Question:
What is the difference between a forehead reduction and a hairline lowering?
Answer:
It is the same operation in my practice. It depends on whether the patient perceives the situation as a forehead or a hair problem. I do about 40 of these operations per year strictly to reduce a high (or tall) forehead or to lower a high hairline. Candidates have to have a flexible scalp and there are certain limitations as to how much reduction or lowering is possible in a one stage operation. Also, the corners of the hairline might need hair transplants if there are really deep recessions or a desire to advance the leading temporal hairs which are fine and acutely angled. Having the experience of years of hair transplant work, I can combine the hairline/forehead work with transplants on those patients who want or need the corners and temples augmented. Cowlick formation requires special consideration and preoperative discussion.
With a 2 stage operation, the first involving the insertion of a balloon tissue expander, we can lower the hairline to almost any level. It takes 4-10 weeks for the expansion process to be completed.
This is not an operation for those who are losing hair such as men and women with early pattern baldness. It works best on women who have always had a high hairline and have good scalp laxity. For those desiring elevation of the brows, it is possible to achieve brow elevation with the same incision. Scars are usually no problem in the long term healing process. If the scar is detectable, such as with cowlick formation, a small hair transplant session is recommended. Most of my patients have not needed or wanted this minor addition.