Hairline Lowering
San Francisco’s premiere plastic surgeons

As many as 20% of all women have what can be described as a high hairline. It usually is a hereditary and natural characteristic. Most modern hairstylists are trained to recognize this and will style the hair combed forward in bangs and thereby disguise it. A high hairline is considered a masculine trait. A hairline that measures its mid-point between 5 cm and 6 cm above a line drawn across the brows is what most classify as a typical and desirable female hairline. A mature male hairline usually is 6-8 cm above the brows.

History

The high inherited hairlines that are often seen from those women of Anglo Saxon ancestry can be exemplified by the history and paintings of Queen Elizabeth I, the great Tudor queen, the daughter of Henry VIII, who reigned for 45 years. She had a naturally high hairline, which is revealed in many portraits.

One can find many portraits of women of English nobility of her time who emulated the queen by actually shaving back an inch or so of their hair to more resemble the queen. This was especially true of the women who were in her court. It should be noted that Bette Davis, in portraying Queen Elizabeth, had to shave her hairline back for such a movie role.

She played Queen Elizabeth twice once when she was a younger actress, and as an older actress playing the older queen, the hairline had to be kept proportionate, though Ms. Davis’ hairline had receded naturally with age. Most women who have high hairlines have a compensatory hairstyle or have little concern with it.

Those who have suffered teasing in their formative or teenage years regarding a “big forehead”, or looking more like a boy, carry this burden into early adulthood. The social stigma is similar to people who suffered severe acne in their teen years and become psychologically traumatized. Even small acne scars throughout adult life often can obsess them.

Procedure

A simple, but sophisticated one-stage hairline lowering (forehead reduction) operation can usually bring down the hairline approximately one inch. An appropriate candidate for this operation who desires lowering of a high hairline has to have an appropriate amount of scalp laxity. Alternatively, modern follicular unit hair grafts can be done to achieve a similar effect. The graft operation often has to be repeated to attain the desired density and a 12-18 month period is necessary for growth to be long enough to be incorporated into all but the shortest of female hair styles.

For those who need great advancement of the hairline or who have a very tight scalp, a two-stage procedure wherein balloon-like expander devices are inserted under the scalp in the first stage. The scalp is stretched over a six to eight-week period by gradually inflating the balloon. This allows us to bring the stretched scalp downward as much as we need. In some cases, it has been lowered up to 10 cm. Although the concept of this hairline advancement surgery is not revolutionary, the sophistication of it is really a modern development.

Does Your Hair Thin Following Hairline Lowering Operation?

There is a lot of discussion as to what changes occur in the hair after the scalp is stretched and the hairline is lowered. Lowering the hairline, as is done in forehead reduction, stretches the scalp and the hairs actually have to thin out to an imperceptible degree.

The same thinning occurs in hair transplantation. The procedure does not give anybody more hair. Hair is taken from one place and put into another. With the hairline lowering operation, however, the change is very subtle and is distributed throughout the scalp rather than having the thinning just in the back.

And, the resulting hair density in the front of the scalp is much greater than with hair transplants. There appears to be many concerns about this especially when the discussion of “shock loss” enters the picture. As an aside, shock loss occurs with almost any scalp surgery, especially with follicular unit hair transplantation. By standard definition, however, “shock loss” means that there will be recovery of hair growth starting in three months and being completed by 9 to 12 months to where hair is again long enough to be incorporated into hair styling.

Significant shock loss occurs in less than 2% of patients having hair transplants or hairline lowering. To lessen this effect of thinning, a number of maneuvers can be done. Dr. Miranda has for the last 12 years inserted a small dissolvable device, called an Endotine, which anchors the scalp onto the skull within 3 cm of the hairline.

This has the effect of taking tension off the closure and, as his recent study has shown, it compresses the hair in the front rather than stretches it. This probably accounts for an infinitesimal more stretching of the scalp behind, but it is spread over the scalp behind for about 25 cm to 30 more centimeters. It has been scientifically proven that the use of the Endotine compresses the hair in the front and eliminates frontal thinning that would occur from the scalp being stretched in the front 3 cm of the hairline.

FAQS

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77 Van Ness Ave, Suite 302, San Francisco, CA

415-379-9015