Lower hairline

Table of contents:

The hairline is characteristic of perceived gender and is marked by age. Forehead reduction and recontouring, also called hairline lowering, is an important procedure in the context of Facial Feminization Surgery (feminization of the face).

The position of the female hairline can vary. Ideally, the hairline should reach 5 to 6,5 cm above the eyebrows. The hairline would then start where the skull begins to slope from horizontal to diagonally vertical. In men, the hairline is on average higher.

Apart from the position, the shape of the hairline is also different. A man usually has receding inlets above the temples that give the hairline an “M” shape. Conversely, the female hair pattern is fuller around the edge of the face and the shape is more oval.

hairline

Aging pattern of the hairline

An additional difference between the male and female hairlines comes with age. There is a typical male pattern of baldness in which the hairline recedes. This is something that usually does not occur in women. Although cisgender women sometimes experience hair loss, it usually involves a general thinning of the hair over the entire scalp and is not manifested in one specific area.

Indications

There are 2 options to achieve a hairline reduction. The following indications indicate which option would be recommended for you.

Hair transplant

  • Only the receding recesses need to be filled (the M-shape, as you see above). No general lowering of the hairline is necessary.
  • Usually 2 sessions are needed to achieve a natural-looking result (requiring 50 to 60 hairs per cm²). We can implant a maximum of 40 hairs per cm² per session.
  • You can choose between the FUE method with shaving of the extraction site (e.g. back of head) or the FUE method without shaving the extraction site. The latter method is suitable for smaller areas.
  • After a surgical reduction of the hairline, people often still have receding inlets that can be filled with a hair transplant (not so many hairs are needed).
  • Filling the scar after hairline lowering—In most cases, the scar becomes virtually invisible after 1 year. However, there are patients in which the scar remains visible. A hair transplant before and behind the scar can ensure that the scar is no longer visible or barely visible.

Flat spot

  • Flexible Scalp—The flexibility of the scalp determines the extent to which the hairline can be advanced. The hairline will be brought forward as far as possible, but it must be taken into account that the wound must then be able to be closed without tension. Normally this will result in a reduction of 0,5 to 1 cm. With a very flexible scalp, reductions of up to 2 cm are possible.
  • Forehead Recontouring—To remove excess skin after forehead recontouring, a strip of skin that has hair growing on it must be removed. If the incision is made behind the hairline, it would cause the hairline to recede even more. That is why we usually recommend lowering the hairline when having a forehead recontouring performed. The lowering effect is sometimes very minimal, but in any case the hairline will not recede.

Hairline lowering in detail

Procedure

  • Surgical Drawing—The surgical drawing is created.
  • A general anesthesia is applied.
  • Incision—An incision is made along the hairline. The incision is made just inside the hairline, in an irregular manner, to avoid a straight scar. After all, straight scars are more noticeable than irregular scars. The blade is also handled at the incision in such a way that about six weeks after surgery, the hair will begin to grow through the scar, making it almost invisible.  
  • Removal—A portion of the scalp is removed at the hairline near the forehead.
  • Mobilization—The scalp is released from the skull and pulled forward. Normally a reduction of 1 to 1,5 cm can be achieved. 

Recovery

  • During the day of the procedure itself, as well as the day after, the patient may experience mild pain or discomfort. This can easily be combated with the painkillers that you will receive from us.
  • To prevent infection, we recommend taking azithromycin once a day after meals for the first 3 days after the operation.
  • The first week—During the first week there may be some swelling and bruising, but it will not be very noticeable. If staples were used, they will be removed after 7 days. Patients from abroad can return home the same day. The staples can be removed in your own country by a doctor. The sutures we use dissolve on their own.
  • The following weeks
    • Sutures—After 2-3 weeks, the dissolvable sutures around the hairline will fall out.
    • Scar—The scar will remain red and thick for 2-6 months. After about 6 weeks, small hairs begin to grow through the scar, making it less visible.
    • Numbness—All patients experience numbness in the front of the skull. The feeling will return within 3-12 months. Sometimes there is itching during the recovery period.
    • Temporary hair loss—After 2-4 weeks after surgery, the fine hairs at the front of the scalp may begin to fall out. This is called “effluvium”. The hair normally grows back after 3 months. We sometimes recommend the use of 5% Minoxidil on this site after surgery. This can reduce the risk of possible hair loss and promote hair growth where there is hair loss, but also where the incision was made.
  • Full recovery—Full recovery can be expected after 12-18 months, when the scar has fully matured. The scar will be visible, but usually fades so much after a year that it is barely noticeable. 

Complications

  • General thinning of the hair—This complication was reported by 1% of patients.
  • Scar—Sometimes the tension on the incision is so great that a visible scar forms. In that case, the scar must be corrected during the operation.
  • Decreased scalp sensitivity—It is possible that the scalp will become permanently less sensitive. Fortunately, the patients who experience this do not experience it as a problem.
  • Infection (e.g. staphylococcus aureus)—As with any surgery, infection can occur (see photo below). With a hairline reduction, it can be extra difficult to keep the surgical area clean and sterile during aftercare. Tiny hairs may grow in or under the skin and cause irritation or infection. These small hairs can usually be removed with sterile tweezers. In the event of an infection, we advise you to:
    • Floxapen 500mg (flucloxacillin) to be used 4 times a day for 14 days;
    • Fucidin ointment to be used for 14 days;
    • clean the wound twice a day with chlorhexidine in water;
    • Apply Flaminal or Flammazine ointment to the wound twice a day;
    • After 10 days, send an evaluation of this treatment to Dr. van de Ven using photographs.
An example of an infection by staphylococcus aureus