Stability of Hairline Lowering Using Small Footprint Soft Tissue Anchoring Devices

ABSTRACT Objectives 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. Methods 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. Results 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). Conclusion Use of the Endotine Forehead‐mini was associated with substantial, sustained hairline lowering with minimal risks. Level of Evidence 4.