Hair transplant vs. surgical hairline lowering for forehead reduction?

Question

I had a consultation with Dr. Kabaker for SHA and I was going to book my appointment today since he is retiring in January, but now I am having second thoughts. I have really thick, wavy-curly hair and am afraid of the hair loss that is inevitable with SHA. I am also nervous about having even a somewhat visible scar at the hairline. This brings me to consider hair transplant procedures to lower my hairline. Would I be able to achieve natural-looking results even if it takes a lot longer?

Jae Pak, MD · Answer

It is best to address your concerns with your doctor.  There are always risks with any surgery.  Dr. Kabaker is a well known and great surgeon who specialize in hair line lowering.

Toby Mayer, MD · Answer

I have a bias due to the fact that we invented the Irregular Trichophytic Forehead Lift  with hairline advancement more than 35 years ago. Since that time I have done  more than 1000 of these procedures without one hairline revision. If properly done the scar should not be visible, the cost is less, you don't have to wait two years for hair length, and you can return to work six days later. Also your eyebrows can be lifted which cannot be done with grafts.  Therefore I see no advantage of grafts!

Sheldon S. Kabaker, MD FACS (retired) · Answer

Since it sounds like you have not yet confirmed  a surgical date in January, it is unlikely I would now have a time slot to do your procedure. If I accepted you as a surgical patient it means you have the ideal situation for getting an outstanding results with low risk. Your concerns for scarring and temporary hair loss have also to be considered for hair transplants. You certainly can get a great result with hair transplants whether done by strip harvesting or FUE. Transplants would require 2 sessions especially since they have to have enough density to match thick hair. Also, they have to be harvested judicially to get mostly the fine softer hairs that you need to match the texture of the existing  frontal hair. (I have revised a number of transplanted female frontal hairlines because course hairs taken from strips in the back of the scalp created abnormally looking,  coarse, front hairlines). This might not happen with FUE wherein the surgeon could shave a  large swath of the donor zone hair to pick out the finer hair  follicles for grafting. There is a lot of finesse required in a female hairline lowering type of hair transplant. It appears you are planning a hairline 2-2.5 cm lower than your existing one and  would want matching high density with fine hairs in the very front. Therefore you have 30-40 square centimeters of forehead that should need 80-90 follicular units per square centimeter. This can only be achieved with two sessions of grafts. Therefore  you would need over 3000 grafts which cannot be done in one session, in my  opinion and experience. Transplants definitely will not result in a visible scar in the front of the hairline. There will be hidden scarring of some sort or another in the donor region, some of which should be in the temples where  finer hairs can be harvested. The goal of the hairline lowering operation is to get an undetectable scar. And, if any scarring is visible it can be hidden with a relatively small number of hair transplants. Some surgeons, routinely plan a later hair transplant session to fine tune a surgically advanced hairline. The beauty of the hairline lowering operation is this versatility. Finally, the subject of hair loss had been brought up. Every hair operation results in temporary diminution of hair coverage when one considers shaving of donor hairs for transplants, the possibility of shock loss of some hairs in a recipient area and the trichophytic incision used in the hairline lowering operation. The only cases of persistent post op hair loss or thinning have been in patients who have hairlines advanced because of hair loss situations such as traction alopecia, hereditary hair loss conditions , prior facelift and forehead lift operations, and ongoing use of wigs and extensions.

William Rassman, MD (retired) · Answer

Of course, Dr. Kabaker is probably the best hair line lowering surgeon in the US, but if you want a hair transplant lowering, we have been doing these for years. Our results are so good that my wife and daughter-in-law had it done and my wife showed it off at the international meeting this year along with 5 other patients. Most doctors could not believe that it was transplanted.  Both Dr. Jae Pak and I do these in our Los Angeles Office, see below+

Hair transplant vs. surgical hairline lowering for forehead reduction?

Answers (4)

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