Crown restoration - challenges to overcome

[Dr Bicer’s Consultant]

Hello,

Next to the hairline, the crown carries challenges when it comes to restoration. Challenges include creating the area's unique spiral pattern, the difficulty of achieving high density, the potential for ongoing hair loss, and restoring an only partially thinning crown.

Surface Area
The crown opens on all sides, and can rapidly expand in surface area, has an insatiable appetite for hair, potentially requiring more hair than the front and mid-scalp combined. Male pattern baldness is progressive; this creates issues when it comes to restoring the area. For example, the crown can expand down the back and sides of the head, doubling the surface area and encroaching into the traditional donor safe zone. Family hair loss history is a guide to your future hair loss pattern, but only a guide. It is often prudent to consider the long-term use of a hair loss treatment, even in conjunction with a hair transplant.

Planning Restoration
Crown restoration as a first procedure is not too common. Largely as the hairline impacts how someone looks and changes their appearance. While it is possible there are exceptions that are age related and whether the hair growth is stable, but for a candidate with an active hair loss gene the risk is greater. Risks include the crown continues to expand, causing a halo of no hair around the treated area. Or, overloading the crown with too much hair, reducing the remaining donor resource, potentially hampering maintaining a natural hair coverage and density over other areas.

Hair Growth Pattern
The spiral, or whorl pattern is unique to the crown, the angle of hairs around the crown spiral varies, with the hair shaft exiting the scalp at acute angles near the centre and becoming more perpendicular further away from the centre of the spiral. This helps to blend naturally with the surrounding hair coverage. Incorrect graft placement can result in wrong angles, creating styling issues, not blending with the surrounding hair, and an uneven hair density resulting in an unnatural appearance.

Crown Hair Density
The donor hair characteristics influenced the hair density placed in the crown, including the crown surface area and general donor hair management. Technically, it is harder to achieve high density in the crown compared to the frontal scalp. The placed density often varies between the perimeter of the crown an inner area. While it´s impossible to match the hair density of a natural full head of hair, the temptation should not be to keep adding a little more, and a little more.

Risks
Crowns regularly only initially thin, even though there is a visible shadow of hair loss, maintaining a thinner hair coverage over the area. Overtime, the hair recedes resulting in no hair growth or an open crown. Transplanting into an area with existing, albeit thinning hair carries a risk of temporary shedding of the pre-existing hairs, known as shock loss. Often the use of a treatment such as minoxidil for months after surgery to pre-empt the risk.

Healing & Hair Growth
Post-op healing, and hair regrowth compared to the frontal and mid-scalp can be slower. The crown's lower vascularity can mean to fully mature compared to the frontal mid-scalp being around 12 months, a crown may need 18 months to fully mature.

Dr Bicer is a firm believer in educating, and this extends to patient expectations being important. Your suitability depends on the extent of your hair loss, how active is hair loss, and future hair loss concerns, whether long-term medications is an option, and understanding how hair characteristics play a key role.

 

[Dr Bicer’s Consultant]

Hello, to go deeper into why the crown needs a higher number of grafts to achieve the look of fullness compared to other areas like the hairline or frontal. The hair growth often appears to lay flatter on the crown due the different angle at which hair grows from the scalp. This is particularly under direct or overhead lighting, highlighting any thinning or the crown starting to open.

Because the hair grows in different directions to create the whorl, there is much less overlapping of the hairs. This results in less hair-over-hair coverage per hair in the crown compared to the forward-growing hair in the frontal regions. To counteract this visual lack of fullness a greater number of grafts must be placed, this will go some way to compensate for the directional changes as the hairs will layer of each more effectively, as a result build up to look of fullness to blend with the surrounding hair.

Take an average size crown with a 6cm diameter, the number of grafts needed could potentially range from 1080 to around 2,700 grafts, based on the desired density, say of 30–50 grafts per cm². The natural hair characteristics will play a key role but the variation in numbers is vast, and even more so considering a thirty density per cm² is not low.

The crown needs more hair is to create a similar looking fullness to the mid-scalp and frontal. However, there are risks when trying to make the crown as full as other areas, wanting to keep going back and adding more hair to the crown. Treating the crown first it becomes more of an issue, largely because it is the sole focus of attention, it cannot hurt to add a little more, tinker with the look, improve the fullness. Unless hair loss is stable there are risks, progressive hair loss and eating into the finite donor hair resource. Treating the crown last, after the frontal and mid-scalp restoration the donor resources will determine what coverage, and or density is viable over the crown.

 

[mania]

The principle challenges in crown hair recuperation are the particular hair whorl pattern, the ability for modern hair loss, lower blood deliver within the crown, and the want for a high degree of surgical skill to gain a herbal look. to beat those, sufferers need to select an experienced health care professional and have realistic expectancies, mainly since it takes longer to peer outcomes and complete density might not be possible in a single consultation

 

[Bigmac]

Nice informative post. Would it be possible to add some crown restoration examples from Dr Bicer?

 

[Dr Bicer’s Consultant]

Nice informative post. Would it be possible to add some crown restoration examples from Dr Bicer?

Hi Bigmac, thanks for your comments. Dr Bicer will check her results and we can then post crown restoration examples. Thanks.

 

[balody]

I had 2000 grafts into my crown 18 months ago and although there is some hair there now the cosmetic difference is minimal.

 

[Dr Bicer’s Consultant]

I had 2000 grafts into my crown 18 months ago and although there is some hair there now the cosmetic difference is minimal.

Hi @balody , 2000 grafts is not a small number, but a crown can consume that easily, just to confirm, you had 2000 grafts/follicular units as that would be 4000 plus hairs, or did you have 2000 grafts/hairs. Because that would have a huge impact.

Assuming it was 2000 grafts/follicular units and the growth was good and the graft numbers were sufficient to treat the surface area and create the look of fullness. In my first post I gave the scenario of a 6cm diameter crown, the number of grafts needed could potentially range from 1080 to around 2,700 grafts, based on the desired density, say of 30–50 grafts per cm². You fit almost in the middle of the scenario, which would be fair to achieve the look of fullness on that size crown.

Can you post any pictures, ideally before and now, to get an idea of the size and growth over your crown area. Maybe the surface area dictated more grafts were needed to not just cover but create fullness.

 

[Bigmac]

Hi Bigmac, thanks for your comments. Dr Bicer will check her results and we can then post crown restoration examples. Thanks.

Sounds good.