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Frequently asked questions on hairline lowering/forehead reduction
1. Cost. Over the past three years, I have received many e-mails from people seeking further information about the hairline lowering procedure that is described on our site. The most frequently asked question is the cost. At present, the cost which includes surgeon's fees, operating room costs, equipment and supplies and most medications is approximately $7000 for a one-stage procedure and double that price for the two-stage procedure which includes the cost of a tissue expander. 2. The next most frequently asked question is whether I know of a surgeon in the immediate area who does this procedure. I have spent many years working on this procedure and refining the technique. And although the concept is simple, there are many small details such as the angles of the incisions, the differences in the direction of hair growth in hairlines, the flexibility of the scalp, preservation of certain arterial supply, and other judgment factors that make it hard for me in good faith to recommend others who have any significant experience with my present technique. The basic concept should be familiar to most cosmetic plastic surgeons that do open (pretrichial or trichophytic) forehead lifts, but the subtleties of the hairline lowering are known and experienced by few. I know many hair transplant surgeons who could do a good job using follicular unit grafts. If you do find someone in your area that does my procedure, it would be wise to ask to see before and after pictures of prior results. Also, let me know who they are for future reference.FOR OUT OF AREA PATIENTS, I will ask for a detailed description of their condition and other detail by e-mal interaction and eventually have a telephone consultation. If we can determine that you are a good candidate for this procedure, we can schedule surgery on a day after a scheduled consultation. If the cosultation is satisfactory for all, we can go ahead with the surgery. The patients can leave for home as early as the day after surgery. I ususally can find a colleague that resides nearby to perform suture removal. 3. Another question I get frequently is, "Can I see more pictures of results on the Internet?" If you are interested in seeing more of these cases, I suggest you come to my office for an in person consultation and I can show you early and late results of patients without having to have the possibility of them being seen and identified throughout the world. To really appreciate what the operation does, it would be best to see the whole face rather than a view from the forehead up or a patient with his/her eyes blanked out. I feel it is very important to protect patient confidentiality. Few people would want to have their identifiable features be shown indiscriminately on the Internet, and I greatly respect that. I have over 60 cases in a PowerPoint presentation in my office of persons whom I have operated on and who have given me consent to show their pictures to prospective patients within the privacy and confidential setting of my office. 4. Another question or series of questions I would like to answer would be related to alternative methods of achieving the results, scars and individual goals. The best alternative method is hair grafting utilizing large numbers of follicular unit grafts. This is a technique that I do routinely on men with male-pattern baldness and occasionally on females who want the alternative operation. I see a great economic and time advantage to the hairline lowering procedure with the only drawback I have found to be related to a temporary numbness of the front part of the hair-bearing scalp. As far as scars go, if one were to harvest a strip of donor material for follicular unit grafting, one would have a scar hidden within the hair which should be no more of a problem than the scar at the hairline with hair growing through it. If we did have an unfavorable scar: 1) I would not charge to revise it; 2) I could do follicular unit grafts. Sometimes we do plan on doing grafts if the hair at the temples (the downward growing hairs need to be brought forward) and the usual customary fees for that would apply. 5. Do I do this procedure on men? I do this operation on highly selected men without male pattern baldness or who have had reconstructed hairlines. Men having this operation have to understand the progressive nature of hair loss in males and that further procedures may be required to maintain a result. 6. I am often asked with this operation and other operations about comparison cost factors. If one were to lower the hairline, our usual 2.0 cm to 2.5 cm, we would move approximately 4000 to 6000 hairs or 2000 to 3000 follicular units. Based upon that movement, the cost is about one dollar a hair compared to grafting which in our practice would be more than twice that cost done over two or three sessions. Also, as I mentioned, with the time factor involved, the result is apparent and disguisable and cosmetically effective within two to seven days, even with sutures in place. 7. What are the side effects and potential complications of this operation? First of all, 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. These set of symptoms can occur after dense graft packing or any incision made in the scalp. Second, there can be some shedding of the hair in the front of the scalp within 2-4 weeks after surgery. The hair has always come back after 3 months, in my experience. I suggest patients apply 5% Minoxidil to the front of the hair bearing scalp starting 2-6 weeks before surgery and resuming it for 3 months 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. Remember, with grafts, the hair almost always falls out and goes through a three month "resting phase" before appearing again. We do this opertion under intravenous sedation so there is no recollection of any pain. Post operatively, most patients are amazed on how comfortable the whole process was compared to any prior operations. As with any surgery there can be unfavorable reactions to local anesthetics, sedatives or pain medicine. The possibility of infection (I have had none so far with this procedure.) has to be stated. When expansion is involved we have to consider the possibilities of expander failure. or displacement requiring removal and replacement Sheldon S. Kabaker, M.D.
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