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.

As a certified facial cosmetic and reconstructive surgeon who also specializes in hair restoration, I can expertly perform the different options you have researched.  When someone considers a forehead lift or facelift, I assess the skin elasticity to anticipate risks of relative scarring that can occur from a procedure like a reverse forehead lift or even a hair transplantation procedure. In your case, for both practical and cost reasons, I recommend hair grafting.

To create a lower hairline, you have to be mindful of how close the hairs are placed in order to make it look natural.  A good strategy is to slowly lower the hairline from the point where it is most dense and transition it from there downward. This is based on the number of grafts that are available as well as the thickness and quality of the hair. In a cowlick, a procedure that might be helpful is to take hairs from the cowlick and transplant them in a different direction to get better coverage.

In traditional hair transplantation, there are hairs that don’t make it because of the type of hair, the surgical technique employed and the amount of bleeding that occurred. So in our practice, we use a material called ACell extracellular matrix which aids in healing by the duplication of tissue. This results in the activation of adult stem cells. In addition, the adult stem cell known as progenitor cells which become less capable or become defective will make hair follicles susceptible to dihydrotestosterone (DHT) the hormone that causes hair loss . Extracellular matrix and platelet-rich plasma formulation of the Hair Regeneration injection stimulates production of progenitor cells, thereby protecting the hair from the hair loss effect of DHT. So extracellular matrix is a good intervention to reverse male or female pattern hairloss and would contribute to the thickening of the hair.