Will Forehead Feminization Change My Hairline?
If you’re considering forehead feminization and would like a rounder, softer hairline, or, quite the opposite, you’d rather your hairline didn’t change at all, you should know that where the incision goes makes all the difference.
There are a three possible placements for the incision. With the posterior coronal approach we use at Facialteam, the incision sits well behind your hairline, which rises only around 1 to 1.5 mm on average. Your eyebrows also lift slightly as they follow your new brow bone, so the distance between your brows and your hairline stays about the same.
Now if you’re looking to reshape it, for example an M-shaped hairline or deep temple recessions, that’s possible too, but only with a hair transplant that could be performed in the same surgical act.
Where is the incision for forehead feminization?
At Facialteam, the incision runs from ear to ear, several centimeters behind your hairline, where your hair is thickest. We call this the posterior coronal approach. Our team developed it and has used it for most forehead cases since around 2017.
Through this incision, the scalp is gently lifted forward so the surgeon can reach the brow bone and the rims of the eye sockets. Many patients ask whether this means the brain is exposed. It doesn’t. The skull stays in place and protects it throughout the surgery.
The scar is a single line closed with stitches, with no shaved strip. It follows a curve rather than a straight line, which helps it blend into your hair. Placing the incision further back adds only about five minutes to the operation, and recovery is the same.
Older techniques placed the incision further forward, close to or along the hairline. It may seem like a shorter route, but it leaves a scar in a visible place.
How much will my hairline move after forehead surgery?
On average, the hairline rises around 1 to 1.5 mm with the posterior coronal approach. A change this small is very hard to notice, even for you.
The reason it moves at all is simple. When the bone of your forehead is reduced, the skin over it has a little less to cover, and a strip of scalp is removed at the incision. Removing that strip doesn’t move the hairline by the same amount. Our earlier research on 300 patients found a ratio of roughly 1:5 to 1:10, meaning each centimeter of scalp removed raised the hairline by about 1 to 2 mm. Moving the incision further back reduced that movement even more.
Two factors can make the rise larger:
- A large bone reduction. The more bone is removed, the more excess skin there is, and the greater the chance of a bigger rise.
- A more forward incision. With older, more forward incisions, the hairline moved noticeably more.
Your surgeon can tell you before surgery whether your forehead is likely to fall outside the average. It’s a good point to raise in your first consultation, so add it to your list of questions for a first FFS consultation.
Why does the distance between my brows and hairline stay the same?
Your eyebrows rise slightly after forehead feminization, roughly in step with your hairline. That keeps the proportions of your forehead, from brow to hairline, close to what they were before.
This isn’t a separate brow lift. When the brow bone (the supraorbital rim, the ridge of bone above your eyes) is reduced and reshaped, the soft tissue of your brows settles onto the new, softer contour and follows it upward. Your forehead looks smoother and your eyes more open, while your face keeps its overall balance. A brow lift can be added when a case calls for it, but that’s a separate decision you’ll discuss during planning.
Will the scar be visible if I wear my hair short?
The posterior coronal scar is designed to stay hidden, even with short hair. It sits in the densest part of your scalp, where skin tension is lowest, and low tension is one of the main reasons a scar heals thin.
Several refinements help:
- A trichophytic incision, angled so that hair can grow through the scar.
- A multiplane suture, which spreads tension across layers of tissue.
- A curved design, which is harder to spot than a straight line.
- PRF (platelet-rich fibrin), made from your own blood, to support healing.
The Facialteam Transparency Hub, which records 2,891 forehead feminizations since 2008, lists impaired wound healing in 0.9% of forehead procedures and hair or shock loss (temporary shedding near the scar) in 0.2%. The forehead revision rate for 2020 to 2024 is 0.92%.
If you’ve already had a hair transplant, the incision won’t damage it. We simply ask for about a year between the transplant and forehead surgery, so the grafts are fully settled before the scalp is lifted again.
When is a hairline incision still the right choice?
Only in a small number of cases, usually when the hairline itself needs to come down significantly. For most patients, and for almost everyone who is happy with their hairline, it isn’t the right option.
Hairline lowering surgery removes a strip of skin from the forehead and brings the scalp forward by 1 to 2 cm. The incision is placed about 2 mm inside the hairline to make the scar less visible. On our hairline page, we describe it as suitable for an unusually high natural hairline or severe hair loss at the temples, and needed by around 1% of patients.
Its drawbacks are why we use it so rarely. Even when the scar heals well, the hairline can start to look artificial. Dr. Daniel Simon, co-founder of Facialteam, puts it clearly: “Even if the scar is not visible, the hairline will become artificial.” Some patients who had this surgery elsewhere end up wearing a fringe again to cover the scar.
When a hairline does need to move forward, we use hair transplants. During forehead surgery, follicles from the scalp strip we remove can be grafted along the front of the hairline in the same operation. This is our Simultaneous Hair Transplant (SHT). Grafts can bring a hairline forward by up to about 1 cm and reshape it at the same time.
What if I scar visibly or have had keloids?
If you tend to form thick or raised scars, tell your surgeon before planning begins, as it changes the risk conversation. Hypertrophic scars (raised, but within the wound) and keloids (scars that grow beyond it) are uncommon on the scalp, but some skin types are more prone to them.
The posterior incision already works in your favor. It’s short and sits under low tension in dense hair, the best place on the head for a scar to heal. Aftercare does the rest:
- Avoid picking at scabs. Scars take years to mature fully.
- Avoid nicotine for 3 weeks before and 3 weeks after surgery.
- One week after your stitches are removed, start applying rosehip oil morning and evening with a gentle massage.
- Two weeks after stitch removal, add a silicone scar gel. Use the gel in the morning and the oil at night for 3 to 12 months.
- Protect any exposed scar from the sun with SPF 50+ for at least a year.
- After a hair transplant, follow your washing protocol exactly, starting with the Betadine shampoo.
If a scar does heal wider than expected, there are options. It can be removed and closed again as an outpatient procedure under local anesthesia and sedation. Hair can be grafted into it for camouflage, and micropigmentation can fill in any areas the grafts don’t cover.
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In most cases, no. With the posterior coronal approach, the hairline rises about 1 to 1.5 mm on average, and your eyebrows lift slightly with the reshaped brow bone. The distance between your brows and your hairline stays about the same, so your forehead keeps its proportions while the bone becomes softer and smoother.
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No. At Facialteam, the incision is a single line closed with stitches, with no shaved strip. The stitches are removed after about a week, and from then on the scar sits inside your hair, covered by it.
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Yes. The posterior incision won’t damage existing grafts. We ask for about a year between a hair transplant and forehead surgery, so the grafts have settled and the scalp has fully healed before it’s lifted again. Let your surgeon know where and when your transplant was done.
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It tends to feel uncomfortable rather than painful, and only for the first few days. Any pain after forehead surgery usually settles within two to four days. Stitches are removed after about a week, so you leave Marbella without stitches in the scar.
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Hairline lowering leaves a scar at the front of the scalp and can make the hairline look artificial, even when the scar heals well. It also can’t properly reshape an M-shaped hairline. We reserve it for the few patients who need a large drop in hairline height. For most people, hair transplants give a more natural result. Your case should be studied individually during a consultation.
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It can happen, but it’s uncommon. Shock loss is temporary shedding around the scar. The Transparency Hub records hair or shock loss in 0.2% of forehead procedures. When it does occur, it’s usually reversible, and our hair team can prescribe treatments to support regrowth.
