Facial plastic surgery

Hairline lowering for a high forehead

Many women have a large forehead secondary to a congenitally high hairline or a hairline that has been elevated after previous cosmetic surgery. Our hairline advancement procedure has been developed to lower that hairline and bring the proportions of the face into balance. With the aging process, the high hairline is accentuated giving women a balding/masculine appearance. The hairline advancement can be performed as an isolated procedure or at the same time as a hairline forehead/brow lift.

Bianca before hairline lowering		Bianca after hairline lowering

Before hairline lowering		After hairline lowering

Correcting the hairline

The female hairline is variable in position. However, a “normal” female hairline is typically positioned 5 to 6.5cm above the brows and usually begins at some point where the scalp slopes from a more horizontal position to a vertical one. This optimal position allows for ease of hairstyling and provides facial harmony and balance.

Scalp advancement involves removing a section of the skin on the forehead (between the hairline and eyebrows) and pulling the scalp forward between 1.0 cm and 2.5 cm to correct for the receding masculine pattern hairline and to approximate, when possible, a more feminine ‘oval’ pattern hairline.

Procedure hairline lowering

Procedure

• This procedure is very well combined with forehead recontouring and brow lift, which are often done via the same incision.
• General or local anesthesia is given.
• An incision is made along the hairline. The incision is made just inside the hairline, in an irregular fashion, to avoid a straight scar. Straight scars are more conspicuous than irregularly curved ones. Also the blade is held in such a direction that about six weeks postoperatively the hair starts growing through the scar, making it almost invisible.
• The scalp will be mobilized to the back of the head and pulled forward as much as needed. Normally 1.5 -2 cm of advancement is no problem.
• A section of forehead skin at the hairline is removed.
• The scalp is fixed to the bone using Endotines to prevent it from pulling back.

  The foreheadskin is fixed to the bone using small reabsorbable devices called Endotine (Coapt Systems Inc, Palo Alto), one on each side.

Recovery

• A dressing is placed around the forehead. It will be removed the next day.
• The patient may suffer from some pain during the first days, which is suppressed with medication. Staples will be removed after 7 days.
• A visible scar exists, but it will typically be too faint to be noticed.

	Close-up of the scar after scalp advancement.

Complications

• Swelling will occur around the eyes, on the forehead and scalp. Forehead numbness will last several weeks to months.