Facial feminization surgery / Hairline
Hairline Lowering
When the forehead is reached through an incision along the hairline, the hairline can be brought forward and reshaped at the same time as the brow bone work. Hairline lowering shortens a tall forehead and rounds out the corners at the temples.
Overview
A shorter forehead, a softer hairline
The height and shape of the hairline set the proportions of the whole upper face. A tall forehead and a hairline that is set back at the temples, the M shape, are masculine patterns. Bringing the hairline forward and rounding it changes the frame around the eyes and brows.
In facial feminization surgery, hairline lowering is tied to the forehead work. The incision that allows it, the pretrichial incision along the hairline, is also one of the two ways to reach the forehead and brow bone. When both are planned, they are done in one operation through that one incision.
How it works
What happens in surgery
Dashed: a high, M-shaped hairline. Gold: the lowered, rounded hairline after surgery.
The incision follows the hairline
A pretrichial incision runs along the front of the hairline, right where the hair begins, and moves back behind the hairline at the temples. This is the same incision used to reach the forehead and brow bone, so when both are planned they are done together.
The forehead work is done first
If a frontal sinus setback, orbital contouring, or a brow lift is part of your plan, that bone and soft tissue work is completed through the same opening before the hairline is addressed.
The scalp is brought forward
The hair-bearing scalp is released and advanced forward to the new hairline position. The strip of forehead skin that now sits in front of it is removed.
The hairline is reshaped
The new hairline is set at the planned height and shape. A high or M-shaped hairline, with recession at the temples, can be rounded and softened, which is one of the features that reads as feminine.
Closure along the hairline
The incision is closed so the scar sits exactly at the junction of the hair-bearing scalp and the forehead skin. Hair grows through the scar over time, which is what helps it blend.
Who it is for
When hairline lowering is part of the plan
A tall forehead
When the distance from the brows to the hairline is long, lowering the hairline shortens the forehead and brings the upper face into better proportion. This is the most common reason it is part of a surgical plan.
Temporal recession
An M-shaped hairline, with the corners set back at the temples, is a masculine pattern. Hairline lowering can round those corners out as the hairline is brought forward.
Forehead contouring already planned
If the forehead and brow bone are being reshaped through a pretrichial incision anyway, the hairline can be lowered through the same incision in the same operation.
When it is not the right choice
Hairline lowering depends on the scalp being loose enough to move forward and on the hair at the hairline being stable. If the hairline is still receding or the scalp is tight, Dr. Ovadia will say so and talk through the alternatives, which may include hair transplantation after surgery.
Recovery
What to expect afterward
Recovery follows the same course as the rest of facial feminization surgery; the full guide is on the recovery page.
Swelling
Swelling is normal and expected. As a general guide, about half settles by 6 weeks and the rest by 6 months. Everyone is different, and this is only a rough guide.
Numbness along the scalp
Temporary numbness of the forehead and the front of the scalp is common. It comes from nerves being stretched during the operation, and it improves over time. Permanent numbness is very uncommon.
Sutures and staples
We typically use some sutures that come out after 5 to 7 days, and some staples that come out after 7 to 14 days.
The scar
The scar sits at the hairline, where the hair-bearing scalp meets the forehead. It is pink at first and fades over the following months. Hair growing through it is part of how it blends.
A facial compression garment is important, and so is sleeping with the head of the bed elevated. Normal swelling comes on slowly; a rapid increase in swelling should be brought to your physician's attention right away. See the recovery after FFS page for the timeline.
Your surgeon
Planned with the forehead, not after it
Hairline lowering is decided alongside the forehead and brow bone work, because the incision that allows it is one of the two ways to reach the forehead. Dr. Ovadia is fellowship-trained in craniofacial surgery and in gender-affirming surgery, and plans both parts together.
He is board certified by the American Board of Plastic Surgery and sees patients in New York City and in Jersey City and Millburn, New Jersey. The forehead procedures themselves are described on the forehead contouring page.
Questions
Common questions about hairline lowering
What is hairline lowering?
Hairline lowering, also called hairline advancement or forehead reduction, brings the hairline forward to shorten a tall forehead and reshape the hairline. In facial feminization surgery it is done through the pretrichial incision, the same incision that is used to reach the forehead and brow bone, so the two are often done in one operation.
Is hairline lowering always part of facial feminization surgery?
No. It is part of the surgical plan when the forehead is tall or the hairline is receded at the temples and the scalp is loose enough to be moved. When the hairline is already in a good position, the forehead can be reached through a coronal incision behind the hairline instead, and the hairline stays where it is.
How far can the hairline be lowered?
It depends on how much the scalp will move, which varies from person to person. Dr. Ovadia assesses this at your consultation. The goal is a hairline that is in proportion with the rest of the face, not the lowest hairline possible.
Where is the scar, and will it show?
The scar runs along the hairline in front and behind the hairline at the temples. It is pink at first and fades over the months that follow, and hair grows through it over time, which is what helps it blend. Where the hair at the hairline is fine or sparse, hair transplantation after surgery can be used to soften it further.
Can hairline lowering be done with hair transplantation?
Yes. Some patients have the hairline lowered surgically and then have hair transplanted in front of or along the scar at a later stage to refine the shape and density. Dr. Ovadia can discuss whether that is likely to be useful for you.
What if my hairline is still receding?
A hairline that is still receding is a reason to be careful. If the hair at the new hairline later recedes, the scar can become more visible. Dr. Ovadia will go over this with you and may recommend treating the hair loss first, or a different approach to the forehead.
Next step
Start with a consultation
Dr. Ovadia will look at the height and shape of your hairline, how much your scalp will move, and whether lowering it fits with the rest of your surgical plan.
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