Hairline Feminization

Hairline feminization techniques are commonly used during facial feminization surgery (Facial Feminization Surgery). In particular, the are used as a part of forehead feminization (Forehead Feminization).

In general, hairline feminization is commonly performed through either a scalp advancement or with the use of hair transplants. The two major components that are evaluated during hairline feminization are the height and the shape of the hairline.

Techniques for hairline feminization

Surgical hairline lowering for hairline feminization

A surgical hairline lowering procedure is performed by creating an incision that follows the anterior border of the hairline at the forehead. The part of the forehead skin in front of the hairline that does not grow hairs is then cut and removed.

Hair transplantation for hairline feminization

Hair transplantations can be performed before, during, or after facial feminization surgery. When performed intraoperatively (during surgery), a strip of scalp can be removed that is then used for harvesting hair follicles. The hair follicles are then implanted during the remainder of the operation.

Hair transplantation can also be performed postoperatively to hide an incision, for hairline lowering, or for filling in the temporal recessions to produce hairline feminization.

Frequently asked questions

What are the differences in hairline shape and hairline height between women and men?

The shape of the hairline can have significant effects on gender characterization. Multiple studies have been performed to characterize masculine and feminine hairline characteristics.^{1, 2, 3} In general, the M-shaped hairline is more common in men and the rounded or rectangular hairline is more common in women.

The distance between the eyebrows and hairline is another characteristic with significant gender differences. A study by Nusbaum et al. found an average distance of 5.5cm between the mid-eyebrow to the frontal hairline midpoint for women.⁴ Koo et al. found an average distance of 6.5cm in men.⁵ These studies are limited due to comparisons between studies and differences that occur at different ages and with different ethnic backgrounds. They also do not take into account how the distances relate to remaining facial proportions. However, on average, women tend to have a lower frontal hairline than men.

Another study was recently released assessing hairline aesthetics in cisgender celebrities. Interestingly, they note that the greatest difference in hairline appearance between attractive male foreheads and attractive female foreheads is the forehead width and shape or height of the lateral forehead hairline.⁶

Is it better to undergo surgical hairline lowering or hair transplants?

Neither approach is inherently better than the other. If your forehead is the appropriate height (or close to it), but not the appropriate shape, hair transplants may be best for you. It avoids placing an incision in an easily visible location and can produce a naturally feminine appearance to the shape of the hairline.

If your hairline needs significant lowering, then a hairline incision may be the best option for hairline lowering. There are some patients who will also undergo a surgical hairline lowering followed by hair transplantation to cover the hairline scar.

Price is also an important factor to consider when deciding between a surgical hairline lowering and hair transplants. Surgical hairline lowering is frequently covered by insurance for facial feminization, whereas it can be significantly more difficult and potentially not possible to have hair transplants covered by insurance for facial feminization.

What is the cost of hairline lowering (scalp advancement)?

Hairline lowering (aka scalp advancement) is rarely performed in isolation. It is commonly performed in conjunction with reduction of the bones of the forehead when performed for transgender women or transfeminine, non-binary individuals. In this scenario, the cost of either procedure is minor compared to the total cost of the operation.

Hairline lowering can be performed for cisgender women and is commonly performed in conjunction with a brow lift.

Hair transplantations either at the time of the operation or postoperatively does incur additional costs.

Recovery

How is the recovery after a surgical hairline lowering?

Recovery is usually tolerated well since scalp incisions generally are not extremely painful. Oftentimes, this procedure is performed in conjunction with other procedures. In those scenarios, the scalp incision is usually a minor concern. Removable sutures are usually placed during a hairline lowering. These are usually removed 1-2 weeks following your operation.

How is the recovery after hair transplants?

The recovery from hair transplants depends in part on whether they were performed at the same time as facial feminization surgery or whether they are performed at a separate date from surgery. Hair transplants that are performed during surgery need to be cared for during the first few weeks by avoiding rubbing on the grafts. The hairs will fall out during the first few weeks and will start to grow back within the first few months.

How do I clean my hair after a hairline lowering for hairline feminization?

Cleaning instructions for your hair and scalp after a hairline advancement is often variable and should be driven by your surgeon on an individual basis. Bandages are usually placed at the time of surgery. The dressings can usually be taken off after about 24 hours. At that time, the hair can be cleaned with water and baby shampoo. Gentle pressure can be applied to the area. No picking should be done by. the patient until seen in the clinic for a postoperative visit.

Hydrogen peroxide can sometimes 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.⁷

How do I clean my hair after hair transplants for hairline feminization?

The area where the transplants were placed should be kept clean after surgery. Starting about two days after surgery, water with mild shampoo can be gently poured over the forehead for cleansing. One should be careful not to rub the grafted area on the forehead.

When can I dye my hair after the operation?

Assuming there are no complications with the healing process, there are no restrictions 1 month after surgery. This includes receiving a haircut or dying your hair.

Do I need to shave or cut my hair for hairline feminization?

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.

Side effects and complications of a surgical hairline lowering

Do people undergo shock hair loss after a surgical hairline lowering?

Shock hair loss can occur after a surgical hairline lowering. This does not happen for every patient. When it does happen, the hair loss usually occurs within the 1-2cm next to the incision. This can cause the incision to be more visible since there is less hair around the incision to provide cover. The hair loss can also occur further up on the scalp and this usually results in thinning of the hair in that region. When shock hair loss occurs in either of these locations, the hairs usually start growing back in the first 3 months. Once the hairs start returning, they usually grow at the same rate as the rest of the hairs on the head.

Will my hair grow back from shock hair loss?

The hair that is lost from shock hair loss after a surgical hairline lowering almost always returns. In rare cases, where there is injury to the skin or follicles, the hair may not return. It is important to discuss each individual scenario with your surgeon to obtain the most accurate prognosis.

Why is the top of my head numb after a surgical hairline lowering (forehead reduction)?

A surgical hairline lowering requires an incision at the front of the hairline. The soft tissues immediate above the incision are mostly innervated by the supraorbital and supratrochlear nerves. These nerves exit the skull within the orbit and then travel upward on the forehead to reach the top of the head. A surgical hairline lowering must cut through these nerves in order to accomplish the procedure. Most younger patients have significant improvement in sensation or near-complete return of sensation to the area. There are many cases where the sensation improves, but never returns to normal. If you think this is important to you, you should discuss this with your surgeon prior to undergoing a surgical hairline lowering.

When will my hairline lowering scar look normal?

A surgical hairline lowering places an incision at the front of your hairline. This will result in a scar at that location. The scar is permanent. There are maneuvers a surgeon can perform to limit the visibility of the scar during the operation and bad scars can be revised after they have completely healed. However, after the hairline lowering, a scar will always exist in that location.

After the operation, sutures will be placed along the incision. The sutures will either dissolve or be removed during a postoperative visit. After the sutures are removed, there may be some areas of scabbing along the incision that persist for a few weeks to a few months.

Once the scabbing has completely resolved, the incision and the area around the incision may become pink. A light pink hue around the incision is a normal part of the healing process. This pink discoloration frequently lasts for multiple months during the healing phase and eventually fades.

In a perfect situation, the scar pigmentation will match the surrounding skin. Frequently, the scar itself is either slightly lighter or slightly darker than the surrounding skin and it may remain that way.

Choosing your surgeon

How do I get the best surgical hairline lowering or best hair transplants in Los Angeles, California?

There are many options for patients searching for a provider for hairline feminization in Los Angeles, California. It is important that each individuals performs their independent research while also discussing with friends and other patients. Ideally, the provider performs hairline feminization frequently as part of their practice. They will then be best equipped to handle the nuances and specific scenarios that arise during a hairline feminization procedure.

Reduction of brow bone protrusion is usually not very painful. When performed with other facial feminization procedures, it is usually not a source of primary concern. When a scalp incision is used to access the orbital rims, there will be swelling of the forehead that can persist for a few months postoperatively. The major effects from surgery to reduce brow bone protrusion are usually obvious immediately following surgery. There can sometimes be significant swelling or bruising of the eyelids that takes a few days to resolve.

Can I see before and after photos of a surgical hairline lowering?

Dr. Mittermiller is continuing to update the before and after photos that are being shared publicly. In addition to the photographs shared publicly, he has photographs of postoperative patients that he can share privately during a consultation. The publicly-available photographs can be reviewed in the website gallery through the link below:

Facial Feminization Photo Gallery

Related posts

Citations

1. Rodman R, Sturm AK. Hairline Restoration: Difference in Men and Woman-Length and Shape. Facial Plast Surg. 2018;34(2):155-8. Epub 2018/04/10. doi: 10.1055/s-0038-1636905. PubMed PMID: 29631285.
2. McKinney P, Mossie RD, Zukowski ML. Criteria for the forehead lift. Aesthetic Plast Surg. 1991;15(2):141-7. Epub 1991/01/01. doi: 10.1007/BF02273847. PubMed PMID: 2035363.
3. Sirinturk S, Bagheri H, Govsa F, Pinar Y, Ozer MA. Study of frontal hairline patterns for natural design and restoration. Surg Radiol Anat. 2017;39(6):679-84. Epub 2016/11/11. doi: 10.1007/s00276-016-1771-1. PubMed PMID: 27830323. https://pubmed.ncbi.nlm.nih.gov/27830323/
4. Nusbaum BP, Fuentefria S. Naturally occurring female hairline patterns. Dermatol Surg. 2009;35(6):907-13. Epub 2009/04/29. doi: 10.1111/j.1524-4725.2009.01154.x. PubMed PMID: 19397668.
5. Koo SH, Chung HS, Yoon ES, Park SH. A new classification of male pattern baldness and a clinical study of the anterior hairline. Aesthetic Plast Surg. 2000;24(1):46-51. Epub 2000/04/01. doi: 10.1007/s002669910009. PubMed PMID: 10742469.
6. 1. Salinas CA, Liu A, Sharaf BA (2023) Analysis of Hairline and Forehead Sexual Dimorphic Aesthetics in 60 Celebrities Using Artificial Intelligence. Plastic and Reconstructive Surgery Global Open 11 (7):e5107. doi:10.1097/GOX.0000000000005107 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10325763/
7. 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.