Hair Transplants
for Crown Hair Loss |
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Effective hair transplantation of the
crown involves many considerations and can be more
complicated than just stuffing in hair grafts.
In his landmark book, Hair Transplantation,
in which he helped pioneer the high standards of modern
hair transplant surgery, Walter Unger MD writes that
the most common mistake when it comes to crown hair
transplantation is to implant grafts in a radial pattern,
like the spokes from the hub of the wheel.
The radial pattern has a central
point, with hair radiating from it in all directions,
like the spokes of a wheel. This is a relatively
easy pattern to conceptualize, but it is, in fact,
not usually found on the heads of non-bald men.
(45) (Article continues below
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The true formation
of hair found on the crown of nearly all men
is that of the whorl pattern (see Fig 6) which
is often right of the center (sometimes left
of center). "Obviously, the only correct
pattern for vertex transplanting is to re-establish
the hair as nature originally intended it."
[African-American men have no particular
pattern.]
In decribing this hair pattern,
Dr. Unger writes: "Hair radiates from
the center of the whorl in the pattern shown
in Fig. , which eventually blends with the hair
on the superior aspect of the posterior part."
Hair transplant veteran Dr. Robert
H. True also points out in online article that
crown hair lays flat and follows the curved
contour of the crown. (Continued below) |
Fig. 6, Diagram
of illustrating the "whorl" on the
vertex (crown) of men and the direction and
pattern of hair growth.
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"In some ways, reproducing
the correct spiral angle while at the same time
creating the appropriate "flatness" angle
is more technically demanding for the surgeon than
a [frontal] hairline. Recreating the whorl is essential
to treating crown baldness. A well constructed whorl
is as much a credit to the surgeon's art as an elegant
hairline. Both must be approached with equal finesse
and have comparable cosmetic value. (46)
Dr. True briefly described his method
for crown hair transplantation:
"The center of the whorl
requires single hairs just like the edge of the
hairline. The receptor sites must properly rotate
in the spiral and be properly angled across the
curve of the scalp to make the hairs lie flat to
the scalp.
"Because it is rarely possible to reproduce
high density in a crown restoration, it is critical
to use only microscopically prepared single follicular
unit grafts. Thus with lower density there will
be no "plugginess" or unnatural appearance."
(46)
Besides recreating mother nature's "whorl,"
hair
transplant doctors also have other important considerations
for the crown which include:
- Future hair loss
- Amount of donor hair
- Loss of hair through hair transplant "shock.
Future hair loss and the amount of donor needs to
be taken into consideration otherwise a crown hair
transplant could result in an 'island of hair surrounded
by bald skin' as vertex hair loss continues to worsen.
Dr. True accurately points out that many hair transplant
surgeons refuse to treat the crown because they feel
it is more important to allocate donor hair to the
front, which they see as more important. "Some
transplant surgeons will not treat the crown, arguing
that the limited donor supply is best focused on the
front."
Some doctors are quite vocal in their bias for frontal
hair restoration while deliberately choosing to post-pone
or de-prioritize the crown. This prejudice ignores
the patients goals in a quite dismissive manner. Frontal
hair loss is important, but should the crown be dismissed
or marginalized so quickly by hair transplant doctors?
These doctors note that crown hair transplantation
can often take two sessions to achieve satisfactory
results and this creates a de facto necessity to preserve
donor hair and set priorities on where it should be
transplanted. The crown can also be a "blackhole"
as another hair transplant doctor described in a book,
in which a countless number of grafts can "disappear"
without ever achieving a satisfactory result.
"...it is important to recognize that
certain categories of patient will never have sufficient
grafts for crown transplanting." Dr. Unger
writes in his book. "In these patients,
it is often best to state this to the individual
as soon as possible, so that he fully understands
that he will always have some bald area in the crown.
Clearly, the most logical plan in evaluating
the uncertain expanding balding crown in some younger
patients is to [watch, wait and see] even
if this means that they may have to live with a
small area of crown baldness until the final pattern
can be fully conceptualized." (45)
However, many hair
transplant doctors do accurately point
out that the patient should do all he can to restore
the crown medically through finasteride,
minoxidil
or other
treatments. The use of these treatments
can bring about satisfactory results without ever
needing a hair transplant. Finasteride is quite effective
at arresting hair loss and may induce new hair to
grow. Minoxidil's new formulation in foam, as well
as super extra-strength minoxidil (up to 15 percent,
with topical finasteride or other anti-androgens mixed
in) available on the internet (38b), is effective
for a large majority of patients in regrowing recently
lost hair.
It's also important to note that these medications
are less effective in regrowing hair in the front
than they are the crown. Since they are less likely
to work in the frontal and mid-anterior regions, these
areas become prime zones for donor grafts.
Besides the considerations of future hair loss and
the amount of donor hair, patients and doctors also
have to consider hair transplant "shock."
When hair grafts are implanted into the recipient
areas, adjacent hairs can be lost due to "shock."
Sometimes, these hair grow back. However, if they
are already undergoing the miniaturization process
due to DHT, and are weak and fine, these hairs might
NOT return.
Consider that an 800 follicular
unit hair transplant into the crown results
in 50 percent hair transplant "shock." This
could leave the patient with a net gain of only 400
follicular units, resulting in an outcome less satisfactory
then expected. A conversation with one respected hair
tranpslant physician revealed that medications such
as finasteride and minoxidil might reduce this potential
"shock" by 50 percent, resulting in a net
gain of 600 follicular units in this example. Patients
should consult with their hair transplant doctors
about this often over-looked phenomenon in order to
manage their expectations.
In conclusion: Many hair transplant
doctors are cautious in their approach to crown transplanting.
Many prefer for the patient to reach a certain age
in order to reveal future hair loss according to the
Norwood chart. Hair transplant surgeons are also biased
towards restoring frontal hair loss over crown hair
loss, and recommend patients pursue medical related
treatment of crown hair loss both before and after
hair transplantation. With this in mind, considerations
such as future hair loss, quantity of donor hair,
and potential loss of hair through "shock,"
are necessary. When hair transplant doctors do proceed
with crown transplanting, immitating mother nature's
whorl through artistry and skilled techniques produces
the best results.
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