21. a novel hairline feminization technique: using temporal rotation flaps to take the m-shape out of masculine hairlines in facial feminization surgery

PURPOSE: Hairline advancement is an impactful part of facial feminization surgery. Published hairline advancement techniques involve uniform advancement of the central hair bearing scalp to lower midline forehead height. Unfortunately, this technique does not address the most masculine portion of the hairline: the lateral temporal recession and “M” shape. We present a novel technique to address this problem and both advance and feminize the hairline shape. METHODS: In our technique, bilateral rotation flaps of hair-bearing temporal scalp are rotated anteriorly to meet the central scalp advancement, and a wedge of alopecia in the temporal recession is excised. Our hypothesis is that this decreases the distance from lateral temporal recession peak (TRP) to lateral brow (LB) and obliquely to the midline glabella (MG) with well-concealed hairline incisions. RESULTS: In our prospective cohort of 27 patients using our technique compared to 10 controls undergoing uniform central hairline advancement, we used measurements from the TRP to lateral brow and from TRP obliquely to the midline glabella to determine if our technique had improved advancement of the lateral temporal recession peak. We demonstrated statistically significant improvements in lateral hairline height (TRP to LB; 2.1 vs 1.0 cm, p =0.006) and oblique advancement (TRP to MG; 3.0 vs 1.1cm, p =0.0001) compared to controls. This did not sacrifice advancement at the midline (1.5cm, no difference) and there were no major complications. CONCLUSION: Our temporal rotation flap technique is a powerful tool to correct temporal recession and feminize the hairline shape in addition to height.