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Man: I have a high forehead since birth and dense hair. Would you recommend a hair transplant or forehead reduction surgery? My hair is wavy and a bit curly. If hair transplant is better for me, then how many grafts would I need to lower my hairline by 2 to 3 centimeters? I have no hair loss problem.

Dr. Prasad: Thank you for your question. You submitted your question, a history that you have a high forehead since birth, that you have dense, thick hair, and that you're not suffering from any hair loss, and you want to know how do you get more hair lower, whether it's by transplant or by a forehead reduction.

So before answering that question, there are some critical things to really understand about the hairline and I would say that the most important thing is to think about what's the future of your hairline? So you submitted a photo for the front as well as from the side that shows the natural male-pattern hairline and what I would say is that you have to be concerned about what would happen, whether or not you had an incision or whether or not you had transplants should your hair start to recede.

When people have hair transplant and are seen later in their life as looking pluggy, it's not because that their transplant was done badly. It's because the transplant had company and that the native hairs and the hairs that were transplanted looked good together and volume effect was nice. But as life went on, the person may or may not have been on medications like Finasteride to try slow down the hair loss progression or they may not have responded to it or they may have a side effect. And whatever the reason was they continue to thin and then what happens is you see the individual grafts and they look pluggy.

So let's say you decide, instead of doing that, let's do a forehead reduction. That forehead reduction requires an incision, and that incision can be camouflaged very effectively when there's hair. If the hair were to recede, then the incision could be apparent. So as is often the discussion, especially for younger people in their 20s or even 30s, is you have to think of the future and be prepared for what are the consequences of making a decision.

So if this is a situation where your family history is such that everybody has lots of thick hair and no one recedes, then the discussion about your options should be a balance of what were to happen if for any reason you did have some recession and that you had a choice between an incision scar or the presence of grafts.

In our practice, we tend to lean towards doing grafts. I think that because what we do, when we do our hair transplant surgery is we use this method called hair regeneration, which, in a way, can act in the right patient as a vaccination effect if they are thinning and prevent progression of the hair loss in the area where we place the grafts. In addition, we maximize the effect of the benefits of the grafts is a well-known thing in hair transplant surgery that not all grafts make it when they are transplanted, and that's a terrible limitation when you think about the limitation of the graft source which is finite. So every hair is gold. And so in our practice, when we do a transplant, we combine that with hair regeneration to preserve existing hair as well as to maximize the survivability of the hair grafts. So I think that that would be worth considering.

Now that being said, understand that with hair transplant, there are limitations in terms of the density that is achieved. So although when you do your research, you'll find all kinds of claims about doing 80, 100 hairs per square centimeter, it's about the surgeon's technical skills to be able to place the hairs, it's about the survivability of the grafts. With that being said, I also explain to my patients that if you are looking to lower your hairline, be prepared for two surgical procedures in order to achieve the optimal density that will give you the results that you desire, because nature creates this type of density which is fantastic and beautiful, but from a surgeon's perspective, recreating that with one transplant is challenging. And when it's right there in the front, it has to be done in a way that is natural and dense. And typically, we have found that it takes two procedures to do that.

So I think that what your next step is to meet and have consultations with doctors who perform both procedures and learn about your options. Think about the future. Think of the possibility of hair receding in terms of how that will impact the appearance should that occur.

So I wish you the best of luck, I hope that was helpful, and thank you for your question.

Large Forehead Correction: Hair Transplant or Forehead Reduction?

Dr. Amiya Prasad discusses the long-term advantage of lowering a hairline with hair transplantation with a hair thickening and a hair loss prevention treatment over forehead reduction surgery.