Question on hairline advancement?

[Christina308]

I was wondering if anyone knows whether or not it's possible to pull the hairline forward in the temple area only, as i have classic MPB recession in this area. All the examples i have seen, seem to pull everything forward at the same rate. This would make the hairline at the middle forehead too low.

[anjaq]

It is possible, but effects of hairline incision hairline advancement are limited to maybe 2 cm. You may need transplants in addition. Dr Bart van der Veen proposed such an approach to me in consultation - doing the incision for forehead surgery at the hairline near the temples but behind the hairline at the top of the head.

[Sophia Sage]

More like 3.25 cm, in general -- it really depends on the laxity of your scalp.

Looking at "beauty" charts, which attempt to create mathematical formulas for female beauty, the there are "ideal" ratios for the proportions of the face.  Looking at a head-on profile, divide the face into three sections -- bottom of the chin to middle of the mouth, mouth to center of the eyes, and eyes to the hairline.  The distance from the mouth to the eyes is more or less fixed -- the procedures available to us today generally can't change this.  This is the distance to compare the eye/hairline distance, which is "ideally" the same.  (Mouth to chin is about 62% of the center distance, "ideally.") 

Now, there is are a couple good reasons for doing a scalp advancement (as a part of FFS) even if your biggest problem is recession at the temples.  Namely, it still reduces the area to fill in with transplants.  The fewer transplants needed, the less cost for the procedure, in general.  As well as less donor material from the back of your head.  Secondly, if your hairline needs an advancement just to get close to that ratio, it's probably going to be beneficial.

Conversely, though, if your hairline is already close to ideal, you might not want to have the advancement.  You can just fill in the corners and have a "high forehead," as it were.  This allows for greater strip harvesting at the back of your head, because you'll have great laxity there without the advancement, as opposed to Follicular Unit Extraction, which is both more expensive and requires the donor area to be shaved.  On the other, other hand, FUE doesn't leave a scar on the back of your head.

So it's really not a cut and dried answer -- it ultimately depends on your unique individual characteristics as to which route is the best for you.

[2cherry]

Yes, I have had the same. But only 1.5cm. Depends on flexibility of the skin. With an expander it is possible to 8cm. But wearing an inflatable expander can be very disturbing.

[Alyssa M.]

To answer your question, yes. Okay, you might end up with a little, but not much. If you did the procedure standalone, perhaps you could fill in the temples, but you would have to talk to your surgeon about that.

In the areas above the temples where there's recession, the skin on either side is pulled together, so that the recessed area shrinks, and the hairline advances significantly more there than in the middle (where you might really not even want any advancement at all in the first place). You might be advancing the hairline 2cm perpendicular to the cut, but if you're advancing it upwards from the ear a little as well and as downwards from the top of your head and that's filling in a peak that has a sharp angle (i.e., the angle at the top of the M in the classic M-shaped hairline of MPB), then you're getting significantly more, like maybe 2 inches rather than centimeters.

You still might want transplants — if the scar doesn't fade enough, or just because there are limits to how good the procedure can get the shape — but a scalp advance performed by a skilled surgeon can definitely address the recession involved in early stages of MPB.

I agree that the photos you can find on the internet aren't super helpful.

[Christina308]

Thanks everyone for the replies. They were most helpful. Alyssa, the technique you describe makes a lot of sense. Am i to assume that the scars from such a procedure would run front to back (in the recessed areas only) rather than ear to ear?

[Alyssa M.]

The scar runs ear to ear. The initial incision follows the original hairline in a curve around the top of the forehead until it hits the peak of the M, then maybe continues back a bit forward, and then goes down to the ear. To the extent that the hairline rune front to back for some portion of that, the incision (and resulting scar) also does. But that's in the context of doing brow work. Maybe you can skip some of that if you just want to eliminate the peak in the recessed area, without doing brow work. But I'm definitely not an expert. That's really something to ask surgeons about.