Everything You Need to Know About Forehead Reduction and Hairline Lowering Surgery

Forehead Reduction and Hairline Lowering Surgery

What is Forehead Reduction Surgery?

Forehead reduction surgery is a type of plastic surgery that’s designed to shorten the distance between your hairline and your eyebrows. It is also commonly called hairline lowering or scalp advancement since the procedure involves moving the hair-bearing scalp forward and securing your hairline in a lower position on your forehead. This is a “high patient satisfaction surgery”; the vast majority of patients who undergo forehead reduction surgery are pleased with the results.

There’s a lot to like about forehead reduction surgery. It can help create more balanced and harmonious facial proportions and give you a much more balanced hairline. Those who undergo this surgery have better and quicker results with forehead reduction than they would with hair restoration surgery. Transplanting hair doesn’t yield as much hair density in the desired area as forehead reduction surgery can achieve.

How does Forehead Reduction Surgery Work?

Forehead reduction surgery is a straightforward procedure performed by professional facial plastic surgeons. The surgery itself typically lasts about three hours, depending on the specifics of your procedure. Forehead reduction surgery is often performed at the same time as other cosmetic procedures, such as brow lifts, so you maximize your time and money.

You’ll be sedated or given anesthesia sedation or general, depending on your and your surgeon’s preferences. Before your surgeon begins, they will plan the demarcation of your new planned hairline. Once your new hairline is drawn, the plastic surgeon will make an incision and loosen the hair-bearing scalp tissues. The final step will be to move the skin forward anywhere from one to three centimeters and remove any excess skin before closing the incision.

It’s possible that the skin of the scalp is not elastic enough to be lowered the desired amount. If that’s the case, the surgeon may consider the placement of a tissue expander under the scalp. During the course of about six weeks, the expander will gradually stretch the skin. Once the skin has been stretched enough, the surgeon will remove the expander and finish the procedure.  An alternative is to have a second hairline lowering procedure.

Your surgeon will use two or more layers of stitches or surgical clips to close the incision after the hairline has been secured. They will also cover it with surgical dressing afterward.

Additional Read: 8 Facts About Hairline Lowering That Will Blow Your Mind

What to Expect When You Schedule Surgery

The procedure moves the hairline location lower on your forehead, permanently changing the proportions of your face. The procedure only takes about 2 hours, and the results are noticeable soon after surgery. Unfortunately, recovery doesn’t happen immediately, but we will guide you through every stage. A full recovery lasts 12-18 months.

Here’s what to expect before, during, and after forehead reduction surgery:

Before Your Treatment

Being as healthy as possible before your surgery helps you heal. Starting a month or so before your surgery, you’ll want to take some steps to ensure you have the best experience possible.

  • 1 week before your procedure, stop taking all aspirin and aspirin-like products (ibuprofen) unless your primary doctor requires it and inform your surgeon
  • 2 days before your procedure, abstain from alcohol until after the surgery
  • 6 hours before your procedure (at least), you’ll need to stop eating or drinking
  • Arrange for a caregiver to help you after the procedure

We’ll discuss these and any other requirements during your initial consultation.

Day of Treatment

On the day of your treatment, you’ll need to have a driver to take you home.

  1. Be sure to wash your face and hair thoroughly. Comb tangles out of your hair.
  2. Refrain from applying any makeup, creams, or any products to your face or hair.
  3. Take one dose of the oral antibiotic with a small sip of water.
  4. Wear a zip-up or button-up shirt and comfortable clothing for the procedure.
  5. If you would like to conceal the dressing when leaving the office, please bring a hooded jacket or sweater, or a scarf to wrap around your head.

During the Procedure

Hairline lowering surgery is typically performed on an outpatient basis. The hairline lowering procedure takes about 2 hours. An irregular trichophytic incision is made behind the first two rows of the existing natural hairline during the operation. Hair can grow back through the scar using this opening. Then, the scalp is pushed forward and raised to create the desired forehead height.

The incision is closed in layers in order to create very fine sutures along the hairline to avoid a noticeable scar. Deep sutures anchor the new hairline in place and a hairline lowering bandage is applied. Patients can typically remove the bandage the next day after the procedure, and no further bandages are usually required.

After Hairline Lowering Surgery

It’s essential to take good care of yourself and follow all instructions in the weeks after your surgery.

  1. Relax and rest with your head elevated above the chest for the first 3-5 days. 2-3 pillows or a reclining chair work well. This will help with swelling.
  2. Keep well hydrated. Eat a low sodium high protein diet to help with swelling and to ensure good healing.
  3. Apply frozen peas in a plastic baggy or an ice pack to the eye area(s) intermittently for the first 36-72 hours. Use a thin washcloth between the plastic and your skin. The bruising and swelling will move downward after the procedure and will be more noticeable around your upper and lower eyelids, and cheeks.
  4. Take your pain medication every 4-6 hours, if needed. Always take narcotic pain medicine with food to decrease nausea. If you do not have pain, do not take the medication. For minimal pain, take Extra-Strength Tylenol ONLY. DO NOT TAKE any aspirin or aspirin-like products.
  5. Clean incisions with a q-tip(s) soaked with hydrogen peroxide. Take q-tip(s) moistened with hydrogen peroxide and roll over the incision and the sutures, this will help remove any dried blood, and keep the incision clean. Then apply antibiotic ointment directly to the incision/sutures with a q-tip or clean finger, 3 times a day for the first 7-10 days (continue until your first post-operative appointment). The goal is to keep the incision clean, prevent any crusts or scabs to the incision, and moist. IF the incision is clean, you may stop the hydrogen peroxide cleaning, but continue the topical antibiotic ointment application.
  6. Refrain from strenuous exercise and high aerobic activities for 1 week.

It’s normal to feel some itching and numbness during recovery that may last up to a year. You may also notice the shedding of fine hairs. Don’t worry; your hair normally grows back after 3 months.

In 12-18 months, your hairline lowering results will look and feel natural.

How Long does it Take to Recover from Forehead Reduction Surgery?

While it depends a great deal on the actual surgery and the individual undergoing it, recovery usually takes about a week. Many people can return to normal activities the week after surgery. That’s usually enough time for much of the swelling and bruising that accompanies the surgery to subside. Most patients are able to travel back home without the surgical dressing as soon as the day after the procedure. Many choose to wear a hat or headband or brush their hair forward to hide the sutures when they resume normal activities like work or school within one week.

Most doctors recommend that patients avoid strenuous activity for the first week or so after the forehead reduction surgery. However, patients will commit to camouflaging the incision for up to 3 months as the incision fades.

Patients have prescribed pain medication for the first few days of recovery. You’ll need to keep your head elevated (including while sleeping) to minimize swelling and bruising. It’s usually a good idea to use several pillows to prop yourself up. This method will help facilitate the healing process.

Aftercare is focused primarily on keeping the incision clean and keeping an eye out for potential infection. In most cases, the surgical stitches or clips along the incision will be removed by your surgical team a week after the procedure.

You can anticipate being mostly presentable at about a week, as there typically isn’t much swelling or bruising around the eyes. After a few months, you’ll see hairs growing through the incision, and the incision itself should be well on its way to healing. You may experience temporary numbness at the incision site for up to four to six months after surgery. This numbness should dissipate as the nerves grow back after surgery.

Within six months, the incision will be fully healed and start to fade. In the meantime, most patients choose to style their hair over the scar to keep it hidden from view. Moreover, patients use headbands, hats, and scarves to conceal the incision.

The Pros and Cons of Hairline Lowering Surgery

Hairline lowering surgery has proven to be a routine procedure with high rates of patient satisfaction. Complications are rare.

Benefits of Hairline Lowering Surgery

The benefits of hairline lowering surgery are significant and noticeable immediately:

  • It’s a permanent solution
  • Can restore or alter facial proportions
  • Can make you appear younger
  • Reduces temporal hair loss
  • Alleviates forehead wrinkles
  • Increases self-confidence and self-esteem

Possible Complications

Although complications are rare, they are possible:

  • Numbness
  • Fluid accumulation
  • Facial asymmetry
  • Bruising
  • Hair loss around the scar
  • Loss of mobility and expression in the forehead
  • A need for revision or secondary surgery.

Does Forehead Reduction Leave Scars?

Forehead reduction surgery typically leaves a scar along your hairline where the incision is sutured closed. The scar is usually easy to hide under your hair.

Hair follicles lie underneath and adjacent to where the incision is placed, and they help to conceal the scar. Within a few months of surgery, look for hairs to grow around the scar to hide it. If you find that hair growth after surgery is not enough to conceal your scar effectively, hair grafting may be needed to cover it up more.

Who is a Good Candidate for Forehead Reduction?

Forehead reduction surgery is most often performed on females or males without a family history of hair loss, as well as individuals looking to curate more youthful, balanced features. The main requirements for a successful procedure are that patients have a high forehead, good scalp elasticity, and no hair thinning. They must also desire to change the proportions of their facial features.

Scalp laxity is important because the stretchiness of the scalp has a direct impact on the result. A fair amount of scalp laxity is necessary for the patient to realize a nice amount of lowering. If the scalp is not that elastic, tissue expansion might be required before the surgery can be completed.

People trying to correct a receding hairline caused by male or female-pattern baldness are not generally good candidates for forehead reduction surgery. If the hairline were to continue to recede because of future hair loss, the incision site would be visible.

Because a high hairline is essential, many of the patients who elect to undergo forehead reduction surgery are female. Since the goal is to shorten the brow-to-hairline distance, forehead reduction surgeries are often performed in tandem with brow lifts or contouring of a, particularly prominent forehead bone. This combination is particularly effective at smoothing forehead lines and furrows by lifting the eyebrows into a more youthful position. It can also take care of vertical frown lines between the eyebrows.

Men with high hairlines may also consider the surgery. Ideally, they would have no family history of hair loss that would potentially reveal their scar.

Transgender patients who are in the process of transitioning from male to female choose this surgery to obtain a lower, more feminine-looking hairline. When this procedure is done to facilitate the transition between genders, it may be accompanied by a brow bone reduction. During that process, the surgeon shaves down the orbital bone right under the eyebrow, near the top of the eye socket. These procedures can be performed via the same incision that is used to lower the hairline. When combined, they make a broad forehead appear significantly less prominent.

Hair transplant surgery can often complement forehead reduction surgery by making the hairline look more natural. Hair transplants will usually be used to round the hairline or make a broad forehead appear narrower.

Thankfully, once completed, the results should last for a lifetime. Once the hairline is secured in its new position, there should be no movement.

Additional Read: Enhance Your Appearance With Hairline Lowering

Find a Qualified and Skilled Surgeon

In general, this procedure is very safe. As with any surgery, there are still risks. Those risks include numbness, bleeding, scarring, bruising, swelling, discomfort, asymmetry, temporary or permanent hair loss, and infection. However, choosing a highly qualified and skilled surgeon will reduce even those uncommon risks to ensure that you achieve optimal results with your forehead reduction surgery.

For the most part, forehead reduction procedures are simple, low-risk, and easy to recover from. If you’re on the fence, consider that the results are often striking, permanent, and immediate, with most individuals reporting consistently high levels of satisfaction with their results.

Since this is normally considered a wholly cosmetic procedure, it is never covered by insurance, so expect to cover the costs on your own or through financing with your doctor’s office. When you discuss your options with a surgeon, make sure that they are well-versed in all the procedures you are looking to undertake when you have your hairline lowering surgery.

Technical expertise has a direct result on the outcome of your procedure. As you consider the costs, listen to the surgical approach, and make sure that you are comfortable with the level of care that your surgeon will provide.  Ask to see the doctor’s work.  An experienced surgeon should have many pictures of patients similar to you to show you.

If you’re in the Chicago area, please consider Dr.Sidle for all of your facial plastic and reconstructive surgery needs. His years of experience and technical proficiency make him one of the leading reconstructive surgeons in the region. He has built his reputation on excellent results and impeccable care for his patients. We’d love to talk to you about your forehead reduction surgery.

About Douglas M. Sidle, MD, FACS

Dr. Sidle specializes in cosmetic and reconstructive surgery of the face, head, and neck. His services range from minimally invasive office procedures with little to no down time to major operations leading to dramatic improvements in appearance. Dr. Sidle is one of a select group of cosmetic surgeons who are “double boarded”. He is Board Certified by the American Board of Facial Plastic and Reconstructive Surgery and by the American Board of Otolaryngology-Head and Neck Surgery.
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