A plastic surgeon who performs forehead reduction surgeries to lower hairlines shares before and after photos, and what to expect

• Insider spoke with plastic surgeon Gal Aharonov on his technique for reducing the size of a forehead. 
• Aharonov makes an incision across the entire hairline, lifts the scalp, and stitches it closer to the face.
• The surgeon said costs start at around $15,000, and patients travel from across the globe to see him.

A few months back, plastic surgeon Gal Aharonov received a new patient: a woman in her early thirties, desperate for a procedure that would shrink the size of her forehead. 

Aharonov, a double-board certified facial plastic and cosmetic surgeon with a practice in Beverly Hills, is the pioneer of a cosmetic surgery that brings the hairline down the forehead. The complicated surgery, which involves lifting the entire scalp off the head, is meant to reduce the size of genetically large foreheads. 

Within two weeks of performing forehead lowering surgery on the woman, her husband told Aharonov she went from an introvert who rarely went out to someone who is constantly meeting friends and family, and doing "things she's never done before."

"He's like, 'You have no idea how different my wife is since the surgery,'" Aharonov said in an interview with Insider. "'You have changed her life.'"

To shed more light on his novel approach, Aharonov walked Insider through how he performs forehead reduction surgery, what the major risks are, and who makes a good candidate.

A plastic surgeon pioneered a new way to reduce the size of someone's forehead.

Candidates for forehead reduction surgery are people born with bigger foreheads than they'd like, not people with receding hairlines.

Though treatments to male- and female-pattern baldness exist, Aharonov said there aren't many ways to put hair in places on the head that never grew hair in the first place, and he said he wasn't taught in school how to lower the hairline. "There weren't really many people doing anything about this issue," he said.

One alternative technique involves placing a balloon under the scalp and inflating it over the course of 2 to 3 months, which expands the scalp tissue. Surgeons go back in a second time, remove the balloon, and then stitch the newly stretched scalp further down the forehead. 

Aharonov said the balloon technique has "a lot of issues," like stretching out and separating hair follicles, which gives the appearance of thinning hair. The technique is also more time consuming for patients, as it requires two surgeries and sometimes several follow-ups for doctors to assess how the scalp stretches. 

Aharonov began researching other options, and in 2008, he said he pioneered a new technique that involves one surgery, not two. The surgery works as follows: 

1. 1. An incision is made just outside the hairline. 
   2. The entire scalp is lifted off the skull.
   3. The scalp is then "glided" to the desired location of the hairline, which is decided upon prior to the procedure by both patient and doctor. 
   4. Stitches are then used to connect the hairline to the forehead skin, excess skin is trimmed off. 

"What you end up with is normal scalp and normal hair density, just now in a lower position," he said. The greatest reduction Aharonov has performed was 2.5 inches, but most patients get about 1 to 1.5 inches reduced. 

The cost of the procedure can vary, but typically starts at $15,000, Aharonov said, which includes consultation, operating room, and anesthesia fees. 

Patients are left with a large scar at their hairline.

The biggest risk to the surgery is "shock hair loss," where the stress of the procedure causes hair loss for several months. Aharonov also said he's had to re-do botched forehead reduction surgeries, performed by other doctors attempting to copy his technique.  

The largest trade-off for forehead reduction surgery, Aharonov said, is the long scar that forms across the length of the hairline, just under where hair grows. Still, Aharonov said most patients would rather deal with the scar, which can be masked once the hairline grows out, rather than a larger forehead. 

 

The procedure is far from a quick fix. Aharonov said it takes about six months for patients to heal, and a year for the scar to settle and hairline to appear natural.

The best candidates for the surgery are people who have thick, course hair, which can hide the scar better, and with good "scalp mobility," or pliability of the skin, which Aharonov assesses during an in-office visit. He said his patients keep normal forehead mobility, but the scalp will feel tight for a few months after the procedure.

Many of Aharonov's patients have dealt with the insecurity since they were kids, so they travel far and wide to see him. 

Though Aharonov pioneered this particular scalp lowering surgery, the doctor said he didn't have a personal connection to anyone with a large- than-average forehead, and was unaware it was an insecurity for so many people. 

But, after 15 years of performing hairline lowering surgeries, Aharonov said the issue has become more personal. He said many patients come to him deeply self conscious and having been bullied for their appearance since they were kids.

Aharonov said most of his patients aren't local to Southern California, instead traveling from across the country and from parts of Europe, Africa, Asia, the Middle East, and Australia. Aharonov's patients are typically under 30, though he's had patients in their 70s come in for the surgery.

"It's not like other surgeries in plastic surgery, where you take someone and maybe just make them prettier," he said. "This is different because you're taking a deep-rooted insecurity that a lot of people have had since they were little kids. It's very gratifying compared to, let's say, just doing a face-lift."