyebrows. Satisfactory hairline lowering is a balance between patient expectations and anatomical limitations. Scalp laxity is a primary determinant of the extent of hairline advancement. Depending on scalp laxity, the advancement can vary between 0.5 and 3 cm. Dark skin has a tendency to have more laxity than pale skin. When the scalp laxity is insufficient for the desired amount of advancement, the use of a tissue expander can greatly increase the possible advancement.

preoperative

2 months postoperative

4 months postoperative

Who is a good candidate for hairline lowering?

  • Women with a high forehead who need 1.5 to 2 cm of advancement—If you wish to know how much advancement of your hairline is possible in a single-step procedure, you can put your index, middle and ring finger of one hand just behind your hairline and move them up and down while pressing against your skull. You will feel the mobility of your hairline. Usually, this movement plus an extra 0.5cm is the expected hairline lowering in a single-step procedure. If you really want more, you will need a two-step hairline lowering procedure with expander.

Who is not a good candidate for hairline lowering?

  • Men — Men are no good candidates for hairline lowering. As their hairline tends to continue to recede as they grow older, scars resulting from the hairline lowering procedure that were hidden inside the hair could become visible leading to high patient (and surgeon) dissatisfaction.
  • Women who only have a widow-peak problem — Women who have a satisfactory height of the forehead in the midline and not too extensive widow-peaks on the side better opt for hair transplantation. The result of hair transplantation only in the area of the widow-peaks will look pretty natural and the disadvantages of a surgery are not justified just by having a faster result.

How to prepare for hairline lowering?

There is no specific preparation for this procedure.

How is hairline lowering performed?

  • Incision — An incision that follows the pattern of the natural hairline is made two to three mm inside the hairline. Straight scars are more conspicuous than irregularly curved ones. The blade is also held in such a direction that about six weeks after the surgery, the hair starts growing through the scar, making it almost invisible.
  • Removal — A section of forehead skin just in front of the hairline is removed.
  • Mobilization — The scalp will be mobilized to the back of the head and pulled forward as much as needed. Normally 1-1.5 cm of advancement is no problem. If more advancement is needed, the placement of an expander needs to be considered.
  • Fixation — The scalp is fixed to the bone using Endotines to prevent the skin from pulling back and so reducing the tension on the scar. Endotines are made of bio-absorbable material and dissolve over time.

What is the average treatment plan of a hairline lowering?

A hairline lowering is performed within a day as an outpatient procedure (no overnight stay in the hospital is needed).

What to expect and do during the recovery period after hairline lowering?

  • The day of the procedure — The day of the procedure and the day after, the patient might experience slight pain or discomfort that can be well managed with the painkillers we will give you.
  • The first week — During the first week there might be a bit of swelling and bruising but it should not be very noticeable. If staples have been used, they will be removed after seven days. Foreign patients can return home the same day. The staples can be removed in their home country by a general practitioner. The stitches we use are self-absorbable.
  • Subsequent weeks —
    • Sutures — After two to three weeks, the absorbable sutures at the hairline will fall out.
    • Scar — The scar will remain red and elevated for a period of two to six months. After about six weeks, small hairs will start growing through the scar making it less visible. See the images below.
    • Numbness — All patients experience numbness of the front of the scalp. The sensation returns after a period ranging from three to twelve months. Sometimes there is an itching sensation during the recovery period.
    • Temporary hair loss — There can be some shedding of the fine hairs within two to four weeks after surgery. This is called an “effluvium” and occurs in about 5% of the surgeries. It is caused by the temporary reduced blood supply because of skin undermining. The hair normally comes back after three months. We sometimes suggest applying 5% Minoxidil to the front of the hairy scalp after surgery. This may lessen the possible fallout and promote a more rapid growth of hairs that might have been shed and those that will be growing through the incision.
    • Full recovery — Full recovery is to be expected after 12 – 18 months when the scar will have reached its full maturity. The scar remains, but it is usually too faint to even notice after one year.

What are the complications of hairline lowering?

  • Hypertrophic scar — Some patients have the tendency to develop hypertrophic scars. This can be treated with (repeated) corticoid injections or surgical excision of the scar followed by (repeated) corticoid injections.
  • General hair thinning — This complication has been reported by 1% of the patients.
  • Diminished scalp sensation — It is possible the scalp sensation is changed permanently. The patients who mention this do not experience it as a problem.

How long can I expect the results of hairline lowering to last?

Forever.

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