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Alexander L. Ramirez, MD; Kevin H. Ende, MD; Sheldon S. Kabaker, MD

Arch Facial Plast Surg. 2009;11(2):84-90.

Objectives  To review a technique and to make quantitative analyses of the senior author's 20-year experience with his preferred technique to correct the high female hairline.

Methods  A retrospective review of 29 female patients who underwent the hairline-lowering procedure performed by the same surgeon (S.S.K.). We analyzed preoperative and postoperative standardized photographs by taking measurements from the medial and lateral canthi to the anterior hairline. Facial height, from the menton to the hairline, was also measured. We calculated mean values and then used a 2-tailed, paired t test to evaluate for statistical significance. Patients also underwent evaluation for satisfaction, complications, and aesthetic result. We reevaluated the measurements from the profile view and compared them with the original data.

Results  The photographed midfrontal hairline position was vertically lowered on average 1.3 cm in patients who underwent a single-stage procedure (P < .001). In retrospect, the analysis was flawed compared with clinical experience. Therefore, the profile views were evaluated, and the correlating true curvilinear advancement was an average of 2.1 cm. Three complications occurred, including 1 major effluvium, 1 minor effluvium, and 1 scar that required revision. Patient satisfaction was extremely high.

Conclusions  Advancement of the female hairline by incorporating an irregular trichophytic incision and a posterior scalp advancement flap is an effective and safe technique that has been used by the senior author for more than 2 decades. The average advancement was 2.1 cm in this study. The technique is immediately effective, well tolerated by patients, and associated with minimal complications. Although it is associated with a potentially visible incision, this technique can be used to make the scar virtually invisible.

Author Affiliations: Aesthetic Facial Plastic Surgery Medical Clinic, Oakland, California (Drs Ende and Kabaker); and Division of Facial Plastic Surgery (Dr Kabaker), Department of Otolaryngology–Head and Neck Surgery (Dr Ende), University of California, San Francisco. Dr Ramirez is in private practice in Honolulu, Hawaii.

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