Your Questions
Your Questions
Q: Dr. Eppley, I am 46 year old male. I was born with a high and wide forehead. I noticed some hair loss/thinning beginning about 15 years ago. I had a strip hair transplant surgery at that time with approximately 1,000 grafts. I used Propecia/Rogaine for years after the procedure with no change. I have been off those hair regrowth medications for years now with no change. I underwent an FUE hair transplant procedure last year of around another 1,000 grafts to improve and lower my hairline. As you can see from the attached pictures, there has been little hair growth with pitting and my forehead remains high and wide. Attached are pictures with a drawn in hairline. The approximate distance from my natural hairs behind the FUE grafts to the central point of my envisioned hairline is approximately 3.5 to 4 cms. Do you think I am a better candidate for another hair transplant or a hairline lowering procedure?
A: A hairline lowering procedure without a first stage tissue expansion will only bring the hairline forward maybe 2.0 to 2.5 cms centrally. With the prior occipital strip harvest (where scalp tissue is lost) that may limit even that amount of hairline advancement. In addition a hairline only brings the central part of the hairline forward and moves the temporal regions less so. While you understandably find your hair transplant results underachieving, the placement of a frontal hairline scar to move the hairline forward does not seem to be a worthy tradeoff with your existing hair density. I would suggest that further efforts should be directed towards additional hair transplants for your hairline lowering efforts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m a 35 year old man interested in a cranioplasty procedure. I haven’t been able to find a plastic qualified surgeon who is capable of performing cranioplasty in my or neighboring countries. There is a clinic in Korea. However their method is not predictable since reshaping given by surgeon at the time of operation by using bone cement requires a bigger incision. I have to undergo skull reshaping surgery due to a flat back of my head as well as the top head which is also flat head on top. In addition forehead recontouring and hair line lowering needs to be done. These procedures must be done in same session because of scalp efficiency concerns. In my case I guess scalp tissue expansion is gonna be first stage prior to skull augmentation in order to achieve maximum silicone implant thickness and to allow the hairline to come forward. I have copies of 3D CT scan in my hand so would please let me know which steps will be taken from now on? Kind regards.
A: You are correct in that those cranioplasty or skull augmentation areas and hairline lowering procedures would require a first stage scalp expansion procedure. I would need to see some pictures of your head as well as eventually a CD of your 3D CT scan. Given that you desire a combined hairline lowering and skull augmentation, the custom designed skull implant would need to be placed through the frontal hairline incision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a shorter, fuller face with softer, more feminine features. I am wondering if I need corrective jaw surgery or could a chin reduction and facial fillers alone achieve the look I want. If there isn’t a great difference in the results of corrective jaw surgery and chin reduction surgery, then I would be more inclined to just get chin surgery because it is less invasive and costly. I do not like the large space between my nostrils and my upper lip. Could rhinoplasty help to shorten that distance? You might not be able to tell from these pictures but as far as my nose. I do not like the hump and I do not like my nasal tip. It is very bulbous and when I smile I feel the span of my nostrils becomes very wide. Finally I feel that I have a very prominent brow bone and feel it makes me look even more masculine. I am wondering if I am a good candidate for brow bone reduction surgery and also hairline lowering in order to decrease the length of my face. Thank you in advance for your help. I look forward to communicating with you soon and seeing the computer facial images.
A: All of the facial fershaping procedures you have mentioned would be helpful in shortening the appearance of your face from hairline lowering, rhinoplasty, subnasal lip lift and vertical chin reduction. It is impossible to comment on whether corrective jaw surgery or chin reduction would be better since that decision requires knowing the state of your bite. (occlusion) If your bite is good, then chin reduction would absolutely be the better procedure.
Brow bone reduction would be helpful to feminize your forehead and would be needed with your rhinoplasty to help bring back the glabellar (central) area of the brow. Otherwise the hump reduction with your rhinoplasty will make a deep nasofrontal angle which is more of a masculine facial feature.
While a subnasal lip lift would be helpful, it can not be performed at the same time as a rhinoplasty due to blood supply concerns to the intervening columellar skin between it and the open rhinoplasty incision.
To properly do computer imaging, I need more than just a lateral or side view. Additional views from the front and even a three-quarter (oblique) view make for a complete imaging assessment of the aforementioned facial changes.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Do you have experience with facial feminization surgery? Particularly with forehead recontouring, rhinoplasty, adam’s apple shaving, and hair line lowering?
A: I have considerable experience with facial feminization surgery (FFS) procedures, particularly the four that you have mentioned which are some of the most common FFS operations. All can make very successful feminizing effects. The key to the hairline lowering is the density of the frontal hairline where the incision has to be made. If this is adequate then the hairline can usually be lowered in a single stage of up to 2 cms based on one’s natural scalp laxity. Combining forehead/brow bone contouring with hairline lowering is particularly convenient since the pretrichial incision provides direct access to the entire forehead. Adam’s apple reduction (aka tracheal shave) is the simplest of the procedure and how much is can be reduced is dependent on what incisional access is used. (directly over it or the more remote submental incision) Reshaping the nose through a rhinoplasty to create a smoother and less prominent nose result depends on the thickness of the overlying skin. The thicker the skin the less it will contract and the size of the nose will reduce less.
Please send me some pictures of your face for my assessment and computer imaging to see what changes may be possible for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in getting a forehead reduction with the hairline lowering included. However the bossing of my forehead is the entire bone, top middle and down to the bottom over the brow bones. Can these areas be burred and reshape with the same approach you use on the brow ridge and eye orbits sockets as well?
A: The entire forehead can be reduced by burring. The only exception or caution would be over the brow bones where the underlying frontal sinus exists. The bone on the front of the frontal sinuses (brow bones) is usually very thin and may be only 3 to 4mms thick before the frontal sinus is encountered. A lateral skull film x-ray is needed before surgery to measure the thickness of the bone to see how much it can be reduced by burring. If more reduction is needed than just burring can allow, then an osteoplastic bone flap technique is needed to maximize the lower end of the forehead reduction. In a woman this is rarely needed however.
That is a long answer to say that a burring technique can sufficiently reduce the amount of bossing of the frontal bone and is often done on conjunction with a hairline lowing/advancement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 26 year old female, I am very self conscious about my forehead and have been for years. I am so tired of feeling embarrassed and having to hide it and limiting what I can and cannot do for fear of it showing. I’ve been researching transplants to lower my hairline. I’ve ran into your website and was wondering if you do hair transplants to lower hair lines? If so a round about cost to have it done? I’m really hoping you can help me and I can get this done and feel 110% more confident with myself.
A: Lowering the hairline, as you may know, can be done by either scalp flap advancement or hair transplants. There are advantages and disadvantages with either approach and neither one is perfect. So let me review these with you. The advantages of hair transplants for lowering the hairline is that it does not create a fine line scar along the frontal hairline (although it will create a scar in the back of the head from the harvest site) and does not involve a true surgical procedure under general anesthesia. Its disadvantages is that it will take at least two hair transplant sessions and close to eight hours of procedure time to get the new hairline properly filled in and up to six to nine months to se the final result. A scalp advancement for hairline lowering creates an immediate hairline lowering in a fairly simple procedure under anesthesia. (like a reverse browlift) It disadvantages is the fine line scar along the frontal hairline and the possibility that some hair transplants may be needed along the scar line for better camouflage. (may or may not be needed)
When comparing these two, it is also important to look at the costs differences between the two. Two hair transplant sessions will definitely cost more than a surgical hairline lowering procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in one-stage frontal hairline lowering? How big will the scar be? As long as the scar isn’t noticeable, I’m definitely interested. How long is surgery? How long is recovery? Will I have to take any medication before surgery? Will I be completely out? Will I accomplish what I’ve wanted all my life, to be able to wear my hair off my face/forehead immediately?
A: For forehead reduction/frontal hairline lowering, there are two techniques based on how much advancement of the frontal hairline is needed. If the amount of advancement is in the 1 to 1.5 cm range, then it can be done in a single operation. Larger amounts (> 2.5 cms) would require a first stage placement of a tissue expander to create the amount of scalp needed to move forward. Frontal hairline lowering is done through a hairline or pretrichial incision and is best thought of as a ‘reverse browlift’. Instead of the forehead skin being lifted from the pretrichial incision, the scalp behind is advanced forward and forehead skin removed where the new hairline will be. While this does place the incision/scar right at the new hairline, it usually heals very well and is barely detectable in patients with little pigment in their skin. (Caucasians) It is a procedure performed under general anesthesia and takes about an hour and a half to complete and is done as an outpatient. Recovery is very quick and there is no swelling of the eyes that is usually seen. One can shower and wash their hair the next day.
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 learning more about the forehead reduction (hairline lowering) surgery. I genetically have a very high forehead that I’ve always been very self-conscious about. I’m just now learning this surgery exists! I live out of state, so I can’t easily come in for a consultation. How do you handle out of town patients for consults? Can you just use the photos? With that, I’d also like to know the approximate cost of this surgery (or can you estimate based off pictures?). I would appreciate any information you can provide, and please let me know what other information I can provide to you. At this time, email is the best way to contact me. Thank you, and looking forward to hearing back from you!
A: Forehead reduction surgery can be beneficial for those women that have a long forehead, which almost measures greater than 6.5 cms from the eyebrow to the hairline. Vertical forehead reduction is a skin operation where forehead skin is removed along the hairline and the scalp is advanced in its place. This requires an incision along the frontal hairline and is very much like a reverse pretrichial browlift. The success of the procedure is primarily based on how much natural looseness the scalp has and how much can be surgically created. It is this looseness that allows the scalp to be brought forward. Generally about 10 to 15 mms can be gain in most patients. If the scalp is very tight or the amount of scalp advancement needed exceeds 15mms, then a first stage scalp tissue expander needs to be placed. You can determine how much scalp advancement is needed by taking a mascara pen or lip liner and drawing a line where you want the new frontal hairline and measuring it. Also remember that the greatest amount of scalp advancement is in the middle and becomes less so as it tapers to the sides into the temporal scalp.
We have many far away patients and further discussions can be done by phone or a Skype video consultation. It is not necessary to come in for a separate in-office consultation. The cost of the surgery is very similar to a pretrichial browlift, as I have mentioned, and my office will pass along the cost to you in a separate e-mail in the next few days.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in forehead reduction and hairline lowering. I would like to know if Im a great candidate for the forehead reduction and hairline lowering. I hit a brick wall when I was younger and that is how I have bumps on my forehead. Can you please respond back to me thank you!
A: Thank you for your inquiry and sending your pictures. I can clearly see your motivation for the forehead reduction and hairline lowering procedures with a long and high forehead and a large protrusion of the frontal bone. You are correct in making the assumption that these two procedures would be of benefit. A less protruding forehead and a lower hairline would be very aesthetically advantageous. The key procedure of these two is actually the hairline lowering as a hairline that was 2 to 3 cms lower would help disguise the forehead protrusion significantly even though it can be reduced by burring somewhat. However, your scalp skin looks fairly tight, as most high foreheads are, and no more than about 1 to 1.5 cms of advancement could be obtained by simple loosening it up and bringing it forward. You would be better served by a first-stage scalp tissue expansion to create more hair-bearing scalp to bring forward. Then the second stage could be a large scalp advancement and bony forehead reduction. This would produce a much better result than a single stage procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know how much it would cost for hairline lowering. Also if I could see before and after results from this procedure because there is only one picture on the website.
A: The cost of hairline lowering is dependent on whether one needs a one or two-stage hairline lowering procedure. That would depend on how much hairline advancement one wants and what the natural looseness of the scalp is. To better help you with cost, I would need to see some pictures of your forehead and a line draining (use lipstick) of where you want the hairline to be. That will answer the question of whether it is a one-stage procedure or a first stage tissue expander is needed. As a general rule, 10 to 15mms of hairline advancement can be obtained in a ons-stage procedure. More than that will require a tissue expander first to create more loose hair-bearing scalp tissue to bring forward. If you try to create that much scalp movement in one-stage the brows will elevate significantly to cover the extra distance and not the hairline coming forward.
There are few pictures of this procedure on the website because patient confidentiality only allows postings that patients agree to show their face…and most people do not want that. And without patient permission we do not distribute patient photos on the websites or to prospective patients to honor their privacy requests.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was curious if it is possible to receive these exact results from forehead reduction if I decided to go with the sinus removal and reshape instead of the tool to burr them down. Also I have what I feel to be extra bone above and on the sides of my eyes that are pretty prominent, thus making my eyes look a little sunk in. Can that be reduced as well? Lastly how far down do you think my hairline have to be reduced and does it look as though I need a tissue expander to achieve the results I’m aiming for or just a stage one?
A: Maximal brow bone reduction is always achieved with brow bone removal and reshaping. It is a far more effective procedure than just burring alone. By doing so I would be also be able to burr down the bone outside of the frontal sinuses (above the brow bone and on the side of the eyes) This bone is thick enough that burring alone would suffice. This would help open up the eyes.
In looking at where you are now and where you would like our hairline to be, that appears to be about a 3cm movement lower. That would require a first stage tissue expander for about three weeks prior to the second stage at which time the hairline can be advanced and the brow bones and eyes reshaped at the asme time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My forehead it’s very high and it also sticks out, I feel it takes the beauty away from my face. Is there a surgery to fix it and if there is I would like to know if it is too risky?
A: The high protruding forehead is usually due to a combination of a hairline that is set back too far and the forehead bone having some degree of protrusion to it as well. It can be treated through a combination hairline lowering (scalp advancement) and burring bone reduction of the upper forehead bone. This procedure is very safe and has no significant risks to it…other than a fine line scar along the frontal hairline. Whether you would be a good candidate for this procedure would depend on how much laxity is in your scalp and the pattern and hair density of your frontal hairline. A review of any pictures of your face/forehead from the front and side view would be very helpful in determining if you are a good candidate for this forehead reduction procedure.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I was interested in getting my hairline lowered as well as brow and frontal bone reduction. However I have a very thin hairline due to constant damage to my hair follicles. Any suggestions and how long after would I have to wait to get a separate surgery.
A: If I understand your question correctly, you would like hairline lowering/scalp advancement combined with frontal/brow bone reduction. The concern, which is both understandable and appropriate, is whether with a fine and thin hairline that you should have the procedure. The answer to that question would be based on what your frontal hairline looks like now (please send me a picture), how much scalp laxity you have and whether you were eventually planning on any hair transplantation along the hairline after the procedure. (as some people do for scar camouflage) The quality (hair density and pattern) of your frontal hairline determines how well the scar would do and its potential visibility. Your existing vertical forehead skin length and your natural scalp laxity determines how much scalp advancement/hairline lowering is possible and whether the result justifies the effort. Knowing that one may be considering the potential for hair transplantation later gives one more freedom to perform the procedure is someone with less than an ideal frontal hairline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello, I am a 19 year old female with a high rounded hairline. I’ve always been picked on and teased due to it. Causing me to quit sports in high school because of my bangs blowing back when I’d run… Im always hiding behind my bangs but unfortunately I won’t be able to in Navy boot camp in six months . I am enlisted in the delayed entry program for the US Navy and I just know that in boot camp the RDC’s will make fun of my hairline as a part of breaking me down. I just want to know if your facility does any sort of military discount for the hairline lowering procedure? Or if fees can be waived out of generosity. I don’t know how that works but I figure it’s worth asking. If this is not possible, thanks anyway for your time!
A: Thank you for your inquiry. A hairline advancement/lowering can be a very effective method forehead reduction if one fulfills three criteria. First the scalp must be naturally mobile enough that it can be moved one to two centimeters forward. You can have a pretty good idea of that by pushing around your own scalp and seeing if it moves forward anyy. Secondly, one has to have a good frontal hairline with adequate follicular density to position a well-designed incision. Lastly, one has to be willing to accept a permanent fine line scar along the frontal hairline. Please send me some pictures of your forehead for my assessment. I have asked my assistant to pass along the cost of such a procedure to you and she is the one to whom you can direct your financial questions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting my hairline as well as my forehead bone reduced. I was wondering do you also reduce the brow bone as well as the area below them and above the nose? I think it’s called the glabella and the bone around the eye socket. Do you do hair transplant procedures too? Do you think I should have my hair line lowered first or get my hair transplant before?
A: There is no question that if you were going to do both a hairline lowering/scalp advancement and hair tranplants, you would always do the hairline advancement first. It would be counterproductive to do hair transplants first and those would need to be cut out for the hairline lowering. Hair tranplants are used after hairline advancement to hide either the hairline scar better or to lower the frontal hairline further than what the scalp advancement can achieve. Whether the brow or lateral orbital rim (eye socket) is reduced with a forehead reduction depends on two factors. First what does the patient want to achieve. Would reducing those areas be aesthetically beneficial? It is really up to the patient to determine if that is needed to get the look they are after. Secondly, what is the thickness of the brow bone over the frontal sinuses. Is it thick enough to allow enough burring to make an external visible change? That can be determined by a simple skull x-ray beforehand.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just had a quick question regarding the forehead lowering procedure. I want to get my forehead lowered however I have a “Y” shaped vein that runs right down the middle of my forehead. Is it still safe to perform the surgery with this and have you ever personally encountered this?
A: Many people have prominent veins in their forehead that undergo browlift and hairline type procedures. Because the veins are in the subcutaneous level of the forehead tissues, they are out of the plane of dissection which is at the deeper subperiosteal level. So they do not pose any ‘risk’ for a hairline lowering/forehead reduction surgery. If the vein(s) crosses into or from the frontal hairline, it will be tied off or cauterized in a hairline advancement as it will be encountered in the dissection from the skin down to the bone. Either way, veins are not an issue in any type of forehead surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have a high forehead along with a long face and I think it would look better if my hairline was brought forward and my forehead shortened. Is this something you could do in a male? I am 27 years old.
A: Shortening the vertical length of one’s forehead can be done by bringing the hairline forward. Much like a ‘reverse browlift’, the hairline is lifted up and brought forward rather than the eyebrows lifted. As a simple variation of the hairline or pretrichial browlift, forehead skin is removed to allow the hairline to come forward into a new and lower position, usually 1 to 2 cms of forehead reduction can be obtained. For women with long foreheads (greater than 7 cms. of length between the frontal hairline and the eyebrows), this is a very effective procedure that may allow them to change their frontal hairstyle afterwards.
In men, however, a long forehead is usually due to a receding hairline. The frontal hairline position in most men is not stable and naturally lengthens with age as hair loss ensues. While a young male does not yet have this problem, and it may not occur in every male, it is impossible to predict which male hairline may or may not recede. If a hairline lowering is done in a man, the scar line will eventually be seen as the hairline recedes later in life. I do not think this is a wise risk to take in just about any male patient.
Dr. Barry Eppley
Indianapolis, Indiana