coronal incision FFS
hairline incision FFS

Scalp Incisions for Facial Feminization

When forehead brow bone reduction is performed, the surgeon usually accesses the site through one of two incisions. These two incisions include a hairline incision or an incision that is behind the hairline (coronal incision). They each have their own advantages and disadvantages depending on the goals of the operation.

Types of Incisions

Hairline incision (pretrichial incision)

A hairline incision is one that follows the middle hairline on the forehead. This is often used to perform a scalp advancement or hairline lowering. When a hairline incision is used, the design below is commonly employed.

hairline incision for hairline lowering
Location of hairline incision for scalp advancement in facial feminization surgery

Coronal incision

When hairline lowering is not necessary for facial feminization, a coronal incision is often used. This incision is placed within the hair to prevent it from being seen. The hair often easily covers up the scar that results from this incision.

coronal incision FFS
coronal incision facial feminization surgery
Location of coronal incision for facial feminization surgery.


Is the hairline or coronal approach better?

Neither approach is inherently better than the other. If your hairline has an appropriate shape and your forehead has an appropriate height, then a coronal incision is likely the better option since the scar can be hidden within your hair.

If your forehead is the appropriate height (or close to it), but not the appropriate shape, a coronal incision with hair transplants may be best for you.

If your hairline needs significant lowering, then a hairline incision may be the best option for hairline lowering.


How is the recovery after a scalp incision?

Recovery is usually tolerated well since scalp incisions generally are not significantly painful. Oftentimes, this procedure is performed in conjunction with other procedures. In those scenarios, the scalp incision is usually a minor concern.

How do I clean my hair after a scalp incision?

Cleaning instructions for your hair and scalp after a scalp incision is often variable and should be driven by your surgeon on an individual basis. If there are no hair transplants, the dressings can usually be taken off after about 24 hours. At that time, the hair can be cleaned with water and baby shampoo.

If staples and non-dissolving suture were used to close the scalp incision, hydrogen peroxide can be used to remove any crusted blood that has formed. If absorbable sutures such as chromic, plain gut, or fast gut were used, then hydrogen peroxide should be avoided. The use of hydrogen peroxide in these scenarios can prematurely break down these suture.1

When are the sutures and staples removed after a scalp incision?

If non-dissolving sutures or staples were placed at the time of surgery, these are usually removed at about 1 week after your operation. If absorbable sutures were placed, these are usually left to dissolve on their own. This usually takes a few weeks.

Do I need to shave or cut my hair for these incisions?

There is no need to cut or shave your hair. The hair is braided prior to the operation to keep it clean and out of the way. At the end of the operation, the hair is washed to keep it clean. Sometimes there can be minor residual bleeding along the incision after the operation. That can get crusted into the hair. Shampoo or hydrogen peroxide work well to remove any crusting that occurs. Shorter hair can make postoperative care slightly easier, but it is not essential for surgery.

mittermiller ffs insurance

Dr. Mittermiller is a plastic surgeon with specialty training in craniofacial surgery and facial feminization surgery. He is primarily located in Los Angeles, California and serves the broader Southern California area.

Contact us today to schedule a consultation.

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What is facial feminization surgery (FFS)?

What is facial feminization surgery (FFS)? Facial feminization surgery (FFS) describes a group of procedures that are performed to feminize the face. These operations are commonly performed for transgender women…


  1. Athre RS, Park J, Leach JL. The effect of a hydrogen peroxide wound care regimen on tensile strength of suture. Arch Facial Plast Surg. 2007;9(4):281-4. Epub 2007/07/20. doi: 10.1001/archfaci.9.4.281. PubMed PMID: 17638764.

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