In the modern era, people value their physical appearance more than ever. Voluptuous hair and well-defined hairline are an important part of physical appearance. Many people have low self-confidence due to high hairline, loss of hair, and a high forehead.
People may lose hair and suffer from high hairline due to various reasons like genetics, diseases, stress, plastic surgery procedures like face-lift, etc. Low hairline can affect both men and women. Many people with such low hairline are unsatisfied with their disproportionately large forehead.
There are ample choices of cosmetic procedures available that promise to improve the look associated with a high hairline and prominent forehead. All of them have their pros and cons. Among the plethora of choices available, hairline lowering surgery and hair transplant are becoming more popular day by day.
Which one to choose? Hairline lowering surgery or hair transplant?
To answer this question correctly, first, we need to understand the core differences between these procedures of cosmetic dermatology.
During hair transplantation, the doctor moves healthy follicles of hair from the part of the head or body where the hair is dense to the part where there is less hair. Special care is given to the curvature, direction, and distribution of the transplanted hair follicles so that a more natural look can be achieved. A good transplant should be able to create an appearance of a well-proportioned forehead for other parts of the face.
There are two types of hair transplant techniques namely, Follicle Unit Transfer (FUT) and Follicle Unit Extraction (FUE). FUE is the best choice for those who don’t want post-procedure pain and want to avoid scarring.
Hair transplantation is more suited to those individuals who have an ongoing loss or thinning of hair or those who lost their hair gradually due to hereditary reasons and trauma and not due to a medical condition. It can treat both male and female pattern baldness as well as uneven hairlines. It is also a great option to hide any scar near the hairline or to correct any areas of thin, patchy, or absent facial hair on the eyebrows, beard, or mustache.
The main drawback of hair transplant is that it takes a considerably long time (6 weeks up to 18 months) to see noticeable results. Another disadvantage is that one may need to wait to start this procedure if there is ongoing hair loss. Hair transplant can give better results and natural-looking hairline only when the cause of ongoing hair loss is treated. Another important thing to note is that the FUT technique may leave a scar in the treated area.
Usually, one hair transplant procedure is enough to establish a new hairline but in some patients, another procedure may be needed 6 months later to give a more dense and well-defined look to the hairline.
Hairline lowering surgery
It is also known as forehead lowering surgery or hairline advancement. This surgery is very helpful to lower the height of the hairline making the individual look younger and healthier. It is suited for those who have a high hairline due to genetics.
Normally, the human hairline is 5-6.5cm above the eyebrows. In hairline lowering surgery, the dermatologist makes a small cut at the natural hairline from one temple to another and removes a small part(3-5cm) of the forehead skin and pull the scalp down and suture it to the remaining part of the forehead to lower the hairline.
Hairline lowering surgery can bring drastic results in improving the disproportionate hairline because it moves more amount of hair in one procedure than a hair transplant. It also addresses other problems such as the low density of hair at the hairline and abnormal exit of hair from the scalp.
Men and women who have a prominently big forehead and naturally high hairline but normal hair volume and no family or personal history of hair loss are the candidates who benefit the most from hairline lowering surgery. Good hair volume and scalp laxity are extremely important in this surgery, so a detailed evaluation by a dermatologist is necessary.
Even if there is minimal laxity to the scalp, this surgery would produce great results but it may be needed to be completed in two steps. First, the scalp is stretched with a balloon-like tissue expander, and then the hairline is reduced.
The main advantage of hairline reduction surgery is that the result is immediate. One can see the lowering of the hairline and reduction in forehead size right after the surgery. The sutures also come out in a few days. Also, the patient who is suffering from hair loss due to genetic reasons don’t need to wait, the surgery can be started right away.
The patient choosing hair transplant surgery will need to transplant about 2000-4000 follicle units if they want to achieve the same results as the hairline reduction surgery, which translates to meticulous and tedious procedures, multiple visits, and long waiting times. Hairline-reducing surgery also has a shorter recovery time of a few days when compared to that of hair transplant which has a recovery time ranging from few weeks to few months.
According to Parsa Mohebi, a hair transplant surgeon the main downside of Hairline lowering surgery is scarring. Since the cut made is quite long, there can be significant scarring. However, if done correctly, a well trained and skillful doctor can completely hide the incision and give you a completely new and exciting look. In some cases, the doctor does so by grafting some follicles of hair around the area of incision to hide the scar.
Limitations of hair transplant and hairline reduction surgery
The main limitation of hair transplant surgery is that it depends on the amount of healthy donor hair sites present in the patient. If the patient has severe male pattern hair loss, the number of healthy hair follicles available for transplant may be highly limited.
The main limitation of hairline reduction surgery is that it depends on the elasticity of the skin of the forehead and the scalp. If the skin is not flexible enough, it is quite difficult to get good results.
Can hair transplantation and hair reduction surgery be combined?
In some special circumstances, when some patients want a lower hairline as well as a narrower forehead, the doctor can put a limited number of transplanted grafts in the front of the temple (where there are no sutures), to migrate the hair in the temple towards the middle thus narrowing the appearance of the forehead as well as reducing the height of the hairline. In such cases, the two procedures can be done together and won’t interfere with each other.
The grafts are taken from the skin of the scalp overlying the posterior part of the temporal bone and in this method also there is a single incision as the normal hairline reducing surgery. Hence, the scar of this combined method is of the same size as that of normal hairline reducing surgery.
What to expect during the doctor’s visit?
First, the doctor will review your past medical history and perform a general physical exam. The doctor will also measure your scalp and evaluate the quality, density, and texture of your hair to determine which type of surgery is suited to you. If a hair transplant is chosen, she/he will determine the number of grafts needed for the procedure. In case hairline reduction surgery is chosen, the surgeon will do a pinch test to ensure the laxity of the skin is adequate. This is important because, to be able to pull down the edge of the scalp to the edge of the remaining edge of the forehead, the skin should have good elasticity.
How to prepare before the procedure?
Like every other surgery, there are instructions to follow before these procedures. The patient must stop taking any blood-thinning medications such as aspirin, vitamin E, fish oil, etc at least one week before the surgery so as not to complicate the surgery or affect the recovery. The patient also needs to sign a written informed consent document. He/she may also be screened for some diseases using some blood tests.
These blood tests before hair transplant are done particularly for two reasons. First, to know the physical fitness of the patient and also to see whether the bleeding and clotting profiles are normal. These may include tests such as CBC, prothrombin and activated partial thromboplastin time, blood sugar, viral markers, etc.
The second category of blood tests is to investigate the cause for hair loss which may include serum iron/ferritin profile, thyroid profile. Sometimes the tests regarding hormones may also be required if the patient is suffering from auto-immune diseases.
What factors to consider before making a final decision?
It’s important to know the nature and cause of a high forehead. Is it due to male or female pattern hair loss or is it due to traction hair loss? Traction hair loss in the frontal scalp is quite common among African-American women who have certain styling practices like braiding.
Also, one should be sure what is the most important look he or she is trying to achieve be it a lower hairline, a differently shaped hairline, or a narrower forehead. He/she should also consider the financial cost of the procedure.
Which one is costlier? Hair transplant or hairline reducing surgery?
The cost of the procedure varies from one country to another and is also dependent on various factors such as the number of follicles to be transplanted, coexisting conditions, or individual demands of the client.
But generally speaking, hairline reducing surgery is cheaper than a hair transplant. A hair transplant with about 4000 grafts to lower 2-3cm of hairline will cost about $15000 to $20,000 and may take 2 to 3 visits. Whereas a hairline reducing surgery to lower the same length of hairline will cost about $7000 to $10000 for a two hours procedure.
Despite sounding similar, hair transplant and hairline reducing surgeries are completely different procedures with a different approach and a unique set of indications. The patient should consult a specialist to determine which option is best suited to him or her.
One should understand that hereditary hair loss is a continuous lifelong process so proper care for the hair is very important even after a procedure like a hair transplant. For a nonbalding female who just wants to lower their hairline and have a small looking forehead, hairline reducing surgery is a better option than a hair transplant with early results and shorter recovery time.