Hairline Lowering for Women

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Many women find their hairlines receding, leaving them with what appears to be an oversized forehead that hints at thinning hair. But plastic and cosmetic surgeons are using surgical scalp transfer and hair transplantation to put hairlines lower. Those procedures allow a woman’s face to have the classic proportions of beauty.

According to the Beverly Hills Institute of Aesthetic & Reconstructive Surgery, many more women are reporting to hair restoration surgeons with complaints of a hairline that is just too high. They dislike the condition because it often hints at balding and the overall thinning of a woman’s crowning glory. The American Academy of Dermatology says about 30 million U.S. women are affected by some form of hair loss.

Moreover, experts say the traditional standard of beauty and facial harmony require a face that is divided into equal thirds; when the face shows a forehead that is too broad, the accepted symmetry is thrown out of whack. Consequently, many women spend considerable time camouflaging that unwanted feature.

The first approach is usually getting more hair to grow by slathering a drug, Minoxidil, the only scientifically proven topical (applied to the skin) therapy to stimulate hair growth.

In one case, a 43-year-old Chicago native (who requested anonymity) told that she suffered in silence for years with a high hairline. And then, eight years ago, she found -- by searching online listings -- a surgeon in California who offered hairline lowering. Years later, on a return visit to the same physician, she applied for an opening, was hired, moved to West Hollywood with her lawyer husband and now counsels other women interested in covering a bulbous forehead.

“I hear from women all over the world about hair loss problems, but 30 percent of my emails are from women wanting high hairlines surgically lowered,” she says. “They are surprised to learn a treatment is available.”

Adds James Harris, M.D., a Denver plastic surgeon and co-author of The Hair Replacement Revolution: “Hair loss in women can be genetic but is often caused by underlying medical conditions like anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress.”

But an unsuspected culprit is also at work, causing some female high hairlines.

“It often comes as a surprise to patients that a risk of some facial plastic surgery is a higher hairline,” says Alan Bauman, M.D., a Miami plastic surgeon who says 40 percent of his patients are women with hair woes. “One of the usual, expected risks to a face or brow lift is causing the hairline to recede an inch or more,” Dr. Bauman says. “It happens when a long incision for a facial procedure is hidden within the hairline.”

Plastic surgeon Sheldon S. Kabaker, M.D. in Oakland, California says he gets the best and most attractive results by surgically advancing a woman’s hairline to the point on her forehead where the skull starts to slope downward.

“On the average women, that’s about an inch above the eyebrows,” Dr. Kabaker says.

Surgeons have two basic ways of moving a lofty hairline closer to a patient’s eyebrows: they can transplant hair into the bare sections or they can excise about an inch of skin and pull the hairline down.

“Both have advantages and disadvantages,” says Dr. Kabaker. “Hair transplantation can require two or three, day-long procedures six months apart and may take two to four years for the full growth to become visible. Hair advancement by surgery, however, shows immediate results but dealing with the scar can be tricky.”

Adds Toby Mayer, M.D., a Beverly Hills plastic surgeon who specializes in hair replacements: “Transplanted hair usually grows in kinky and wiry, like the fibers in a Brillo Pad. The hair is rarely ever the same texture again. Plus, because hair transplantation is so labor intensive, it costs four times as much as removing a small strip of skin at the hairline.”

To get rid of a large forehead and advance a patient’s hairline, the surgeon removes a narrow strip of hairless skin right where the hairline and forehead meet. With the patient under general anesthesia, the surgeon makes a zigzag incision across the forehead, just a couple of hairs into the fine hair of the hairline. The surgeon then buries the hair edge when he sutures the two edges together so that hair grows in -- and just in front of -- the scar.

In a second variation, the surgeon combines hair advancement with a brow lift.

“If I perform a surgical hairline advancement on a woman’s forehead on a Thursday, she can usually go back to work on Monday,” says Dr. Mayer. “The hairline is immediately lowered and there is no change in the texture of the hair. Plus, it costs four times less.”

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Charles Downey
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