Forehead reduction is a surgical procedure that reduces the height of your forehead and balances the proportions of your face. Hairline lowering or advancement on the scalp, performed by the best-ranked plastic surgeon in New York Dr. Gary Linkov, can create a forehead reduction and improve the overall appearance of the face and hair. At City Facial Plastics, located in Midtown, Manhattan, we offer different options for lowering the hairline, depending on the individual.
What Is Forehead Reduction?
Forehead reduction, or hairline lowering surgery, refers to a surgical procedure that shortens the forehead by removing upper forehead skin and therefore lowers the hairline. It is more common in women because of the stability of the forehead hairline compared to men who frequently experience hairline recession from male pattern baldness. While forehead reduction most often refers to a surgical hairline advancement, another option is a hair transplant to lower the hairline and reduce the forehead.
In traditional facial aesthetics, the face can be divided into vertical thirds, with the topmost boundary at the hairline. Ideally, the forehead hairline in women is 5-6cm above the eyebrow, and 6-8cm in men. Another landmark for the ideal hairline in men and women is the point where the scalp slopes from a horizontal to a more vertical orientation. Some men and women have high hairlines and are interested in forehead reduction to lower the hairline and improve facial proportions.
What Is Scalp Lowering?
One of the quickest options for forehead reduction is scalp lowering. This involves a surgical movement of the scalp and hairline forward or lower on the forehead. This is best for “loose” scalps that can be surgically altered and is almost exclusively performed on women. This method is often preferred as It can bring the hairline forward up to two inches. It is equivalent to performing about 6,000 hair follicle grafts, all in one procedure.
Hair grafting, or transportation, can also be used for lowering the hairline. This is popular for both men and women with high or receding hairlines. Some women may not be good candidates for scalp lowering. This is if they just need their hairline rounded, have a tight scalp or have had brow lifts. They may consider hair transplants instead. We use FUE hair transplants utilizing advanced technology, like the Trivellini System, for improved results.
Scalp Micropigmentation (SMP)
Mainly for men, SMP is an option to lower the hairline and reduce the forehead. This is often used for men with shaved heads that want to extend their hair “shadow” further for a more youthful appearance.
Dr. Gary Linkov is a highly respected facial plastic surgeon and hair loss specialist in New York. To learn more about options for hairline lowering at City Facial Plastics in Manhattan’s Upper East Side, contact our office to schedule a consultation.
Who Is a Good Candidate for Forehead Reduction?
The following characteristics may qualify someone for a forehead reduction, including:
- Stable hairline
- High hairline (>6cm in women; >8cm in men)
- Medically stable for surgery
- Large forehead
- History of endoscopic brow lift that has raised the hairline
- Good scalp mobility
What Is the Relevant Anatomy for Forehead Reduction?
Forehead reduction, by way of a surgical hairline advancement, involves manipulating layers of the scalp. The following is a summary of these layers, which will help the reader understand how a hairline lowering surgery is done.
Scalp Layers (superficial to deep):
- Skin – The skin of the scalp is the thickest skin of the body. It is densely adherent to the underlying fat.
- Subcutaneous – Contains hair follicles, blood vessels, lymphatics, and nerves. It is densely adherent to the galea.
- Galea – Tough connective tissue layer. It encompasses the frontalis and occipital muscle.
- Loose areolar (subgaleal fascia) – Critical layer for forehead reduction surgery. The greatest contributor to scalp mobility. Easy plane of dissection.
- Pericranium – Thin, tightly adherent to cranium bone.
What to Expect During the Initial Consultation?
During your initial consultation for a forehead reduction, a top-rated facial plastic surgeon in New York City, Dr. Linkov will discuss and evaluate the following important factors:
- Medical history – A thorough review of any medical conditions or prior surgeries.
- Current medications – Knowing your current medications and any allergies that you may have will help guide decision making for your surgery.
- Degree of hair loss – It is important to assess if any hair loss is present and what pattern the hair loss represents, as some conditions are not amenable to forehead reduction. The danger of doing a hairline lowering surgery on a patient with a receding hairline is that the scar from the surgery will be difficult to hide if no hair is present.
- Facial measurements – Knowing the preexisting forehead height and several other variables is important for deciding on the degree of hairline surgery.
- Scalp laxity – Dr. Linkov, as the best-in-class plastic surgeon in UES, Manhattan, will assess your scalp laxity to determine how much forehead reduction is possible and if it would meet your expectations. Some patients with poor scalp laxity may need a balloon tissue expander for weeks prior to the procedure.
How Is Forehead Reduction Done?
The general steps of a forehead reduction (hairline lowering surgery) when performed by the best-ranked plastic surgeon in NYC, Dr. Linkov as a surgical hairline advancement include:
- Informed consent – The indications, risks, and alternatives to surgery are discussed at length with patients in the initial consultation and again on the day of surgery. Patients must understand that this is a permanent change that cannot be easily reversed.
- Markings – The preoperative markings include several marked measurements from the nasion (top of nose). The nasion to the existing hairline is measured. The planned neo-hairline is marked out. Also, vertical markings are made at the level of the pupils to guide future endotine placement.
- Anesthesia – Usually a combination of deep sedation with an anesthesiologist present, and local anesthesia is used to keep the patient comfortable during surgery. 1% lidocaine with 1:100,000 epi is used to infiltrate along the planned incision at the forehead hairline as well as along the posterior scalp. Plain injectable saline is also used as a tumescence to help reduce bleeding during surgery.
- Prep and Drape – The eyes are carefully protected. The patient is then prepped (with betadine) and draped in the usual sterile fashion in the operating room.
- Incision – An incision is made at the hairline, just behind the fine vellus frontal hairs, with a trichophytic approach, beveling at an angle that is approximately 90 degrees to the natural exit of surrounding hairs. Once through the subcutaneous layer, the incision trajectory is turned straight down into the subgaleal plane. Markings are made with an incision through the pericranium at the marked levels of the pupils on both sides to later guide endotine placement.
- Subgaleal dissection – Dissection is performed in the subgaleal plane all the way back to the nuchal ridge and laterally to the limits of the galea. This is accomplished using a combination of facelift scissors, curved periosteal elevators, and digital undermining.
- Scalp advancement – The undermined scalp is then advanced and put through several rounds of mechanical creep using several penetrating towel cramps until adequate advancement is obtained, down to the marked neo-hairline. If advancement is not adequate from these maneuvers, then 1-2 galeotomies are made (cuts into the galea to promote further stretching).
- Forehead undermining – The forehead flap is undermined inferiorly in the subgaleal plane for about 3 centimeters. This is done carefully not to elevate the brows if this is not part of the planned procedure.
- Endotine placement – The areas of original periosteal scoring are then revisited and expanded to allow a landing zone for the endotines. A bovie is used to mark the area for endotine placement, and then two 3.0 or 3.5 sized endotines are placed in a paramedian position in line with the pupils using a manual drill. The endotines will face in a direction opposite to how they are normally placed for a brow lift.
- Secure scalp flap – The scalp is then pulled down and advanced over the endotines, until the endotine prongs securely engage the galea and keep it in place.
- Forehead tissue removal – The forehead reduction procedure continues with an incision over the forehead first in the midline and then with the same beveled angle as that at the hairline. Non-hair-bearing forehead tissue, including skin, frontalis muscle, and galea, is then fully removed.
- Incision closure – The incision is then closed serially progressing from central to lateral on both sides with a dissolvable suture for deep fixation. Then, a non-dissolvable suture is used to close the skin at the hairline and along with the temporal posterior extensions.
- Bandage – The hair is cleaned. Polysporin ointment is applied to the incision lines. Telfa, fluff, kling, and tape are applied as a head wrap. It is left on for the first 24-48 hours.
As you can see, forehead reduction is a complex surgery that requires carefully coordinated steps to achieve natural and safe results.
How to Prepare for the Forehead Reduction?
Once you have decided to undergo a forehead reduction (forehead lowering surgery), an experienced facial plastic surgeon in NYC, Dr. Linkov will discuss in detail how to prepare for your surgery. There are a few steps you should take before your hairline lowering surgery to get the best results.
These steps include:
- Avoiding certain medications and supplements that may thin the blood, such as:
- NSAIDs – ibuprofen (Motrin) and naproxen
- Vitamin E
- Garlic, Ginger, Ginseng, St. John’s Wort, Ginkgo, Black Cohosh
- Stop smoking at least 2 weeks before surgery, as tobacco products can decrease blood flow to the skin and compromise the healing of the surgical site
- Pick up medications at the pharmacy, as you will be prescribed certain medications to take after surgery, such as:
- An antibiotic
- Pain medication
- Identify an escort home, as you will need someone to accompany you home and stay with you at least the first night after surgery
What to Expect on the Day of the Procedure?
On the day of your hairline lowering surgery, it is important not to eat or drink 6 hours before. Surgery to make hairline lower is most often performed under deep sedation with an anesthesiologist, so there will be no pain during the procedure and you will have no recollection of the procedure. You will be asked to change into a surgical gown and women of child-bearing age will need to take a pregnancy test. The intake process can take about an hour, the surgery usually takes 2-3 hours, and recovery will be about another hour.
What Is the Recovery From Forehead Reduction?
Recovery after forehead reduction surgery varies from person to person. There is a short-term healing phase that occurs in the first few days to weeks after hairline lowering surgery and a longer-term healing phase that occurs in the weeks to months after surgery. How long you will spend in each phase depends on a variety of personal factors.
The short term healing phase
The short term healing phase occurs in the first few days to weeks after surgery. Common, anticipated aspects of healing in the short term phase include:
- Bruising – Bruising may occur though it is rather infrequent. If it occurs it can linger for up to 2 weeks.
- Redness – It is normal for there to be some redness at the surgical incision. Redness gradually improves but can linger for up to 12 weeks.
- Swelling – All patients will experience some degree of swelling. The amount of swelling also varies from person to person. Swelling gradually improves but it can descend down over the forehead and eyes with gravity.
- Bleeding – It is common to have some spots of blood for the first 48 hours after surgery. This may not be visible due to the bandage. More extensive bleeding can occur but is rare.
- Pain – There is usually some degree of pain in the first few days which gradually improves. Pain medications are given to help ease the discomfort.
- Numbness – All patients are told to expect 6 to 12 months of diminished sensation (or numbness) of the frontal scalp.
There are several precautions you should take during the short term healing phase to ensure the best result and minimize bleeding.
Some of these precautions include:
- Using antibiotic ointment as advised by your doctor at the incision lines
- Avoid rigorous exercise for at least 1-week postoperatively
- You should refrain from scalp manipulation for at least 3 weeks to allow the area to heal
- Attend your follow up appointment for suture removal at about 1 week postoperatively. You can remove the bandage placed after surgery at 24-48 hours.
The long term healing phase
The long term healing phase occurs in the weeks to months following your forehead reduction surgery. The amount of time each person will spend in the long term healing phase also varies on the individual’s personal health characteristics and the extent of the surgery that was performed. In general, you can expect to see final results about 1 year post-operatively. Your doctor will schedule you follow up appointments to monitor your progress. Occasionally, steroid injections are used to help control the healing of the frontal incision line. Hair can start to grow through the incision line as early as a few weeks after surgery.
What Are the Risks and Complications of Forehead Reduction?
The risks and complications of hairline surgery, include:
- Poor scarring
- Undesirable aesthetic result
- Damaged skin
- Hair loss (telogen effluveum)
- Visibility of scar with future hair loss
As you can see, many issues can arise from a forehead reduction. It is important to choose a surgeon who understands these potential problems and has strategies in place to avoid such complications.
What Are the Contraindications for Forehead Reduction?
There are patients who should avoid a forehead reduction, these include patients with the following:
- Blood thinners that cannot be stopped
- Medical conditions not suitable for anesthesia
- Poor density at the hairline
- Poor scalp mobility
- History of coronal brow lift
- Unrealistic expectations
What Are the Alternatives to Forehead Reduction?
The primary alternative to a hairline lowering forehead reduction, or surgical hairline advancement, is a hair transplant. To lower the hairline by about 2cm with a hair transplant alone, for example, at least 2000 grafts are typically required. It will take about one year to see the final result with a hair transplant and it is more challenging to create as much hairline density as one would see with a hairline lowering surgery. For these reasons many patients, if candidates, opt for this type of surgery.
Which Celebrities Have Had a Forehead Reduction?
Caitlyn Jenner is believed to have had a hairline lowering surgery. Whether it was performed with a hairline lowering advancement surgery or with a hair transplant is unclear. Forehead reduction is one of the many surgeries considered in facial feminization surgery.
Are Patients Satisfied After Forehead Reduction?
Patients are generally highly satisfied after forehead reduction. Bringing the hairline down in a patient with a large forehead helps better frame the face and brings attention more to the eyes and other facial features.
What Is the Cost of Forehead Reduction in Manhattan, NY?
The hairline lowering surgery cost is a combination of a surgeon’s fee, facility fee, and anesthesia fee. These are sometimes reported as a combined fee in certain offices and other times broken down into their components in other offices. The surgeon’s fee can range from $5000 to $10000, plus the additional fees for the operating room and anesthesia. The cost of forehead reduction or hairline lowering surgery will vary by location, surgeon experience, and demand, along with the anticipated complexity of the surgery.
Who Is the Best Forehead Reduction Surgeon in NYC?
Dr. Gary Linkov, a NYC hair restoration top-ranked expert, is a leading voice in hair restoration. He has advanced knowledge of underlying disease processes and is up-to-date on the latest therapies, offering his patients top of the line care with non-surgical and surgical solutions. He also has alopecia areata himself which allows him to empathize with his patients and deliver the most compassionate hair restoration care in NYC, from the heart. As a facial plastic and reconstructive surgeon, as well as a hair transplant surgeon, Dr. Linkov is able to properly assess your needs and deliver exceptional results.
Forehead Reduction Before and After
Do you have any questions about forehead reduction in New York City? Would you like to schedule an appointment with an experienced facial plastic surgeon in Manhattan, NYC, Dr. Linkov? Please contact our City Facial Plastics office for a consultation. You can have the appearance you want with the best hairline lowering surgery options we offer.