Crown Design & Graft Placement

[Hattingen Hair]

Sometimes it may be felt the crown is the neglected area when it comes to a hair transplant. Some like to make demarcation lines as to where it starts, but it ´s not really that easy, probably easier to measure the hair line, frontal third, mid-section and then crown as approximate regions. The crown opens on all sides, from the frontal and sides to dropping at the back; some cultures the area expands further due to bone structure expanding down each side potentially doubling the surface area.

A small crown can easily be a circle say 6×6, and for easy measuring, but for those proficient in maths the PY equation applies; this calculation is designed to give the values of a circle.

This makes it much harder to treat a crown, where to start, how many grafts to use and where to place them for the chance is the surface area will increase over time even by just a little; for example if the crown opened by 1cm more all the way round the surface area has dramatically altered.

This is why, and this goes for the frontal sides receding down also it is important to bite into the existing hair a little to ensure for future loss to some degree; rather than placing in the obviously thin area only which would suffice maybe for a year or two and eventually leave an island of hair.

The crown also because of design and surface can have an insatiable appetite for hair, the placement differs from the frontal areas so it needs more to give the same appearance of thickness. Because of this it could need a good 1/2 the hair again compared to the frontal/mid. Generally someone ´s donor cannot give this so a thinner look from a HT or lower density placed is common in the crown.

If you start working in the crown first then you must be mindful not to €œback load € the HT, using most of the re- sources available only in the crown and not enough to ad- dress frontal loss and being able to balance the look of a natural if thinning head of hair.

In conclusion, crown work and artistic design go together, in some cases the crown can be hard to treat, especially in younger candidates.

 

[bullitnut]

hattingen wrote:

If you start working in the crown first then you must be mindful not to €œback load € the HT, using most of the re- sources available only in the crown and not enough to ad- dress frontal loss and being able to balance the look of a natural if thinning head of hair.

Good post Hattingen, the backloading always bothers me...especially when you see patiets throwing loads of grafts in the crown, future planning is essential with crown work.

Why do crowns grow in slower?....i have heard people say they have know idea time and time again but someone somewhere must have done a study on this surely*nl

 

[Bigmac]

Good post, most of my work is crown as my frontal third is ok, little work done there.

 

[bullitnut]

Your frontal third looks really strong and solid BM...out of curiosity though where do you think you would be on the norwood scale now without meds and surgery?

Was your loss pre Finasteride etc slow or fast dude?

 

[sl]

Nice post and so true of the crown area and how to approach it.

 

[Bigmac]

What density would you say a crown needs to have a decent coverage with a thinning look, not bald, if that makes sense.

 

[sl]

Good question BM and often the crown is done with other loss in mind so rear loading is not wise. The donor is finite and with more advanced loss the aim is to break the shine of loss in the crown but for others with just more local loss there then one may be able to place at a higher density.

We would place at 30 or 40 FU per cm2, there are challenges of going high due to the spiral design needed and very different to placement to mid scalp for example and as said before we need to keep in mind progressive loss also and not over invest in one area.



The patient should not expect to not see skin as the hair itself will part and go in different angles and education is paramount as to expectations for crown work and the appetite for grafts present in this area. That said good results can be achieved and hairs per grafts, hair to skin colour and even the length that the hair is worn post surgery all have an impact.

 

[bullitnut]

Great thread this.... sl is right i agree something as simple as hair length can play a huge factor in making the crown look less thin. I know mine looks much better when it is a little longer as it creates a kind of layering effect. Hair styles also play a big part and many patients have a brushed back style which covers and disguises a thin crown well.

 

[Dazzster26]

Hi Guys
Great thread this is and I just had to join in on this one as I was thinking about getting some temple work and lowering the hairline 1 cm as well , however sometimes I look at the crown and it seems like i could use some more grafts in their but thats when my hair is shorter and when its longer it looks fine , my wife says its fine and you cant expect to have a crown that shows no scalp mmmm , am in no hurry to get the 3rd HT
Merry Christmas Guys


Dazz

 

[mg42]

Throwing in some body hair is an option, crown is known as black hole and body hair sound like an option.
My concern is does body hair grow well in crown and how many bht grafts per cm^2 can you transplant


What is average crown RADIUS of bald man?

 

[hairtech]

Also mathematically mg42 pi is:

3.141592653589793238462643383279502884197169...

Anyway... this is a good thread and topic.

 

[Bigmac]

Thanks for the reply Sl.

 

[Westcoaster]

The crown area has the potential to expand from a very small area to a Nw5 state, with this in mind Docs will usually treat the crown with caution. Having the hair strategically angled when placed will enable good coverage once grown out.