Do I Have a Fivehead?!
woman with eyes closed, hands on head

-by highly-trained facial plastic surgeon Alex Montague, MD

I was actually treating “fiveheads” surgically before I ever heard the term. If you are similarly not aware of what this term means, let me enlighten you. It’s a play on words referring to a larger than normal, or larger than desired, forehead. Five is greater than four, or “fore.” See what I did there? Regardless of what you call it, there are a lot of patients looking to treat their high hairlines, tall foreheads, or “fiveheads” surgically. In fact, there seems to be a recent increase in the number of patients looking for this type of treatment, and I have seen the procedure on the rise within my own practice.

Are Only Men Concerned with Large Foreheads?

A problem that we classically associate with men with receding hairlines is actually also something women worry a lot about, too. The difference for women, however, is not the aging process but rather just a naturally higher frontal hairline. But it can cause significant anxiety, and cause women specifically to be fearful of certain hairstyles or even afraid to wear their hair back in a ponytail as they always feel the need to use their hair to shield their forehead.

What Procedures can Reduce Forehead Size?

There are actually two procedures for treating a high forehead: a hair transplant or forehead reduction surgery. Here at the Quatela Center, we offer both options. Which procedure is best will differ from patient to patient.

If performing a hair transplant to lower the hairline, hair follicles are physically transferred from the back of the scalp to the frontal hairline area to create a new hairline that is lower on the forehead. This is typically the better option for men as it avoids an incision on the forehead that could become visible with age and thinning hair.

Forehead reduction surgery, however, works differently. In this procedure, an incision is made just within the frontal hairline and the existing hairline is actually advanced forward and sits lower on the forehead.  We use a special incision, called a tricophytic incision, that is specifically designed to allow hair to regrow in front of the incision. Thus, the incision, while intimidating to some, heals beautifully and is well camouflaged within the frontal hair. I am seeing an uptick in both procedures, but surgical forehead reduction in particular seems to be in vogue right now and patients are invariably happy.

Key Points, Advantages, and Disadvantages

Hair Transplant

  • No frontal hairline incision so no risk of scarring.
  • Can essentially lower hairline as far as desired assuming enough donor hair is available.
  • Able to change/contour the hairline into a different pattern (if desired).
  • Better for men as frontal hairline thinning that naturally occurs with age can cause even a well camouflaged scar to be visible over time.
  • Results take about 1 year for full new hair growth.
  • Transplanted hair rarely is as thick as the original hair; thus, the new hairline tends to be thinner and patients may desire a secondary transplant to thicken the area.

Forehead Reduction Surgery

  • Involves an incision in the frontal hairline that causes scalp numbness for 6 months to 1 year.
  • Incision takes around 2 weeks to heal but may not be fully camouflaged for 3-6 months.
  • Results are essentially immediate other than the above-mentioned healing time.
  • Can typically lower the hairline 1.5-2cm, which is all the vast majority of patients need or desire. However, in rare instances, tissue expansion can be employed to allow for much larger reductions.

If you are interested in learning more about the options available for reducing forehead size, please call our office at (585) 244-1000 to speak to a Patient Consultant.

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