Can Significant Hairline Lowering Be Done Without A Tissue Expander?
Q: Dr. Eppley, I am looking into hairline lowering, jaw reduction with male liposuction (chin too long), brow reduction (I believe I will have to have my brow cut off and reshaped. Also, I have heard of a procedure called the FROST procedure for hairline lowering without a tissue expander. Do you perform this procedure? I have a high forehead and want to make sure it is right.
A: Hairline lowering in men is unique because of the important and unknown stability of the male frontal hairline. The patients has to be selected carefully based on their hairline pattern, density, age and genetics. Having done numerous male procedures that involve an incision along the frontal hairline (hairline lowering, pretrichial brow lifts, brow bone reductions), I have always been impressed with how well the scar usually does despite an always concern about it. Interestingly, recent published research has shown that the hairline incision (in women) seems to preserve hairline stability. (whether the same is true in men is speculative but not necessarily proven) The amount that the hairline can be moved forward depends on the natural stretch of one’s scalp and the technique used to do it. While there is no question a tissue expander always ensures the maximum amount of hairline advancement, most patients do not want that two-step process. (particularly men) There is nothing new or unique about the FROST procedure for hairline lowering. It is a good acronym for the technique but is an approach that I commonly use in men or women. Most surgeons think of hairline lowering a raising up a portion of the top of the scalp to bring it forward. This more limited approach to hairline lowering will usually not get more than about 1 cm of movement at best. But if one raises the entire scalp (behind the hairline incision) in a subgaleal plane the whole to the bottom of the back of the head, scores the galea for further release and then secure its anterior edge to the desired position on the frontal bone with transosseous sutures, advancements of 3 to 5 cms are possible. (this is what is done in the so called FROST procedure) It is just a more aggressive form of scalp mobilization that many surgeons may not feel comfortable doing.
Dr. Barry Eppley