Your Questions

Q: Dr. Eppley, My forehead is very noticeably high. And it makes my long narrow face even worse. I only style my hair certain ways to cover it (or try to). I’ve been wanting a forehead reduction for years and I certainly do not want to go to just anyone. I know you are very experienced in this procedure. Is it possible to still preserve the roundness of the hairline? I’m a little frightened by some results I see where patient’s new hairlines look like they were drawn across their forehead with a ruler! Also, my forehead lacks projection. I realize I am female and I certainly don’t mean I want the big masculine brow bone! But my forehead goes straight down to my eyeball. I feel like the brow should at least come out a little to be aesthetically pleasing. I know foreheads are often shaved down during this, but can ‘bone’ or something else be added?

A: Most hairline advancements that I have seen done have a rounded effect across the hairline. This is almost unavoidable because the greatest amount of hairline advancement is in the center of the forehead and less so as it goes back into the temporal areas. A hairline advancement can not really just create a perfectly straight line across the forehead.

Brow bone augmentation can be done using bone cements or a custom brow bone implants. When done in conjunction with a hairline advancement, the open exposure provided by this procedure allows any of the brow bone augmentation options to be used.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a hairline advancement (forehead reduction) surgery one month ago. I’m losing some hair on the scar and was wondering how long will it take before it grows back? Im still not too happy about my head. I don’t feel like I can wear my hair back. I still feel my hairline is high. My husband says it looks good however! Thanks.

A: There are limit to a one-stage hairline advancement surgery based on teh scalp’s elasticity and how much the forehead can be reduced. Hair shafts along the incision line will typically shed in the first few weeks to month after surgery due to the trauma of the surgery. (hair follicles do not like traumatic events) This still leaves the follicles underneath the skin/scar which will regrow hair, at the growth rate of 0.05mm per day (the follicle lies 6 to 8mms under the skin), which will take about 8 to 10 weeks to begin to appear at the skin surface. (1mm per 10 days or 3mms per month) Thus it will take around three months until some hair growth has occurred through the scar. This coincides with when the redness of the hairline scar begins to get better. (less red) Between the hair growth and the maturation of the frontal hairline scar, it will take about 6 months for the appearance to become more normal. It takes up to a year for the scar to fade as much as it is going to and to have enough hair growth length to see the final true hairline location and pattern.

While easy to stay, it takes patience and lot more healing time to really judge your final perception of the surgical result.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a frontal hairline advancement. I have no issues with hair loss. My hair hairline simply dips back into in the middle and that’s where I drew a line if that was eliminated on my picture. I have some breakage on the edges from hats and headbands, but nothing permanent. It grows back instantly. Is this possible? I know you are the best at this procedure so I thought I would ask you.

A: Thank you for sending your picture. Where a hairline advancement works the best is exactly where your hairline issue is….in the center of the frontal hairline. Given where you have put the markings for the desired hairline edge I think is a very achievable goal. Scalp elasticity always determines how much the hairline can be moved but a 1 to 2 cm forward movement is possible in most people. It is at the sides of the hairline advancement, the temporal region, where a hairline advancement has the least effect…unless the incision is placed right at the edge of the hairline which would usually not be desirable for most patients. This is a procedure that has a very quick recovery so expect to be back into a normal life within 7o to 10 days after surgery.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a frontal hairline advancement. I have no issues with hair loss. My hair hairline simply dips back into in the middle and that’s where I drew a line if that was eliminated on my picture. I have some breakage on the edges from hats and headbands, but nothing permanent. It grows back instantly. Is this possible? 

A: Thank you for sending your picture. Where a hairline advancement works the best is exactly where your hairline issue is….in the center of the frontal hairline. This is because the best mobility of the scalp comes the center where the maximal its release is done down the middle all the way to the back of the head. This is due to the limits of the incision and resultant scar. In order to keep the scar from extending all the way down to the ears, most hairline advancements cut back no further than the high temporal region. As one gets closer to the end of the scar the amount of scalp advancement disappears.

Given where you have put the markings for the desired hairline end point I think is a very achievable goal. Scalp elasticity always determines how much the hairline can be moved but a 1 to 2 cm forward movement is possible in most people.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, i want my forehead made smaller with a shorter hairline. I would like to have a procedure at your facility to have the central frontal bone vault reduced to about 5mm and the glabella the triangular area in between the eyes over the nose and under the brows,I had a interview with a previous surgeon who was actually to far from me to travel but he was saying my scalp is flexible   Enough to bring it down to 2 cmd maybe another half once he loosened this area underneath my scalp. I forgot the name of it,do you have any idea what he’s referring to and do you use this same technique?

A: You are referring to a hairline advancement procedure as part of an overall forehead reduction. This requires the scalp be loosed up so it can be brought forward and the hairline lowered. The more natural scalp flexibility one has, the easier and more hairline advancement that can be achieved. This is often done with frontal bone remodeling such as frontal bone reduction and some brow reshaping/contouring. You are correct in assuming that about 5mms of frontal bone can be safely reduced by burring.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a novel browlift reversal procedure and I suspect if anyone can do it you can.  A few years ago I had a brow lift performed. I hated the result. I felt like it stretched out the skin over my forehead too tight, making the bone underneath more prominent. I know in a typical scenario you might recommend a forehead reduction or some sort of burring. I however had a unique idea. I notice that in a few cases you mention the use of screws to hold the skin to the bone. I notice that when I push my scalp foreword toward my face, my forehead skin returns to the place it used to be. I was praying and hoping that you might be able to use that screw mechanism or whatever it is to hold my scalp in the forward position, returning it to its original position and thereby avoiding the forehead reduction, which I am not willing to even consider. It would mean the world to me if this could be done. I am desperate and in emotional pain. If you could make this happen it would be a God-send.

A: What you are describing is pretty much how a browlift reversla procedure is done. The very fact that you can do adequate mobilization of the forehead downward by pushing on the scalp suggests that is a real possibility to reverse your browlift. The concept of resorbable screw or suture anchor fixation to hold the released forehead tissues down is just as valid as using it to hold a browlift up. The only question then is what incisional approach to use to do it. What type of incision was used to do your browlift, endoscopic (which I assume), pretrichial, or coronal??

Using your existing endoscopic incisions (which are either two or three), the entire forehead and brows as well as the scalp behind them can be released. Then the scalp is advanced forward (epicranial shift) and is secured forward (pushing the forehead and brows down) by two or three point resorbable screw fixation to the frontal bone. I would anticipate this approach to a browlift reversal to work quite well as it is just a form of hairline/scalp advancement.

Dr. Barry Eppley

Indianapolis, Indiana

 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

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a hairline advancement. I have been looking at your website for a while and you’re the only doctor I’ve found who may be able to perform the surgery I want. My forehead sticks out and bit and I would like to shave it down just a little to make my forehead flatter. I was wondering if this would be possible judging by the images I’ve attached. I’m also thinking I’d like to get my hairline advanced just a little bit. The area I’ve shaded is about the area I’d like to get it reduced to.

A: It is very common for a frontal hairline advancement and a bony forehead reduction to be combined together to create the changes you have shown. You have mentioned that you want just a ‘little hairline advancement although your images show a hairline advancement that I would judge to be up to 10 to 15mms. (which for a hairline advancement would not really be judged as little, that is usually the very maximum that can be achieved in a single stage procedure in just about anyone and even that depends on how much natural laxity of the scalp one has.

What is not very common is to have a male request or to actually do a male hairline advancement. I have done them it, it is just a procedure that is much more commonly done in women. The reason being is that most women have a stable frontal hairline while that is certainly not assured in men. This there is always the concern about placing a fine line scar along a hairline that may or may not be there in the future. While there is no alternative to having an incision to do a bony forehead reduction, there is an alternative (hair transplantation) to a hairline advancement.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in forehead reduction surgery. I serve in the military and I really want this forehead reduction done. I hate my forehead. It is wide with a high hairline and my forehead protrudes. Please help me! I would love to do the military program but this procedure is not on the list.  Attached are some photos which shows how high my hairline is and how my forehead bulges out.

A: While you would be a good candidate for a forehead reduction or scalp hairline advancement, it appears you would need almost a 2 cm advancement given the length of your forehead. This means a first stage scalp tissue expander is placed to create more hair-bearing scalp that then can be used and advanced to create a really significant forehead reduction as a second procedure. Without a tissue expander or a two-stage approach, the most hairline advancement that can usually be obtained is around 1 cm. While forehead bone reshaping would be also be done, the forehead always seems to stick out more when the hairline is way high and the upper forehead is sloped backwards. Even a hairline advancement procedure alone make a prominent forehead look less protruding because its total vertical length becomes less.

The Patriot Plastic Surgery program applies to all elective aesthetic plastic surgery procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in forehead reduction/hairline advancement surgery. I am a 20 year old female, and I wanted to ask about forehead recontouring. I would like to know more information. I am self-conscious about my forehead as it curves/bulges outwardly. I’m not sure if this is applicable to this, but I have included a picture to get a better opinion.  I also want my hairline lowered. Will a tissue expander be needed?

A: The success of frontal hairline advancement depends on the tightness of one’s scalp and how much forward movement of the hairline one desires. If the scalp has some looseness and the amount of hairline advancement in not greater than 10 to 15mms, then a scalp expander will not usually be needed. Although I have seen some patients whose scalp is so tight that is barely moves even with full release.

A hairline lowering will help but will not get rid of the bulge appearance completely. The two procedures are often done together for maximal effect.

Based on this profile picture you have sent, I think your rounder forehead can be made flatter. The relevant question is how much? Generally up to 4 or 5mms can be taken from the most central prominent area. But I alway check a simple skull x-ray first to see how thick the bone is in that area.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in some type of forehead reduction. I am a young woman and I’m not happy about my face at all. The biggest problems I have are with my jawline and my frontal bone. I also have really deep insetted eyes. I’m kinda chubby but I used to be skinny and I had to exact same problem. I have big cheeks , something like squirrel cheeks and jowls on the side of my face. I really want a nice tight jawline. When I tighten the skin together and pull it through my ears I see it the way I would want it to be. I was wondering if that is possible for me without having a jawline surgery.

I have a very big frontal bone and I would love to have a nice flat forehead like most women have. I was wondering if that is possible for me to get it flattened. Maybe there is also someting you could do for my deep insetted eyes. I want to send you some picture’s and I’m wondering if you could look at them yourself and if you have any tips for me to make me as beautiful as possible.

A: Thank you for your inquiry and sending your pictures. The most effective procedure that you could do for your face would be a combined orbital/forehead reduction and hairline scalp advancement. This would reduce the depth of your eyes, lessen the brow ridge prominence, and make the forehead look smaller.

Only a jowl lift can create the desired look you are after along the jawline and you are too young for that procedure. There are no non-surgical methods that can create the same effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a question or two. I’m 18 years old and have an really messed up forehead. Its bulgy, has horns and the brow bones sticks out and I also have a high hairline but small forehead. Is 18 to young to be fixing this? What age should I wait till. This is my biggest insecurity. And also how is the pain process?  Thank you for taking your time to read this and I hope you respond soon! I have attached pictures so you can see how ugly it is!

A: It looking at your pictures, I see an uneven forehead, small upper prominences (what you can horns) and some brow prominence. You also have a mildly high frontal hairline or long forehead. That all could be treated in a single procedure, going through a hairline or pretrichial incisioon, burring down the forehead from brow bones up to the horns and then bringing the hairline forward to close. (removing so upper forehead skin to make your forehead vertically shorter. Surprisingly, that is not a painful procedure afterwards (patients report more like a headache) as it is really just a reverse form of a cosmetic browlift procedure with some bone reduction. At your age, your forehead bone is fully grown so it is perfectly appropriate to be doing these permanent modifications. The question to consider is not your age for the procedure (physical maturity) but whether this is enough of a concern for you to justify a surgical change. (emotional maturity)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have an weird forehead. It has that I mainly have a brow as a man and it also has horns (exotosis) I was wondering if you do such surgery to fix this/shave down my skull to get me a desired smooth forehead as a female should have. I also have a high hairline so I’m wondering if you can pull it down. How old do you have to be? I know 18+ but the skull doesn’t finish developing until what age? I am 20 so I don’t know if I am old enough yet. Also, can both surgeries be performed at the same time?

A: The skull is largely finished developing by one’s early teens, it is the facial bones below it that continue to develop until the late teens with the mandible finishing complete growth around age 21. Therefore, at age 20 you can have frontal/brow bone reduction without any concerns about growth implications. The only issue is how much the brow bones can be reduced given the frontal sinus which lies underneath it. That could be determined before surgery by a simple lateral skull film. The hairline advancement/vertical forehead skin reduction is done through a pretrichial incision. This also provides the exposure needed for the forehead and brow reduction so, by necessity, these two procedures would be performed at the same time.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a forehead reduction. I have attached two photos of my forehead for your review. I hope these are enough. As you can see my forehead is massive and it gets me down !! Can you help? Is it always successful? Is there much recovery?

A: Thank you for sending your pictures. What you refer to as a massive forehead is one that is very long. I would estimate that the measurement between your eyebrows and the edge of your frontal hairline is at least 7.5 cms. If the forehead length in females is greater than 6.5 cms it is considered too long. This can be improved with a frontal hairline advancement, also known as a forehead reduction. This is where an incision is placed along the edge of the frontal hairline, the scalp behind it is loosened, lifted and brought forward, and the forehead skin underneath then removed. The amount of forehead skin removed is the amount that the vertical length of the forehead is shortened. Generally, 1.0 to 1.5 cms can be reduced in the middle of the forehead. There is less so taken out from the sides where it tapers into the upper temporal area. This is a very effective and successful procedure. Forehead reduction is an outpatient procedure that takes 90 minutes to do under general anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I have a question about the postop healing process for a forehead reduction/hairline advancement. It has been just about 2 months since my surgery and my scalp is still not healed. I have some large areas of scabbing over the incision sites and don’t know but it seems like they should be healed by now. I don’t know if I am doing something or taking some medication that would slow this healing process. Please just let me know if this is normal I can also send you some pictures if you would like.

A:  It is certainly not common to have a forehead incision that is not completely healed after two months. The scalp is such a well vascularized tissue that it is hard for any portion of it to not heal unless there is a good reason. Most likely, these non-healing areas represent spitting sutures. If you look close at them after removing the scabs, you may see little white threads which are dissolveable sutures sticking out. Many times along the hairline the body will spit them out long before they will ever dissolve. There presence at the incision lines now serves as a chronic source of infection which appears like a pimple or small draining sinus. This is a common problem in many body areas and the hairline is no exception. If you can pick out those white sutures you will remove the source of irritation and the areas will go on to complete healing. I have seen this wound occurrence many times after pretrichial browlifts and forehead reductions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I don’t like having a large forehead. I would like it reduced by at least an inch. I understand by having the eyes done that will also can help. I also hate how one eye brow is lower than the other one. I am sending pictures from the front and side views so you can what I mean.

A: Thank you for sending your pictures. I can see the three issues of concern, your very long forehead, eyebrow asymmetry and extra skin on the upper eyelids. Most frontal hairlines (forehead reductions) can be advanced close to an inch, depending upon how mobile one’s scalp is after it is freed up. The advancement is always greatest in the middle and tapers out towards the temporal hairline. To improve your eyebrow asymmetry, more skin would be taken out on the left side than the right as it tapers outward. The upper and lower blepharoplasties would be done in the conventional fashion with skin and fat removal. The combination of all three would make for quite a periorbital and forehead rejuvenation effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in the combination of a browlift and a hairline advancement. My brows are now sagging too low and I have always had a high forehead. With a browlift alone I fear that the front part of my hairline will go back further with some of the browlift methods. I visited a plastic surgeon and he told me that both could not be done at the same time. But I have also read in your articles that it can be done simultaneously. I am confused. If they can be done at the same time, how does it work? And why would this plastic surgeon say it can’t be done?

A: Just like a browlift loosens and lifts the forehead tissues upward, the scalp can be loosened and moved forward. They key to these procedures is that when done independently, they rely on having a fixed point onto which the loosened tissues are fixed. For the browlift, it is the frontal hairline, For a frontal hairline advancement, it is the forehead tissues as the fixed point. When doing a hairline (pretrichial) browlift and frontal hairline advancement at the same time, which can easily and most conveniently be done together, the key is to create a point onto which both can be used for stabilization. There are different ways to achieve the fixation of the two flaps but I prefer to use outer cranial table drill holes with galeal suture fixation. This not only provides good fixation but keeps the tension off of the suture line so the hairline scar does not widen and excessively show. For the right patient, this combination can produce excellent results and achieve a more total forehead rejuvenation. I can understand why some plastic surgeons would not combine these two procedures as their movements seem to be working against each other. But that is a matter of preference and experience, not an issue of technical feasibility.

Dr. Barry Eppley

Indianapolis, Indiana

Q:I would like to ask you some advise. I have a high natural hairline that makes my forehead look bigger. I don’t have problem of losing hair. I would like to have a hairline lowering, but I don’t know how to choose between a forehead reduction and a hair transplant. With the forehead reduction I will have a quick result and after seeing some pictures on internet the result looks great. The bad point is the scar and I would like to know if this procedure can have a bad consequence for the future. For the hair transplant I would like to know if the result can be natural, I have long and dense hair. I have attached some pictures for you to see.

A: Thank you for sending your pictures. I don’t know if that is the standard way you wear your hair or whether you were doing that just for the pictures. (I’ll assume you were doing that just for the pictures) You have a very good hair density and a relatively full hairline pattern. I really think you could go either way with a hairline advancement or hair transplants. each has their own advantages and disadvantages for you. Hair transplants will have no hairline scar but I doubt you can get the density of your natural hair down to 2 cms from your existing hairline. You certainly won’t be able to do it in one session. If for whatever reason you don’t like the transplants then that effort will be wasted by doing a hairline advancement after. With the hairline advancement, you will get a well matched hairline density and pattern but at the expense of a very fine line scar.

My thoughts are that the hairline advancement is the best initial approach. Because…if the scar is too prominent it can be easily covered up with some hair transplants later. The reverse is definitely not true.

Dr. Barry Eppley

Indianapolis Indiana

Q: I have two forehead bumps that are very distressing to me. They have been there since I was very young. They stick out like horns and I am very self-conscious of them. Can they be taken down and made smooth with the rest of my forehead? What is involved in this type of surgery and what are the risks?

A: Thank you for sending your pictures. I can clearly see the two upper forehead bumps. While they are not true osteomas, they are protrusions of the frontal bone. They can easily and simply be reduced through burring reduction. You can take down the outer table of the frontal bone in these areas up to 5mms to 7mms which should make them smooth and even with the rest of your forehead contour. This can be done through an incision either back in your hairline or just along your hairline. This would result in a very fine line scar. The hairline incision, commonly used in pretrichial or hairline browlifts, offers an advantage in that one could advance the frontal hairline forward if one desired. In your pictures, it appears that your forehead is fairly long between the hairline and the eyebrows. That distance could be easily reduced at the same time by bringing the hairline forward. I have found that to be very helpful with burring down upper forehead prominences as the combination of bone reduction and a shorter forehead length makes for a very smooth and more pleasing forehead shape.

Dr. Barry Eppley

Indianapolis, Indiana