Dr. Sheldon Kabaker

First of all, let me emphasize that this operation is most commonly done on young women with high hairlines who are not losing hair. This operation creates a true trichophytic scar (a scar with hair growing through and in front of it) which will only be detectable if hair is lost later in life.

In this instance , I am showing a 5 day result with density that cannot be equaled by strip or FUE harvesting unless multiple sessions are done. Please be aware of the point that this operation is only for very few men who are not in the process of losing hair, have a family history of similar hairlines, have a high hairline and have scalps that are flexible enough to allow for this procedure. I also have done this on men who have already had hair tranplants and the hairline is too high.

If there is a future plan to shave the head , the scar from this or any scalp surgery procedure will show. There are at least 3500 follicular units that have been moved forward in this case. If that much hair is moved by any other means, I doubt if one could shave the head and not have evidence of surgery show, even if done the best FUE extractor.

30 year old male whose hairline has not changed since he was 16 years old. There is no family history of hairloss. However, most of the men have this high hairline with thick hair throughout their lives. This patient had an operation to lower the hairline, which is usually reserved for young women with high hairlines, or men who have had prior hair transplants. This patient had adequate scalp laxity to move his hairline down almost 3 cm's, and agrees to have hair transplants should he become bald in the front at a later time in his life.

He is shown before surgery and a number of comparative views.

The first pair shows the view from above (the surgeons view) before and right after his surgery.

The other views all show him 5 days after his surgery, when the stitches have just been removed.

We expect him to have a totally undetectable scar.

65 year old male who underwent a single graft session of 2300 grafts. He is shown before grafts and 7 months after. The donor scar is hard to find and looks no different than parted hair.

66 year old professional musician, wishes to have better coverage at midscalp and crown. No work was desired to the front. The patient underwent 1500 follicular unit grafts in one session.

Shown before and 10 months after, prior to recent second session of 850 grafts. Note, the patient has all white hair.

Was this a Fleming flap procedure??

This is not the "Fleming-Mayer Flap". I do know that Drs. Fleming and Mayer perform this same hairline lowering procedure. This is a much more simple procedure when it can be done. It works best on patients who do not have hair loss. Usually it is performed on women who have concerns with a large , masculine forehead. I do not advocate it for routine male pattern baldness although there have been exceptions; i.e.. after prior hair transplants to the front of the hairline. The new hairline is the front of the old hairline with the scalp advanced downward.

The Fleming-Mayer flap ,which is a modification of the Juri Flap developed in Argentina in the late 1960's , moves hair which comes from the side and back of the head . It takes 3 stages to perform and changes the hair direction. It is advocated mostly for male pattern baldness or certain reconstructive situations.

This 35 year old female has always been bothered by her big forehead, and wished to have her hairline lowered. Her scalp laxity was slightly less than average. At surgery, her hairline was lowered 2.2cm (slightly less than 1 inch) the equivilent of moving 2500 follicular units. The patient is shown before the surgery with the surgical markings, a view from the top before and immediately after surgery, and four paired views before and 13 days after surgery. Note how undetectable the scar is, even at this early date.

This patient had mini-grafts and micro-grafts in his late 20's, and presented for more work in 2002. Since then, he has had 2611 grafts in 2 sessions to give more coverage for progressive hairloss, and a more natural look with a slightly lower hairline.

Some of my cases just want the option of a lower hairline. It is a small minority of women whose hairlines are a bit high who care greatly enough about this to have surgery. Most hair stylists simply cut bangs for these women. Those women with very high , masculine hairlines are the majority of my hairline loweriing patients. There are no studies of the psychology of concerns for these borderline high hairlines but the patients who have a correction are extremely happy. Remember, these women have not , in most cases, had hair loss. Their hairlines are inherited stable characteristics. Anyone who suffers from hair loss has very different issues trying to regain a part of their image that has been lost. I (who has lost hair starting in my mid 20's) and most posters understand this.

18 year female who wanted her hairline lowered approximately 1 inch. She preferred a procedure that would give her a result much faster than follicular unit grafts could. Approximately 2 weeks ago she had a one stage hairline lowering procedure performed under twilight sleep and local anethesia. The first pair of pictures, shows her before the surgery and at its conclusion one hour later. This view is from the top of the head. The other views are pairs of different poses done before and one day after surgery. She returned to school on the 2nd post operative day with her hair combed over the stitch line, and did not attract any attention.

The amount of scalp that was moved had approximately 3500 follicular units.

This young women wanted her hairline lowered and preferred not to have it done by follicular unit transplantation. Her hair was very thick, her hairline was 7.5cm above her brows, and she wanted it at a level of 5.5cm above the brows. On June 16, 2010, her hairline was lowered in a single stage operation, which removed the skin between the old hairline and where she wanted it.

In sequence, we see the pre-operative situation, the markings of the hairline, a view from the top of the operating table, before and right after the surgery, a series of three before, and one day after pairings (note sutures in place) and pairings of before and one year after.

65 year old male desires modest coverage of the midscalp and crown.

1500 grafts

48 year old male, gradually losing frontal forelock and no longer can look well groomed. 2000 follicular unit grafts done to frontal region, with emphasis on moderately dense packing of the frontal forelock.

Long term results at 2 years are shown. The patient has maintained the same result for the past 6 years.

41 year old male with gradual thinning hair on the top of the head, a family pattern. No loss in front.

1200 follicular unit grafts done. The patient is shown at 3 years.

41 year old male with loss of forelock and some thinning of midscalp. The patient desires a better groomed appearance with the least amount of work and expense.

One (1) session of 1580 grafts was done, creating a high conservative forehead.

This shows that a small amount of hair in the right places can make a nice lifetime change. This patient still has enough reserve donor material for another 6000 grafts if, and when he ever wants or needs them.

The last 4 photos show before and 5 months after the grafting.

45 Year old male with progressive male pattern baldness, assessed at Class VI, who has increasing concern with a circular scar from childhood at the end of his old frontal hairline.

On November 17, 2008, we performed 2616 follicular unit grafts. (strip harvest)

The patient is shown 10 months after his first graft session-first set of before and after's shown.

On October 27, 2009, a second session of 1821 follicular unit grafts taken around his old scar (see photos with donor site markings)

Last pairs of before and after photographs show the patient at age 47, two years after initial work, a total of 4437 grafts. Portions of well healed, undetectable donor scars are shown.

This patient was transplanted with an exceptionally low hairline to cover his old scar. I estimate that 2000 of these grafts, if placed with a higher hairline, would give denser coverage. The patient is extremely happy with his result.

56 year old male wishing to improve sagging, aging neck and crown baldness. In 2005, a facelift was done involving extended excisions into the donor area of the hairline. A donor strip was taken of skin that would otherwise have been discarded. 1000 grafts were made and placed into the bald area after the conclusion of the facelift. A year later, another 1000 grafts were done, taken from the same area, leaving only one scar line.

Early and Long Term ( 6 years) results are shown.

21 year old male with frontal hair loss and strong family history of male pattern baldness that presents early in adulthood. Hairloss appeard to be stablized on DHT blockers for a 2 year period. The patient was determined to have hair restoration surgery, being well informed he will likely lose hair behind the grafts, and need more work later in life.

The patient had approximately 2000 grafts performed on the balding areas, and has been followed for 5 years, taking Dutasteride and/or Finasteride. He maintains good coverage after 5 years, without any apparent further balding behind his grafts.

Pre-operative and immediate post operative pictures shown, along with result after one year and results at 5 years, with and without styling.

52 year old male with Class 3 balding . Treated with 1700 follicular unit grafts. 3 year result shown. These results and native hairs maintained with Propecia.

This 63 year old patient had plug grafts done over 30 years ago. Many session were done with grafts taken throughout the "safe" donor zone and some above it. With age, baldness came down to uncover the scars above the "safe" zone. This patient wished correction to avoid use of a hair piece.

He was treated by placing 1600 follicular unit grafts, into acutely angulated recipient sites, created within and above his fringe. The grafts were harvested from the temporal and parietal area's of both sides.

The first five pictures show the pre-operative situation. The next two pictures show the zone to be grafted, the next followed by two views of the prepared recipient sites, and one view of the sites filled with 1600 grafts.

The next to last view shows the grafts at 2 weeks, and the last few show comparative images.

This 26 year old professional entertainer had an excellent result with an FUE transplant that gave him a stable, mature hairline. For professional purposes, he wished the hairline to be lowered to create a certain youthful image. He had an extremely flexible scalp. With a one stage, hairline lowering operation, we were able to bring his hairline down an average of 2.8cm, maintaining the natural irregularities of his FUE grafts. By moving the scalp forward in this manner, we were able to move the equivilent of 3000 follicular unit grafts in a one and one half hour procedure, which allowed him to resume activities the next day.

This operation is usually done for women with high hairlines, but I will perform it on older men with stable hairlines or those who have been transplanted and have adequate scalp laxity.

54 Year old female with a history of thinning hair since age 16. Family tendency for this condition. Had some transplants done 15 years prior without noticable improvement.

1600 follicular unit grafts performed on 12/19/2009 via strip harvesting. Photo shown of early results shows the shock loss of adjacent hairs during first 6 weeks, and recovery by 6 months.

The final results (last three pictures) compare before and after 10 months after surgery.

The patient is extremely happy. She is applying 5% Minoxidil once per day.

33 year old female with an extremely high hairline. This hairline averaged 8cm above the brow. There was good laxity of the scalp, fine hair with good density. Photos show before and immediately after lowering of approximately 2.5 to 3cm.

53 year old male who had mini and micrografts done 15 years previously. Subsequently, he had a brow lift with hairline incisions and visable scars. Treated with 1500 follicular unit grafts, harvested around old donor scar. Grafts were placed in thinning mid frontal area and into and in front of, the frontal scars. Results at 3 years shown.

This man had many mini graft and micrografts done in the mid 1990's. Over time he lost more hair, and again has a styling problem. In June 2009, he underwent 2238 Follicular Unit Grafts taken with strip harvesting around his old donor sites. The paired photos show his result at 6 months.

65 year old male presented with a class VI baldness. The patient underwent follicualr unit grafting of 1 session- 2640 grafts. Photos show Pre Operative, immediate post operative, virtually undetectable scar from strip harvesting and, before and 7 months after grafts.