I am going to undergo a subcutaneous forehead lift as I do not want my hairline to go backwards. Will the scar be noticeable or not?
Many years ago we described a technique where the incision is made in the hairline (trichophytic), not in front of the hairline (pre-trichial). With the trichophytic incision hair will grow through and in front of the incision, and the surgeon can control the hairline position.
Every browlift has its plus and minus. There are now "hybrid" procedures which do not involve the typical jagged anterior hairline incisions, and actually remove a section of widow's peak. The scars are almost universally excellent.
As in all plastic surgery, there is a huge artistic component beyond the "what procedure do you do"; it is as important as the procedure being chosen who is doing it.
Endoscopic browlifts are fraught with several problems. First and most concerning, they move up the hairline. In fact any browlift originating from above the hairline moves up the hairline. That translates to a high forehead, which can give a prematurely elderly appearance. In many patients it is not an issue, but in many, particularly those above 40 who are noticing their hairlines receding, it is an issue. Also endoscopic incisions typicallly cause some hair loss around the incisions, resulting in 3 small bald spots above the hairline.
Coronal incisions (ear to ear) are still used, but also move up the hairline considerably and often result in numbness due to division of the supraorbital nerve deep branch, which is spared in most other forehead lifts.
Experienced surgeons are familiar with many techniques, and use them to benefit their patients maximally. You may wish to read our book chapter on forehead lifts in the textbook Mathes, referenced below.
Dear Nermo
You have to understand that a we surgeons believe that whatever we do is great. This includes hiding scars in plain sight. I will flat out tell you without knowing your surgeon that he absolutely believes that your hairline scar will be perfectly hidden. I am also here to tell you that with perhaps a rare exception, these scars never quite work out as well as initially described.
It is true that a well-designed beveled incision through the edge of the hair line will permit hair to grow through the scar and help hide it. Yet the eye can perceive that something is not right about these hairlines. Inevitably there is a loss of hair density in the best of these incisions after they have healed that screams: 'Man Made." This type of issue occurs with micrografted hair. Even a two hair micrograft along a hairline can look artificial due to uncontrolled compression and a lack of randomness. Incisions that are made in front of the hair line no matter how well they heal are even worse.
There may be no loss of hair and yet something natural that makes the hair line is lost. Of course, the arguments for these incisions is that it won't push the hair back. Almost always, its much better to push a natural hairline back 5 mm than to have a shorter forehead and an altered hairline that looks unnatural no matter how well the surgeon tells you it healed. Consider finding a surgeon who is comfortable with the endoscopic forehead lift and avoid the hairline scar.
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