Hairline Advance Scar worth it for Forehead surgery or is coronal best?

[Lia]

Hi ladies. I'm set to have forehead reconstruction in a few weeks. At present my hairline is a little high, but within normal ranges. I would benefit from an advance, but I scar easily. One opinion I received suggested a coronal incision to avoid the scar, but with a modest brow lift, which would be necessary to address any  slack tissue due to less bony prominence, I'm wondering if my hairline would be a lot farther back. I realize hair transplants can address this later, but ideally I'd like to not have to do that. Basically, my high hairline is the same as my mom's. My overall facial balance is fine as it is. IF a modest brow lift is done, roughly how many cm should I expect it to move back?
If anyone who has had coronal incision can share their experiences, that would be great. Also, if women who have had hairline advance can share their thought on how bad the scarring is, I would really appreciate it. Hearing your personal experiences would be immensely helpful. Thanks!

[RubyAliza]

Hey,

    Answers might get complicated on this one. Some surgeons say that your hairline will go up about the same distance your brows get lifted. Of course, this depends on your level of brow bossing and many other factors, such as your skin elasticity. I got a coronal incision and I wasn't happy with my brows after. My hairline was left high but my brows not high enough. This is because the farther away the incision is behind the hairline, the less effective the browlift. Hairline incision browlifts are far more effective. It's a matter of physics (I had my surgeon just explain this to me in detail).

     Have you seen your surgeon's hairline incision scars? Some surgeons who use irregular trichophytic incisions can make a scar that is practically invisible. Basically, the scar won't be a straight line so it won't catch one's eye, and hair will also have grown through it. That would be the ideal - a hairline incision that looks great.

     In my case, I ended up getting hair transplants to fix the higher hairline and to fill in the corners. Now I'm back to the original surgeon to redo the coronal incision to fix the brow lift. This time the incision will probably be in a different place closer to my new hairline (might use my old hairline). In hindsite, I'd rather have had the hairline incision and just gotten transplants over the scar and in the corners, if necessary.

    Sorry for the complicated answer

- Ruby

[Lia]

Thanks so much, Ruby. This is extremely helpful info. I don't want a lot of lift to my brows, so perhaps coronal might work. But I understand your reasoning. Sorry you have to have It redone. How much father back did your hairline initially go?
I agree, there may be many opinions on this subject! I hope others will share their experiences. Thanks!

[tgirlamg]

HI Lia,

I have had two procedures both involving incisions from above the ears and then curving forward along the widows peak... They shaved the hairline back a little so the hair would grow back in front of the incision which for the most part it did... There were some small imperfections but I wear wigs so I didn't stress on them... Scalp advance was part of my procedures along with brow lift forehead recontouring etc... When you are pulling things that many ways... Things just settle where they settle when all s said and done... I found the scalp advance probably had the least visual impact of everything I had done but I think if the advance was the only procedure done at the time... You would see more advancement that stays where they put it!...

Take Care,
Ashley

[Debra]

The way Dr D-B described like:

any kind of forehead bone work will end up with extra skin so some of it has to get removed

if both sides of the scar are hair then that means some hair goes and that means more forehead, less hair.

Whereas if one side of the scar is not hair then that non-hair side will have some skin removed and that's what allows for an 'advance (or staying put) of the hairline because the hair stays but the extra forehead skin goes.

[Xipup]

This topic has been in my mind a lot.  Until just a few days ago I was scheduled for surgery in September to include a coronal incision. That surgery has been postponed until my questions and concerns about the scar can be answer and hopefully allayed.

Both male pattern baldness and age related alopecia in both males and females runs in my family. The MPB is halted and not a concern, however,  the other issue of age related alopecia was a chief concern for me. 
The coronal incision was chosen for having a lower incidence of permanent scalp numbness as well as  improved concealment. If nothing about my hair changed as I grew old the coronal incision would be fine, however, if I developed hair loss similar to my lineage I wondered how comfortable I would be with a visible scar circumscribing my head.

Transplants consultations have said that I could expect up to 1500 grafts. Right now I plan to fill the peaks with those grafts. If I were to have scalp advance those 1500 grafts would also need to cover the scar across the front.

Some patients I've spoken to have said that they were not happy with the scar following scalp advance and were self-conscious of it. They eventually had 1500-3200 hair grafts to cover it.  Given my family history of thinning and having fewer grafts to work with I have elected not to have the scalp advance.

I have not been able to find, from public sources or surgeons, are examples of the coronal incision particularly in people with thin hair or images of the incision as people grew older.

For either the coronal or advance incision the change in hairline height doctors have described as "a few millimeters" or "about an 1/8th inch".

[oneoftwo]

This topic has been in my mind a lot.  Until just a few days ago I was scheduled for surgery in September to include a coronal incision. That surgery has been postponed until my questions and concerns about the scar can be answer and hopefully allayed.

Both male pattern baldness and age related alopecia in both males and females runs in my family. The MPB is halted and not a concern, however,  the other issue of age related alopecia was a chief concern for me. 
The coronal incision was chosen for having a lower incidence of permanent scalp numbness as well as  improved concealment. If nothing about my hair changed as I grew old the coronal incision would be fine, however, if I developed hair loss similar to my lineage I wondered how comfortable I would be with a visible scar circumscribing my head.

Transplants consultations have said that I could expect up to 1500 grafts. Right now I plan to fill the peaks with those grafts. If I were to have scalp advance those 1500 grafts would also need to cover the scar across the front.

Some patients I've spoken to have said that they were not happy with the scar following scalp advance and were self-conscious of it. They eventually had 1500-3200 hair grafts to cover it.  Given my family history of thinning and having fewer grafts to work with I have elected not to have the scalp advance.

I have not been able to find, from public sources or surgeons, are examples of the coronal incision particularly in people with thin hair or images of the incision as people grew older.

For either the coronal or advance incision the change in hairline height doctors have described as "a few millimeters" or "about an 1/8th inch".

This issue really does get confusing.   Here is the way I understand it.

It makes it easier if we use a variation on the terminology.   The reality is that with Type III forehead FFS, you are either going to get:

A) Anterior hairline incision - -  that may (if you wish) result in an easy scalp ADVANCE, which is normally preferred, since it is easy.  But the surgeon does not HAVE to advance the scalp, but it is really easy to do that with that surgery, so it is most often done that way.  Thus the term "scalp ADVANCE" has become almost a synonym for having an anterior hairline incision.   Technically,  advancing the scalp is an option available with the anterior hairline incision.

The alternative is:

B) Coronal incision across the mid scalp area - -  and then you WILL have some degree of  hairline/scalp RETROGRADE MOVEMENT (for lack of a better term.)  There is simply no way to do the type III procedure using the mid-scalp incision without having the anterior hairline moved backwards (posterior). 

[Richenda]

I have found this topic and discussion so helpful. There are some brilliant, informative, replies.

I have one question: surely an anterior hairline scar can simply be covered by foundation? Am I being thick?

I'm lucky to have a head of hair so am leaning strongly in favour of this rather than coronal. I don't really want to lose any hair.

[confused_very]

im just accepting a hair transplant as part of the process. My hair is thinning all around, it hasn't got to bald patches yet like on the crown but i am very coscious of how much shedding i do daily.
For me, i am more comfortable with a front scar where they only really have to cut skin away rather than into the hair and the hair transplants will cover the scar, in my distorted thinking world, it is net zero loss of hair and just transferring it from one place to another. i also don't want my hairline pulled any further back from the coronal approach, i am trying to actually fix that issue.

[kittenpower]

I have the scar in my hairline, and it is mostly invisible, so I am happy with it; especially since I didn't have any hair loss at the incision sites.