Can Forehead Tissue Expansion Raise My Lowered Hairline?

Q: Dr. Dr. Eppley,I am reaching out to inquire about doing a hairline raising procedure. I had facial feminization surgery about a year ago that included a hairline lowering procedure. This improved my temple recession. However, the surgeon also lowered the center of my hairline to avoid creating an extreme arch to my eyebrows. Overall, I am dissatisfied with how lowering my center hairline has impacted the proportion of harmony of my face. I am looking for options to extend my hairline up 1-2cm. Based on my research, I am under the impression this could be done by performing a two stage procedure. 1) leveraging a tissue expander to stretch the skin of the forehead 2) remove the tissue expander and remove a portion of the skin behind the hairline (behind the hairline to avoid making a weird hairline) to extend the position of the hairline up. Ive included pictures below of my current pic and a morphed ideal pic. Can you please let me know if Dr Eppley thinks he is able to achieve this?

A:Thank you for your inquiry and sending your pictures. As you have well explained what you are trying to achieve is an increase in the non-hair bearing upper forehead area of at least 1 cm or maybe even as much as 1.5 cm. The options to do so include the following:

1) Laser hair Removal. I would be remiss if I did not mention that this is always an option and it certainly the only nonsurgical one short of shaving/plucking. Its advantages are it is not surgery and it offers precise control of the location of the raised frontal hairline. You do have one advantage for laser hair removal in that you have dark hair in which it always works the best because of the darker pigment attraction. The obvious disadvantage is the need for multiple treatments to achieve the effect and whether you can get rid of 100% of the hairs..

2) Forehead Tissue Expansion. As you have previously described the surgical alternative is a four head tissue expansion followed by upper forehead flap advancement with excision of the undesired frontal hairline. Well this can be effective, as tissue expansion on a bonus surface has been around for 50 years now, there are some specific disadvantages. First and foremost the location of the tissue expander is going to be very prominent and will create its own temporary aesthetic deformity. The tissue expander really needs to stay in place for several months to allow the tissues to expand and properly relax. The relaxation phase is actually more important than how much it is expanded. The error in this approach that I see people do is they don’t believe the tissue expander and long enough for the understandable reason of its obvious presence. The second issue with forehead flap expansion is the potential for relapse. This can be largely overcome, however, by securing the advanced forehead flap to the bone. Thirdly, I don’t think you would be able to achieve a 2 cm expansion into the frontal hairline. Hey more realistic outcome it Is a 1cm advancement due to the naturally very tight tissues of the forehad

So as you can see the two stage forehead expansion and flap advancement is a straightforward concept. But wearing the expander on your forehead for the duration needed is the challenge of the procedure.

Dr. Barry Eppley

World-Renowned Plastic Surgeon