Lower your hairline. Raise your confidence.
Self-confidence can take a serious hit when an out-of-proportion hairline or forehead draws unwanted attention away from your other facial features. Many people with a high hairline avoid wearing their hair in a ponytail or pulled back in any way that draws attention to their high hairline, while others may hide it underneath a hat. A high hairline is usually genetic but fortunately, there is a surgery available that will efficiently shrink the forehead's size by lowering the hairline. Dr. Regina Rodman, a double board-certified facial plastic surgeon with Face Forward, lends her expertise to hair advancement procedures to bring symmetry to your face and transform your confidence. Schedule your consultation today to discover all of your hairline options.
At Face Forward Houston Hairline Advancement is for women and men who were born with a very high hairline and a long forehead – sometimes jokingly referred to as a “fivehead.” This procedure lowers the hairline, which creates a shorter forehead and balances your facial proportions. Not only does it reduce the vertical height of the forehead, it can also be combined with a browlift if desired. To advance the hairline, an incision is made a few hairs behind the hairline. Dr. Rodman uses her specialized diagonal technique called a trichophytic incision to help hairs grow through the scar when it’s healed. The scalp is elevated, all the way to the back of the head. Once all of the tissue is loosened, the whole scalp is brought forward. Extra, overlapping skin from the forehead is removed, and very careful layers of stitches are placed to seal the hairline to the new, lower forehead.
Another procedure that Dr. Rodman performs in conjunction with the above procedures is a brow lift. In a brow lift, Dr. Rodman raises the tail of the eyebrows slightly above the orbital rim to create a gentle arch. This takes away the heavy, tired, or saggy appearance and creates a refreshed, soft, and feminine appearance. She takes care to create a look where patients still appear natural. The goal is for patients to still appear as themselves, just a rested and refreshed version of themselves. Your Hairline Advancement will be performed in Dr. Regina Rodman‘s surgery center located in Houston, TX.
People with a naturally high hairline or a prominent forehead who generally have thick hair and no history of hair loss make good candidates for hairline advancement surgery. Patients who have receding hair, hair loss, or a changing hairline should investigate the cause of the change and wait until the hairline is stable before having surgery. How much the hairline can be advanced depends on the laxity of the scalp. A good way to test your scalp laxity is to put your finger on your hairline and see how much it can move up and down. As a rough guide, the difference between the highest point you can push it and the lowest point you can push it is generally the amount of skin that can be removed. Of course, it is still imperative to talk to Dr. Rodman in depth about your options during your consultation.
But what about the scar?
The most common question about hairline advancement, or forehead reduction, is about the scar. While the idea of a scar that stretches across the forehead along the hairline might initially be overwhelming, the good news is that although the scar is long, it hides very well in the transition between the forehead and hair. When we look at other people, we are used to seeing a change between the texture and color of skin and the hair. Putting a small scar in this transition works like an optical illusion, and it is nearly invisible. The placement of the scar is important, but there is another trick Dr. Rodman uses to hide the scar. This is called a trichophytic incision. When the incision is made, the blade is held at an angle. The cut through the forehead skin is diagonal instead of straight down. This leaves the follicles (the roots or bulbs) of the first few hairs in place. Although the growing hair gets cut off in the surgery, the follicle is still present and can still grow hair in the future. Once the excess skin is removed, the new forehead skin is brought up to the new hairline, cut at the opposite angle, and draped over the follicles. With time, these follicles will grow hair again. The hairs that they grow will grow through the scar and help hide it.
The second surgical trick Dr. Rodman uses is to close the scalp in several layers. After she finds the new position of the brows and hair, she drills small tunnels into the outside shell of the bone in the skull. This is only through the very top layer of bone and is not dangerous. She then pulls the hair forward and lifts the brow (when desired), and secures these with a stitch into the bone tunnel. This holds the new brow and hairline position firmly in place and prevents tension on the suture line. She then puts long-term dissolving sutures into the galea, which is another strong layer of tissue. These two layers are what hold the wound edges together and give strength to the closure. These stitches do dissolve over time but last long enough for the scar to heal well. The goal with Dr. Rodman’s layered closure is to have no tension on the skin so it can lay nicely and heal together. By using two strong layers underneath the skin first, the skin edges come together perfectly.
The top layer of stitches in the skin are simply used to seal the top layer. These stitches come out in about one week. It is fine for these stitches to come out at this point because there are still two layers of stitches underneath that will hold the incision together for many weeks to come while it is still healing. Some patients ask about staples. No! We do not use staples in the face! The words “face staples” are like profanity in our office. While we may use them for a portion of the incision that is entirely in the hair, staples are never used in the face. Staples can cause tract marks (think Frankenstein) and do not heal as well as removable sutures. Dr. Rodman believes that if you are going to invest in a surgery that improves your appearance, you deserve every detail to be the best it possibly can be. In addition to surgical techniques, patients must perform diligent scar care. For the first two weeks, patients must ensure that they keep the incision covered with Vaseline or Aquaphor. Some patients also choose to wear a headband to cover the incision in addition to Vaseline or Aquaphor.
Any plain soft cloth headband will be fine, as long you can wash it after each use. The headband is also a good trick to hide the incision for patients who have to go back to work quickly after the procedure. After the incision is totally sealed and there are no red spots, patients switch from Vaseline or Aquaphor to scar gel. Face Forward sells Silagen scar gel with SPF. Silagen seals in moisture and helps soften the scar as it heals, but it does not feel greasy. Once the incision is fully sealed and there are no scabs or crusting, patients can put makeup on over it if they desire. Sunscreen is a MUST for the first year after surgery. If the scar gets sunburned and turns red, it tends to stay an angry red. Keeping the scar covered with sunscreen or a hat is crucial in the first year of healing.
As the scar heals over the course of a year, it will go through many phases. Stitches are left in the hairline for the first week. One week after a hairline advancement Houston patients will have to return to the clinic for removal of these stitches, and it may look a bit raw for another week. By one month, much of the scar has sealed and healed and is usually looking good. Between months 2-4, the scar begins to look red and it may even look worse than it did a month before. This is completely normal, and actually a good sign! The redness is caused by new blood vessels growing in, which heal and remodel the scar. If you were to look with a magnifying glass, you could see hundreds of tiny blood vessels growing into the scar tissue. From far away, the blood vessels just make the scar look red. This process is called “neovascularization” and means everything is healing well. By month six, the redness fades, and the scar starts to turn white. It will continue to contract (become smaller) and flatten. The changes become less dramatic at this point, but the scar will continue to remodel and improve.
To help patients heal as well as possible, we provide up to three treatments of platelet-rich plasma injections to accelerate hair regrowth in the area around the scar. We also can add microneedling, dermabrasion, or steroid shots to improve the appearance of the scar as needed. Our goal is the same as yours; have a scar that is barely visible once it’s healed. Look over our photos to help you get an idea of what to expect!
A Healthy Scalp
Everyone’s healing and pain threshold are different, but the short answer is that this isn’t a terribly painful procedure. Patients generally complain of a tight feeling and dull headache for a few days after surgery, but most are able to switch to Tylenol after the first or second day after surgery. After hairline advancement Houston patients need about one week off of work and three to four weeks away from high-intensity exercise or lifting weights. Patients will be back to normal after one week but will need to continue scar care for up to one year after hairline advancement surgery. We recommend Silagen scar gel, available in our office, to soften and fade the appearance of the scar as it heals.
Hair advancement surgery is a permanent solution. No matter how much the brows naturally droop with time, the procedure will permanently reduce the size of the forehead.
One of the concerns regarding any kind of procedure that has to do with the scalp is the temporary loss of hair. This is an occurrence known as telogen effluvium or “shock loss.” At any given time, there is a certain percentage of hair follicles in the telogen, or “sleeping,” phase of hair growth. During this phase, the hair follicle stops growing the hair and takes a rest. This is why we lose hair every day in the shower and in our hairbrushes. The follicle rests for a few weeks and then grows new hair.
After surgery, the change in blood supply from the surgery causes more hair follicles to go into the telogen phase than usual. The follicles are still alive and well but may shed their hair. This may result in a temporary period where more hairs are seen falling out after surgery. In many cases, this is only temporary, and patients can look forward to regaining their luscious locks. However, to help speed up the process, we offer up to three treatments of platelet-rich plasma injections. PRP injections for non-surgical hair restoration consists of injection into the area of thinning hair to stimulate new hair growth and improve the health and texture of existing hair without the need for surgery.
Schedule Your Houston Plastic Surgery Consultation Today
The Face Forward process starts with a consultation. You will meet with Dr. Rodman (either in the office or via video call) to discuss the result or look you want to achieve. Dr. Rodman will review and educate you about your options and schedule you for the procedure of your choice. Follow-up appointments will be scheduled as necessary. Achieve your look and enjoy the new you! Schedule your consultation for plastic surgery in Houston at Face Forward today.
1900 North Loop West, Suite 370, Houston TX 77018