HAIRLINE LOWERING SURGERY
(FOREHEAD REDUCTION SURGERY)
BEFORE & AFTER PHOTOS OF HAIRLINE LOWERING SURGERY
What is Hairline Lowering Surgery or Forehead Reduction Surgery?
Reducing the size of the forehead by moving the entire scalp forward and removing the extra forehead skin. An excessively high forehead can be due to developmental or genetic factors, hair loss, or from prior surgery. A high hairline or excessively high forehead can make an individual feel self conscious.
There are two main ways to lower a hairline: the first option is moving the scalp forward and removing a portion of the forehead skin, and the second option is to make the forehead appear smaller by grafting hair to the forehead, hence making the hairline appear lower.
Dr. Aharonov is the leading plastic surgeon in the world for forehead reduction or hairline lowering surgery. He pioneered and is the ONLY surgeon who performs his trademarked Forehead Reduction One Stage Technique (FROST), which lowers the hairline significantly without having to use a tissue expander. Dr. Aharonov's FROST procedure can lower a hairline large distances that previously was only possible with a two stage procedure using a balloon tissue expander.
Forehead Reduction or Hairline Lowering Surgery
Forehead reduction or hairline lowering surgery consists of advancing the entire scalp forward, effectively moving it to a new lower position. Most times in people who are naturally born with a higher hairline, there are adhesions during embryonic development that prevent the scalp from rotating to a lower position. This surgery is intended to correct the position of the scalp to where it would have been if the adhesions did not prevent the proper movement. Once the scalp is advanced to a lower position, the extra forehead skin is removed. Dr. Aharonov uses the latest techniques in minimally invasive surgery and scar reduction to help your scars heal virtually imperceptibly. Dr. Aharonov's technique of forehead reduction surgery has proven to be immediately effective, well tolerated by patients, and associated with minimal complications and minimal pain. Some patients can return to work as early as 2 days after their hairline lowering surgery.
Good candidates for forehead reduction or hairline lowering surgery include people with a high hairline or large forehead who otherwise have normal hair, and no history of hair loss.
Hairline Lowering Surgery in Women
Hairline lowering is best suited for women who were born with a high hairline. This procedure can be performed alone, or in combination with a brow lift to raise the position of the eyebrows. Most patients with a naturally occurring high hairline are suitable for a one stage hairline lowering procedure. Optimal outcomes are achieved in patients with an otherwise normal density head of hair, but with a large forehead that is too big for their preference.
Dr. Aharonov is well known for his virtually invisible scarring. The scar is the most important indicator of optimal outcome for forehead reduction surgery. If a patient has a smaller forehead but an obvious scar, they will be just as self conscious about the scar as they were about the large forehead.
Hairline Lowering Surgery in Men
Hairline lowering surgery is best suited for men who have always had a high hairline and are NOT actively losing hair. Men with thinning hair or who are actively losing hair should consider medical treatment to reduce the amount of hair loss before considering any procedure or surgical intervention.
Forehead reduction surgery does NOT raise the eyebrows at all, which is a concern of many men. A combination of Forehead Reduction Surgery and a forehead lift can be performed at the same time, if raising the brows is also desired.
Hairline Lowering Surgery Combined With a Brow Lift
If the position of the brows is of concern to a patient, the best time to address brow position is combined with this surgery. Through the same incision for the hairline lowering, a brow lift can also be performed. This saves a patient recovery time and cost compared to having two separate surgeries.
Revision Hairline Lowering Surgery
Currently, a significant number of our cases are revisions of other surgeons' work. Whether it is an unnatural hair grafting result that a patient is not happy with, an unacceptable scar from a previous attempt at lowering the hairline, or just an inadequate reduction gained from a previous surgery, revision work can be both gratifying and challenging.
If there has been previous hair grafting, it is important to know whether an FUE or FUT hair grafting procedure was used. The length of the incision from a previous FUT procedure might complicate attempts to revise the results. It is still possible to perform the revision if the length and depth of the scar were within normal and did not affect scalp blood flow significantly. Please contact our office for more information regarding these special circumstances.
Chin Augmentation Along with Hairline Lowering Surgery
For reasons not fully understood, about 60% of patients who have a larger than ideal forehead also tend to have a smaller chin than is ideal for their face. Maybe the two might be related developmentally. If that is something that is bothersome, there are a few ways to augment the chin. The first is to use a chin implant. Chin implants can be easily placed at the same time as the forehead reduction surgery through a mini incision under the chin. Another way to augment the chin is with fillers. This is an office based non surgical solution which could quickly and easily make the chin larger with minimal risk. In fact, the filler is reversible and can easily be dissolved for any reason at all. If your chin is an issue to you, discuss this with Dr. Aharonov during your consultation.
Forehead Reduction One Stage Technique (FROST) with Simultaneous Hair Grafting
Dr. Aharonov currently prefers to wait at least 3-6 months in most patients before performing hair grafting after the forehead reduction. Hair grafting is more consistent and predictable when performed at a later time than when done at the same time. For this reason most people should hold off on doing hair grafting until the forehead has a chance to heal for a few months. Most patients do NOT need any hair grafting after hairline lowering surgery.
Brow Bone or Frontal Bone Contouring Along with Forehead Reduction Surgery
Some people might have an overly prominent brow bone or frontal bone which they might find aesthetically undesirable. These bones can be contoured and reduced during the Hairline Lowering Surgery. Another way to make brow bones less noticeable is with blending of the brow bone with fillers or fat injections which can create a softer contour.
Tissue Expansion for Lowering the Hairline (Two Stage Forehead Reduction Surgery)
In instances where the hairline needs to be lowered by significantly more than 2 inches, the Forehead Reduction One Stage Technique (FROST) might not be enough to lower the hairline adequately. In these instances the two stage technique with a tissue or scalp expander might be needed to lower the hairline by such a large amount. This is considered a two stage procedure. In the first stage, a tissue expander is placed under the scalp. The tissue expander is then slowly filled with water 2-3 times a week over the course of 6-8 weeks to help stretch the scalp and provide further slack for adequate hairline lowering. When there is sufficient scalp expansion for the forehead reduction surgery, the next stage is performed. The second stage is similar to the one stage hairline lowering surgery. This is done in the operating room under IV sedation. It is important to know that with a tissue expander the scalp is stretched out over a greater area leaving the hair much thinner in density. The FROST technique does not stretch the scalp and instead advances the entire scalp as is leaving the hair density unchanged. Tissue expansion, on the other hand, stretches the scalp instead of just advancing it, leaving the scalp and hair thinner.
The amount of time needed for tissue expansion is also variable and is not easy predictable. While a surgeon might tell a patient that it will only take a month, as the expansion process is underway, the surgeon might revise the expansion time needed. It is not uncommon for us to receive patients who are halfway through the expansion process with another surgeon and who are fed up and frustrated over it. It is important to know that it might take over 3 months to expand the scalp before making the decision to undergo the procedure.
BEFORE & AFTER PHOTO OF A PATIENT WHO WAS UNDERGOING TISSUE EXPANSION WITH ANOTHER SURGEON WHO KEPT PUTTING OFF THE SECOND STAGE. THIS IS 6 DAYS AFTER WE PERFORMED THE REVISION
Follicular Unit Grafting for Lowering the Hairline
Follicular unit hair grafting is an option for people who either have a thinning hairline or just want to lower their hairline or reduce their forehead by less than 1 cm. Hair grafts are harvested from the back of the head and grafted one by one to the forehead. Because the forehead skin is not as receptive to hair grafts as scalp is, the results are many times suboptimal.
Good candidates for hair grafting include men with a thinning hairline, or women with either a thinning hairline, or who only need about 1 cm or less of forehead reduction or hairline lowering, or for people with only temporal recessions who would like them filled in a little. Attempting to lower a hairline significantly with hair grafting alone is not only extremely expensive, but can often lead to very unnatural results. It is virtually impossible to achieve normal hair density with hair grafting alone, even with multiple procedures. Patients often end up spending tens of thousands of dollars, as well as several years, just to end up with suboptimal results that in many cases need to then be excised. One round of hair grafting will NEVER achieve adequate hair density and can take over a year to see the final results. Dr. Aharonov has had dozens of patients who had spend sometimes tens of thousands of dollars on hair grafting, just to then have a one stage forehead reduction to lower the original hairline and cut away all the grafts. Dr. Aharonov will discuss your options and goals with you to see if you are a good candidate for this type of forehead reduction.
What to expect from a Forehead Reduction or Hairline Lowering Surgery
During your consultation Dr. Aharonov will go into detail over what to expect from your hairline lowering or forehead reduction surgery. All of your questions and concerns will be addressed. Most initial consultations can be through video chat. Before having your consultation it will be very helpful to have a few pictures of your face and hairline sent via email for Dr. Aharonov to review. It is possible for us to take care of all the preoperative details after your video consultation.
Dr. Aharonov's patients benefit in many ways over any other surgical practice. Here are some ways the surgical experience is superior:
1. Dr. Aharonov performs hundreds and hundreds of hairline lowering surgeries. No other surgeon in the world performs even a fraction of his surgical volume. This provides Dr. Aharonov with a virtually flawless and seamless mastery of his FROST surgery.
2. The resulting scar from his hairline lowering surgery is unparalleled due to the absolute lack of tension on the scar and other proprietary surgical techniques. Other surgeons often place too much tension on the scar which leads to an enlarged thickened scar that only gets worse over time. You can see examples of Dr. Aharonov's scar over 10 years after surgery.
3. Even with minimal scalp laxity, about 2-3 cm of reduction can be achieved with Dr. Aharonov's technique. Most other surgeons would recommend a tissue expander or blame the lack of reduction on not having enough scalp laxity. With Dr. Aharonov's FROST surgery, even the tightest patients will achieve a significant amount of lowering.
4. Dr. Aharonov has perfected a way to have substantially less swelling after surgery which means a faster recovery and speedier return to work or school.
Who is NOT a Good Candidate for Forehead Reduction Surgery
Several factors play a role in deciding who is and who is not a good candidate for forehead reduction surgery. These factors include hair density, future hair loss risks, and history of previous surgery. The only absolute contraindication for forehead reduction surgery is a previous history of a coronal brow lift. A coronal brow lift is performed through a long incision about a couple of centimeters behind the hairline and spanning the entire head almost from ear to ear. This a a type of brow lift that unfortunately is still done by some surgeons. The brows are raised by cutting away hair bearing scalp and raising the brows and forehead higher. This could cause a person with a normal sized forehead to all of a sudden have a large and high forehead.
If a patient has a history of hair grafting using strip excision, and the resultant scar is considerably long, this might be a relative contraindication to hairline lowering surgery due to potential blood supply compromise. This can be assessed on a case by case basis to determine the extent of the risk.
Other relative contraindications to surgery include people with very thin hair density, or people who are actively losing hair.
Preparing for a Hairline Lowering or Forehead Reduction Surgery:
Anesthesia for Forehead Reduction or Hairline Lowering
Dr. Aharonov performs all of his hairline lowering surgeries in an AAAHC accredited outpatient surgery center in Beverly Hills. Board certified anesthesiologists, which are medical doctors, perform all of his forehead reduction surgery cases. Dr. Aharonov prefers to have a physician caring for your anesthetic needs during your hairline lowering surgery, as their experience minimizes risks. Dr. Aharonov uses an extremely safe combination of IV sedation and local anesthetic, not general anesthesia. This technique provides superior operating conditions combined with maximal patient safety and comfort. You will be completely asleep with no chance at all of waking up during your hairline lowering surgery. In all likelihood, you will awaken with very little discomfort, nausea, or anesthetic side effects. On the day of your Hairline Lowering surgery, you will meet your anesthesiologist and can discuss any questions that you may have.
What to Expect After Forehead Reduction or Hairline Lowering
After a forehead reduction procedure there might be some swelling in the forehead, head, or even the eye or cheek area. Many patients are healed enough to go back to work after a couple of days. Your forehead and head will be wrapped overnight, and the dressing will be removed the following morning. You will be able to shower and shampoo your hair the next day after your surgery. After 6 days, Dr. Aharonov will remove your sutures.
Patients who have the hairline lowering or forehead reduction surgery will experience numbness in the front of the scalp behind the incision. This numbness can last anywhere from a couple of weeks to months, as the nerves slowly grow back.
Activity Level and Exercise After a Forehead Reduction or Hairline Lowering
You should avoid strenuous activities for one week after surgery to decrease any swelling or bruising. Most patients return to work in about a week after surgery, but some patients return to work even sooner.
Frequently Asked Questions About Forehead Reduction Surgery and Hairline Lowering Surgery
1. Why is your way different?
We like to treat our patients the way we would want to be treated. I would personally not want to walk around with a tissue expander in my head unless I absolutely needed it. I would not want to get hair grafting to lower my hairline more than 1 cm because it NEVER looks as natural in real life and up close as does a hairline lowering surgery. I would want my surgery to be done in a fully accredited surgery center NOT in a regular office. I would want IV sedation to be performed by a board certified anesthesiologist NOT a nurse. These are the ways some places cut corners and cost. I would want the best for myself and would only do the same for my patients.
2. Is it possible to get a more rounded hairline with the forehead reduction surgery?
The amount of roundness possible with the hairline lowering surgery depends on factors such as scalp laxity and amount of reduction desired. Dr. Aharonov will discuss your individual situation with you during your consultation. If the amount of roundness desired is not possible with jus the hairline lowering surgery in your case, it is possible to make the hairline more rounded by using a few hair grafts if needed. Hair grafting is usually not needed for most patients if they have a dense hairline and adequate scalp laxity. Hair grafting is more accurate and predictable when done separately and therefore Dr. Aharonov prefers to not combine the two procedures unless absolutely needed.
3. How bad will I look right after surgery? Will I be able to hide it fairly well?
There is actually a pretty quick recovery time after the hairline lowering surgery. There could be a small amount of bruising and some swelling which resolves quickly. Most patients can hide the fact that they had surgery within several days after their hairline lowering procedure. During your consultation you will see many patients during all stages of healing to give you a good idea of what you will look like after your forehead reduction surgery.
4. How much does Forehead Reduction Surgery cost?
We understand that many of our patients live far away form our office and would like to know ahead of time what the cost of hairline lowering surgery might be. There are a few variable that will contribute to the eventual cost including difficulty of your particular case, whether or not hair grafting will be needed, and whether or not a tissue expander might be needed. We can usually give you a pretty accurate estimate after seeing your photos and for sure after having a phone consultation. If you just need a ball park figure please contact our office either by phone or via email and we will be more than happy to give you a range. The reason there is a range in cost for different patients is because each case is unique and might take significantly different times to perform. For example, a simple case might take about 45 minutes, while a difficult case might take close to 3 hours. The anesthesia, nurses, and operating room fees are based on an hourly rate. Hence a longer case will be more expensive. Scalp laxity, distance needed to be lowered, and the shape of the head all play a role in how difficult a case might be.
5. How long after Forehead Reduction Surgery can I fly back home?
Most patients who fly in from out of state usually stay for a week. All the sutures are taken out either 5 or 6 days after surgery. You are free to fly back home after that. Occasionally if a patient cannot stay that long, special arrangements can be made to have a physician or nurse closer to their home take remove the sutures. If so, you would be able to fly home 1-2 days after surgery.
6. I had a consultation with another surgeon who said I would need a tissue expander even though I only need one inch of reduction. Why is your technique different?
When comparing results from different surgeons, please make sure you are comparing apples to apples. Many other surgeons can only lower a hairline by only about 1 cm, or about a third of an inch, in a one stage procedure. Their before and after photos might be only after a tissue expander was used. Dr. Aharonov's Forehead Reduction One Stage Technique (FROST) is very different than other surgeons' techniques. If you only need about an inch of lowering you probably do NOT need a tissue expander and your hairline lowering surgery can be performed in one stage with Dr Aharonov's technique, even if fairly tight scalps.
7. What type of anesthesia do you use for Forehead Reduction Surgery?
For the Forehead Reduction surgery IV sedation is used NOT general anesthesia. This is done by a board certified anesthesiologist in a fully accredited surgery center. IV sedation is much safer and more comfortable than general anesthesia. You are not paralyzed or intubated. You are fully asleep and comfortable.
8. Does Forehead Reduction Surgery raise the eyebrows at all?
Forehead Reduction surgery does NOT raise the eyebrows at all. Some patients request to have brow elevation or a brow lift at the same time which can be done as well. But as is, the Forehead Reduction surgery does NOT raise the eyebrows with Dr. Aharonov's technique. Other surgeon's techniques might lead to some brow elevation, but NOT Dr. Aharonov's technique.
9. Is there a chance that my scalp will stretch backwards and my hairline go back at all after surgery?
With Dr. Aharonov's technique for forehead reduction, there is NO chance that the scalp will retract and recede again. The scalp position is fixed in place to the skull at the new position and will not move back at all.
10. Does the Forehead Reduction surgery raise the hairline at the back of my neck?
While we have not actually measured whether or not this happens, there might be a small elevation of the hairline at the back of the neck when the scalp is advanced forward. This elevation is most likely far less than half the amount of the actual scalp advancement. If the hairline is advanced by 4 cm the hairline at the back of the neck might raise by less than 1-2 cm. This has not been an issue for any previous patients.
11. My scalp feels very tight and does not move much. Does that mean I am not a good candidate for a one stage procedure and will need a tissue expander?
I have dealt with scalps that were extremely tight. While there is never a guarantee as to how much a hairline can be lowered, even it very tight scalps it is usually possible to lower the hairline by 2-3 cm. Each patient is unique and results will vary.
12. The center part of my forehead is fine, but I have significant recessions in my temples. Is hairline lowering surgery right for me?
If there is enough scalp laxity, it is possible to lower temporal recessions significantly with a modified hairline lowering surgery that Dr. Aharonov has pioneered. Even if the front of your hairline does not need significant lowering, this modified hairline lowering surgery might be right for you.
13. Can I see more before and after photos of your work?
Due to patient confidentiality concerns the photos on the website represent only a small fraction of the before and after photos available for viewing in the office during a face to face consultation. During your consultation you will see many photos of all stages of healing in many different patients. This will give you a better idea of what to expect after your surgery and during the healing time. I am always very thankful when a patient gives me permission to show their before and after photos as it helps others see what to expect from forehead reduction surgery.