Forehead reduction surgery, also known as hairline lowering or scalp advancement, is a cosmetic procedure designed to reduce the vertical height of the forehead. It aims to create a more balanced facial appearance by moving the hair-bearing scalp forward, effectively shortening the distance between the eyebrows and the hairline.
Pre-Surgical Steps
The journey toward forehead reduction begins with an initial consultation. Patients discuss their aesthetic goals and medical history, and the surgeon assesses facial features and suitability.
Scalp laxity, or elasticity, is a key factor, as it influences the amount of hairline lowering possible. Ideal candidates have a high forehead, good scalp flexibility, and adequate hair density. If scalp laxity is limited, a tissue expander may be used to gradually stretch the skin over several weeks for greater advancement.
After assessment, the surgeon plans the new hairline, often marking its position on the forehead. This planning ensures the new hairline aligns with the patient’s desired aesthetic and often incorporates a wavy contour for a natural appearance. Patients receive instructions before surgery, including avoiding certain medications, smoking, and alcohol to optimize outcomes and minimize risks.
The Surgical Procedure
Forehead reduction surgery is performed under general anesthesia for patient comfort. Local anesthesia may also be used to reduce pain and bleeding. An incision is made along the natural hairline, often using a “trichophytic” technique. This incision is designed to be irregular or beveled, allowing hair follicles to grow through the resulting scar, camouflaging it effectively.
After the incision, the hair-bearing scalp is loosened and separated from underlying tissues, typically in the subgaleal plane, and advanced forward. To achieve greater mobility and lowering, galeotomies (small incisions in the galea, a dense fibrous scalp layer) may be performed. The scalp can be advanced by 1 to 2.1 centimeters, though patients with favorable scalp laxity or prior tissue expansion might achieve up to 5.5 centimeters.
In select cases, such as for facial feminization or a prominent brow bone, the underlying frontal bone may be contoured or reduced through the same hairline incision. This combined approach allows for comprehensive upper face reshaping. After the scalp is advanced, a strip of excess forehead skin (typically 1 to 3 centimeters) is removed. The incision is then closed in layers using sutures or staples, with deep sutures anchoring the new hairline securely. This closure technique aims to minimize visible scarring and promote optimal healing.
Post-Surgical Care and Recovery
After surgery, dressings are applied and typically removed the next day. Patients can expect swelling, bruising, and mild discomfort during initial recovery. Prescribed pain medication helps manage discomfort. Temporary numbness in the scalp and forehead is common, persisting for weeks to months as nerve endings regenerate.
Patients should follow activity restrictions for proper healing. This includes avoiding strenuous activity, bending, and heavy lifting for several weeks. Keeping the head elevated, especially while resting, helps reduce swelling. Proper wound care, including keeping the incision site clean, is essential.
Sutures are generally removed about one week post-surgery. Initial recovery, with significant reduction in swelling and bruising, typically occurs within one to two weeks. Incision areas may take three to four weeks to heal properly. Complete healing, including scar fading and full sensation return, can take six to eighteen months. Hair growth through the incision line may begin around three weeks post-operation.
Expected Results and Important Considerations
Forehead reduction surgery typically yields immediate and permanent aesthetic outcomes, resulting in reduced forehead height, improved facial balance, and a more proportionate, natural-looking hairline. A linear scar will be present along the new hairline. However, due to the trichophytic incision technique and hair regrowth through it, the scar usually becomes discreet and well-hidden by surrounding hair. Initially, scars may appear reddish but typically fade over several months to a year.
Temporary side effects are common, including numbness or altered sensation around the incision site. This occurs due to nerve manipulation, but sensation typically resolves as nerves regenerate, often within a year. Some patients may experience temporary hair thinning, known as shock loss, around the incision, which generally regrows. For long-term care, sun protection is advised to support scar healing. Patients should contact their surgeon if they experience persistent bleeding, signs of infection, or prolonged numbness during recovery.