Hairline Lowering
Conveniently Located to Serve the Dallas, Fort Worth, Collin, and Denton Counties.
Conveniently Located to Serve the Dallas, Fort Worth, Collin, and Denton Counties.
Conveniently Located to Serve the Dallas, Fort Worth, Collin, and Denton Counties.
Hairline Lowering
Many patients, particularly women, are self-conscious about a high hairline. In most cases, this is genetic. Dr. Matthew Richardson specializes in hair restoration and facial plastic surgery. His unique skill set allows him to improve the overall facial balance by lowering the hairline and shortening the forehead.
Dr. Richardson performs a high volume of hairline lowering/forehead reduction surgeries at his Frisco, Texas, surgery center in the north Dallas suburbs. He treats forehead reduction surgery patients locally from throughout the Dallas-Fort Worth metroplex, regionally from the Texas, Oklahoma, and Louisiana areas, and nationally for patients from all over the country. Many patients fly in for this surgical procedure after first meeting with Dr. Richardson for a video consultation.
He customizes the treatment plan for each patient to achieve the best possible results. Hairline lowering, also known as hairline advancement, scalp advancement, or forehead reduction, is a very gratifying procedure for patients, as most have dealt with this hereditary condition their entire lives.
In either the one or two-stage procedure, the patient is left with an irregular scar along the hairline that is usually pink or dark in color initially and then fades over several months. Once the incision is well-healed (usually 7 to 10 days after the procedure), the scar can be camouflaged with makeup.
These incisions placed along the frontal hairline are usually reserved for women, as they tend to have a stable frontal hairline. While they may suffer from hair thinning, the frontal hairline does not typically recede like it does in a man. For men who want to lower their hairline, a hair transplant is usually the best option.
Hairline lowering with a hair transplant does not require any linear incisions along the hairline, but it does not usually attain the same density as a hairline advancement procedure with only one hair transplant session. In most cases, patients will opt for a second hair transplant session about one year after the first to achieve even greater density in the transplanted zone. Once this second session is complete, patients have usually achieved excellent density.
The upside of this technique is the lack of any linear scar along the hairline. The downside is that the entire process takes about two years to see the final result as hair grows slowly. Additionally, the transplanted grafts after the second session (usually performed 9-12 months after the first) will take a full year to mature. Click here to learn more about hair transplant procedures.
In some cases, patients will choose to combine the two techniques: they will have the one-stage hairline advancement procedure to move the hairline down a few centimeters and then come back 6-12 months later to have a few hair transplant grafts placed just in front of, around, and in the scar to camouflage it even more.
This entirely depends on:
- Patient preference
- Their particular anatomy
- How well they heal after surgery
During your consultation, Dr. Richardson can discuss these options with you in detail and formulate a personalized treatment plan based on your anatomy, goals, and lifestyle.
Is Forehead Reduction Surgery Painful?
In most cases, forehead reduction surgery causes little to no pain. Most patients report mild soreness the first evening after the procedure, but it is very rare to experience any significant pain. Patients are provided with pain medication to take as needed.
What Is Hairline Lowering Or Forehead Reduction Surgery?
Forehead reduction surgery is a surgical procedure designed to shorten the vertical height of the forehead. Specifically, it shortens the distance between the hairline and the eyebrows, as well as that between the hairline and eyes, nose, mouth, etc. The hairline moves lower on the face. This surgery is designed to help patients with a large forehead or high hairline.
What Happens During Hairline Lowering Surgery?
During forehead reduction surgery, the patient is given intravenous (IV) sedation to help them fall asleep. They remain breathing on their own, and the scalp is numbed with local anesthetic injections. A scalpel is used to make an incision across the hairline and into the temple areas to make the scar heal well and camouflage it within the hairline.
The hair-bearing scalp is loosened, separated from the underlying bone, and then advanced forward. Special techniques are performed to allow the scalp to stretch safely during surgery. In many cases, Dr. Richardson will use an Endotine or Ultratine device to help fixate and support the scalp while it heals. This dissolves under the skin over the course of several months and is fixated to the underlying bone.
The excess forehead skin is then carefully trimmed away, and the incision is meticulously closed with several layers of sutures so that it heals beautifully. A dressing is applied, and the patient awakens quickly from anesthesia. In Dr. Richardson’s hands, this procedure takes approximately 1.5 hours from start to finish.
How Much Can I Lower My Hairline? How Big Is A “Normal” Forehead?
In most cases, Dr. Richardson can lower the hairline by 2.0 – 2.5 cm in one surgical session. Keep in mind that human tissue does stretch under tension, so removing 2.5 cm of forehead skin may result in lowering the hairline by approximately 2.25 cm or so.
This is different for every patient. Also, it is very important to recognize that measurements are subjective. When placing a ruler against the forehead to measure its size, the position of the ruler can drastically change the results when adjusting slightly in multiple directions.
Finally, the fine, sparse hairs (“baby hairs”) along the frontal hairline are often not usable for hiding a scar, so the incision must be made further up in the hairline in order to use mature, healthy hairs for hiding the scar. This may make the surgical results appear slightly less when measured postoperatively than the amount of skin that is removed during surgery. All of these things are normal and part of EVERY forehead reduction surgery.
For all of these reasons, patients should not fixate on exact numbers and should instead aim for visual improvement, which is almost always dramatic and significant. Patients who are fixated on specific forehead measurements and who would be disappointed with anything less than a specific number are not good candidates for hairline lowering surgery.
There is no true “normal” forehead height. Dr. Richardson will generally measure from between the eyebrows to where the thick or dense part of the hairline starts (not the fine “baby” hairs). The goal after surgery for many patients is to be in the 5.5 to 6.5 cm range, but this can vary. Many women look very beautiful with hairlines higher than this range.
Hairlines lower than approximately 5.5 cm from the brows risk looking unnatural, strange, and aesthetically unappealing. For this reason, Dr. Richardson does not lower the hairline beyond the 5.5 – 6.0 cm range.
Can A Patient Have Forehead Reduction Surgery More Than Once?
In most cases, yes, a patient can have more than one forehead reduction surgery, BUT this depends on the individual and their scalp laxity. The scalp will generally stretch with time, possibly allowing another centimeter or so to be removed later. In most cases, patients achieve adequate advancement with a single procedure.
What Can I Expect After Hairline Advancement Surgery?
Patients can experience mild soreness that is generally short-lived. A dressing is placed overnight and removed in our office the morning after. At that point, the nurses and Dr. Richardson will check to make sure the patient is healing well. Patients will review their simple wound care instructions and be allowed to travel home for approximately one week.
Please avoid strenuous physical activity for two weeks. Mild bruising and swelling are possible but are usually minimal. Patients can camouflage the incision with their hair, a hat, or a soft headband while it is healing, as long as they are clean. You’ll need to return a week later for post-op suture removal.
Patients living outside a reasonable driving distance from DFW will not be candidates for tissue expansion due to the complexities involved in these cases and the frequent office visits required.
The incision will fade over time, and hair will grow up through the incision to help hide the scar. This process takes many months to finalize, but most patients can easily hide their incisions and are back to normal activities within two weeks.
How Is Forehead Reduction Surgery Different From A Brow Lift?
In forehead reduction surgery, the hairline is lowered. In a brow lift surgery, the brows are raised. In both cases, the forehead MAY decrease in size, but this is NOT the case for every type of brow lift. Brow lifts are customized for the individual based on their anatomy and the techniques will vary, usually due to the position of the patient’s hairline.
Will My Face Be Stretched Or Brows Raised With Forehead Reduction Surgery?
Forehead reduction surgeries do NOT lift the brows unless we intend to do so with a brow lift. In cases where a brow lift is combined with a forehead reduction, the net effect will be that the forehead is smaller (shorter vertically), with some of that change coming from brow elevation and some coming from hairline advancement or lowering. In most cases, forehead reduction surgery is performed without a brow lift, and the brow position does not change for these patients.
How Is Hairline Lowering Surgery Different From A Hair Transplant?
With hairline lowering surgery:
- An incision is made across the hairline.
- The scalp is elevated.
- The hairline is advanced.
- The excess skin is removed.
- The incision is carefully closed.
In a hair transplant procedure, hair is:
- Taken from somewhere else on the patient’s scalp (almost always from the back)
- Divided up into tiny individual follicles
- Transplanted one at a time into the forehead skin below the patient’s natural hairline
In most cases, a second hair transplant procedure will be needed to achieve adequate density. The end result can be similar between the two techniques. Still, forehead reduction surgery is a much faster change and usually results in better density than hair transplants can achieve unless multiple hair transplant procedures are performed.
What Is A Single-Stage Versus Two-Stage Or Multi-Stage Forehead Reduction? Do I Need A Tissue Expander?
Lowering the hairline can be performed in a one-stage or multi-stage procedure, depending on the degree of desired lowering and the amount of scalp laxity present. Hairline lowering can also be done in conjunction with other surgical procedures, particularly brow lifting. A brow lift combined with hairline lowering surgery in a one-stage procedure can significantly improve and shorten the appearance of the forehead.
In a one-stage forehead reduction, a carefully placed and hidden incision is made along the hairline to advance the hair-bearing scalp and shorten the forehead in one surgical procedure. This technique can result in hairline advancements typically in the range of 1.5-2.5 cm or more. This is the most common method patients choose, as it is quicker and requires only one operation.
Most female patients with hairlines starting in the 7-9 cm range are satisfied with approximately 2 cm of hairline advancement. Patients with initial hairlines higher than about 9 cm from the brows may be unhappy with lowering the hairline to only 2-2.5 cm as they may feel as if the forehead is still too big. These patients may need a multi-stage procedure or might not be good candidates for hairline lowering procedures in general.
There are a variety of multi-stage procedures. In some cases, a similar incision is made during the first stage, and a tissue expander is placed beneath the hair-bearing portions of the scalp.
Over the course of 6-8 weeks, the tissue expander is slowly filled and stretches the scalp. In the procedure’s second stage, the tissue expander is removed, and the hairline is advanced and lowered to a greater degree than in a one-stage hairline lowering. Again, patients who live outside of reasonable driving distance from DFW will not be candidates for tissue expansion due to the complexities involved in these cases and the frequent office visits required.
Some patients may also opt for hair transplants as a planned second-stage procedure to help camouflage the scar or customize the hairline shape. However, this should NOT be relied on to lower the hairline further — only to thicken the hairline or camouflage the scar.
Other patients may be candidates for a second forehead reduction surgery after the scalp has had time to stretch further, but this is a rare situation and will not reliably lower the hairline much more than 1 additional cm even after extended healing time between surgeries. This depends on the patient’s hairline, goals, and anatomy.
What Are The Contraindications To Forehead Reduction Surgery?
Patients who are not candidates for any hairline lowering surgery often have medical conditions such as:
- Heart or lung disease
- Wound healing disorders
- Poorly controlled diabetes
- Any active scalp disease
- Scarring alopecias
- Bleeding disorders
- Other serious conditions
Candidates need to be non-smokers, since smoking negatively affects skin elasticity, prolongs the healing process, and can lead to poor wound healing, more visible scars, and hair loss.
Is Forehead Reduction Surgery Only For Women?
In general, YES, forehead reduction surgery is safe only for women. There may be some exceptions to this rule in highly motivated male patients with no family or personal history of hair loss or hairline recession. In almost all cases, Dr. Richardson will not agree to perform forehead reduction surgery on male patients. This is because almost all men will have some degree of hairline thinning and recession over time.
Even 1-2 millimeters of hairline recession over the years will result in a highly visible, exposed scar on the forehead that could potentially be impossible to hide and crippling to the patient.
Male-to-female transgender patients who are medically stable on hormone therapy may be candidates for hairline lowering surgery if there is no significant thinning. If these patients do have hair loss or thinning of the frontal hairline or other parts of the scalp, they are probably better candidates for hair transplant surgeries. Dr. Richardson can help with this assessment during a consultation.
What Are The Risks Of Hairline Advancement Surgery?
Expected risks of forehead reduction surgery include scalp numbness, bruising, and swelling. Rare risks of hairline lowering surgery include bleeding, visible scarring, poor wound healing, infection, shock loss, hair loss along the incision, and the need for revision or future surgeries like hair transplant surgery.
Is Forehead Reduction Surgery Safe For All Skin Tones, Races, And Ethnicities?
Dr. Richardson commonly performs forehead reduction surgery on patients of all skin tones and ethnicities, including Caucasian, African-American, Asian, Hispanic, and multi-racial patients, among others.
Keep in mind that patients with darker skin tones WILL have a more difficult time hiding the scar. Scars in these patients tend to eventually heal lighter in color than the surrounding skin.
Patients with fair skin and dense hair along the frontal hairline see the best results. African-American patients usually need to have dense hair along the frontal hairline and have a forehead no higher than about 9 cm from the brows to be good candidates for forehead reduction.
Patients with a combination of thin hair, very high hairlines, and darker skin tones are the worst candidates for forehead reduction surgery (and may not be candidates at all) because the combination of the skin color and the lack of hair density will not hide the scar well. Additionally, when the hairline is very high, these patients may need tissue expansion (or more than one hairline lowering procedure) to achieve adequate forehead reduction/hairline advancement.
Patients with only one issue listed above might still be reasonable candidates. For instance, if you have good hair density and scalp mobility but a darker skin tone, you are likely still a good candidate. However, if you have poor scalp mobility AND thin hair AND a darker skin tone, you likely won’t see the best results.
Who Is Qualified To Perform Hairline Lowering Surgery?
Forehead reduction surgery should be performed by board-certified surgeons with experience in facial surgery, hairline lowering surgery, and hair transplant surgery. Hairline lowering is not a common procedure for most surgeons and should not be performed by just any doctor or even just any plastic surgeon. Forehead reduction surgery requires both artistry and technical skill to achieve the best result.
Dr. Richardson is a hairline-lowering expert. He is fellowship-trained in hair restoration surgery and facial plastic surgery, making him uniquely qualified to perform this procedure. He is also double board-certified in head and neck surgery and facial plastic surgery.
How Long Does A Forehead Reduction Last?
Forehead reduction surgery is permanent. While the brows may fall slightly over the years due to the natural aging process, the forehead will always be smaller than it was before surgery. The forehead does not stretch back to its original position. Once the tissues are in place, scar tissue under the skin holds them together after the initial healing phase.
Will I Look Different After A Forehead Reduction?
Yes, the forehead will be smaller, and the hairline will be lower. Otherwise, the face will look the same without changes in brow position, eye shape, or any other facial features.
How Do I Prepare For A Forehead Reduction Surgery?
At Texas Facial Aesthetics, we give patients very specific instructions regarding:
- Both prescription and over-the-counter medications to avoid (primarily those that increase bleeding risk)
- Any preoperative labwork or testing that needs to be performed (based on the patient’s age and medical history)
- Scalp stretching exercises
Stretching the scalp by hand in the weeks and months leading up to surgery can help it heal easier after surgery and facilitate greater scalp mobility during the procedure. This mobility helps us move the scalp and advance the hairline more. The video below describes how we recommend that our patients stretch the scalp.
How Much Does Hairline Lowering Surgery Cost?
Hairline lowering surgery costs will vary based on facility fees, anesthesia pricing, and many other factors. We are able to keep costs low through our high volume of hairline lowering surgeries at our private surgical center. Pricing is generally going to start at $10,500, depending on the factors above. We are happy to provide you with a price estimate. Please call or email us for more information.
Can a Hairline Lowering Treatment Be Combined With Other Facial Plastic Surgery Techniques?
Some patients prefer to pair their forehead reduction surgery with another procedure. Combining the brow lift with a forehead reduction is a popular option that offers enhanced benefits. We also commonly perform the following procedures in conjunction with hairline lowering:
How can I set up a hairline lowering surgery Consultation?
Call or text Texas Facial Aesthetics at 469-362-6975 to set up a consultation with either Dr. Matthew Richardson or Dr. Jordan Cain. You can also email us at info@txfaces.com for more information.