Hairline Lowering

Hairline lowering surgery also known as forehead reduction surgery or scalp advancement is a surgical procedure to lower the height of the hairline. The procedure is performed almost exclusively in women where up to 5 cm of shortening can be created. In some cases, to further contour the hairline, a hair grafting procedure can be performed to reshape the hairline which can create a more feminine rounded appearance to the sides of the hairline. In cases where more than 5 cm of lowering is required then a 2 stage procedure with tissue expanders may be necessary to achieve the required level of hairline lowering.

The upper third of the face and hairline is a key aspect of defining ones gender because it forms the framework for the whole face. Hairlines in men tend to sit further back on the skull compared with a women’ hairline. This gives the impression of a larger and more prominent forehead in men. In women the hairline sits at a lower position and takes on more a rounded appearance compared with the square-like appearance found in men. For many women with higher hairlines, the hairline can be lowered into a more female type of hairline with smooth curved lines leading to overall facial harmony and balanced aesthetics. An excessively high hairline can lead to a reduction in self-confidence and may lead many women to reduce the number of hairstyles they choose to have as the main priority is always to cover the prominent forehead.

Causes of an excessively high hairline:

• Genetic factors
• Hair loss from previous surgery such as a coronal browlift

Procedures commonly combined with hairline lowering:

• Brow lift surgery aims to raise the level of the brow to create a more balanced aesthetic appearance
• Eyelid surgery or blepharoplasty
• Facelift
• Forehead contouring also known as a foreheadplasty can be used to precisely reshape the forehead bone

Hairline lowering is an outpatient surgical procedure meaning you will admitted and discharged on the same day which allows you to recover in the comfort of your own home. The hairline lowering procedure can be performed under either a general anaesthetic or a local anaesthetic. Although our surgeons recommend TIVA general anaesthesia for optimal comfort. The surgeon begins by marking the location of the planned new hairline. The incision is performed in a zig-zag configuration to closely resemble the appearance of a natural looking hairline.

The skin above the marked new hairline is surgically removed. The skin margins are then carefully sutured together in 3 layers to reduce the tension on the superficial aspects of the incision. As the incision is sutured, the new hairline is surgically lowered to the planned marked position. Your surgeon may choose to use non-dissolvable sutures which are then removed at your follow-appointment as these give much better scar cosmesis compared with dissolvable sutures. During the healing process, hair follicles will regrow through the incision line and this helps to disguise the appearance of the resulting scar.

Where the hairline needs to be advanced more than 5cm, then a 2 stage procedure is necessary. In the first stage, a temporary implantable device called a tissue expander will be inserted to place the forehead skin on stretch. The tissue expander is essentially an inflatable balloon which when inflated beneath the skin will stretch the skin. The balloon is inflated by injected sterile saline solution. The tissue expander is left in for approximately 4-6 weeks before being removed and the surgical hairline advancement taking place in the second procedure. In some cases, your surgeon may recommend a third stage hair transplant procedure to increase the density of the hair follicles. The skin that was placed on stretch by the tissue expander often leads to reduction in density of hair follicles as the hair follicles are spaced further apart.

Patients who smoke will be advised to stop for at least 2 weeks before the date of their procedure. Smoking has detrimental effects on your circulation and is well known to slow the healing process. All medications, prescribed and over the counter will be reviewed. Aspirin and aspirin containing medicines should be stopped both before and after surgery. Aspirin and NSAIDS impair the body’s natural clotting process and may cause bleeding complications after surgery. If you require pain relief after surgery, paracetamol is advised.

What tests may I need before surgery?

Patients recovering after hairline lowering tends to have very little in the way of postoperative pain. Bruising of the forehead and eye region may develop and this often resolves within 5-7 days. Swelling of the region may take a little longer to settle. Most patients are able to return to work after one week although it is possible to commence light activities after about 2-3 days. Numbness of the area near the front part of the scalp is quite common and is mostly temporary in nature but may take up to three months to fully resolve.

Hairline lowering surgery is a commonly performed procedure at Centre for Surgery. At your consultation, your surgeon will discuss the potential risks and complications associated with the scalp advancement procedure.

Potential scalp advancement complications

• Anaesthetic risks
• Postoperative haemorrhage
• Excessive scarring
• Delayed wound healing
• Hair loss around the incisions
• Nerve injury leading to numbness
• Facial nerve injury
• Surgical site infection
• Brow asymmetry
• Requirement for a revision procedure