While other surgeons are able to lower the hairline only minimally with a one stage procedure, the technique I use can lower the hairline by at least an inch to potentially over 2 inches in one stage without having to use a tissue expander or balloon. Try to compare apples to apples. Most before and after pictures you will see online from other surgeons for the hairline lowering surgery are of patients who have had a tissue expander. All the before and after photos on our website are of patients who have had a one stage procedure without the use of a tissue expander. This is a huge difference. I firmly believe that for patients who need 2 inches of reduction or less, the one stage procedure should be the surgery of choice. For those patients who need over 2 inches of reduction, a tissue expander should be considered.
Regardless of how "tight" your scalp might be, if you need less than an inch and a half (4 cm) of a hairline reduction, you should NOT need a tissue expander. Although I can never guarantee how much hairline lowering can be performed with the one stage procedure, I have never not been able to lower it by at least an inch and a half when needed.
Having a tissue expander in place is not much fun. It is weeks and weeks of walking around with a balloon under your scalp needing to come into the office 2-3 times a week for expansion. For the last several weeks you are walking around like a cone head. If you do not think one to one and a half inches of hairline lowering will be enough and you do not want to risk trying the one stage procedure, then you should consider the two stage hairline lowering with tissue expander.
The majority of my patients have had consultations with other surgeons who have recommended the tissue expander. We have always been able to get a very nice hairline lowering without it. I have had a few patients where they could have probably used a little bit more of a reduction, but they were still happy with the reduction as well as not having to go through the tissue expansion process.