Hairline Lowering

This procedure achieves balance and harmony of the forehead with your face. Hairline lowering reduces the receding hairline on the sides (temporal recession) and lowers the hairline overall. 

Feminizing hairline lowering is used very often in transgender patients undergoing gender affirmation surgery. 

Cis gender males experiencing androgenic alopecia, or hair loss, and cis gender women who desire a shorter, more petite forehead also undergo hairline lowering, or scalp advancement. 

Aesthetic Considerations of the Forehead

Defining features of the forehead include the hairline, the brow area, which includes the eyebrows, the brow bone, and the area between the eyebrows, or the glabella, and the temples, or bone defining the sides of the forehead. 

Differences in these areas can cause a more aged versus youthful appearance, or a more masculine or feminine appearance. 

Areas of hair loss and a higher hairline are associated with a more aged appearance. 

Gender Differences in the Forehead

The hairline is generally higher in males than in females. That is, males tend to have a taller forehead than females. The hairline also has a typical “M” shape in males related to a receding hairline on the sides, above the temple region. This is a male-pattern type of hair loss to due androgen hormones affecting hair follicles. In females, the hairline has a rounded shape and is shorter than in males.

These differences at the hairline, as well as the brow area, are quite impactful with respect to gender identification. 

In Feminizing Hairline Advancement, these changes are made:

  1. The hairline height is decreased, making the forehead shorter
  2. The temporal lateral hair recession is replaced with hair bearing scalp
  3. A round hairline with a smaller forehead is created

Hairline Advancement Surgery

Creation of a natural looking, youthful, balanced hairline

Transformation of an M shaped into a rounded hairline

Forehead shortening

Hairline Advancement is also known as:

  • Scalp Advancement 
  • Feminizing Hairline Surgery

In Forehead Reduction Surgery, the bony forehead is reduced by removing and setting back bone. The forehead can alsobe reduced by decreasing the amount of skin and decreasing the height of the forehead. This is done by lowering the hairline, which makes the forehead shorter. Forehead skin is removed and hair bearing scalp is brought forward in its place. This feminizes the forehead immediately gives a natural, more youthful appearance. 

What is Hairline Lowering Surgery Like? 

A pretrichial incision along the hairline of the forehead is marked out. The incision is angled and placed right in front of the hairline to preserve the hair follicles. Dr. Costa uses meticulous techniques to maximize preservation of your hair follicles. The incision is carried out along the receding hairline corners and into the hair bearing temples. The scalp tissue is carefully raised up and released from underneath, preserving the blood supply and your hair follicles. The scalp is advanced and the excess forehead skin removed. The receding hairline corners are closed off. This results in a natural appearing hairline that harmonizes with the rest of the face. 

Your hair is carefully braided and secured during the surgery; your hair is NOT cut or shaved. 

Hairline Lowering and bony Forehead Reduction procedures are commonly performed together. Through the hairline incision, the forehead tissue is reflected downward and the bony contouring and reconstruction performed through this incision. 

Will I Have Drains?

No drains are used. Instead, you will have a head wrap the compress the area. 

What is the Recovery Like?

This procedure does not produce much discomfort, which is fantastic. You will mainly notice swelling after the surgery, which peaks at 72 hours post operatively and then decreases. Most of the swelling will be around the eyes including the eyelids. You will wear a compression wrap around your head for several days to minimize swelling and will sleep with your head elevated for comfort and to minimize swelling. Sutures are removed 1 week later. 

Infection is very unusual. You will be given antibiotics in the operating room and post op. There will be numbness of the forehead and scalp which takes weeks to months to resolve. 

When Can I Return to Work?

If this is the only procedure, you may feel ready to go back to work a week later, possibly 2 weeks later. 

Hair Transplantation

Hair transplantation can be done before or after facial feminization surgery. It can be used for adding hair to the temple recession, lowering the hairline, or concealing a scar around the hairline. 

Cost of Hairline Lowering 

Hairline lowering for facial feminization for transgender patients may be covered by insurance. Other times, it is an out of pocket expense.

Hair transplantation is often an out of pocket expense. For cis gender patients, it is most typically an out of pocket expense.