There are some females who have a very long forehead and they may desire lowering of such a high hairline. Although hair transplantation is an option, that approach is tedious, fairly costly, and may take a long time to see the final result. An alternative and my preferred approach in my Indianapolis plastic surgery practice is to use a modification of a hairline browlift procedure.
The female hairline is ideally about 6 cms. above the brows and is usually where the forehead starts to slope backward into the scalp. The length of the forehead (hair to brow distance) should represent about one-third of the vertical height of the face. When the forehead is too long, and the hairline is too high, it is quite obvious. The appearance of a high hairline lends to a more masculine look and can make one look older as well. If the hairline is high enough, the hair will exit the scalp in an unnatural manner, limiting the type of hairstyle that one can wear and creating a balding look.
A good technique that can lower the hairline 1 inch or more is to use a modification of a traditional hairline or trichophytic browlift procedure. By making an irregular incision just inside one’s existing hairline across the front of the scalp, the forehead skin flap is dissected downward. The posterior scalp flap is then widely undermined as far back as one can go with instruments. The loosened hair-bearing scalp is then advanced as far forward and down as possible over the forehead skin. After marking, the forehead skin above the marks is removed thus advancing the frontal hairline downward. Before closing the incisions, I prefer to stabilize the advanced scalp by securing its underlying galea layer to burr holes in the forehead skull with permanent sutures. This allows adequate advancement of the hairline and closure of the incisions without tension which is an important key to a good-looking and very narrow scar. The skin is closed with very small sutures that are removed in 7 to 10 days.
This hairline lower procedure, or ‘reverse’ browlift if you will, produces an immediate result. A scalp dressing is used for just one day and one can shower and wash their hair the very next day. There is no bruising and only a small amount of swelling. The biggest issue is that the scalp will be numb behind the incision and may be so permanently.I have used this hairline lowering approach most commonly when a browlift is needed. By definition, a high hairline with low brows needs a hairline browlift approach anyway. So brows can be lifted and the frontal hairline lowered at the same time.
The hairline lowering procedure is an uncomplicated procedure that can very successfully lower the hairline at least an inch to inch and a half. The biggest issue is the scar but an irregular incision that is relatively tension-free usually turns out quite well. By the way the incision is made, hair growth usually occurs through the scar helping aid in its disguise.
Dr. Barry Eppley
Indianapolis, Indiana