Hairline Lowering, Filling, and Rounding Out Options? (photo)

There are two techniques for advancing the overly high hairline- hair grafting, and the surgical hairline advancement (SHA).  Few doctors offer both of these procedures, but given my experience as a facial plastic surgeon specializing in hair restoration, it makes sense that I can not only offer them to my patients, but also specialize in performing them.

 

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 appear to be a better candidate for hair grafting.  I'd anticipate a procedure of 1500 to 1700 or so  grafts to fill in the area I have marked out on the attached photos in blue, achieving a natural appearance and moderate density.  Some patients desire a second procedure in 10 plus months to achieve greater density, while most patients find the density after a single procedure to  be satisfactory.

You would need an examination to make sure you would be a candidate.You can review the VIDEO of women who had the hair line lowering to gauge what is possible.

Forehead lowering is a surgical procedure where the scalp is lifted up through an incision along the hairline and undermined posteriorly extensively. The scalp is then pulled forward into the new position and the excess forehead skin is trimmed.The cowslick could be removed during the procedure if you wish.

Various techniques are used to stretch the scalp in surgery. The deeper tough layer (galea) is incised from side to side to allow stretching of the scalp. Usually tissue expanders are not needed for even significant advancement. This is much more effective than hair grafting and probably would cost less.

The procedure does cause some numbness of the scalp behind the incision, but this does not appear to be a problem and does not bother people that have had the procedure. I would encourage you to find a surgeon that has experience with this operation rather than having hair grafting.

Search out a good hair graft doctor.  I strongly recommend Neograft that allows single follicle harvest.  Forehead reduction is also an option however that does leave a fine scar along your hairline. 

Lowering your hairline the desired 1-1.5 inches while designing a natural-looking new hairline should be possible via FUE hair transplant and would be your best bet in terms of minimized scarring. However, candidacy for the procedure and the practicality of your goal depend on a few variables, one of them being the density of the hair on the back/sides of your scalp. If you decide to seriously pursue hair grafts, I advise you to seek multiple consultations with various FUE hairline specialists. Best of luck to you.