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April 22, 2020

Hair Transplant – Crown Area

​The Weakest Link

​The crown or vertex area of the scalp is often the first place male pattern hair loss occurs. It starts off incidiously. At first, it looks like the whorl at the back of the head is expanding in size, it can be very subtle. A whorl is the part of the scalp, usually towards the back and top of the scalp where hairs radiate in a spindle-like direction. In other words, the hair direction are ever-changing in a circular manner. This always forms the weak spot of the scalp, as light easily reaches the scalp and it is more difficult for the hairs to cover. In most cases of male pattern hair loss, the crown is affected to a certain degree.

With time, the area slowly expands until a point someone starts to notice. Usually it is a loved one, a friend or your hairstylist who first notices it, rather than the patient himself. Why? This is because the crown area is difficult for the individual to see, unless with a mirror or when the hairstylist shows them the back at the end of a hair-cut.

​Crown Area - The Most Difficult To See And Tedious To Treat

​Before long, it becomes almost an obsession to constantly check on the balding area at the crown, and this is made worse because it is not so easy to see or take photos of the top of one’s own head. Sometimes, my patients complain that in a lift, that is the time they notice their balding crown on the lift’s ceiling mirror. In other instances, some see a photograph of the back of their head and are concerned at the rapidly expanding bald area. Taller people tend to have it better as it is harder for others to see.

​Options to treat this problem include medication like finasteride or dutasteride, hair growth sprays, hair growth lasers and even hair supplements in mild hair loss. For those that have significant thinning, a hair transplant may be the most effective option.

Only​ Experienced Doctor​s To​ Do Hair Transplant On Crown Area

​Hair transplant is a minimally invasive procedure to move healthy hair shafts from the abundant area at the back and sides of the head, to the needy areas. In this case, it is to the crown area. However, only experienced doctors should attempt to work on the crown as this is known to be a technically difficult area to treat. Some hair transplant doctors make it a policy to not do hair transplant to the crown because it is easy to get it wrong and even harder to get it right.

​What ​Makes Transplanting Hairs To The Crown Area Challenging?

  1. ​Firstly, the hair directions are constantly changing in a spiral fashion. This makes planting the hairs at the correct angle and direction highly tricky. One must have the relevant experience and training in order to create a natural result, not damage surrounding existing hairs, and also to ensure good graft survival.

  2. Secondly, the area involved is usually quite large. This means that quite a lot of grafts may be needed, and it takes experience to know exactly how many grafts will give an optimum result. Very often, we find that the crown area was under-treated elsewhere, leaving a suboptimal result.

  3. Thirdly, there are usually a lot of pre-existing hairs that have not thinned yet. This means it is possible to damage the existing hair shafts, while planting the new hair. This is known as shock-loss. And if it was poorly done and many existing hairs are damaged during the transplantation, it can result in permanent scarring and permanent loss of hair to the area, making it worse than before the hair transplant.

  4. Another problem is that the area may not have stabilized and is still expanding in the balding area. This means that we could plant hairs in the balding areas today, but the area might become larger over the next few years. It takes experience to know when is a suitable time to transplant hairs to the crown area.

In general, it is important to take a detailed history and family history to get an idea of where the thinning might lead to, considering factors like the age of the patient, first onset of hair loss symptoms, current hair loss condition, how the surrounding hairs look under a magnified hair scope, whether there are sufficient donor hairs to fill in future areas of balding, etc. The list goes on and on in the consideration and planning for the hair transplant. As a very general guide, we find that best time to consider a hair transplant is in the late 20’s onwards and only when we have exhausted other options.

The best assurance against future balding or progression of hair loss is to be on a proven maintenance programme for the hair. We take great pains to explain to our patients the importance of preventing further ​hair loss, maintaining and strengthening existing hairs. This is the best advice for patients who are concerned if they may lose more hair in time to come. We also choose our patients carefully. The patient should not be under 30, have a good donor density and area for harvest for planning purposes.

​Crown Hair Transplant Most Common In Balding Men

​While the crown area is a very common area to experience balding in men, it is an area that is challenging for all the reasons mentioned. With proper planning, judicious use of an optimum number of grafts, it is possible to have a very satisfying outcome for transplant to the crown area. We have been performing hair transplants for more than 12 years, and are happy to report that most times, the outcome is very predictable, natural and long lasting. If you are considering a hair transplant, always ask to see the doctor’s work before deciding if you are comfortable to proceed with a hair transplant. We have a large portfolio of “before and after” photos for you to make an informed decision on the quality and volume of our work.

​The best crown that you can wear, is the one you never have to take off.
​Think Hair, Think Dr. Harold

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