Surgical Hairline Advancement (SHA-lift)

Surgical Hairline Advancement  (SHA-lift)

The female hairline is variable in position.  However, a “normal” female hairline is typically positioned 5 to 6.5cm above the brows and usually begins at some point where the scalp slopes from a more horizontal position to a vertical one.  This optimal position allows for ease of hairstyling and provides facial harmony and balance.  
There are a number of women who have a hereditary high hairline or high forehead. The appearance of a high hairline can make women look masculine and/or older than they actually are. The associated high forehead is often seen as unattractive and their hair styling is often limited to combing downward (bangs) to camouflage it. These women, even though there are no signs of hair loss, are dissatisfied with their naturally high forehead and wish they could lower their hairline to a more cosmetically pleasing location. 
The female hair line lowering procedure starts by making a non-repeating, irregular Trichophytic incision within the fine hairs of the anterior hairline. This incision cuts across the hair shafts but leaves the bulb of the hair follicle intact. The trichophytic technique allows hair growth through the scar to help camouflage it. By this method, we try to create a similar transition zone as seen in follicular unit grafting. The hairline subsequently appears natural and undetectable. 
After the incision, the scalp lifted off of the skull all the way to the back of it. Tumescence is used to minimize bleeding. Extensive undermining (a process used to separate the scalp from the underlying muscles and supporting tissue to increase elasticity) is performed in this plane and is rapid and bloodless. In the forehead, dissection in this plane is done to just below where we want the hairline. The scalp is then advanced forward and the excess non-hair bearing forehead skin is excised with an incision that is parallel to the bevelled trichophytic incision. The wound is closed in two layers. The deep layer of the scalp is closed for strength and to approximate the wound edges. The skin closure is done with delicate fine stitches. To ensure a good cosmetic result, there is no tension on the wound. A light dressing is placed and removed on the first postoperative day. A cosmetic result is appreciated immediately. The hair may be combed downward and there is minimal bruising and oedema. Sutures are generally removed 7 - 10 days later. Many patients have resumed working and social actives in 4-5 days. The most important concern to this technique for hairline advancement is the possibility of an obvious or unattractive scar. The technical points of the trichophytic incision are critical in avoiding this complication. As the hair grows and the wound matures, the scar will become virtually non-existent. Hair grafts could later be performed if the scar were visible. Overall, patients tolerate this procedure very well. Patients often report some decreased sensation of the frontal scalp, but this usually resolves by 6 months. Other complications have been extremely rare.

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1 year after treatment

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