Hair and Hairline
Many FFS surgeons and patients believe that on average, women have lower hairlines in the middle than men but this is not actually true. In fact, women have higher hairlines in the middle than men (you can read more about this towards the bottom of the page under "Misconceptions"). Of course men often get male pattern baldness and this can raise the hairline but when balding is not present, the average male hairline is lower in the middle than the average female hairline . If you look at the corners of the hairline the situation is reversed with women having lower corners and men having higher corners.
In terms of overall shape, the higher corners and lower middle of the male hairline tend to give it a square or “M” shape while the lower corners and higher middle of the female hairline tend to give it a rounded shape. Here is an animation created from averaged male and female faces showing the differences I have just described:
You will see the same differences in other examples of averaged faces on the internet. A good example is the Face of Tomorrow website or the BeautyCheck website. You can also see some of these “prototypes” in part 3 of my thesis on facial feminisation here.
1: Scalp Advance:
In a scalp advance a strip of skin is removed in front of the the hairline, the scalp is lifted away from the skull and pulled forward to fill the gap. There is a limit to how far the scalp can be moved in one go - 2 or 3 cm (an inch to and inch and a half) is typical so two or more separate scalp advances several months apart may be required to achieve the desired result. If the surgeon is also doing work on the forehead bones, they can do it through the same incision as the scalp advance. Occasionally, surgeons can place and inflatable bag under the scalp - this is inflated a little at a time over the course of several weeks to stretch the scalp ready for a scalp advance.
There is always a visible scar from a scalp advance but just how visible will be partly down to luck, partly down to the skill of the surgeon and partly down to your own tendency to scar. Many patients feel their scar is almost invisible except to people who know what they are looking for. The scalp advance technique severs two nerves that supply sensation to the scalp. The sensation often does not fully return and you may notice one or two numb or partially numb patches on your scalp. This is not generally a problem though and you only tend to notice the numbness if you are feeling for it. The hair growing near the incision may fall out after a scalp advance. This hair will start to grow again 3 to 4 months later.
2: Hair Transplants:
In a modern hair transplants (called "micro-follicular grafts") a strip of skin is removed from the back and sides of the scalp and all the hair follicles are dissected out of it (each follicle contains between 1 and 4 hairs). They are then be transplanted to the areas where they are needed - filling the corners above the temples, bringing the hairline forwards if necessary and thickening areas where the hair has become thin. The transplanted hairs all fall out soon after the transplant but the hair follicle is alive and about 3 to 4 months after the surgery, the hairs start to grow again. There is a limit to how densely the hair can be packed in at one time so more than one procedure may be needed to achieve a good density.
I have had 2 sessions of hair transplants. Here is a close-up picture of my hairline so you can see how they look about 4 years on. The front centimetre or so is all transplants:
Sometimes small itchy pimples appear where the hairs are growing through. These are annoying but only last for a few weeks generally. The incision is long but not as deep as the incision for a scalp advance. Also, no large nerves are cut and the scar is hidden under the hair.
So why then do so many people believe men's hairlines are lower overall? There could be several reasons - male pattern baldness is quite common so in that respect we are used to seeing cases of men with high hairlines and we generally don't see that particular type of recession on women. Secondly, men's hairlines are higher in the corners and maybe we notice that more than the height in the middle. Then again, it might simply be a myth that has gone around for no apparent reason.
The fact that many patients and surgeons believe it to be true though is a problem because it can lead people to have surgery to move the whole hairline forwards when they don't need it and when, in many cases, it can actually have a slightly masculinising effect. For the majority of faces I work on the height of the hairline in the middle does not need to change – I only need to fill in the corners of the hairline to give it a rounded female shape.
You can read more about hairlines in Part 1 of my Facial Feminisation Thesis but I can sum up my approach to hairlines with this simple rule:
The shape of the hairline is more important than the height!