What is Hairline Lowering Surgery or Forehead Reduction Surgery?
Hairline lowering surgery reduces the size of the forehead by moving the entire scalp forward and removing the extra forehead skin. An excessively high forehead can be developmental or genetic, or it can result from hair loss or prior surgery. A high hairline can make a person feel self-conscious about the balance of their face.
There are two main ways to lower a hairline. The first is surgery: moving the scalp forward and removing a portion of forehead skin. The second is hair grafting: placing grafted hair on the forehead so the hairline appears lower.
Dr. Aharonov is a world-leading plastic surgeon for forehead reduction and hairline lowering surgery. He pioneered his trademarked Forehead Reduction One Stage Technique (FROST), and he is the only surgeon who performs it. FROST lowers the hairline significantly in a single surgery, without a tissue expander, achieving reductions that previously required a two-stage procedure with a balloon tissue expander.
Dr Gal Explains Options For Hairline Lowering
Dr. Gal's FROST Technique for One Stage Hairline Lowering
Most other surgeons lower the hairline by stretching the scalp forward, with or without first placing a tissue expander. That approach may be enough for a patient who needs less than 2 cm of lowering and has good scalp laxity. Dr. Aharonov performs many types of hairline advancement and pioneered the tensionless one-stage scalp advancement: the entire scalp is repositioned forward without stretching it and without tension.
In people born with a naturally high hairline, adhesions from embryonic development often prevent the scalp from sitting in its proper, lower position. This surgery releases those adhesions and corrects the scalp to where it would have been without them. Once the scalp is advanced, the extra forehead skin is removed.
The incision is placed precisely at the hairline using a trichophytic technique, which allows hair to grow through the scar so it heals virtually imperceptibly. Dr. Aharonov's technique is immediately effective, well tolerated, and associated with minimal complications, minimal pain, and less swelling than conventional approaches. Some patients return to work as early as 2 days after surgery.
Good candidates for forehead reduction or hairline lowering surgery are people with a high hairline or large forehead who otherwise have normal hair and no history of hair loss.
A Note From Dr. Gal
If you're reading this page, you've probably spent years thinking about your forehead — in photographs, in mirrors, maybe wearing your hair forward to cover it. I hear some version of that story from nearly every patient who comes to see me, and I want you to know I take it seriously.
I developed my one-stage technique because the standard options asked patients to accept too much: months with a tissue expander in the scalp, or a result that fell short of what was possible. I believed a high hairline could be corrected in a single surgery, with an incision designed so that hair grows through it and the scar heals virtually imperceptibly.
Here is my promise, and it is the same for every patient: I will only recommend surgery if I believe your result will look completely natural. If I don't think you are a good candidate, I will tell you so honestly. You will never feel pressured into anything in my office.
And every stitch of your closure is placed by my own hand. That is how I have always done it.
Hairline Lowering Surgery in Women
Hairline lowering surgery is ideal for women who were born with a high hairline. It can be combined with a brow lift or frontal bone contouring through the same incision when those concerns are present. Most women achieve their result in a single stage.
The true mark of a well-performed hairline lowering surgery is a virtually invisible scar. Dr. Gal's tensionless microscopic closure combined with a trichophytic incision technique allows hair to grow through the incision line, which is why his patients' scars heal so discreetly.
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 Brow lift can be performed at the same time, if raising the brows is also desired.
Common Procedures Combined with
Hairline Lowering Surgery
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.
Combining these procedures saves a patient recovery time and cost compared to having two separate surgeries.
Bone Contouring
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.
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.
Revision Hairline Lowering after a failed attempt to lower the hairline with hair grafts
Hair 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 hundreds 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 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:
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Dr. Aharonov performs thousands 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.
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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 15 years after surgery.
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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.
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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.
Some swelling in the forehead, head, or around the eyes and cheeks is normal and resolves quickly. Your head will be wrapped overnight, and the dressing — along with a small drain — is removed the following morning. Dr. Aharonov personally calls every patient the evening after surgery.
You may shower and shampoo your hair the day after surgery. Sleep on your side with no pressure on the back of your head. Cold compresses to the eyes and warm compresses to the back of the neck help with swelling the first night. Sutures are removed about 6 days after surgery, and most patients return to work within a few days to a week.
Numbness in the front of the scalp behind the incision is expected. It fades as the nerves slowly grow back, which can take anywhere from a couple of weeks to a few months.
Who is NOT a Good Candidate for
Hairline Lowering 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 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, otherwise known as FUT, 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.
FAQ
Frequently Asked Questions About Hairline Lowering Surgery or
Forehead Reduction Surgery
1. Why is your way different?
I would not want to walk around with a tissue expander in my head unless I absolutely needed one. I would not want hair grafting to lower my hairline, because grafting never looks as natural up close and in real life as a surgical hairline advancement. While most practices focus on cutting cost, we take the opposite approach: how do we make every aspect of the surgery the best possible.
2. Is it possible to get a more rounded hairline with the forehead reduction surgery?
The roundness achievable depends on your scalp laxity and how much lowering you need — Dr. Aharonov will assess this with you at your consultation. If surgery alone cannot create the roundness you want, a small number of hair grafts can refine the shape afterward. Most patients with a dense hairline and adequate laxity do not need grafting. When grafting is needed, it is more accurate performed separately, so the two procedures are usually not combined.
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?
Many of our patients travel from out of town and want a cost estimate in advance. The fee depends on the complexity of your case, whether hair grafting is needed, and whether a tissue expander is needed. We can usually give an accurate estimate from your photos, and a firm quote after consultation.
Contact our office by phone or email for a ballpark range: because every case is unique, fees vary with operating time — a straightforward case takes about 45 minutes, while a difficult one can take close to 3 hours, and anesthesia and facility fees are hourly. Scalp laxity, the distance of lowering, and head shape all affect difficulty.
5. How long after Forehead Reduction Surgery can I fly back home?
Most out-of-town patients stay for about a week. Sutures are removed about 6 days after surgery, and you are free to fly home after that. If you cannot stay that long, we can sometimes arrange for a physician or nurse near your home to remove your sutures, in which case you could fly home 1 to 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 in fairly tight scalps.
7. What type of anesthesia do you use for Forehead Reduction Surgery?
IV sedation — monitored anesthesia care — administered by a board-certified anesthesiologist in a fully accredited surgery center. It is not general anesthesia: you are not paralyzed or intubated. You are fully asleep and comfortable throughout the procedure. I perform all my surgeries in an AAAHC accredited outpatient surgery center in Beverly Hills. I have been working with the same anesthesiologist for 20 years. 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.
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?
No. With Dr. Aharonov's technique, the scalp is secured to the skull in its new position and will not drift or recede backward.
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?
Not necessarily. Dr. Aharonov has worked with extremely tight scalps, and even then the hairline can usually be lowered 2 to 3 cm in a single stage. There is never a guarantee of an exact distance — every patient is unique — but a tight scalp alone does not mean you need a tissue expander.
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.
14. When can I resume activity after Hairline Lowering Surgery?
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.