Hairline lowering surgery
What is classic hairline lowering?
Hairline lowering (also called a scalp advancement or forehead reduction) is a surgical technique that allows patients to have their frontal hairline advanced certain distances depending on variables such as pre-operative hairline height, scalp laxity and patient preference. The alternative treatment would be hair transplantation.
Compared to hair transplantation, there are a few advantages:
- Hair density will be the same as on the rest of the hairy skull which gives a very natural looking result.
- Immediate result.
- Surgical procedure is necessary.
- Scar that can vary from almost invisible to very visible depending on the skills of the surgeon, the preferred hair style of the patient and sometimes the scarring tendency of the patient.
What can hairline lowering do for you?
This procedure can be performed to address a congenitally high hairline or sometimes a hairline that has recessed from hair loss. It is performed mostly on women. The normal attractive female hairline midpoint is usually 6 – 6.5 cm above a point between the eyebrows. Satisfactory hairline lowering is a balance between patient expectations and anatomical limitations. Scalp laxity is a primary determinant of the extent of hairline advancement. Depending on scalp laxity, the advancement can vary between 0.5 and 3 cm. Dark skin has a tendency to have more laxity than pale skin. When the scalp laxity is insufficient for the desired amount of advancement, the use of a tissue expander can greatly increase the possible advancement.
Who is a good candidate for hairline lowering?
- Women with a high forehead who need 1.5 to 2 cm of advancement — If you wish to know how much advancement of your hairline is possible in a single-step procedure, you can put your index, middle and ring finger of one hand just behind your hairline and move them up and down while pressing against your skull. You will feel the mobility of your hairline. Usually, this movement plus an extra 0.5cm is the expected hairline lowering in a single-step procedure. If you really want more, you will need a two-step hairline lowering procedure with expander.
Who is not a good candidate for hairline lowering?
- Men — Men are no good candidates for hairline lowering. As their hairline tends to continue to recede as they grow older, scars resulting from the hairline lowering procedure that were hidden inside the hair could become visible leading to high patient (and surgeon) dissatisfaction.
- Women who only have a widow-peak problem — Women who have a satisfactory height of the forehead in the midline and not too extensive widow-peaks on the side better opt for hair transplantation. The result of hair transplantation only in the area of the widow-peaks will look pretty natural and the disadvantages of a surgery are not justified just by having a faster result.
What is expander assisted hairline lowering?
A hairline lowering with expander is a procedure that involves two operations. In the first operation, a balloon is placed under the scalp that is gradually filled in the subsequent weeks to expand the scalp. In a second operation, the hairline is brought forward to the desired position.
- A great advancement of the hairline is possible.
- The result is more natural than with hair transplants as the density of the hair is the same everywhere.
- The balloon has to be filled over a period of eight weeks.
- Cosmetic inconvenience during the last three weeks of the expansion. The swelling caused by the expansion can normally be hidden quite well with a scarf or hat.
- Two operations are needed.
- In rare cases the expander needs to be removed and the advancement of the hair line will be less than hoped for in the beginning.
How is the expander assisted hairline lowering performed?
- The operation is performed under general anaesthesia.
- During the first operation the croissant-shaped expander is inserted under the hair-bearing skin and filled up to 120 ml. Dr van de Ven has developed his own expander and instruments to insert it, which enables him to advance the hairline sometimes up to 10 cm (depending on the patient’s scalp laxity).
Expansion period: six to eight weeks
- The balloon is expanded by injecting saline water over a period of six to eight weeks, depending on the required advancement. The injection dome is not under the scalp but hangs next to the ear, so the patient can fill it.
- Until the end of the filling period, a bulge is visible beneath the hair-bearing scalp. If skin laxity is sufficient, the expansion is well tolerated by patients aside from the cosmetic inconvenience during the last three weeks of the expansion. The swelling caused by the expansion can normally be well hidden with a scarf or hat.
Important warning: During this period of expansion, it is of paramount importance that the patient listens to her own body and stops the expansion when severe pain occurs. The patient also should have the skin over the expander inspected daily for extreme paleness by a friend or relative. Extreme paleness is a sign that the blood supply of the skin overlying the expander is insufficient and that the expansion needs to be paused. If not, there is a serious risk for skin necrosis (dying of the skin) resulting in skin perforation and sometimes even extrusion of the expander. After the expansion has been paused for one or two days, the patient can restart the filling. If several pauses are necessary, this could mean that the second surgery, being the actual hairline lowering, needs to be postponed. It is important that the patient accepts this postponement and does not try to force the procedure as there will be a high risk for the complications previously mentioned. If severe pain continuous to occur, both surgeon and patient might even have to accept that this patient was not such a good candidate for expansion, that the expander needs to be removed and that advancement of the hair line will be less than hoped for in the beginning.
- The second operation is also performed under general anaesthesia. During the second and final operation, the device gets removed and the expanded hair-bearing scalp is moved forward, replacing the top section of the high forehead or wide widow peaks. With this approach, we are able to move hairlines up to ten cm and close wide widow peaks. The procedure of this hairline lowering surgery is basically the same as a hairline lowering without expander.
Frequently asked questions
How many grafts do I need?
The number of hair follicles (grafts) that can be used for a hair transplant is limited. There are some 5,500 grafts in the donor area that can be used for a hair transplant. It is therefore not only a question of determining how many grafts are needed to improve the hairline/recipient area, but also how many grafts can be used to the maximum. Transplanting too many grafts at once can even cause hair density to deteriorate.
Is hair transplant surgery painful?
According to most patients, a hair transplant is not a painful experience. Patients are always given local anaesthetics and other medications to alleviate the discomfort. Most patients report that the procedure is pain-free and that the patient's recovery is not necessary. However, the procedure can take a long time as all hair follicles have to be harvested one by one.
Is it necessary to shave my hair before hair transplant surgery?
You can choose. We use both the Shave FUE method (= Follicle Unit Extraction with shaving) and the No-shave FUE method (= Follicle Unit Extraction without shaving). It is also called "unshaven FUE", "non-shaven FUE", "U-FUE (or Undetectable FUE)" or long hair FUE. This entails transplanting long hairs. This way no one knows that you have had a transplant. Of course, the No-shave FUE method is more time-consuming and more cumbersome to harvest and implant. Therefore, the price per graft is also higher.
How long does it take to recover?
After the operation:The hair is NOT washed or styled. The hair is still loose so it would just fall out. The skin needs time to grow back together again. You will be given a bandage that must remain in place for at least 2 days. You could go back to work, but we recommend taking a week off to fully recover.
After about 3 days:Carefully remove the bandage and clean the hair with water and a mild shampoo. Do not stand under a jet but let the water drip gently over your head. Pat dry gently (do not rub). In this stage, slight swelling and scabs will form.
After about 2 weeks:The newly transplanted hair will fall out - this is normal.
After about 2 months:The hair can be dyed again.
After about 3 months:The new hair will start to grow until about 12 months after your hair transplant. And of course, if you have long hair, the new hair will take a while to catch up.
What is the difference between FUE and FUT transplants?
During an FUE hair transplant (= Follice Unit Extraction), hairs are harvested one by one from the donor area and transplanted into the recipient area. This is quite labour intensive for our specialists. Therefore, this method is more expensive and in addition, fewer grafts can be transplanted a day than an FUT hair transplant. However, you can choose the Shave (the donor area is shaved in advance) or the No Shave method (long hairs are harvested and implanted). Kinky-curly hair (e.g. 3 C of 4A, B or C) is very brittle and therefore not suitable for FUE treatment.
During an FUT hair transplant (= Follicle Unit Transplant), a strip of skin is removed from the donor area at the back of the head and reimplanted into the recipient area. This makes it slightly cheaper than FUE and faster, but a major disadvantage of this technique is that it leaves a scar in the donor area. For these reasons we do not use this method in our clinic.
Will I have to undergo an additional hair transplant in the future?
It is possible that your hair loss will continue. Especially if you have had a hair transplant at a young age. All transplanted grafts will continue to produce hair for the rest of your life, but the hair around them that you had at first could fall out at a later time. In that case, you could consider extra treatment.
What is the cost of hair transplant or hairline lowering surgery?
Hair transplants or hairline lowering surgeries vary greatly from patient to patient, which is why it is difficult to put a general price for hair surgery. It depends on what your wishes are, how large the zone is, which method you choose (Shave FUE or No Shave FUE), how many grafts you will need, etc. The costs will be determined during your consultation or you can request a personalised quote to get an idea.
More information about the price per graft can be found here.
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