Why hairline advancement surgery is done

Hairline advancement is done as a gender affirming procedure for those seeking a more feminine appearance. This may help to reduce gender dysphoria symptoms, as well as improve overall quality of life for trans-identifying individuals.

Hairline advancement isn't for everyone. Your doctor might caution against surgery if you:

  • Have significant androgenetic alopecia (patterned hair-loss)
  • Have a severe chronic condition, such as heart disease or diabetes
  • Have a body mass index that's greater than 35
  • Are a smoker

What to expect during hairline advancement surgery

Before the procedure you will have a consultation with your surgeon where you will come up with an individualized plan, as well as have a discussion of expectations. Pictures will be obtained from various views for planning as well as comparison following the procedure.

During the procedure you will be fully asleep (general anesthesia). Typically, incisions are made from ear to ear along the cranium. Meticulous dissection is then carried out along the back of the head, as well as along the forehead. Forehead skin will then be removed, advancing the hair-bearing scalp down. The incisions will be closed with sutures and/or staples and drains may or may not be placed to help avoid blood collecting under the scalp tissues.

After the procedure it will be important to remain upright as much as possible to help reduce swelling and bruising. You may be prescribed antibiotics and narcotic pain medication for comfort. Ice therapy will typically be recommended to help reduce swelling.

You may notice temporary hair-loss at the incision lines (telogen effluviam), however this typically resolves in several months.

Results

You can expect immediate improvement of the hairline position following the procedure, however commonly swelling will soon set in and will take a period of time to resolve. Most swelling will be improved in 3-4 weeks, however, do not expect final results for about 1 year after surgery.

Risks of hairline advancement surgery

  • Failure to achieve desired result. Patients may not notice the improvement they were hoping. Counseling on realistic expectations is imperative prior to undergoing surgery.
  • Swelling/bruising. Significant swelling or bruising is likely to develop after the procedure. This may affect the eyes/eyelids and progress down the face and neck. Most swelling and bruising are expected to resolve within 3-4 weeks of the procedure.
  • Alopecia. Frequently the incisions are hidden within the hair. Hair follicles could be damaged or stressed during this process leading to hair loss that could be temporary or permanent.
  • Changes in skin sensation. During a hairline advancement procedure the elevation of tissues can affect the nerves in the scalp area. You'll likely feel some reduced sensation or numbness. This usually diminishes in the months after the procedure.

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