That picture was of a case done without an expander. It would have been a single stage reduction. Ie. Just one single surgery to bring the hairline down all at once on one day.
Single stage is possible when you only need 2-3 cm reduction and/or your scalp is loose. Women tend to have looser scalps.
In my case i need around 3.5 cm reduction and i have a tight scalp so the expander was the only way to do it properly.
It's been okay so far. I've lived through far worse. I'd go through a hundred surgeries like that if i could become good looking at the end. Being ugly is worse than a few days of surgical pain or a few months of inconvenience from inflating a balloon in your head.