Hairline Lowering vs. Hair Transplant

The various hair transplant options available to patients have grown over the last decade (or more). The options are numerous enough now, which is why it is important for men and women to study their choices and decide which option is best for their situation. 

For patients with a high hairline or tall forehead and with no ongoing hair loss, a unique set of choices present themselves. These patients have the option of having a traditional hair transplant or a hairline lowering procedure.

THE DIFFERENCE BETWEEN THE TWO PROCEDURES

The differences between the two procedures are that hairline lowering is a surgical scalp advancement operation, which involves stretching the existing frontal hair and moving it further down towards the eyebrows after a strip of the forehead skin is removed. The hairline is laterally and figuratively lowered. A similar goal can be accomplished with a hair transplant by taking strips or tiny plugs of hair from the back or side of the head and moving them to the front. With a hair transplant, patients will need between 2000-4000 follicular unit grafts to move the same amount of hair as the average hairline lowering operation. That amount is also necessary to get the density achieved with hairline lowering. 

WHICH PROCEDURE HAS MORE ADVANTAGES?

The advantages between these two procedures depend on the situation of the individual patient. It’s best to do a hair transplant if the patient is dealing with male or female pattern loss and if they have ongoing hair loss. In this case, a hair transplant is better because the surgeon is transplanting better hairs than the ones that already exist in the front.  However, if a patient has a hereditarily high hairline, which hasn’t changed much since the teenage years, or even the early 20’s, hairline lowering is a better option because it gives almost immediate results and moves more hair.  A flexible scalp is a key preexisting condition for choosing this approach.

CAN THE TWO PROCEDURES BE COMBINED?

Some surgeons have attempted to combine the two procedures.  If a patient is trying to lower the central hairline then there’s no advantage to placing grafts in the front hairline at the same time.  Having the blood supply altered due to the skin being under some tension from the stiches causes the grafts that are placed in the front of the suture line to survive poorly. With the proper surgical technique, employing trichophytic incisions and closures, hairs grow through the resulting scar usually making it invisible. After a year, if there is a detectible scar, a small number of grafts can be employed to conceal it.

For patients who want a lower hairline along with a narrower forehead, the surgeon can put a limited number of transplanted grafts in the front of the temple hair (where there is no suture line), in order to move the temporal hair towards the center.  This narrows the appearance of the forehead as well as lowers the center of the forehead or the hairline.  In this situation the two procedures can be done at the same time and won’t interfere with each other. With the grafts being taken from strips in the posterior temple along the routine skin closure, there is no more scarring than a routine hairline lowering procedure.

PREPARATION BEFORE THE PROCEDURE

It is advised to avoid any medication before the procedure, which might thin the blood.  Some examples include aspirin, vitamin E and fish oils.  Patients should be off them for at least a week prior to the procedure as it may complicate the operation or recovery.

WHAT SHOULD YOU CONSIDER BEFORE MAKING A DECISION?

It’s important to determine the nature and cause of a high forehead.  Is it due to ongoing hair loss from hereditary male pattern or female pattern baldness?  Or is the lost hair due to traction? Traction hair loss in the front of the scalp is very common amongst African-American women from certain styling practices. 

Also, one should determine what are the long-term goals with the procedure. A lower hairline? A different shaped hairline?  A narrow looking forehead?

WHAT'S THE COST FOR THE PATIENT?

Hair transplants can involve up to 4000 grafts in order to lower the hairline by 2-4 cm and can range from $15,000 to $20,000. In many cases it can take up to 3 sessions to be completed. It takes up to a year for such a process to give the end result. A patient with a loose scalp can have a hairline lowering procedure, lowering it by 2-3 cm with a result that is almost immediate.  The hairline lowering procedure costs around $7,500 to $10,000 for a 2-hour procedure.

ARE THERE ANY LIMITATIONS TO THE PROCEDURES?

The main limitation in hair transplants is the amount of donor hair the patient can spare.  If its a male with a severe balding pattern that is starting on their head, there are only so many hairs that can be taken from the back and sides of the head while still have enough hair left to look normal. 

The limitation with hairline lowering is how far the hairline can be adapted based on the laxity and flexibility of the scalp and forehead.

WHAT IS THE RECOVERY TIME?

The full recovery time for hair transplants is about fourteen days. The grafts form tiny crusts, which take two weeks to fall off. The hairs don’t actually start to provide coverage for another 3-4 months. However, some patients return to work as easily as the next day, with a baseball cap.

After a hairline lowering procedure, patients needs to wear a bandage for 2 days.  They may experience some swelling of the forehead.  Patients will look okay with their hair combed down to cover the stitch line within 2 or 3 days.  The stitches come out in about 8 days but it takes a little while for hair to grow through the scar. 

ANY MISCONCEPTIONS OR COMPLICATIONS WITH THE PROCEDURES?

The most common hair transplant myth is that patients will have a full head of hair for the rest of their life after one procedure. The majority of people having hair transplants have male pattern baldness and that myth is difficult to make a reality.  Hair transplants give the illusion of more hair by relocating it in a place where you can style it and look better groomed. 

The most significant complication of any surgery of the scalp is  shock loss. Any operation on the scalp temporarily changes the circulation to the scalp.  Hairs may fall out due to shock loss but they always return within 3-4 months.

CONCLUSION

Although hairline lowering and hair transplants are similar in some aspects, the two procedures have entirely different applications and indications. Patients are encouraged to take the time in figuring out which procedure suits their need the most.

Patients with hereditary hair loss should remember that it is an ongoing process as they continue to age, and consistent care and treatment will be necessary for the rest of their life. The hairline lowering operation, when done on the non-balding female, should give a lifetime result. 

Written by Cosmetic Town Editorial Team based on an exclusive interview provided by Dr. Sheldon Kabaker in Oakland, CA.