Hairline lowering surgery

Hairline lowering surgery, also known as foreheadplasty, is a surgical procedure aimed at correcting an overly high forehead.

Patients seeking hairline lowering surgery are men and women who feel that their forehead is overly high and out of proportion with the rest of their facial features. It is not suitable for men with receding hair as the scars need to be hidden in the hairline.

Mr Paul Wilson can combine hairline lowering with a brow lift or brow contouring if required for the optimum results.

Frequently asked questions

What is a hairline lowering forehead reduction

This is a procedure designed to lower a high anterior hairline down towards the brow. In addition there will also be an element of brow elevation by a few millimetres. A special device called an Endotine is paced at the time of the operation to secure the scalp in place.

How low can the forehead be lowered?

Typically, a 2cm reduction in brow height is feasible, although more can be achieved. It is very important to establish the degree of hairline lowering before the procedure. This is an agreed position between the surgeon and the patient. It is important not to make the brow too short.

Do I need a forehead reduction?

The operation is purely aesthetic. If you perceive that your forehead is too high compared to the norm, then you can be considered for this operation. Absolute numbers don’t matter so much, it is the relative proportions that count, and what you think, not every body else. It is very important to have realistic expectations about the results that can be obtained. Mr. Wilson will discuss this with you in detail.

How many consultations do I need?

You will be offered 2 consultations prior to your procedure, to ensure you receive all of the relevant information, have a cooling off period to think about things, and have time to ask further questions.

Do I need a pre-assessment?

Yes, you are required to attend a nurse-led pre-assessment clinic 1-2 weeks prior to your procedure.

Can I get credit to pay for the operation?

Yes, Zebra finance is available at the Spire Hospital. This can be discussed after your first consultation with Mr. Wilson’s PA, Karen.

Will I be shown before and after pictures of previous patients who have undergone this procedure?

Yes, Mr. Wilson be happy to show you before and after pictures.

Can you morph my photographs to give me an idea of what I will look like post- operatively?

Yes, this is possible, with Crisalix 3D software. This gives you an impression of what you could look like. It is for illustrative purposes only and does not guarantee a surgical outcome.

Where is the incision?

The incision extends from one ear to the other across the temple into the anterior hairline and similarly across to the other side. The temple hairline will remain in the same position, i.e. about 2cm from the lateral brow in an oblique direction.

How long does the procedure take?

2.5 hours typically

Will photographs be taken before and after the procedure?

Yes, photographs will be taken before and after the procedure for documentation and inclusion within your medical record. Consent for photography will be taken.

Will there be drains placed?

No, not usually.

Will I have any dressings?

Yes, there will be a head bandage placed at the end of the operation. This is removed the following day.

How long will I stay in for?

I would recommend an overnight stay.

What position do I lie in after the procedure?

I would recommend sleeping in the supine position on your back with 2-3 pillows for head elevation, during the first week.

When will the stitches be removed?

10 days. The stitches are bright blue so the nurse can easily remove them.

How is the scalp held in place?

The scalp is held in place using a dissolvable triangular device called an Endotine with small prongs, that engages the skull and the scalp simultaneously. This device takes 6 months to dissolve. It is possible to feel the prongs of the device initially.

Can I wash my hair?

Yes, you can wash your hair the day after your operation. It is very important not to move the scalp too vigorously, to prevent bleeding, wound dehiscence or dislodgement of the scalp from the Endotine device.

How long do I need off work?

I would recommend two weeks, to be presentable.

What if there is a problem or I have concerns after the operation?

Please contact the Spire hospital at any time if you have a problem. If necessary your Consultant will be contacted to see or speak with you. The nurses in the dressing clinic are available 6 days a week.

Where will my eyebrows be?

There will be an element of eyebrow elevation, by a few millimetres perhaps, but this will reduce over time. Expect a small degree of asymmetry.

Will it affect my blinking?

No, although your eyelids may be swollen post-operatively for a few days.

How soon after surgery can I colour my hair again?

4-6 weeks and discuss with your hairdresser.

Will it be a natural hairline or will it look like I’m wearing a wig?

I will try and keep the natural contours of your hairline.

What if I don’t like it?

You will inevitably have to get used to the new position of your hairline and brow. I’m afraid the ultimate aesthetic outcome is not guaranteed to meet your expectations. This is why a thorough discussion needs to take place before the surgery. Your expectations need to be realistic and addressed.

Can it be undone?

No, this would be very difficult without skin grafting.

Can it be redone?

Ideally not but yes, possibly. I would leave it at least 18 months for the scalp to stretch first.

Would I have to pay for a second operation?

Complications per se, are covered by your surgeon and the hospital. Improvements in the outcome of your surgery will not be covered by the hospital or anaesthetist. The surgical fee may be waived on this occasion.This is at the discretion of your surgeon.

Will I still be able to have muscle relaxing injections such as ‘Botox’?

You can still have these injections if you need them. Initially, there will be some improvement to the wrinkles within your forehead.

When can I go back to exercise?

Please refrain from heavy lifting, bending and stooping and strenuous exercise, including sex for 4-6 weeks following the operation.

What can I do before the operation to improve my outcome?

Pease don’t take any drugs that can thin the blood including NSAIDS, aspirin, anticoagulants, herbal remedies, vitamins and minerals. Please do not smoke for 6 weeks before and after the operation. Please don’t drink alcohol 48 hours before the operation and remain well hydrated.

I’ve already had hairline lowering forehead surgery by another surgeon. Can you revise it?

A second operation is always more difficult than the first. This is possible after 18 months. The risks and complications are greater and your expectations need to be addressed. Please discuss this with your surgeon.

When can I drive and fly?

You can fly and drive after your stitches have been removed, providing there are no complications.

How long is my follow-up?

You will be reviewed at ten days, 6 weeks, 6 months and one year. You will be offered annual visits thereafter. Dressings nurses are available every week while you are healing, if necessary.

What are the options to hairline-lowering forehead reduction surgery?

Hair transplant, by a qualified hair transplant surgeon.

Can hair transplant still be performed after forehead reduction?

Yes it can, by a qualified hair transplant surgeon. I do not perform hair transplant.

If hair transplant is required following foreheadplasty, this will be billed for separately.

I am a male patient, can I have this procedure too?

Yes, it is possible to perform this procedure if you are a man, however, with age and male pattern baldness, it is inevitable that the hairline will ultimately end up beyond the scar, leaving the scar visible in front of the hairline. Hair transplant is a better option for men. Of course the two operations can be combined.

What are the risks and complications of the procedure?
  1. Scarring. Usually it takes up to 18 months for scars to mature. Initially all scars are raised, red, lumpy, itchy and tender, before settling down in to fine white lines. The scars are in a zig-zag fashion across the anterior hairline to try and hide the scar. The incision is also bevelled to allow hair follicles to grow through the scar.
  2. Bleeding. There will definitely be bruising following the operation as the scalp is very vascular. Bleeding is controlled at the time of the operation but it is possible to bleed after the operation. In this case you will be returned to the operating theatre to stop the bleeding.
  3. Blood transfusion. This is unlikely but maybe necessary if there is excessive bleeding. You may be discharged home on iron supplements if your haemoglobin is low after the operation.
  4. Swelling. This is expected and normal following the operation. Your face may be swollen as well. Swelling and bruising take about 3-4 weeks to settle down initially.
  5. Infection. Antibiotics will be administered at the time of the operation to try and prevent this eventuality. Sometimes stitches can ‘spit out’ and be associated with a small collection of pus. Simply removing the stitch resolves this situation usually.
  6. Cellulitis. This represents a spreading infection and needs admission to hospital for antibiotics and possibly washout of the wound.
  7. Wound breakdown. If the wound is under too much tension or if there is an infection, then the wound can break down. In this case the wound will heal up by ‘secondary intention’, which means that the wound is left to heal up on its own. In this case the scar may be worse. You may need a scar revision in this instance, in the future.
  8. Scalp cysts. These may occur due to hair follicular cysts or inclusion cysts within the scar line.
  9. Hair loss or alopecia. It is inevitable that at least a few hair follicles are lost during the procedure. Also, because the scalp is stretched out, the density of the hair follicles will be less, but not obviously. Alopecia can occur around any scar transgressing the hair follicles.
  10. Long-term effects. As you grow older the density of hair follicles is likely to reduce and the position of the hairline will alter, thereby making the scar more noticeable.
  11. Sensitivity of the scalp. You will definitely have a patch of numbness either side of the scar and most likely to the vertex of the scalp. This will slowly improve over time, however there will always be a small patch of reduced sensation.
  12. Skin necrosis. If the wound is under too much tension and the vascularity to the wound edges is compromised then part of the skin either side of the wound can turn black, called skin necrosis. This risk is increased in smokers and diabetics.
  13. Pain. Your anaesthetist will administer adequate pain relief during and after your operation. You will be sent home with a cocktail of analgesics to ensure you are pain free.
  14. Shooting pains. Neuromas, cut end of nerves may develop following this procedure. They usually settle down with time.
  15. Chronic pain. It is possible to develop chronic pain from any operation. This is unusual but possible. Long term analgesics may be required in this instance from a pain specialist.
  16. Asymmetry. Every effort will be made to make you as symmetrical as possible, however please expect that there will be a small amount of asymmetry as this is relatively normal.
  17. Over-do or under-do. Every effort is made to ensure that your hairline is placed exactly at the position you requested, however please give or take a couple of millimetres either side to take in to account tissue elasticity and Mother Nature.
  18. General anaesthesia. Your anaesthetist will discuss the risks associated with this procedure.
  19. Thrombosis and embolism. The procedure takes about two hours to perform. During this will be wearing TED stockings and calf pumps will be in place during and after your procedure. You are encouraged to mobilise early after your operation to prevent a clot in your legs and/or a clot in your lung. This is rare.
  20. Unsatisfactory aesthetic outcome. Whilst every effort is made to give you the best possible aesthetic outcome , sometimes it is just not possible to give you the result you desire. This may be due to unrealistic expectations, limits of surgery or complications of surgery. Revision surgery is at the discretion of your surgeon, if possible, and the Spire hospital. Additional costs may be incurred.

Price of hairline lowering surgery

Price is always a factor when you’re planning a cosmetic surgery procedure and we try to offer competitive prices without compromising our commitment to patient safety and care.

If a brow lift or brow contouring surgery is deemed necessary to produce the optimum result then there may be a modification to the cost but this will be discussed in full and the figure we quote is always the final figure.