Top of my scalp is completely numb 5 1/2 weeks after hairline lowering/forehead reduction. When will sensation return?

Question

I had one stage hairline lowering done 5 1/2 weeks ago. The surgeon excised just over 1 cm of skin from my forehead. The sides of my head, particularly around the temples, is still quite sore, and the ENTIRE top of my scalp remains completely numb. There is some mild itching, which I've taken as a sign that the nerves are regenerating, but I'm still concerned at the continued loss of feeling. At this stage is it normal to still be so numb?

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  Numbness after any surgical 
procedure is expected for several weeks to months following.  As the 
nerves to the area are traumatized and will then experience a temporary 
neuropraxia, a transient loss of nerve conduction.  This usually 
resolves over the next 6-12 weeks, but depending on the procedure 
performed, sometimes much longer.  Typically this should resolve by 1 
year.  As it goes past this date, the likelihood of the sensation 
returning is small.  However, it can take up to 2 years.  If no return 
from there, it is unlikely to return.  It should be discussed that 
persistent sensory changes may develop following any surgical 
procedure.  The usual signs of the nerves regenerating and neuropraxia
 resolving is itching, followed by a burning sensation and then 
occasional sharp, shock-like pains.  These will be normal to experience,
 and actually a promising sign.  Usually, normal sensation returns, but 
is is also possible to have decreased sensation or even increased 
sensation to the areas affected.  Re-educating nerves postoperatively is
 often helpful and will allow proper instruction for the affected 
sensory nerves - methods include using different textures to the 
affected areas when showering, bathing, applying lotion, etc.  If 
bothersome, there are some medications that may be helpful, including 
Neurontin for pain for hypersensitivity.  You can try various textures 
such as washcloths, loofahs, cotton sheets, etc.  Massaging the areas is
 also beneficial for the incision to make the finest scar possible.  The
 last place to regain the sensation will be directly adjacent to the 
incision/scar as the nerves will make its way from the periphery to this
 location.  If continual pain arises, evaluation is warranted.  After 
ruling out other causes, one rare explanation may be that a neuroma has 
developed and may require surgical excision.  This is very unlikely 
unless a large sensory nerve has been transected inadvertently during 
the procedure.  Hope that this helps!  Best wishes!

Matthew Richardson, MD · Answer

Some degree of scalp numbness is to be expected after a forehead reduction (hairline advancement) procedure. The primary nerves that supply the front part of the scalp are generally cut as part of the procedure, and over time, this sensation returns. While some small amount of permanent numbness is possible, this is not common, and not an issue for most patients. Nerve regeneration can take many months or even years in some cases. I always encourage patients to discuss any of their postoperative concerns with the surgeon who performed the procedure.All the best,

Jae Pak, MD · Answer

Numbness is a normal after a forehead reduction surgery.  It can last weeks to months.  It is a good idea to follow up with your surgeon for a recheck.

Steven Vath, MD · Answer

Thank you for your question.  You are still very early in the healing process. Soreness is to be expected at 5 1/2 weeks post op.  Additionally, it can take up to 18 months for the sensation to fully return to your scalp. Be patient. Itching or the feeling of "pins and needles" are indications of nerve regeneration and these are normal signs of healing. Please call your plastic surgeon's office if you would like some reassurance.

Robert M. Wald, Jr., MD · Answer

It is normal to have numbness following  your procedure. When a scalp lowering procedure is performed, the nerves that supply sensation to the forehead and scalp are bruised. It can take several months for these nerves to wake up and for you to regain your normal sensation. Itching is also quite normal and indicates the scalp is healing and the nerves are regenerating. Everyone is different and the times for these nerves to work normally varies from patient to patient.

Timothy R. Miller, MD · Answer

Yes, it is common to have the numbness you are describing 5 1/2 weeks after your procedure.  The itching is indeed a sign that your nerves are recovering.  The numbness can persist for 6 months but can take one to two years to return to complete normal sensation.  However, the timeline is typically about 6 months.  Be careful with hairdryers (curling irons) and other similar devices until the sensation returns so as to avoid burning or injuring the skin.I hope this helps.

Robert H. Hunsaker, MD · Answer

It depends on precisely which tissure plane the lift was done on and whether any specific attempt to preserve the main nerves for sensation to the crown was made. If just bruised nerves it is mostlikely to return. If you had a deeper plane dissection, it is more likely that these nerves were sacrificed and while sensation will not return, the are will get smaller and your brain will typically begin to progressively ignore it more and more over time. Usually it is not an issue long term. Ask your surgeon if he/she identified and preserved the nerves or cut them.

Suzanne Kim Doud Galli, MD, PhD, FACS · Answer

During surgery, the cutaneous nerves can be severed. It can take several weeks to several months for the sensation to return. Be patient and give yourself time to heal.

Curtis Wong, MD · Answer

usually resolve with time, even when the nerves may be cut completely.  You can only hope for the best and it would be encouraging if you developed electric like sensations in your scalp as it usually is a sign of healing.

William Rassman, MD (retired) · Answer

With a hairline advancement surgery, small nerves are cut and they will eventually heal and sensation will return in week or a few months

Top of my scalp is completely numb 5 1/2 weeks after hairline lowering/forehead reduction. When will sensation return?

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