What sort of end result is possible in terms of density for a patient whose hair loss is only affecting the crown?
You have to be careful. The crown (vertex) can be a dangerous place for hair transplants. If you are in your 20’s, I firmly believe that the crown should never be transplanted during that age range. If one is in his 30’s, then I think any coverage done there should be on the “light” side without maximal density. The reason is that often in a man with androgenic alopecia (male pattern baldness), the borders of the crown can expand, such that the square area of the crown zone increases logarithmically. If a younger man has this zone filled in densely, there is the danger that 10-20 years down the road there could be a 1-2 inch wide “halo” of bald skin around it, which is a very unnatural thing.
I have seen many of these from old hair transplants. Light coverage, on the other hand, fans out in the whorl direction typical of the crown’s hairs. If the crown enlarges, they simply fan out a little further to help cover that bald area and it isn’t that hard to find some donor hair to fill that space in to match the density of what is already there. But with a dense central part of the crown filled in, you then have to match that extreme density, which is usually impossible to do in the face of a shrinking donor area.
For men over 40 with a small to medium size crown and ample donor stores, I do think it is possible to “dense pack” and go for it. It is ideal, when doing so, to only do that area, as then the blood supply to the area is very good, without other recipient holes in the front compromising that area’s circulation.
Returning again to the younger male, many of them only have hair loss in the crown at the time they see the hair restoration physician. But, many of them go on to lose the hair on top and in front later on, which is always a more important area to fill in. That is another reason for not using up a large amount of the donor hair in the rear crown.
To give an extreme example, the photos here are of a 45 year old man that came to me many years ago, who, at the age of 25, had the small hole in the back that was bald filled in with the grafts that were used at that time, which happened to be the large plugs. As you can see, during those 20 years his crown expanded and a huge halo resulted. The second photo shows the result after I removed all of these grafts and placed FU’s at the upper border.
So the message is: Be careful what you wish for. Be conservative in the crown, especially if you are younger.
Mike Beehner, M.D.
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community