As many as 20% of all women have what can be described as a high hairline. It usually is a hereditary and natural characteristic. Most modern hairstylists are trained to recognize this and will style the hair combed forward in bangs and thereby disguise it. A high hairline is considered a masculine trait. A hairline that measures its mid-point between 5 cm and 6 cm above a line drawn across the brows is what most classify as a typical and desirable female hairline. A mature male hairline usually is 6-8 cm above the brows.
It has been noted that a high proportion of women with high hairlines have are descendants of peoples of Great Britain or China. Although I have not reviewed any published statistics on this, it has been my clinical observation for the past 30 years. Of course, high hairlines are seen in women from a wide variety of backgrounds. A notable group of women who have high hairlines are African Americans who have a combination of hereditary factors and traumatic factors from straightening the hair and pulling it back, therefore, at times pulling out the weaker hairs in the front and the temples. Usually there is a history of straightening the hair and pulling it tightly back in various hairstyles, i.e., corn rows, tight braids or buns, One should note that in almost every predominantly African American neighborhood, there are a disproportionate number of women’s wig stores which cater to older African American women who want to have the appearance of a full head of hair.
The high inherited hairlines that we often seen from those women of Anglo Saxon ancestry can be exemplified by the history and paintings of Queen Elizabeth I, the great Tudor queen, the daughter of Henry VIII, who reigned for 45 years. She had a naturally high hairline, which is revealed in many portraits. Also, one can find many portraits of women of English nobility of her time who emulated the queen by actually shaving back an inch or so of their hair to more resemble the queen. This was especially true of the women who were in her court. It should be noted that Bette Davis, in portraying Queen Elizabeth, had to shave her hairline back for such a movie role. She played Queen Elizabeth twice once when she was a younger actress, and as an older actress playing the older queen, the hairline had to be kept proportionate, though Ms. Davis’ hairline had receded naturally with age.
Most women who have high hairlines have a compensatory hairstyle or have little concern with it. Those who have suffered teasing in their formative or teenage years regarding a “big forehead”, “looks like a light bulb”, or looking more like a boy, carry this burden into early adulthood. I find this similar to people who suffered severe acne in their teen years and become psychologically traumatized. Even small acne scars throughout adult life often can obsess them.
In addition to the common hairstyles to disguise the high Tudor-like female hairline, surgery can be performed. A simple, but sophisticated one-stage hairline lowering (forehead reduction) operation can usually bring down the hairline approximately one inch. An appropriate candidate for this operation who desires lowering of a high hairline has to have an appropriate amount of scalp laxity. Alternatively, modern follicular unit hair grafts can be done to achieve a similar effect. The graft operation often has to be repeated to attain the desired density and a 12-18 month period is necessary for growth to be long enough to be incorporated into all but the shortest of female hair styles.
For those who need great advancement of the hairline or who have a very tight scalp, a two-stage procedure wherein balloon-like expander devices are inserted under the scalp in the first stage. The scalp is stretched over a six to eight-week period by gradually inflating the balloon. This allows us to bring the stretched scalp downward as much as we need. In some cases, it has been lowered up to 10 cm.
Although the concept of this hairline advancement surgery is not revolutionary, the sophistication of it is really a modern development.