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Natural outcome possible for hairline lowering

Article-Natural outcome possible for hairline lowering

“Forehead lowering,” “hairline lowering” and “forehead shortening” all refer to the same technique used to effectively achieve a significant change or advancement in the hairline — a procedure that makes the forehead itself appear shorter in people who have longer and taller foreheads, according to Ben Talei, M.D., a facial plastic surgeon and medical director at Beverly Hills Center for Plastic & Laser Surgery in California. 

“Up until the past few years, patients have been somewhat apprehensive about the procedure because they could not find many experienced doctors,” Dr. Talei says. “Patients were worried about scars or unnatural looking hairlines.”

But with procedure modifications, patients can now expect a very natural outcome that even the closest family members won’t notice, according to Dr. Talei. “The hairline can be advanced much further forward than a classic hair transplant in most people. I tend to release more of the scalp, so it advances forward with less tension, but without damaging the scalp in any way,” he explains.

Instead of using anchors that are palpable under the skin and can make patients feel discomfort, Dr. Talei anchors the hairline forward into tiny holes in the bone with temporary dissolvable sutures. “In some cases, these [previously used] anchors would cause pain and even hair loss in a circle above the area where they were placed,” he recalls.

Dr. Talei tells The Aesthetic Channel that candidates for the procedure are those with stable hairlines and with no indication of future hair loss.

The surgeon has performed the surgery in about 200 patients over the past five years, all of them women or transgender (from male to female transformation on hormonal replacement therapy) between the ages of 20 and 60. Notably, men tend to have a receding hairline that continues to change over time.

“These female and transgender patients have taller foreheads that seem to be too prominent and tend to dominate the facial balance,” explains Dr. Talei, who says he often performs the procedure in conjunction with a facelift.

Technique, Recovery & Results

The first step of the in-office procedure is marking the new hairline with patient input. “We try to outline the advancement we want to attain, as long as any potential changes in hairline design are symmetric,” Dr. Talei says. 

The patient is then put to sleep with IV sedation only, usually a Cloud 9 or twilight anesthetic.

Next, an incision is placed across the entire frontal hairline in a fashion that, once the hairline is repositioned, the hair can grow back through the incision. “This helps to disguise or camouflage the incision,” Dr. Talei notes.

The scalp is typically advanced 2 cm to 4 cm, then tacked tension-free down to the bone — made possible by releasing different parts of the fascia or the scalp to advance the hairline forward and anchor it to the bone through tiny tunnels that are formed in the bone.

Afterward, excess skin from the forehead is cut away, which provides the forehead a new height and position. The incision line is then closed with several layers of tension-free sutures, totaling over 100 individual deep and individual sutures, “which helps the incision heal almost invisibly,” Dr. Talei says.

Patients are in and out of the office in three hours, with the actual procedure taking about 90 minutes.

Before leaving the office, patients are instructed to place the medications minoxidil and Latisse on their hairline incision for several months. “These two drugs help regrow the hair through the incision line faster,” Dr. Talei says.

For the first few days after the procedure, patients typically experience a slight headache. Conversely, the anterior part of their scalp can be numb for one to two months.

At days four and seven, the superficial sutures are removed in-office for optimal healing. Most patients return to work within a week of the procedure.

“The incision becomes difficult to see in anywhere between three and six months,” Dr. Talei says.

Dr. Talei says results are permanent. However, about 10% of patients schedule a follow-up hair transplant procedure for a softer appearance of their hairline or to slightly advance certain areas of their forehead. “We pluck out hairs from the back of the head and reimplant them into the frontal hairline,” Dr. Talei says.

More recently, Dr. Talei has enhanced the incision line and the hair retention using platelet-rich plasma (PRP) and nanofat or emulsified fat injections. “Patients actually achieve stronger hair growth from these injections, plus better incisional healing and more hair growing out through the incision,” he says.

Although the number of doctors performing forehead reduction remains relatively few, “they have become better at doing it,” Dr. Talei says.

         A 59-year-old female patient shown before and approximately four months after forehead reduction surgery.

         Photos courtesy Dr. Ben Talei