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Cessation of Hairline Recession following Open Forehead Rejuvenation

Guyuron, Bahman M.D.; Gatherwright, James M.D.; Totonchi, Ali M.D.; Ahmadian, Rouzbeh M.D.; Farajipour, Navid B.S.

Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 1e–6e
doi: 10.1097/01.prs.0000436815.88590.4e
Cosmetic: Original Articles
Video Discussion

Background: The senior author (B.G.) observed that patients who underwent forehead rejuvenation using a pretrichial incision did not experience hairline recession. The aim of this study was to objectively measure the effects of forehead rejuvenation on hairline recession.

Methods: A 15-year retrospective review was performed in 31 forehead rejuvenation patients [17 endoscopic and 14 open (pretrichial incision) with adequate early (within 1 year) and late (≥8 years) postoperative photographs] and 11 age- and follow-up–matched cosmetic surgery patients who did not have forehead rejuvenation. Hair recession was measured using the Mirror program for Windows by averaging two successive perpendicular distances from bilateral medial canthi to the hairline and dividing by the intercanthal distance. In pretrichial incision patients, the distance from the incision to the anterior hairline was recorded.

Results: The difference in short-term postoperative hairline measurements among groups was not significant (p = 0.445). Only the pretrichial group demonstrated significant stability between short-term and long-term hairline positions (p = 0.005). The pretrichial group demonstrated a stable or improved hairline position compared with either the endoscopic (p = 0.017) or control group (p = 0.006), whereas these patients demonstrated significant recession over time. Hairline measurements between early and late postoperative photographs in the endoscopic and control groups were not significant (p = 0.621).

Conclusions: The pretrichial incision results in a stable hairline position over time compared with the endoscopic technique or matched controls. Pretrichial incision patients did not demonstrate separation between the scar and hairline, indicating no hair loss in this site.



Cleveland and Akron, Ohio

From the Department of Plastic Surgery, Case Western Reserve University School of Medicine; University Hospitals of Cleveland Case Medical Center; and Northeastern Ohio Universities College of Medicine.

Received for publication April 11, 2013; accepted July 24, 2013.

Disclosure: The authors have no financial interests to disclose.

A Video Discussion by Patrick Sullivan, M.D., accompanies this article. Go to and click on “Video Discussions” in the “Videos” tab to watch.

Bahman Guyuron, M.D., Department of Plastic Surgery, Case Western Reserve University School of Medicine, 29017 Cedar Road, Cleveland, Ohio 44124,

©2014American Society of Plastic Surgeons