Hairline Lowering Frisco TX
Many patients are self-conscious about a high hairline, particularly women. In most cases, this is genetic. Dr. Matthew Richardson specializes in hair restoration surgery and facial plastic surgery. This unique skill set allows him to improve the overall facial balance by lowering the hairline and shortening the forehead. Dr. Richardson performs a very high volume of hairline lowering / forehead reduction surgeries at his Frisco, Texas surgery center in the north Dallas suburbs, performing many forehead reduction surgeries every month, and sometimes multiple forehead reduction surgeries per day. Dr. Richardson treats forehead reduction surgery patients locally from throughout the Dallas-Fort Worth metroplex, regionally from the Texas, Oklahoma, and Louisiana areas, and nationally for patients from all over the country. Many patients fly in for this surgical procedure after meeting with Dr. Richardson for a video consultation as a first step.
Dr. Richardson is an expert in facial aesthetics and will customize the treatment plan for each individual patient in order to achieve the best possible results. Hairline lowering, also known as hairline advancement, scalp advancement, or forehead reduction, is a very gratifying procedure for patients, as most have dealt with this hereditary condition their entire lives.
In either the one-stage or two-stage procedure, the patient is left with an irregular scar along the hairline that is usually pink or dark in color initially and then fades over the course of several months. The scar can be camouflaged with makeup once the incision is well-healed (usually 7 to 10 days after the procedure). These incisions placed along the frontal hairline are usually reserved for women as they tend to have a stable frontal hairline and while they may suffer from thinning of the hair, the frontal hairline does not typically recede like it does in a man. For men who desire to lower the hairline, hair transplant is usually the best option, as described below.
Another option for hairline lowering is hair transplant, which can be performed to lower the hairline. Hairline lowering with hair transplant does not require any linear incisions along the hairline, but does not usually attain the same density as a hairline advancement procedure with only one hair transplant session. In most cases, patients will opt for a second hair transplant session about one year after the first session in order to achieve even greater density in the transplanted zone. Once this second session is complete, patients have usually achieved excellent density. The upside of this technique is the lack of any linear scar along the hairline. The downside of the hair transplant hairline advancement is that the entire process takes about two years to see the final result as hair grows slowly and the transplanted grafts after the second session (which is usually performed 9-12 months after the first) will take a full year to mature. Click here to learn more about hair transplant procedures.
In some cases, patients will choose to combine the two techniques: they will have the one-stage hairline advancement procedure to move the hairline down a few centimeters, and then come back 6-12 months later to have a few hair transplant grafts placed just in front of, around, and in the scar in order to camouflage it even more. This entirely depends on patient preference, their particular anatomy, and how well they heal after surgery.
Dr. Richardson can discuss these options with you in detail during your consultation and formulate a personalized treatment plan based on your anatomy, goals, and lifestyle.
What is hairline lowering or forehead reduction surgery?
Forehead reduction surgery is a surgical procedure designed to shorten the vertical height of the forehead. This surgery shortens the distance between the hairline and the eyebrows, as well as the distance between the hairline and eyes, nose, mouth, etc. The hairline moves lower on the face. This surgery is designed to help patients with a large forehead or high hairline.
How is a forehead reduction performed? What happens during hairline lowering surgery?
During a forehead reduction surgery, the patient is given intravenous (IV) sedation to help them fall asleep. The patient remains breathing on their own, and the scalp is numbed up totally with local anesthetic injections. A scalpel is used to make an incision across the hairline and into the temple areas in a very specific and technical way in order to make the scar heal well and camouflage the scar within the hairline. The hair-bearing scalp is actually loosened and separated from the underlying bone and then advanced forward. Special techniques are performed in order to allow the scalp to stretch safely during surgery. In many cases, Dr. Richardson will use an Endotine or Ultratine device in order to help fixate and support the scalp while it heals. This device dissolves under the skin over the course of several months and is fixated to the underlying bone. The excess forehead skin is then carefully trimmed away, and the incision is meticulously closed with several layers of sutures so that the incision heals beautifully. A dressing is applied, and the patient awakens quickly from anesthesia. In Dr. Richardson’s hands, this procedure takes approximately 1.5 hours from start to finish.
Is forehead reduction surgery painful?
In most cases, there is very little to no pain with forehead reduction surgery. Most patients will report mild soreness the first evening after surgery, but it is very rare for patients to have any significant pain. Patients are provided pain medication to take as needed.
How much can I lower my hairline? How big is a “normal” forehead?
In most cases, Dr. Richardson is able to lower the hairline 2.0 – 2.5 cm in one surgical session. Keep in mind that human tissues do stretch under tension, so removing 2.5 cm of forehead skin may result in lowering the hairline approximately 2.25 cm or so. This is different for every patient. Also, it is very important to recognize that measurements are subjective. When placing a ruler against the forehead to measure the forehead size, the position of the rule can be adjusted slightly in multiple directions in order to drastically change the results of the measurement. Finally, the fine, sparse hairs (“baby hairs”) along the frontal hairline are often not usable for hiding a scar, so the incision must be made higher into the hairline during surgery in order to use mature, healthy hairs for hiding the scar. This may make the surgical results appear slightly less when measured postoperatively than the amount of skin that is removed during surgery. All of these things are normal and part of EVERY forehead reduction surgery. Patients should not fixate on the numbers for all of these reasons, and should instead aim for improvement, which is almost always dramatic and significant. Patients who are fixated on specific forehead measurements and who would be disappointed with anything less than a specific measurement are not good candidates for surgery.
There is no true “normal” forehead height. Dr. Richardson will generally measure from between the eyebrows to where the thick or dense part of the hairline starts (not the fine “baby” hairs). The goal after surgery for many patients is to be in the 5.5 to 6.5 cm range, but this can vary. Many women look very beautiful with hairlines higher than this range. Hairlines lower than approximately 5.5 cm from the brows run the risk of looking very unnatural, strange, and aesthetically-unappealing. For this reason, Dr. Richardson does not perform hairline lowering procedures to lower the hairline beyond the 5.5 – 6.0 cm range.
Can a patient have forehead reduction surgery more than once?
In most cases, yes, a patient can have more than one forehead reduction surgery, BUT this depends on the individual patient and their scalp laxity. The scalp will generally stretch with time, and this may allow for another centimeter or so of forehead reduction if a second forehead reduction / hairline advancement surgery is performed at a later date. In most cases, patients achieve adequate advancement with a single procedure.
What can I expect after hairline advancement surgery? What is the downtime and recovery after hairline lowering surgery?
Patients can expect mild soreness after surgery that is generally short-lived. A dressing is placed overnight and removed in our office the morning after surgery. At that point, the nurses and Dr. Richardson will check to make sure the patient is healing well. Patients will review their simple wound care instructions, and are allowed to travel home for approximately one week. Patients are instructed to avoid strenuous physical activity for two weeks. Mild bruising and swelling are possible, but are usually minimal. Patients are allowed to camouflage the incision with their hair, a hat, or a soft headband while it is healing, as long as these items are clean. Patients return at one week post-op for suture removal. As many patients fly in for this procedure from out-of-state, these patients often stay in town for 48 hours after surgery, fly home for 4-6 days, and then return at one week for suture removal. Some patients from out-of-town will choose to stay in the Dallas area for one week while they recover. Patients who live outside of reasonable driving distance from DFW will not be candidates for tissue expansion due to the complexities involved in these cases and the frequent office visits that are required.
The incision will fade over time, and hair will grow up through the incision to help hide the scar. This process takes many months to finalize, but most patients are able to hide their incision very easily and are back to all normal activities within 2 weeks.
How is forehead reduction surgery different from a brow lift?
In a forehead reduction surgery, the hairline is lowered. In a brow lift surgery, the brows are raised. In both cases, the forehead MAY decrease in size, but this is NOT the case for every type of brow lift. Brow lifts are customized for the individual based on their anatomy, and the techniques will vary, usually due to the position of the patient’s hairline.
Will my face be stretched or brows raise with forehead reduction surgery?
Forehead reduction surgeries do NOT lift the brows unless we intend to do so with a brow lift. In cases where a brow lift is combined with a forehead reduction surgery, the net effect will be that the forehead is smaller (shorter vertically), with some of that size change coming from brow elevation, and some of the size change coming from hairline advancement or lowering. In most cases, forehead reduction surgery is performed without a brow lift, and the brow position does not change for these patients.
How is hairline lowering surgery different from a hair transplant?
With hairline lowering surgery, an incision is made across the hairline, the scalp is elevated, the hairline is advanced, the excess skin is removed, and the incision is carefully closed. In a hair transplant procedure, hair is taken from somewhere else on the patient’s scalp (almost always from the back of the scalp within the hair), divided up into tiny individual follicles, and then transplanted one hair follicle at a time into the forehead skin below the patient’s natural hairline. In most cases, a second hair transplant procedure will be needed to achieve adequate density. The end result can be similar between the two techniques, but forehead reduction surgery is a much faster change and usually results in better density than hair transplants can achieve unless multiple hair transplant procedures are performed.
What is a single-stage versus two-stage or multi-stage forehead reduction? Do I need a tissue expander?
Lowering the hairline can be performed in a one-stage procedure or a multi-stage procedure, depending on the degree of lowering that is desired and the amount of scalp laxity present. Hairline lowering can also be performed in conjunction with other surgical procedures, particularly brow lifting. A brow lift combined with hairline lowering surgery in a one-stage procedure can result in significant improvement and shortening of the appearance of the forehead.
In a one-stage forehead reduction surgical procedure, a carefully placed and camouflaged incision is made along the hairline and used to advance the hair bearing scalp and shorten the forehead in one surgical procedure. This technique can result in hairline advancements typically in the range of 1.5-2.5 cm and sometimes more. This is the most common method that patients choose, as it is quicker and only requires one procedure. Most female patients with hairlines starting in the range of 7-9 cm are satisfied with approximately 2 cm of hairline advancement. Patients with initial hairlines higher than about 9 cm from the brows may be unhappy with lowering the hairline only 2-2.5 cm as they may feel as if the forehead is still too large. These patients may need a multi-stage procedure or may not be good candidates for hairline lowering procedures in general.
There are a variety of multi-stage procedures. In some cases, a similar incision is made during the first stage, and a tissue expander is placed beneath the hair-bearing portions of the scalp. Over the course of 6-8 weeks, the tissue expander is slowly filled and stretches the scalp. In the second stage of the procedure, the tissue expander is removed and the hairline is advanced and lowered to a greater degree than in a one-stage hairline lowering surgical procedure. Again, patients who live outside of reasonable driving distance from DFW will not be candidates for tissue expansion due to the complexities involved in these cases and the frequent office visits that are required.
Some patients may also opt for hair transplants as a planned second stage procedure to help camouflage the scar or customize the hairline shape, but this should NOT be relied on to lower the hairline further, only to thicken the hairline or camouflage the scar. Other patients may be candidates for a second forehead reduction surgery after the scalp has had time to stretch further, but this is a rare situation and will not reliably lower the hairline much more than 1 additional cm even after extended time for healing between surgeries. This depends on the patient’s hairline, their goals, and their anatomy.
What are the contraindications to forehead reduction surgery? Who is NOT a candidate for hairline lowering surgery?
Patients with medical conditions such as heart or lung disease, wound healing disorders, poorly controlled diabetes, any active scalp disease, scarring alopecias, bleeding disorders, and other serious medical problems might not be candidates for any hairline lowering surgery.
What are the risks of hairline advancement surgery? Is forehead reduction surgery safe?
Expected risks of forehead reduction surgery include scalp numbness (this is a normal part of the surgery and to be expected post-op), bruising, and swelling. Rare risks of hairline lowering surgery include bleeding, visible scarring, poor wound healing, infection, shock loss, hair loss along the incision, and the need for revision or future surgeries such as hair transplant surgery.
Is forehead reduction surgery safe for all skin tones, races, and ethnicities?
Yes, but patients with darker skin may not always be good candidates for reasons described below. Dr. Richardson commonly performs forehead reduction surgery on patients of all skin tones and ethnicities, including Caucasian, African-American, Asian, Hispanic, and multi-racial patients, among others. Keep in mind that patients with darker skin tones WILL have a more difficult time hiding the scar. Scars in these patients tend to eventually heal lighter in color than the surrounding skin, and patients that are prone to poor wound-healing may not be good candidates for forehead reduction surgery. Patients with fair skin and dense hair along the frontal hairline see the best results. African-American patients usually need to have dense hair along the frontal hairline and have a forehead no higher than about 9 cm from the brows to be good candidates for forehead reduction.
Patients who have thin hair, very high hairlines, and darker skin tones are the worst candidates for forehead reductions surgery (and may not be candidates at all) because the skin color and lack of hair density will not hide the scar. Additionally, when the hairline is very high, these patients may need tissue expansion to achieve adequate forehead reduction/hairline advancement.
Is forehead reduction surgery only for women?
In general, YES, forehead reduction surgery is safe only for women. There may be some exceptions to this rule in highly-motivated male patients with no family or personal history of hair loss or hairline recession. In almost all cases, Dr. Richardson will not agree to perform forehead reduction surgery in male patients. The reason for this is that almost all males will have some degree of hairline thinning and recession over time. Even 1-2 millimeters of hairline recession over the years in a male patient will result in a highly visible, exposed scar on the forehead that could potentially be impossible to hide and crippling to the patient.
Male to female transgender patients who are medically stable on hormone therapy may be candidates for hairline lowering surgery if there is no significant thinning. If these patients do have hair loss or thinning of the frontal hairline or other parts of the scalp, they are probably better candidates for hair transplant surgeries. Dr. Richardson can help with this assessment during a consultation.
Who is qualified to perform hairline lowering surgery?
Forehead reduction surgery should be performed by board-certified surgeons with experience in facial surgery, hairline lowering surgery, and hair transplant surgery. Hairline lowering surgery is not a common procedure for most surgeons and should not be performed by just any doctor or even just any plastic surgeon. Forehead reduction surgery is highly technical and requires both artistry and technical skill to achieve the best result. Dr. Richardson performs a very high volume of forehead reduction surgeries, and is a hairline lowering expert. He is fellowship-trained in both hair restoration surgery and facial plastic surgery, making him uniquely qualified to perform this surgery. He is also double board-certified in both head and neck surgery and facial plastic surgery.
How long does a forehead reduction last? Is hairline lowering surgery permanent?
Forehead reduction surgery is permanent. While the brows may fall slightly over the years due to the natural aging process, the forehead will always be smaller than it was before surgery. The forehead does not stretch back to its original position. Once the tissues are in place, scar tissue under the skin holds them in place after the initial healing phase.
Will I look different after a forehead reduction?
Yes, the forehead will be smaller and the hairline will be lower. The face will otherwise look the same without changes in brow position, eye shape, or any other facial features.
How do I prepare for a forehead reduction surgery?
In our practice, we give patients very specific instructions regarding both prescription and over-the-counter medications to avoid (primarily medications that increase bleeding risk), information about any pre-operative labwork or testing that needs to be performed (based on the patient’s age and medical history), and discuss scalp stretching exercises with our patients. Stretching the scalp by hand in the weeks and months leading up to surgery can help the patient’s scalp to heal easier after surgery and facilitate a greater degree of scalp mobility during surgery. This scalp mobility helps us move the scalp and advance the hairline more during the procedure. The video below describes how we recommend that our patients stretch the scalp.
How much does hairline lowering surgery cost?
Hairline lowering surgery costs will vary between markets and surgeons. This also depends on facility fees, anesthesia costs, and many other factors. We are able to keep costs low through our high volume of hairline lowering surgeries at our private surgical center. Pricing is generally going to start at $10,500 depending on the factors above. We are happy to provide you with a cost estimate. Please call us or email us for more information.
EMAIL US today or call us at (469) 362-6975 to schedule a consultation and find out more about how we can help you look your best.
CLICK HERE to see more forehead reduction before and after photos!