Hairline Advancement

Dear Dr Epstein

I have recently met Monica P who had a hairline lowering procedure with you in 2007; she lives in London and we could meet up. It was great to see her and to listen to a real story - and i was surprised because i didn't expect such a good result. I think the density is almost perfect in her transplanted area and it looks so natural even though she only had one procedure. The scar is almost invisible and i am impressed now simply because i don't tend to trust photos on websites and would question everything coming my way but now i have to admit that you did achieve something so good with her hairline.

Monica is very happy with the result and with her new hairline and it is great to see a patient who is so happy with the result. I still have an appointment booked with Dr Bessam Farjo in London in November 2010 - he has such a long waiting list that i could only book an appointment for a consultation at that time. I would like to hear his opinion as well before embarking on the surgery.

There is no other UK based hair transplant surgeon whom i would consider and I will get back to you when i decide. Thank you

Best wishes
G

The hairline advancement/lowering procedure can lower the overly high hairline whether due to genetics, hair loss, or prior surgery such as browlifts. Most commonly it is performed on women, where the high forehead can be shortened. In addition, it is possible to actually change the shape of the hairline, making it more oval or rounded by filling in the upper temporal/side regions, creating a more feminine appearance. This is a procedure in which Dr. Epstein, as well as some of the other Foundation for Hair Restoration and Womens Center for Hair Loss doctors specialize, performing them on patients from around the world on average 2 to 3 times weekly.

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Before.

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Just 6 weeks after surgical hairline advancement procedure.

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Before and after surgical hairline advancement.

There are two techniques that can be used to advance the hairline. The most common, because it has many advantages, is with hair transplants. In this technique, as many as 2,800 or more hair grafts can be placed in a single procedure with natural appearing results. Performed usually under a mild oral sedative, this 4 to 6 hour long procedure is essentially painless, as is the recovery period. These grafts, each containing 1 to 3 hairs, are each placed in the natural direction of growth, into very tiny incisions both in front of as well as between the existing hairline hairs in order to increase density. Most patients are fully presentable by 4 to 7 days, and allowed to resume normal activities, including exercise and hair washing, at 5 days. The transplanted hairs fall out after 3 weeks, then start to regrow at 3 months- requiring a total of 6 or so months before the results are quite noticeable. The hairs can grow not only in areas that once had hair, but also in areas where hair never grew. The donor hairs come from the back of the scalp, which continue to grow for a lifetime. To provide a natural appearance, the hairs are transplanted primarily one and occasionally two at a time, with the finest hairs up front, the natural way the hairline hairs grow. There are few risks with the procedure. The donor site, from where the hairs are removed, typically heals as a less than 2 mm wide incision, easily concealable with existing hair in the area.

The other hairline advancement technique is a surgical procedure that involves shortening the forehead while surgically moving the hairline forward. An incision is made right along the front of the hairline, and sometimes along with shortening the forehead, the eyebrows can be raised up, if desired, so that a browlift is performed. The result is a fine line incision scar along the hairline which typically heals up to be barely if at all visible, plus is typically designed by our team to have hairs growing through it. This is definitely a bigger procedure than transplanting with hair grafts, but can be quite effective and produce rapid results. Most patients are presentable at 5 to 7 days, and the sutures come out at around a week.

In order for the surgical advancement procedure to be successful, the patient needs at least a moderate amount of flexibility of the scalp along the frontal region. This can be tested by placing your index finger right along the middle of the hairline, then seeing how high up and down it can be moved. Being able to move the finger a total of an inch or so is generally what is needed to lower the hairline enough. If the scalp is not loose enough, the occasional patient may choose to undergo what is called tissue expansion. With this technique, a balloon tissue expander is surgically placed under the front three inches or so of the scalp, then over an 8 to 10 week period, the balloon is gradually inflated with saline. As it does so, it stretches out the scalp and allows for much more hairline advancement/lowering, as much as 2 inches if desired. Both of these procedures are typically performed in the office operating room under either an oral sedative or deeper intravenous sedation, the choice being up to the patient in consultation with one of our doctors, who have extensive experience with these procedures. As you can well imagine, most patients are not interested in having this expander.

In fact, for most patients, hair grafting is the procedure of choice. It avoids the need for making an incision along the hairline, and is a much less involved surgical procedure. Another advantage of hair grafting is that our surgeons are able to achieve better rounding out of the hairline, especially filling in and lowering the sides. The main advantage of the surgical advancement procedure, however, is that there is an immediate result with unsurpassed density in just a single procedure. In addition, in as soon as 2 months later, a hair grafting procedure can be performed to round out the hairline as well as to conceal any possibly fine line scars that can result.

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After 1 procedure 2650 grafts for hairline advancement.

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After one procedure 1900 grafts.

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After one hairline advancement procedure of 2,800 grafts.

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After hairline advancement procedure of 1,950 grafts. Close up of donor site fine line scar

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After one procedure of 3,100 grafts for hairline advancement.

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After one hairline advancement procedure of 2,000 grafts.

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Before and After one procedure 1,500 grafts to restore hair loss as a result of prior browlift and facelift, including restoration of the sideburns.

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After one procedure of 1,800 grafts to repair a distorted hairline after brow lift surgery.

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10 months after 1 procedure of 2700 grafts. Close up of donor site fine line scar

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After 2200 grafts to advance the hairline. Close up of donor site fine line scar

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Before and After a hairline advancement procedure 1,750 grafts and 350 grafts to eyebrows.

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After hairline advancement procedure of 2,525 grafts and eyebrow transplantation procedure.

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After a procedure of 1800 grafts.

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10 months after one procedure 3900 grafts for hairline advancement. Close up of donor site fine line scar

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After one hairline advancement procedure 1800 grafts.

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After 2800 grafts hairline advancement procedure on a 16 year old born with a very high hairline.

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After 1 procedure hairline advancement - 2450 grafts.

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One week after surgical hairline advancement. This is a one stage procedure capable of advancing the hairline in women with high hairlines.  In this case, by over 1 inch.  Dr. Epstein specializes in these procedures.

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One week after surgical hairline advancement procedure.

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Just ten days after surgical hairline advancement procedure. Note that with this procedure, in which Dr. Epstein specializes, the results are essentially immediate.

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Just 8 months after 1750 grafts to lower hairline.

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1 week after surgical hairline advancement procedure.

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2 months after surgical hairline advancement procedure.

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Before

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Marked

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After 3 months surgical hairline advancement procedure. Note the minimal visibility of the hairline incision. At the time of the taking of the after photos, patient was back in the office for a hair grafting procedure of 600 grafts to round out the hairline and fill in the temporal regions, as marked out. This is a procedure in which Dr. Epstein specializes, as it has several notable advantages over hair grafting, most importantly being the near instantaneous and impressive results of a lower hairline.

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After, 8 weeks later with balloon expander in place and new hairline lower hairline marked out ("immed bef 2nd surg") and 1 day after surgery ("immed aft"). This patient desired a much lower hairline, and chose to have the surgical hairline advancement procedure. Because she had a very tight scalp, she underwent tissue expansion to provide excess scalp skin to permit the over 5 cm of advancement. Both procedures - the insertion of the balloon expander, and the removal of the expander with the hairline advancement procedure - were done under light intravenous sedation.

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After facelift and reverse browlift with surgical hairline advancement. Patient had prior browlift that not only left scarring but also elevated up her hairline and eyebrows too much. She underwent the procedure to advance her hairline and at the same time have a lowering of the eyebrows after they were overly elevated from her prior surgery.