Your Questions
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 am interested in forehead reduction. I have had 3500 FUE strip harvest hair transplants done five years ago. While the grafts have taken well without hair loss I have a remaining large forehead. I still have some elasticity to the scalp and am interested in seeing what a forehead reduction can do.
Q: The key element of a successful forehead reduction (and I assume you mean hairline advancement and not bony reduction) is the scalp elasticity as you have already noted. That scalp elasticity comes from the back of our head primarily and not so much the top when the scalp is advanced. If you have had 3500 transplants that would indicate to me that you have had at least two harvests procedures and a linear scar exists across the back of your head. (unless it was done by Neograft or Artiss) That does not bode well for much scalp mobilization no matter how loose it may seem. (although I can not say for sure about the scalp elasticity just by looking at pictures) Secondly there is also the issue of needing a frontal hairline incision. This is always a little bit more risky for prominent scarring in men as opposed to women. Hair density along the frontal hairline is important so that issue also needs to be considered.
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 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, 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, Where do you do surgery? What are the facility fees? What would the price be to narrow or burr the chin just at the bottom edges to make it look less square? Also, I have a flat forehead in the center with prominent eyebrow muscle, which makes the flat forehead area look flatter. How wold you fill in the flat forehead or the center of the forehead in a female? Fat injections? What would the price be?
And can you shorten the forehead skull if the hairline is a little high?
A: In answer to your questions:
1) My cosmetic surgeries are done in a private outpatient cosmetic surgery center. The operating room and anesthesia fees are based on the time that it takes to perform the procedure(s). That must be determined on an individual patient and the specific procedures they are having.
2) Narrowing the chin is done by intraoral ostectomies or removing the sides of the chin through a reciprocating saw technique.
3) A flat glabellar area can be built up by a variety of techniques with fat injections being the simplest to perform.
4) If one’s frontal hairline is too high, its length is not going to be lowered by reducing the height of the skull as that amount of skull height reduction can not be done. Shortening the long forehead is done by a procedure known as scalp or frontal hairline advancement.
I will need to first review some pictures of your face to see exactly what needs to be done before the costs of the procedures can be provided.
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 am really interested in forehead reduction/hairline lowering. I am 21 years old and have not been able to find any local surgeons that can perform forehead reduction surgery. My forehead is incredibly long from the top of my eyebrows back to my hairline. It is like the entire front part of my skull is way in front of my hairline. I am looking for more information as to how this procedure is done and what my options are. I have sent some pictures so you can see for yourself my issue.
A: In looking at your pictures I can see the amount of frontal and temporal recession of your hairlines. You forehead is at least 8cms if not more. While vertical forehead skin reduction and hairline advancement can be done, its success and method depends on how much laxity or looseness your scalp has. Using the natural scalp laxity that can be obtained by surgical release, you will likely get a 1 to 1.5 cms advancement in the midline of the forehead and less so as it tapers into the temporal area. Up to 3cms or more can be obtained with a two-stage approach using a tissue expander first, followed by a second-stage scalp advancement. To find out what you need and which method may be best for you, do the marking test. Trace out the desired hairline with eyeliner pencil and then do a measurement to see how much advancement in centimeters that you need. Also take a feel of your natural scalp tightness by pushing forward on it and see how tight or loose that it is. These are the tests I would do if you were sitting in front of me to answer what method is needed to achieve your forehead reduction goals.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi doctor, I have a big forehead and I need a scalp advancement to make it smaller. To do this surgery do you needs to shave my hair? What is the maximum of centimeters that you can reduce? How much does this surgery cost? Thank you.
A: A long forehead can be reduced by moving the scalp forward (hairline advancement) and removing upper forehead non-hairbearing skin. While this does leave a fine line scar along the frontal hairline, that is usually nto a problem for most women. As long as the hairline is distinct with reasonable density, the scar is usually a good trade-off. One of the keys to a scalp advancement is to secure it to the underlying frontal bone in its new position. This will not only prevent relapse but will also take the tension off of the scarline so it heals as narrow as possible.
In answer to your specific questions:
1) No hair is ever shaved for the procedure.
2) Usually at least 2 to 2.5 cms of scalp can be advanced with the same vertical reduction in forehead skin. That tapers off into the temple areas. The greatest amount of advancement is in the center.
3) The overall costs are about $ 7500 – $ 8500
For those women afflicted with a very high hairline, a forehead reduction procedure through a scalpadvancement can be life-changing. One can think of it as a ‘reverse browlift’ so it is an outpatient procedure that takes about 2 hours to perform. The very next day one can wash and style their hair.
Indianapolis, Indiana
Q : Hi Dr Eppley, I am inquiring about how to reduce a long forehead. My forehead is so long it is ridiculous. I have good hair but my hairline is so far back I can’t wear my hair pulled back. My forehead also has a bulge in it near the hairline which makes it look like it is even back further. I have heard that a plastic surgery procedure exists that can pull my hairline forward. Is this possible?
A: The typical distance for most people between their eyebrows and their hairline (forehead length) is up to 7 cms. When that distance is greater than that, most people would consider it to be a long forehead. In actuality, however, if one thinks that they have too much forehead skin then they do.
One’s forehead can be shortened through a skin excision procedure. The skin is removed in front of the hairline and the scalp hair brought forward in its place. In essence, this is a reverse browlift. The amount of scalp advancement can be up to 2 cms to 2.5 cms without any problem. More can sometimes be obtained by a very posterior scalp elevation at the subgaleal level the whole back to the occiput. Even more than that can be obtained by a two-stage procedure using a tissue expander although this is reserved only for the most severe cases.
The trade-off for a forehead reduction is a fine line scar along the hairline. As long as one has reasonable hair density and hair quality this is not a concern. With the forehead bone exposed, any bony contouring or reduction can be done at the same time.
Dr. Barry Eppley