Surgical Hairline Advancement: Patient Candidacy and Best Techniques

African-American patient before (A) and 1 year after (B) hairline lowering surgery.

Male African-American patient before (A) and 4 months after (B) hairline lowering surgery; performed due to no risk factors for future male pattern hair loss.

Scalp laxity test determines how far the hairline can be advanced. Before (A), displacement of hairline as far forward as it can be advanced (B), and the marking of the planned location of the lowered hairline (C).

Female patient with end-stage frontal fibrosing alopecia who underwent unsuccessful hair grafting 2 years earlier, before (A), after 5 weeks of balloon tissue expansion because of a very immobile scalp (B), and 1 day after hairline lowering surgery (C) where the unaffected frontal hairline was advanced 23mm to permit the excision of the prior hair grafts returning her to a more feminine-positioned hairline.

Kabaker modification of incision design, allowing for optimal rounding out of the hairline, before (A) and immediately after (B).

Second of two coronal galeotomies are made with careful incising of the galea. Each galeotomy can provide 3-7mm of additional advancement, but must be made carefully to avoid any damage to more superficial vessels.