Hairline lowering in two operations with expansion

Hairline lowering in two operations with expansion

If the scalp is tight or more than 2 cm of advancement is needed or the widow peaks are very wide, the following two-stage procedure can be considered. This technique has been developed by Dr. Kabaker and used for over 20 years. It has proved to be almost immediately effective and is well tolerated by patients.

FAQs about this procedure


Tissue expansion is a procedure commonly used in reconstructive surgery to repair burn wounds and injuries with significant skin loss. Its use in hair replacement surgery has generated dramatic results because it gives significant coverage in a relatively short amount of time.

Skin expansion is a common surgical procedure to grow extra skin through controlled mechanical overstretch.It creates skin that matches the color, texture, and thickness of the surrounding tissue, while minimizing scars and risk of rejection.

In this technique, a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp that is next to a bald area. The device is gradually inflated with salt-water over a period of weeks, causing the skin to expand and grow new skin cells. This causes a bulge beneath the hair-bearing scalp, especially after several weeks.

When the skin beneath the hair has stretched enough, usually about two months after the first operation, another procedure is performed to bring the expanded skin over to cover the adjacent bald area.


1. First operation (placement of expander)

During the first operation the croissant-shaped expander is inserted under the hair bearing skin and filled up to 120ml.

2. Filling of the expander

The balloon is expanded over a 7-week period,  to stretch the scalp sufficiently to allow for 4-8 cm of advancement.  Hair-bearing tissue can be expanded to approximately twice its size without a noticeable deficit in hair density.

This is well tolerated by patients aside from the cosmetic inconvenience during the last three weeks of the expansion.

3. Second operation (hairline lowering)

During the second and final surgery, the device gets removed and the expanded hair-bearing scalp is moved forward, replacing the top section of the high forehead or wide widow peaks.  With this approach we are able to move hairlines as far as 8 cm and close wide widow peaks. The procedure of this hairline lowering surgery is the same as the one of the simple one stage hairline lowering surgery. 


  • Temporary hair loss may occur.
  • Shifting of the expander, which never is a real issue.
  • Rare complications can be skin necrosis if expanded too fast. This can be avoided by carefully following the instructions given by Dr Bart van de Ven.
  • If during the operation a minor skin perforation is made by accident, the expansion sometimes becomes impossible.


FAQs before surgery

Sometimes I get asked to model during a photoshoot. How long should I wait to book one after my FFS?

That is a very difficult one. It depends very much upon your healing and we can’t give you any guarantee about how long it takes before you look good enough for a photoshoot.
It could be 4 months, but it could also be a year. Of course it also depends on the amount of work that has been done.

When can I have sauna again after my FFS?

You will have to wait for 4 weeks, then you are free to have a sauna!

What does this procedure cost?

There are 3 options to receive a financial and operative proposal. You can either send us pictures and receive a quote and an FFS simulation, or you can book a Skype or a live consultation with Dr Bart van de Ven during which you will also receive a quote and FFS simulation.

How do I get my FFS price request?

Click here if you want to get a general idea of FFS prices.

Is it common to have complications during the expansion?

Complications during expansion have become very rare since we place the expander on the back of the head. Leakage of the expander or a serious infection have never occurred.

Can I get this surgery if I’m a cis woman?

Yes, of course. We perform Facial Feminization Surgery on all women. Every woman is welcome at our clinic!

How much time should there be between placement of the expander and the actual hairline lowering?

Depending on the amount of hairline lowering necessary you will need 6 – 8 week for the expansion

How often should I inflate the expander?

Twice a day you will have to inflate 10ml of water (saline). We will supply you with all the necessary things after the expander has been placed.

Is the expansion very painful or disfiguring?

Thanks to a new technique developed by Dr van de Ven the expander can be placed on the back of your head. With the new technique patients don’t complain of pain during the expansion anymore and it has become much easier to hide the expander.

FAQs after surgery

How long does it take until the sutures in my hairline dissolve?

The white skin sutures dissolve in 1 or 2 weeks. If they would still be in the skin after 2 weeks they will easily break when you pull with your fingers.

When can I start dying my hair again?

Before you can start stain your hair again after a forehead recontouring the incision should have healed 100%. If the incision was made a few cm inside the hair (no hairline lowering) this will take about 6 weeks. In case you had a hairline lowering this might take longer (up to 4 months).

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.

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