What the research shows
What it achieves. Pooled studies report an average lowering of about 1.6 cm (Vila 2022), and large recent series report about 2.3 to 2.5 cm (de Azevedo Marques 2025, Ekizceli 2026). The forehead moves toward the same height as the middle of the face (Berenguer 2022). Photos taken from the front understate the change; measured along the curve of the head in profile, one surgeon's average advancement was 2.1 cm (Ramirez 2009).
Matching the operation to the forehead. One surgeon used an endoscopic forehead lift for a mildly long forehead, a lift through a hairline incision for a moderately long one, and true scalp advancement for a very long one (Guyuron 2008). For patients having a forehead lift, a hairline incision combined with scalp advancement lowers the hairline instead of raising it, at the cost of a scar further forward (Marten 1999). Hair transplantation is another way to lower the hairline, with no follicle infections, cysts or asymmetry reported in one series (Park 2019).
Recovery and risks. Scalp numbness happens in nearly everyone and fades, within two to six months in reported series (Alabdulkarim 2026, Martins 2025, Espinosa 2025). Pooled across studies, inflamed hair follicles affected about 1 patient in 4, scar problems about 1 in 20, and about 1 in 75 needed a revision; satisfaction was close to universal (Alabdulkarim 2026). Temporary hair shedding is also common (de Azevedo Marques 2025).
The scar. Cutting the skin at an angle across the hair follicles lets hair grow through and in front of the scar; in a blinded split-face trial this gave a better scar in nearly every patient (Camirand 1997).
Does it hold. With sutures through small tunnels in the skull bone, forehead length did not change between one and twelve months (Min 2019), and lowering with small absorbable anchors also held past a year (Abrahamson 2026). In a large series of excisions at the hairline, the forehead lengthened again by about 2 mm at two years (Lee 2021).
Who should be careful. Patients with conditions that thin the hairline, such as male pattern baldness or frontal fibrosing alopecia, need careful selection, as do those with expectations the operation cannot meet (de Azevedo Marques 2025).
Where surgeons disagree
- How often problems occur. One pooled analysis put complications at 1 percent or less (Vila 2022); a later one found about 6 percent because it counted follicle inflammation and fluid collections (Alabdulkarim 2026).
- How to anchor the scalp. Some surgeons use bone tunnels, designed to avoid implants (Min 2019, Martins 2025); others use absorbable anchors, which in one series came with temporary hair loss in about 1 patient in 7 (all regrew with minoxidil) and a further operation in about 1 in 10 (Abrahamson 2026).
What is new
- Series from mixed populations show Black patients had larger advancements, and scars were rated good across the group (de Azevedo Marques 2025).
- A tension-free scalp flap anchored to bone gave stable results with one thick scar in its series (Martins 2025).
- In facial feminization, scalp advancement of about 2 cm also closes the receding corners of the hairline (Garcia-Rodriguez 2020), and most patients who also had the forehead bone contoured found their forehead natural (Perrillat 2023).
What is still unknown
- Results beyond two years; follow-up is often short or incomplete, partly because patients travel for the operation (Abrahamson 2026, Vila 2022).
- Standard definitions of complications and satisfaction, which would let studies be compared (Alabdulkarim 2026).
Key papers
- Camirand 1997: an angled incision gives a better hairline scar.
- Marten 1999: lowering the hairline during a brow lift.
- Guyuron 2008: matching the operation to forehead length.
- Ramirez 2009: how measurement changes the reported advancement.
- Min 2019: bone tunnel fixation held the new hairline.
- Lee 2021: small relapse at two years after hairline excision.
- Vila 2022: pooled average lowering.
- Alabdulkarim 2026: pooled complication rates and satisfaction.