Transcription
Even though we cannot see the area as clearly as our hairline, when the crown of the head is thinning, it often bothers people. What is the best way to improve the vertex or the crown of the head? Do hair transplants even work on that area? Let's dive into non-surgical and surgical ways of optimizing your crown.
Men and women can experience hair loss differently, but often the crown is involved, and sometimes that's the first place where hair loss starts. When it comes to a non-surgical hair restoration, the first goal is always to not lose any more hair. The best way to do that is usually to lower the levels of DHT, because it's the DHT that's leading to the miniaturization of our hair follicles. We can do it with prescription-based medications like fastrite or dutasteride, or more natural compounds like saw palmetto or pumpkin seed oil. Of course, the prescriptions are going to be more potent than the non-prescription options, but both types are available for from the Feel Confident brand. Of course, a proper diet and the right nutrition is also extremely important in preventing further hair loss, and stress reduction is often not discussed enough, but is critical for trying to maintain your hair because we know that high levels of cortisol can lead to hair loss.
Another important goal when it comes to non-surgical hair restoration for our crown is to improve the fullness of the hair. In my clinical practice, I find that the most powerful way to do this is through the use of oral minoxidil. While topical minoxidil has been shown to have some selectivity for the crown of the head, what we find with oral minoxidil is that it usually causes an increased fullness of our hair, not only in the crown but also throughout other areas of the scalp, and sometimes beyond the scalp as well. Other options to improve the fullness of our hair in the crown area can include low-level laser light therapy, microneedling, PRP or platelet-rich plasma, and we have a video dedicated to that. Scalp massage has even been shown to potentially have a minor role in improving the fullness of our hair, and shampoos that have components like curcumin and caffeine have also been shown to increase the growth of hair.
Other non-surgical options include trying to camouflage the thinness of the crown of our head. This can be done with, for example, the use of fibers, which are known to be a bit messy and can look artificial, but if they're applied daily in the right way, they can surely make the hair look thicker in the crown. Another option is scalp micropigmentation or SMP. I find that SMP works great when there's already some hair present. Some people like the look of SMP on just bare scalp, but I find that if there's at least some hair in the area, if you add SMP, it can make the area look more full, and we have a video dedicated to SMP, so please make sure to check that out if you're interested. And of course, a wig or a hairpiece can be used to selectively target the crown region. When some people think of wigs, they think that it has to encompass the entire head, but there are some wigs and hair systems that specifically address the crown. So some people will get a hair transplant for the hairline, and then they'll use a hairpiece for the area further back.
Now, when it comes to surgical options for crown hair restoration, one option is a scalp reduction surgery. This is a procedure that some people think Donald Trump may have had, and we have a video dedicated to all the different procedures that he may have had to arrive to his current state of hair. But a scalp reduction is rarely performed today for purely aesthetic purposes. These can be painful procedures, and sometimes they leave behind scars that are quite visible. Many of our modern hair transplant techniques have made scalp reduction surgery essentially obsolete.
And when it comes to hair transplant surgery, many patients still ask me today if it works for the crown. Well, let me tell you right here, right now, it does. But there are some nuances that we need to discuss. And remember, hair transplants can be performed using FUE or FUT techniques. Both are equally as effective in restoring the crown area. The main difference is how you harvest the grafts. Remember, with FUT, we're cutting out a linear strip of tissue from the back of the scalp and leaving a linear scar behind. And with the FUE technique, we're removing individual grafts and leaving behind small circular scars.
Let's talk about some of the challenges of doing a hair transplant for the crown region. The crown is usually a larger surface area than what most people realize. Sometimes I tell my patients to take their hand and put it on the frontal scalp, and then move it back to the crown, and see just how much space you need to cover. When doing a crown hair transplant, most are quite surprised at how much bigger the crown area can be compared to the frontal scalp. Also, a curved surface area like the crown is harder to create density in compared to a flatter surface like the frontal scalp. The overall surface area when it comes to the crown can be quite large, and later on in this video, I'll be showing you some of my own patients, some real clinical examples, to help illustrate some of these points that I want to discuss today about the crown.
The crown also has a whirl pattern or a cowlick, at least one. Some people have more than one cowlick in the crown, and because of this, there's an area that lacks the shingling effect. And shingling refers to hairs that essentially are overlapping one another, and that's something that we more often see in the frontal scalp. But when it comes to the crown, because of the radial nature of that area, you don't get as much shingling. So the density never looks as impressive as the frontal scalp, particularly if you start with the same sized area to cover and the same base density with the frontal scalp compared to the crown. With the crown, you're not going to get the same impact with the same number of grafts. Also, the angles and the directions of the hair are constantly changing. So again, that is where we lose that shingling, and we start to have weaker appearing densities.
It's very important with a crown hair transplant to avoid the halo effect. And the halo effect is when a hair transplant is performed into the epicenter of the crown where it appears to be the weakest, but there isn't a good fade out into where you have hair further out into the mid-scalp or maybe the parietal scalp. And because of that, you have the central area that looks very dense, and then you have this almost clearing zone, this halo, that's starting to form, and then the hair starts up again. That is not a natural look. So in order to avoid that, what I frequently do these days is I create essentially two zones that I look to fill with the transplanted hair. There's the outer zone that's going to get a slightly lower density of hair, and then there's the inner zone, and that zone typically gets close to a 2x density that's going to be the weakest central zone. So we're still usually adding higher density to that most bare area, but we're including that clearing zone so that we don't get the halo effect.
So here are some of my clinical pearls when it comes to crown hair transplants. For the same number of grafts placed, you're going to get a better bang for your buck working into the frontal scalp compared to the crown, in terms of the density that's generated. So when you're working into the crown, it's important to lower the patient's expectations compared to doing frontal scalp work. And it's equally important to remind patients that additional procedures might be necessary to further increase the density of the area.
And when people ask me how close to my original hair density am I going to come with a single crown hair transplant, what I often look at is what is their base density, what is the overall coverage zone that I'm working on, also what is the caliber of their hair, and how many grafts are we able to transplant in a given session to try to replenish the crown. I'm then able to estimate what the approximate percentage of the original hair might be in the crown post hair transplant. And that number can range fairly broadly. It can be anywhere from reaching maybe 10, 15% of their original density if it's a massive area of the crown and, for example, they're starting off with absolutely a bare scalp. Or maybe we can reach percentages of closer to 80 or 90%. But in order to reach those levels in a single surgery, we usually have to have some base percentage of hair present, maybe 20%, maybe 30%, maybe 40% of the original, and then we're able to boost it up into percentages that closer match their original hair. But if they're starting off with a completely bald area, it's not going to be possible in a single surgery to take them from 0 to 100%.
Another pearl of mine is to not invest too many grafts into the crown until the frontal scalp looks sufficiently filled. Meaning that if someone comes in and most of the frontal scalp is gone, I don't think that it's a wise decision to do an initial surgery into the crown area because the patient can likely use it in the frontal scalp much more, especially from just an overall aesthetic perspective, compared to putting a large number of grafts from the beginning right into the crown and then still having a frontal scalp that's missing.
Before we get into the clinical examples, let's do a brief FAQ. Does crown restoration take longer to show results compared to other areas that are transplanted? The answer is no. The shedding and regrowth patterns are quite similar whether you're working on the crown, the frontal scalp, or the mid-scalp. Will a hair transplant last forever in the crown? Just like with all hair transplants, not necessarily. And the reason is because we don't know exactly how your hair will fare down the road. And the best way to ensure a great long-term outcome is to be on medical therapy, so you're reducing the further loss of hair and you're increasing the overall fullness of your hair. And that usually is the best way to maintain your surgical results for a long, long time. But for patients who get a hair transplant and they don't want to be on medical therapy, for example, we just don't know how they will fare down the road.
Now, let's get into some of my own personal clinical examples so we can see some of this crown hair restoration come to life. My first patient actually came to me initially for a frontal scalp procedure, and we featured his result on our website that we'll show here. And then he came back saying, "Hey, I'd like the rest filled in as well." So he had a starting density that was very weak, as you can see here. And the area to cover was quite large. So we went in for a 2800 graft procedure. This is now, remember, his second hair transplant with us, and we worked from the outside in to avoid the halo effect. And you can see that his final result, a year later, looks significantly better than where he started as far as the crown is concerned. Even though there is still some thinning occurring in the center of that crown, but it still looks like something that you would see in nature because it doesn't have that halo effect. We work from the outside in, and we closed down that crown. And with a smaller procedure, we can improve things even more for him, but he's overall quite happy with his result, and he's not looking to get a third procedure at this time.
The next patient here also came to me initially for some hairline refinement, and then came back for a crown procedure. So when you look at his crown, you can see that his starting density is rather weak, and his overall coverage area is medium-sized. So we placed 2200 grafts into that crown, and you can see his final result here. Granted, he wears his hair longer now, and he's colored it some, but you can see that this is a really nice improvement. Has it completely blocked the crown in its entirety? No. There's still some light penetration, and with a touch-up procedure of let's say another 500 to 700 grafts, we'd likely get that light penetration down significantly. But again, he's quite happy with his current outcome.
Now, here's another example of where our starting density was now a bit better than the first two examples. I would call this a medium type of density, and his overall area that we were working on to fill was also medium-sized. And the other component in this patient case is that he had thick caliber hair. So for this gentleman, we actually transplanted 4,1400 grafts into the crown, and you can see that you don't need 4,000 grafts to create a nice impact for someone. And so this was able to minimize the scarring in the donor area because look at his donor area, it looks immaculate because we didn't need a ton of grafts. And his overall crown exposure has significantly diminished. I mean, maybe there's still a little bit right at the whirl, but the whirl is always going to be the thinnest part. So he was extremely pleased with his outcome after a single procedure.
So, as you can see, hair transplant surgery is not a one-size-fits-all type of solution. It has to be customized to the individual, and more grafts isn't always better, and it's not always necessary. So forget about just focusing on the graft count, and make sure that your surgeon is doing a lot more about strategizing about what is best for your specific scenario. I hope this shows you some of the promises and the limitations of crown hair restoration. All of hair restoration starts with adequate planning and the proper strategy to optimize patient outcomes, and I hope this presentation showed you all the importance of setting realistic expectations when it comes to crown hair restoration, especially as it compares to doing work at the hairline.