# Stability of Hairline Lowering Using Small Footprint Soft Tissue Anchoring Devices

## TL;DR

This study shows that using the Endotine Forehead-mini device for hairline lowering leads to stable and long-lasting results with minimal complications.

## Contribution

The study provides empirical evidence on the stability and outcomes of hairline lowering using the Endotine Forehead-mini over a 13-year period.

## Key findings

- Hairline lowering using the Endotine Forehead-mini resulted in significant and sustained reduction in upper facial height.
- Complications occurred in 26% of patients but were mostly minor and resolved with treatment.
- Patient satisfaction was high, though not formally measured.

## Abstract

One principle of facial aesthetics is based on “facial thirds,” and hairline recession/large foreheads disrupt this balance. Hairline lowering can improve harmonious aesthetics and often uses bioabsorbable implants. This study seeks to establish the outcomes and stability of hairline lowering using the Endotine Forehead‐mini in a single‐surgeon cohort in the United States.

This is a retrospective review of a single‐surgeon cohort from 2011 to 2024 that underwent hairline lowering. Patient demographics, outcomes, and complications were documented. Upper facial third ratios were measured preoperatively and postoperatively and compared using paired t tests. The stability of the upper facial third ratio was assessed over time using paired t tests between the first postoperative visit and subsequent visits.

100 patients were included, with 58 having images available for analysis. 100% of patients had a statistically significant reduction in upper third percentage medially (μ = 3.5% lower, 95% CI = 3.1%–3.8%, p < 0.001) and laterally (μ = 3.1% lower, 95% CI = 2.7%–3.6%, p < 0.001) at their first postoperative visit. As patients travel for this procedure, follow‐up varied; however, hairline lowering was stable from first follow‐up to 3–6 months, 6–12 months, and past 12 months. Patient satisfaction appeared high but was not formally assessed. Complications occurred in 26% of patients: transient alopecia in 14% (all resolved with minoxidil), 10% required additional surgery (scar revision, further hairline lowering, or hematoma evacuation), 2% had hematomas managed nonsurgically, 5% had scalp irritation, and 1% had a postoperative infection (treated with antibiotics).

Use of the Endotine Forehead‐mini was associated with substantial, sustained hairline lowering with minimal risks.

4.

Facial aesthetics and balanced proportions are influenced by “facial thirds,” and hairline recession/large foreheads can alter this natural harmony. Hairline lowering with bioabsorbable fixation devices, such as the Endotine Forehead‐mini, aims to restore facial balance through stable advancement of the hairline. In this 2011–2024 single‐surgeon series of 100 patients, hairline lowering with the use of these implants produced significant and lasting reductions in upper facial height with low complication rates and high patient satisfaction.