I'm having surgery with Dr. Spiegel in three weeks. I just had my final Skype call with him prior to surgery. I have an okay hairline height in the middle, but the typical "M" shape caused by receding at the temples. In the call, Dr. Spiegel told me that if I got a scalp advance during my forehead contouring, he could make shape of my hairline less M shaped. I have heard from other people that a scalp advance mostly lowers your hairline, but doesn't help with the shape. Is what Dr. Spiegel is telling me true?

Is there anything else I should know about scalp advances that could make me reconsider getting one?

He can bring the M shape corners closer together but that has limit because else too much tension builds up at the wounds and you will get a nasty scar. Thats why one can either do it in two stages with a tissue expander or have a hair transplant after surgery.

Eu fiquei com uma cicatriz feia e perda de cabelo nas laterais da cabeça. Sorte que como é na lateral o cabelo esconde, se fosse na frente seria muito pior. O argumento do médico foi a tensão. Já via adiantamentos muito maiores que não houve perda de cabelo. A cicatriz tem que ser bem posicionada para não haver esse tipo de problema.

I was left with an ugly scar and loss of hair on the sides of the head. So that as the side hair hides if it were in front would be much worse. The doctor's argument was tension. Longer saw much larger advances that there was no hair loss. The scar has to be well positioned to be no such problems.

Scalp tension here too.  From a 2cm advance all around my hairline, I now have a nasty forehead scar.  Scalp was just too tight and during the healing process the edges of the incision were tugged apart.  It happens, no fault of the surgeon who I instructed to be aggressive in his approach.

BUT...

Would I do it again?  Absolutely.  The scar, while hideous and Frankensteiney without makeup, is concealable (sort of) with makeup.  And the advance took my forehead from being rather huge and unpassable to being merely on the high side of feminine.  Nothing a $6,000 hair transplant session can't fix to tidy things up that the plastic surgeon couldn't do with his sledgehammer, which is pretty damn good considering that beforehand it was something that would have taken a $15,000 hair transplant to fix.  My scalp had to be sliced open anyway to get to the forehead for contouring and a brow lift.

You can't make an omelette without breaking eggs.  Unless you have the incision across the top of your scalp and way behind the hairline, it's gonna leave a scar.  It all depends on how much scar you're willing to trade for a better hairline.

With a scalp expander, near-miracles can be accomplished. Take a look at my 'Mayer is a God' thread.

A good surgeon is not using excuses. Proves its competence with results. Not using fake profiles on forums to lie or threaten dissatisfied patients!

Whom are you talking about Jhulyglow? And doesn't the result or the visibility of the scar also depend on the surgeons approach? some surgeons decide to place the incision a little before the hair line so you don't lose any hair bairing skin with the downside being that the scar is more visible. While others place it in the hairline so it's less visibile but you lose hair bairing skin. So even though it's lowered you always lose a little bit of your existing hair. I don't know if surgeons give you an option? in particular Dr.Bart where I intend to go....

Made in South America. I was not satisfied. Any asymmetry with, Bone difference from one side to the other, the loss of hair in the scar. At the right time post pictures and ask the opinion of all.

Spiegel wouldn't lie to you - he's telling the truth. Like JaniceNL said, the issue is tension. The main problem you're dealing with is that fixing the m-shape means removing sections of skin and pulling and stitching them laterally (tension from side to side). If the doctor tries to remove too much skin, ie correct a very strong m-shape in one surgery, the skin will be too taut and the scar may separate, cause hypertrophic scarring, and/or permanent hair loss from shock. However, Spiegel would likely not do that - he'd do a good job fixing the m-shape. I got mine done by Dr. Rossi, invisible trichophytic incision but luckily I only had a moderate m-shape. Since I was only fixing the m-shape, he just did a behind the hairline coronal trichophytic incision in which the hair is already growing through. Dr. Spiegel does that as well. So I say go for it, your doctor knows what he is talking about.

    However, if you do that you cannot move your hairline down much at the same time because the tension would be vertical and lateral. See Dr. Ousterhout's book on FFS - the tension in both directions would work against one another. For this reason, Ousterhout suggests that these be done in different procedures with a minimum of 6 months in between.

    In my case, I wasn't satisfied with only fixing the corners. My hairline was too far back. Since I was in Buenos Aires already, I was able to get 1400 hair grafts (4000 hairs total because they were mostly grafts of 3 except the front most transplants). It's only been two months but they're growing in beautifully. The advantage of using hair transplants is that 1) they are far less expensive in other countries - I paid $1600 for mine, 2) the doctor was able to create exactly the hairline I wanted - he drew it literally with a pen until I was satisfied and that's exactly what I got, and 3) I have no scar on my forehead but it was lowered a centimeter in the middle and sides and an inch in the corners. I will update my thread (Rossi - June 3rd) with a picture of it. The only downside of doing it the way I did - coronal incision, fixed m-shape, and transplants - that there are still some wrinkles on my forehead from not being pulled tight with a surgical hairline lowering. Also brow lifts are more effective with surgical hairline lowering and are less likely to far more than expected. My fell more than I would have like personally.

     There's as detailed an answer I can give. Spiegel is a great doctor, even if some don't like his attitude. That's what happens; some people get really good at what they do and take too much pride. I've heard people around here say that but I wouldn't care because you're in such good hands though! So happy for you You're going to be even more beautiful. Good luck ShadowCharms!

- Ruby

Dr. Spiegel is very good for beautification. I do not see taking very bone.

To be perfectly honest, I don't see a lot of ffs surgeons who really finish the job regarding bone work. I always look at the before and after and think: "personally I would have liked a little more removed" I guess i'm just afraid that the work I'm getting done will be too conservative and i'll need revisons done after like some of you posted on here, what a nightmare and waste of money.....

i have a receding hairline at the temples,my mom and sisters have the same problem,what we do is grow our hair out on top to hide it..that pic in my avatar is me from 14 yrs ago and i still look the same as i did back then. me i hate surgery of any sorts so surgery of any sort is out of the equation for i live in enough pain to add to it,,

Review is really a problem. But I do not think about remaking with the same doctor. I think it was wrong once, it can get worse. Lucky who gets success in the first surgery. So it should be a choice very well thought out. Find enough. Do not be influenced by false profiles that want to sell surgery. FFS for a transsexual is a dream for doctors is only profit! But still there are good surgeons.