Question 1

What is forehead reduction surgery?

Accepted Answer

Forehead reduction surgery, also called hairline lowering or scalp advancement, shortens the distance between your hairline and eyebrows by moving the scalp down and forward, positioning your hairline lower on your forehead.

This surgical procedure can create more balanced facial proportions and a much fuller hairline. According to Dr. Jeffrey Epstein, a hair restoration surgeon in Miami, “The density achieved is unsurpassed—typically greater than the results that can be achieved with two hair transplant procedures.”

Question 2

What are the pros and cons of forehead reduction?

Accepted Answer

Pros

Eliminating excess forehead skin creates a denser hairline, resulting in fuller-looking hair. “If your surgeon makes the incision back into thick hair, you can increase your new hairline’s density,” explains Dr. Richard Fleming, a facial plastic surgeon in Beverly Hills, California.
Results are immediate and permanent.
The procedure does not change existing hair texture and curl or decrease hair density. However, the surgeon can cut out widow's peaks and cowlicks, to improve your hairline.
Making a large forehead look smaller can make patients less self-conscious and boost self-esteem. "Seriously, it's the best decision I have ever made! My family told me I would regret spending money on this, but no one will understand what it’s like to have a massive forehead unless they have one themselves!" says one RealSelf member.

Cons

Occasionally, patients are left with a visible scar along their new hairline. When the procedure is performed properly, the incision should have hair growing through it, to hide the scar. However, if a scar remains visible, you may choose to conceal it with hair transplant surgery.
The surgery can reduce the height of the forehead, but it can’t narrow a wide forehead. You’d need a hair transplant for that.
A fair amount of scalp laxity (stretchiness) “is required to achieve a nice amount of lowering,” according to Dr. Epstein. Patients who don’t have enough skin laxity may need tissue expansion, to slowly stretch their scalp.
You will have temporary numbness right behind the surgical incision. “The numbness usually fades in four to six months, as the nerves regrow,” says Dr. Epstein.
It’s rare, but some patients suffer post-op hair loss. “This is typically the result of overzealous advancement of the scalp skin and/or over thinning,” Dr. Epstein says.

Question 3

How much does a forehead reduction surgery cost?

Accepted Answer

Several factors affect the cost of hairline lowering, including where the procedure is performed, the type of anesthesia you have, and the credentials of your surgeon.

Forehead reduction is rarely covered by insurance, but you may be able to finance your procedure.

You can finance your treatment with CareCredit.

See our complete guide to forehead reduction surgery costs

Question 4

Forehead reduction before and after pictures

Accepted Answer

The forehead reduction photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 5

Who's a good candidate for forehead reduction?

Accepted Answer

The best candidates for hairline lowering surgery have a high forehead, good scalp mobility, minimal to no frontal hairline thinning, and a desire to change the proportions of their facial features.

“The procedure is ideal for patients who find it hard to conceal their high forehead with their hairstyles,” says Dr. Fleming.

Some surgeons perform the procedure in conjunction with a brow lift (to reduce sagging and smooth wrinkles) or contouring a prominent forehead bone, which can also shorten the brow-to-hairline distance.

“Forehead reduction is more common in women than men because this surgery is best for people who were born with a high hairline, not for those trying to combat a receding hairline from male- or female-pattern baldness,” says Dr. Pak. If the hairline continues to recede due to hair loss, the incision site can become visible.

Male patients who are appropriate candidates are typically older, with no family history of hair loss, explains Dr. Epstein. He also performs forehead reduction surgery on female gender-affirmation patients who want a lower, more feminine-looking hairline. In these cases, a forehead reduction procedure may also be combined with a brow bone reduction, during which the surgeon shaves down the orbital bone at the top of the eye socket, under the eyebrow, to make a large forehead less prominent.

Question 6

How is forehead reduction surgery performed?

Accepted Answer

Forehead reduction surgery typically takes one to three hours, depending on your doctor's surgical technique and the specifics of your procedure. You'll be given either local anesthesia with sedation or general anesthesia, depending on the extent of your procedure and your provider's preference.

Here's how the procedure works.

Your surgeon marks the spot of your planned new hairline and makes an incision.
The hair-bearing scalp is mobilized then moved forward one to three centimeters. “Ideally, the hairline will be secured in its anterior position with some type of fixation,” says Dr. Epstein. He prefers Endotine clips.
Any excess forehead skin is removed.
Your surgeon then closes the incision with two layers of stitches or surgical clips.
Finally, a surgical pressure dressing will be applied for 24 to 48 hours to prevent swelling.

In cases where the scalp skin is not elastic enough to move forward, a tissue expander can be placed under the scalp. “As it is inflated over four to eight weeks, it will slowly stretch the scalp skin, to provide the necessary laxity,” Dr. Epstein explains.

Once the skin is sufficiently stretched, your surgeon will remove the expander and finish your hairline lowering procedure.

Question 7

How long does recovery take?

Accepted Answer

“Recovery is different for each person,” says Dr. Pak. “Most people can resume normal activities the next day, though there may be some pain, redness, swelling, and bruising.”

Some patients take a week of downtime after hairline lowering, to let any swelling or bruising that may occur resolve before they head back to work. Others are able to return to work or school as soon as two days later, wearing a headband or hat or brushing their hair forward to hide the sutures.

“Recovery from forehead reduction is actually quite easy,” says Dr. Epstein. “Most of my patients are able to fly back home the first day after the procedure without any head dressing and be fully presentable one or two days later. There is typically minimal or no swelling or bruising around the eyes. Within one month, hairs will be growing through the incision, and it’s usually not very visible.”

Your provider should walk you through their recovery recommendations, which may include:

taking prescribed pain medication to ease any discomfort during the first few days
avoiding strenuous activities for the first week
keeping your head elevated (even while sleeping) to minimize swelling and bruising
keeping the incision clean and checking for any signs of infection

In some cases, your surgical stitches or clips will dissolve; in others, your doctor will remove them about a week post-procedure.

It takes about six months for the incision site to fully heal and fade, but most patients can style their hair in a way that hides the incision as it heals.

Question 8

Are forehead reduction surgery scars visible?

Accepted Answer

You will have a forehead reduction surgery scar, but it should be easily hidden under your hair. “Hair follicles are buried under the incision, so hair will grow in front of it and effectively hide scars,” says Dr. Fleming.

If your natural hair growth post-surgery doesn’t conceal the scar as much as you would like (or you have unexpected hair loss), hair grafting can help to camouflage it.

Question 9

How long does forehead reduction last?

Accepted Answer

Hairline lowering results are permanent. “The hairline, once lowered, should stay in its lower position for a lifetime,” says Dr. Epstein. “I have seen patients, eight years after forehead reduction surgery, with their hairline in the exact same location it was right after their procedure.”

Question 10

What are the risks of forehead reduction surgery?

Accepted Answer

“In general, forehead reduction surgery is very safe,” says Dr. Matthew Richardson, a plastic surgeon in Frisco, Texas. You can expect bruising and swelling during the healing process, but "most forehead reduction surgeries are very easy to recover from, and the risks are small."

That said, every surgical procedure has risks. Forehead reduction surgery carries risks of:

infection
numbness around the incision (usually temporary, but occasionally more long-lasting)
bleeding
visible scarring
discomfort
asymmetry
hair loss at the incision site (usually temporary, but permanent in rare cases)

During your initial consultation, your provider should talk you through these potential complications and how to mitigate them.

FOREHEAD REDUCTION

Jeffrey Epstein, MD, FACS

Karyn Repinski

Jeffrey Epstein, MD, FACS

Karyn Repinski

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Jeffrey Epstein, MD, FACS

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