Would I Benefit from Hair Transplantation to Reduce Forehead? (photo)

Female pattern hair loss is more of a defused thinning of hair compared to male pattern hair loss which is more about receding hairlines at the temple as well as the thinning of the crown. To know the real cause of the hair loss, I would do a biopsy about 2-3 mm in diameter and taking several representative section of the scalp and send it to a pathology lab to get the diagnosis.

Hair transplantation is the movement of genetically resisted hair. Usually, the hairs are taken from the middle portion of the back of the head. The success of the hair transplant is dependent on the density of the donor area, how thick the individual hairs are and how much coverage must be achieved. Unfortunately, there are a lot of people who perform hair transplantations who are not qualified to do the surgery and who did not have the right training and background. They tend to have wrong diagnosis of the patient and have unsuccessful hair transplantation.

In hair transplantations, some hairs don’t survive because of bleeding, blood pressure or just the way the tissue was manipulated. So, when I do these types of surgeries, such as moving the hair forward, I tend to be very conservative. I use the application of a regenerative medicine technology called extracellular matrix (ECM) made by ACell that’s derived from the pig bladder. This material allows healing and the activation of the adult stem cells so that there is virtually no scar tissue. It also heals by duplication which accelerates the healing process. It results in greater density of hairs as well as a natural-looking hairline.

I advise that you meet with a reputable hair restoration specialist to get a proper diagnosis of your condition. Discuss with the surgeon hair transplantation techniques that are suitable for you as well as using regenerative medicine to enhance healing and protection of the hairs.  I hope that was helpful, and thank you for your question.

There are two techniques for advancing the overly high hairline- hair grafting, and the surgical hairline advancement (SHA).

The SHA technique is a 2 hour procedure performed usually under local anesthesia with some oral sedation (but if desired, can be performed under intravenous sedation) that involves making an incision along the hairline and advancing it, lowering it by as much as 1 ½ inches (3.5 cm) or more in a single procedure, removing the excessively high forehead skin, with virtually instantaneous results.   The sutures along the hairline are removed at 5 to 7 days, leaving a fine line scar that is designed so that hairs actually grow through it.  To secure the advanced hairline in its more forward position, oftentimes small Endotine" hooks are placed below the scalp, which dissolve after 4 to 6 months (they cannot be felt unless you push down directly on them).  This procedure is best for patients with a flexible scalp to allow for sufficient advancement, and can be combined with a browlift for patients desiring a more youthful eye region if the eyebrows have fallen with age.  To assess your scalp laxity, you need to place your index finger right on the midaspect of your hairline, and see how far it can move back and forth-  this total excursion is a reasonable estimate of just how far the scalp can be advanced with the SHA.  Another requirement for being a good candidate is that there should not be any thinning of the frontal hairline, and that the hairline hairs are stable.   Lastly, some patients choose to undergo hair grafting after the SHA to both round out the hairline, allowing filling in of the temporal regions, as well as to help further conceal the fine line scar that may be visible in the occasional patient.  This grafting can be performed as soon as 3 months after the SHA, and typically ranges from 300 to as many as 800 grafts.

The more commonly chosen procedure to advance the overly high hairline is hair grafting.  This is a typically less "surgical" procedure, involving the transplanting of 1200 to as many as 2400 grafts (depending on how much lowering is desired) in a single procedure, taking 3 to as many as 8 hours to perform (it is a very meticulous procedure).  Every graft is placed into tiny recipient sites (0.5 to 0.8 mm in size) each one made by me- these sites then determine the direction, pattern, and angulation of growth to assure a natural appearance.  The transplanted hairs typically fall out within 3 weeks, then start to regrow at 4 months, taking a full 10 months or longer for final results.  The hair grafting procedure is ideal for hairlines that are thin or thinning out, for those who want a hairline that not only is lower but also is more rounded, and for those who opt not to have or are not good candidates for the SHA.

In your case, you need to be properly evaluated by a surgeon who has experience with these different techniques, to make sure you are treated with the procedure that has the best chance of success.

From the photos, it appears that a hair transplant would achieve your goals. Follicular unit extraction is the ideal technique for hairline procedures due to the expanded donor hair options (i.e. nape hair) to execute the most natural-looking result. FUE also minimizes scarring. However, a consultation would be necessary to further evaluate your hair loss, the quantity of grafts necessary, and your general health (for example, your prior reaction to anesthesia and medications could pose a problem). Depending on the clinic, you’re looking at a rough cost estimate of $10,000 to $15,000.

Hair transplantation would be beneficial to your forehead aesthetics.  This would produce the least amount of scarring (donor hair scar in back of scalp; well hidden by hair). Forehead skin/scalp procedure would place a potentially more visible scar at the hair line.  Addition, one must consider what this procedure would do to the eyebrow aesthetics.  Hair transplant cost vary from surgeon to surgeon and region to region. Range may be from $5000.00 to 12,000.00. I would continue use of Minoxidil at the 5% strength and visit with an experienced hair restoration surgeon to map out a plan.

Dr.ES

I would wait at least one year after starting the Minoxidil and would recommend using 5% but only after consultation with a doctor who has some background in hair loss or hair restoration. It should definitely be determined that you are not continuing to lose hair before considering any type of hair or scalp surgery.

If surgery is to be done whether it be transplants or a hairline advancement procedure or a combination of both, you are looking at $7,000 to $15,000 of costs. Noticeable scarring should not be a problem.  I favor hairline lowering/forehead reduction when the proper conditions are present. The hairline you designed is definitly acheivable with stable hair conditions.  

Yes, you can do either a forehead reduction (also known as a hairline lowering procedure) or a hair transplantation procedure.  The forehead reduction procedure has decreased in popularity over the past 5-10 years possibly due to the success of follicular unit transplants (which can give an outstanding, natural appearing result).  Doing some online research is your first step.  Your next is to schedule an in-person consultation with an experienced hair transplant surgeon so that you can discuss which option(s) are best for your particular case.  Good luck to you. Dr. P

Yes, you could benefit but you should be seen in person by an MD for an evaluation in person.  Also, it is important to look into FUE vs FUT options.  Plastic surgery also does forehead reduction as  a surgery but the scar may be different.