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Anatomic Comparison of Two Incision Designs on Scalp Advancement for Hairline Lowering Surgery
Greg Bran1, Maarten van Genechten2, Mateusz Koziej3
1GB Aesthetics, 70 Harley Street, London, W1G 7HF, UK.
Aesthetic Plastic Surgery
|August 10, 2026
Summary
Hairline lowering surgery with bilateral extensions (BE) offers greater scalp advancement than a single anterior incision (AI). This technique may improve results, particularly at the lateral hairline.
Area of Science:
- Plastic Surgery
- Anatomy
- Biomechanical Analysis
Background:
- Hairline lowering surgery (HALO) commonly uses anterior incision (AI) or AI with bilateral extensions (BE).
- The biomechanical effects of different HALO incision designs are not well understood.
Purpose of the Study:
- To compare the scalp advancement achieved with AI versus BE incision designs in HALO surgery.
Main Methods:
- Cadaveric dissections were performed on five heads.
- Scalp advancement was measured after AI placement and again after adding BE, with additional dissection.
- Statistical analysis compared advancement between the two incision designs.
Main Results:
- The BE design resulted in significantly greater scalp advancement at all measured points compared to AI.
- Midline advancement increased by 21%, right mid-pupillary by 24.29%, and left mid-pupillary by 28.15% with BE.
- Qualitative observations indicated substantially greater advancement at lateral hairline endpoints with BE.
Conclusions:
- Preliminary anatomical evidence suggests BE incision design allows greater scalp advancement than AI, especially laterally.
- Findings are based on a small sample size and require cautious interpretation.
- Further clinical studies are needed to validate these anatomical observations.