Can I Safely Have Hairline Lowering After a Coronal Incision From Prior Skull Surgery?

Q: Dr. Eppley, I’ve had several scalp contouring surgeries done with you (6 or 7 coronal scar “openings” in total if I remember correctly). I wonder if it’s safe for me to have a hairline lowering surgery done, if it’s over 1 year post op since the last head surgery, or is there a risk of skin necrosis between the coronal scar and new scar from the hairline lowering then? I’ve heard it should be safe 1 year post op, since the head grows new arteries and blood vessels, but I wonder if this is the same case with me since I’ve had so many scalp surgeries done…? 

A: Good to hear from you again. If I understand what you wanting to do, you want to move the entire scalp (which is what a hairline advancement is) which would necessitate undermining well past the coronal scar. And the pertinent question would be whether the intervening scalp between these two incisions (new frontal hairline one and the old coronal one) would survive? That is obviously a very good question and I have not seen a similar case of hairline advancement. It is possible the scalp will survive without any problem, but if it does not….

All I can say about that question is when in doubt….do a delayed approach. You make the hairline incision needed down to bone and then simply suture it closed. Then 4 weeks later perform the actual hair advancement. This is what is called a true ‘delayed flap’ approach and has been used for skin flap surgery for one hundred years. In this way you ensure that new blood vessels find they way into the narrow island of skin between the two incisions from each side.

Dr. Barry Eppley

Indianapolis, Indiana