Hairline lowering and recontouring

The hairline is an identifying trait for gender, and accentuated by age.

 

Gender of the hairline

The female hairline is variable in position. Ideally would be a hairline 5 to 6.5 cm above the brows and usually beginning at the point where the scalp slopes from a more horizontal position to a more vertical position.

In males the average hairline is higher than the average in females.

Another difference is the shape of the hairline. A man usually has receded corners above the temples that give it an “M” shape. Conversely, the female hair pattern is oval shaped, smoother and full around the facial edge.

An additional difference between male and female hairlines comes with the age. There is a typical male pattern of baldness with a recession of the hairline. How many women do you see walking around with a receding hairline? While biological women sometimes do suffer from hair loss, it is usually an all-over thinning of the hair from the entire scalp and isn’t specifically targeted to one area.

Feminizing the hairline

Hairline lowering 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. If the widow peak are very large or a big advancement is needed, a two-stage procedure with a tissue expander is required.

Normally an advancement of 1 cm is possible without creating a wide scar. When advancing more than 1 cm, especially when the widow-peaks need to be excised in a V-shape, there can be a lot of tension on the wound, depending on the mobility of the scalp, which causes a wide scar. The survival rate of hair grafts inside the scar is low. Before performing hair transplantation the scar needs to be excised and the wound closed without tension. This is possible about 1 year after the hairline lowering.

Hairline lowering is a permanent feminizing solution for those patients who do not suffer from a receding hairline. It acts as a temporary fix for a receding hairline for patients suffering from hair loss, but will not stop the hair loss. We highly recommend that these patients seek out an additional hair loss solution, like hair transplantation, to keep the hairline looking full and healthy.

This operation can be easily combined with a forehead/brow lift to achieve the optimal result in those with both a high hairline and aging, drooping brows. The incision of both procedures is the same.

Procedure hairline lowering

The flexibility of the scalp, the amount of lowering that is required and the extent of the widow peaks determine if the hairline lowering surgery can be performed as a simple on-stage procedure.

Normally an advancement of 1 cm is possible without creating a wide scar. When advancing the hairline more than 1 cm, especially when the widow-peaks need to be excised in a V-shape, there can be a lot of tension on the wounds which causes a wide scar. The survival rate of hairgrafts inside this scar is low. Before performing hair transplantation the scar needs to be excised and the wound closed without tension. This is possible about 1 year after the hairline lowering.

If the hairline needs to be advanced to a very large distance (more then 1.5 cm) or if the scalp is tight or the widow peaks considerable, a two-stage procedure with a tissue expander should be considered. This procedure involves the placement of the expander as the first stage and advancement of the hairline as the second stage.

• Surgical drawing—The surgical drawing is made:
  
• General anesthesia—
• Incision—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. The blade is also held in such a direction that about six weeks postoperatively the hair starts growing through the scar, making it almost invisible.
  
• Removal—A section of forehead skin at the hairline is removed.
• Mobilisation—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.
• Fixation—The scalp is fixed to the bone using Endotines to prevent it from pulling back. This device is made of bioabsorbable material and dissolves over time.
  

Recovery hairline lowering

• Pain— The patient may suffer from some pain during the first days, which is suppressed with medication.
• Staples and stitches—Staples will be removed after 7 days. For patients from abroad, they can return home the same day. The staplescan be removed in their home country by a general practitioner. The stitches are self absorbable.
• Scar—A visible scar exists, but it is usually too faint to even notice after one year.
• Numbness—All patients experience numbness of the front of the scalp. The sensation almost always returns in a 3-12 month period. Sometimes there is an itching sensation during the recovery period.
• Temporary loosing of  hair—There can be some shedding of the fine hairs in the front of the scalp within 2-4 weeks after surgery. This is called an “effluveum” and occurres  in about 5% of the surgeries. The hair normally comes back after 3 months. We sometimes suggest the use of 5% Minoxidil to the front of the hair bearing scalp after surgery. This can 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.

 

Complications hairline lowering

• General hair thinning— This complication has been reported by 1% of patients.
• Scar—Sometimes the tension on the incision is so big, a visible scar exists. In that case a scar revision surgery has to be performed.

FAQ

You still have a question concerning this procedure? Please ask your question. We will answer your question and if generally applicable add it to the FAQ of this page.

 

How long does it take for the endotines to disappear?

According to the manufacturer it takes about 3-6 months for the endotines to absorb. According to our experience it takes about 6-12 months for the endotines dissolve completely.