Many FFS surgeons and patients believe that on average, women have lower hairlines in the middle than men but this is not actually true. In fact, women have higher hairlines in the middle than men (you can read more about this towards the bottom of the page under “Misconceptions”).
Of course men often get male-pattern baldness which can raise the hairline, and some men have naturally high hairlines. But the average male hairline, when balding is not present, is lower in the middle than the average female hairline.
If you look at the overall shape of the hairline, masculine hairlines tend to have an M shape or square Π shape, while feminine hairlines tend to be rounded like this: Ո.
Many women also have what I call “ghost corners“. These are hairline corners like you see in the masculine Π and M shapes, but they are filled with fine downy hair rather than being naked. And there is another, rarer feminine hairline shape that is particularly common in South Asia that I call the “omega” hairline which comes forwards into little peaks in the corners.
Surgical Options for Filling the Corners:
1. Scalp Advance:
Some surgeons try to fix the corners with a scalp advance which involves cutting along the hairline and stretching the scalp down in various ways to try to fill the gaps. I have seen little evidence that this is an effective technique – only a limited amount of corner closure can be achieved; it leaves a scar along the hairline and it also tends to put a lot of tension on the scars. This tension can cause the scars to widen and be more noticeable.
2. Hair Transplants:
Hair transplants look more natural than a scalp advance and you don’t end up with a scar along the hairline. They would normally be done a few months after any forehead surgery. Facial Team have developed a way of doing them at the same time as forehead surgery by harvesting a strip of scalp from the incision they use to do forehead surgery. They are then able use the hair follicles from that strip to fill the corners. See below for more on hair transplants and how they work.
In the minority of trans women who have naturally high hairlines or who have baldness affecting the hairline height, it might also be appropriate to lower the whole hairline, but again, it is usually best to do this with transplants because you avoid putting a visible scar along the hairline (see “scalp advance” below).
Surgical Options for Lowering the Hairline:
1: Scalp Advance:
In a scalp advance a strip of skin is removed from in front of the hairline, the scalp is lifted away from the skull and pulled forward to fill the gap. There is a limit to how far the scalp can be moved in one go – an inch or an inch and a half (2 to 3 cm) is typical so two or more separate scalp advances several months apart may be required to achieve the desired result. If the surgeon is also doing work on the forehead bones, they can do it through the same incision as the scalp advance.
However, There is always a visible scar from a scalp advance. How visible it is will partly depend on luck, partly on the skill of the surgeon and partly on your own tendency to scar. Some patients with a faint scar feel that it is not a problem, but for many others, it is clearly visible and they are conscious of it.
2: Hair Transplants:
You can also lower the hairline by using transplants. This leaves a much more natural-looking hairline with no visible scar. The transplants would normally be done a few months after any forehead surgery. See below for more on hair transplants.
Some people combine both procedures – they start with a scalp advance during their forehead surgery, then a few months later, they finish the hairline and fill the corners with transplants. However, it can still be difficult to hide the scar this way because transplants don’t take as well in scar tissue, and the scar is only a little way into the new hairline meaning you may still be able to see it through the transplants.