Concerns with Crown/Vertex hair restoration

[Understanding Hair]

When planning hair restoration, the common assumption is, crown restoration is secondary or neglected compared to other hair loss areas, especially the hairline. Even though this is not the case, it simply has more to do with the need for careful planning. Creating natural hair coverage is the priority, with considerations based on age, hair loss stage and family history.

Starting with the centre of the crown, the spiral, or two spirals for a double crown. The hair grows out from this point. In a circular pattern. Until blending with the surrounding hair, orientation and lay. The crown surface area is hard to map out. As it expands from all sides, and moves forward, to the point the crown meets the mid-scalp. Crown hair placement is quite different from anywhere else on the head. Because the crown is circular and opens. As a result, the graft distribution varies, from single hairs to multiple hair units. Along with the orientation and angle of hair placement.

Treating minor crown thinning on a younger candidate can be problematic. Same can apply to diffuse crown thinning. A hair transplant has a finite amount of hair to use, and especially if hair loss is progressing, planning can be impossible. Making it difficult to maintain a natural coverage and hair density. If the crown begins to open at an early age, it´s often best to consider a hair loss treatment rather than a hair transplant. The crown or vertex can vary widely in size, as it can blend into the mid-scalp, back and sides of the head.

A hair loss pattern can expand that the crown drops down the back and sides of the head. Not only expanding the surface area of hair loss but decreasing the donor hair surface area. Advanced crown hair loss, the area can expand to exceed the size of the frontal and mid-scalp combined, with a surface of 175 cm². Even with transplanting, a minimal density (15 FU cm²) will need approximately 2600 FU. With a higher density, 40 FU cm², that equates to seven thousand grafts/FU used. However, this is more than the average person has available in their donor area, and this is just for the crown.

Consequently, if crown restoration is first, it´s essential to be mindful of the graft numbers and the potential hair loss to not backload the result. Without careful planning, starting restoration from the back and working forward will result in running out of hair before finishing the coverage. As a result, this makes treating the crown harder, compared to starting with the frontal and working back.