Dr. Daniel E. Rousso just returned from two meetings recently, the American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS)
A high hairline is a relatively common physical trait that can cause the upper face and forehead to appear disproportionately large. Usually hereditary, this characteristic is often disguised with bangs or similar hairstyling strategies. Dr. Daniel Rousso, a board-certified plastic surgeon and a founding member of the American Board of Hair Restoration Surgery, offers hairline lowering surgery to improve the position and appearance of the hairline in relation to the forehead and face. This procedure, also known as hairline advancement, can usually lower the hairline approximately one to two inches, thereby minimizing a large forehead and improving facial balance.
While men or women can have a high hairline, women are more likely to be candidates for this procedure because a high hairline is viewed as a masculine trait. A typical female hairline is approximately five to six centimeters above the brows, whereas for a male it is six to eight centimeters above the brows. Men may not be candidates because of age-related male pattern hair loss, which is common in men and can interfere with the results. All candidates for hairline advancement should have no personal or family history of progressive hair loss. Most importantly, candidates must have an appropriate amount of scalp laxity to undergo this procedure.
Hairline lowering surgery is usually performed on an outpatient basis. During the procedure, Dr. Rousso excises the lax tissue of the forehead and/or scalp and then advances the scalp forward to create a new, lowered hairline. Trichophytic incisions help reduce the visibility of the scar; they are placed at an angle to allow the hairs to grow through the new scar. Regrowth occurs both in front of and through the hairline scar so that it looks as natural as possible.
Some candidates have unusually high hairlines and need significant advancement. For these candidates and for those who have a tight scalp, a two-stage procedure may be performed. In the first stage, balloon-like expanders are inserted under the scalp. These are progressively inflated over six to eight weeks to stretch the scalp for the second stage of the operation, in which Dr. Rousso will remove the expander, excise the excess skin, and pull the scalp forward to lower the hairline.
If candidates do not have sufficient scalp laxity for the traditional approach and are not candidates for tissue expansion, follicular unit hair grafts may be used to create a similar effect. Dr. Rousso may perform either FUT (follicular unit transplantation) or FUE (follicular unit extraction) to lower the hairline, and repeat operations over the course of 12 to 18 months are often needed to ensure that the desired hair density is achieved. The downside of this alternative is that the new frontal hairline, while desirably lower, may not achieve the same level of hair density as the hairline lowering procedure.
After the Procedure
One of the advantages of the hairline advancement procedure is that the hair is not trimmed and does not go through a “shock” phase that is typically seen after transplants. The hair stays long and is styleable within a week or two after the procedure. Most patients will have some numbness and/or itching of the scalp for a few weeks after the procedure. The scar is designed to allow hair to grow through the scar and camouflage the scar. This will continue to improve over the first three to six months after the procedure and is virtually imperceptible with time.