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I posted a while back on how Trichophytic incisions and closures were originally developed for forehead lifting, then adopted by many hair surgeons. Here is a small additional thread on the same topic.
With forehead lifting, the standard coronal lift involves a cut about an inch and a half back in the hair. The forehead is lifted and a strip of hair-baring scalp is excised. This lifts the eyebrows, but also lifts the hairline...in my opinion, un-naturally. Most white women have high hairlines to begin with, you raise that hairline another inch and you start to look odd. I know, I've seen lots of those women up close over the years.
To counter that, doctors then put the cut in front of the hair...it avoids raising the hairline, but you see the scarline forever. Then in about the late 80s, doctors started cutting about 4 or 5 hairs behind the hairline, but angled the incision so as to cut ABOVE the roots of those 4 or 5 hairs. When forehead skin is lifted and cut off, again a bevel cut is made. Then when the angled forehead skin is placed down and sewn up, there are 4 or 5 rows of hair roots that will grow out in front of the scar.
Shown is a young lady's forehead that I closed with trichophytic closure last week. I took her sutures out on day 6 and the pictures are shown. Note that there are no hairs YET in front of the scar. It takes several months for them to grow in.
Also shown is another lady who I did a forehead lift on now at 4.5 months showing hair in front of the scarline, which itself will continue to fade for about a year.
Now ideally, this same result SHOULD occur with strip closures closed trichophytically. But I think there is much more variability due to the thickness of the donor scalp being re-approximated during closure, and scalp stretching with normal head and neck movements during the first several months postop. Nevertheless, trichophytic closures are a valuable tool for the hair surgeon.
Dr. Lindsey McLean VA
__________________
William H. Lindsey, MD, FACS
McLean, VA
With forehead lifting, the standard coronal lift involves a cut about an inch and a half back in the hair. The forehead is lifted and a strip of hair-baring scalp is excised. This lifts the eyebrows, but also lifts the hairline...in my opinion, un-naturally. Most white women have high hairlines to begin with, you raise that hairline another inch and you start to look odd. I know, I've seen lots of those women up close over the years.
To counter that, doctors then put the cut in front of the hair...it avoids raising the hairline, but you see the scarline forever. Then in about the late 80s, doctors started cutting about 4 or 5 hairs behind the hairline, but angled the incision so as to cut ABOVE the roots of those 4 or 5 hairs. When forehead skin is lifted and cut off, again a bevel cut is made. Then when the angled forehead skin is placed down and sewn up, there are 4 or 5 rows of hair roots that will grow out in front of the scar.
Shown is a young lady's forehead that I closed with trichophytic closure last week. I took her sutures out on day 6 and the pictures are shown. Note that there are no hairs YET in front of the scar. It takes several months for them to grow in.
Also shown is another lady who I did a forehead lift on now at 4.5 months showing hair in front of the scarline, which itself will continue to fade for about a year.
Now ideally, this same result SHOULD occur with strip closures closed trichophytically. But I think there is much more variability due to the thickness of the donor scalp being re-approximated during closure, and scalp stretching with normal head and neck movements during the first several months postop. Nevertheless, trichophytic closures are a valuable tool for the hair surgeon.
Dr. Lindsey McLean VA
__________________
William H. Lindsey, MD, FACS
McLean, VA
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