Crown movement?

[NervousNelly]

I'm not sure as to why I thought of this question and I might know the answer myself, but I thought I would put it out there and see if there are any other viewpoints.

 

When the surgeon removes the strip, and then sutures the incision, does the crown move downward?? I assume that because the main insertion area for the skin and underlying tissue is at the nuchal ridge, that the scalp will move downward.

 

If this is accurate, does that mean that an individual with say 3 surgeries now has his crown lowered towards the neck approx. 4 centimeters? That seems like quite a difference. Did I explain my question well?

 

I guess the reason that I ask is that my concern has always been the frontal area (which I believe it should be for most people) because unless I bend over or someone is taller than me, my crown bald spot is not really visible. As I progress with other surgeries though, I guess that bald spot might become slightly more noticeable from behind? I think you get what I mean.

[NervousNelly]

I'm not sure as to why I thought of this question and I might know the answer myself, but I thought I would put it out there and see if there are any other viewpoints.

 

When the surgeon removes the strip, and then sutures the incision, does the crown move downward?? I assume that because the main insertion area for the skin and underlying tissue is at the nuchal ridge, that the scalp will move downward.

 

If this is accurate, does that mean that an individual with say 3 surgeries now has his crown lowered towards the neck approx. 4 centimeters? That seems like quite a difference. Did I explain my question well?

 

I guess the reason that I ask is that my concern has always been the frontal area (which I believe it should be for most people) because unless I bend over or someone is taller than me, my crown bald spot is not really visible. As I progress with other surgeries though, I guess that bald spot might become slightly more noticeable from behind? I think you get what I mean.

[nobuzz4me]

That is a great question NN, I am only guessing, but I think the crown would move little to none and the nape of your neck would do the moving upward. Anybody???

[Bill - Seemiller]

Nervous,

 

Interesting question. I'm honestly not sure of the answer. I would venture to say there is some overall scalp movement since the skin is being stretched, but I would guess there is more impact on the donor area than the recipient area. I would venture to say there is some overall movement, but if you picture pulling on anything that is lax there will be more movement in one area than other.

 

Take your arm for example. On the front part of your forearm, take your thumb and your pointer finger and spread them about 4 cm apart. Now squeeze them together. If you look at the area you squeezed, you now have a big clumb of skin in between your fingers. Now try it again. This time look to the right and left of the fold. The skin obviously stretches. But the further away you are from the fold, the less it moves. So I would venture to say that the crown does move a little, but hardly 4cm, just as below the donor area, it also stretches, but hardly 4cm. Even if you don't take into consideration what I just said (the further away from the donor area, the less stretching that occurs), if a 4cm strip was taken out, you would still only have 2cm of movement in the crown and 2cm of movement below the donor area. But since one must take into consideration what I said above...I would suspect, there's very little difference and surely nothing obvious. a 4 cm strip (btw) is HUGE, and as far as I know, it would be rare that anyone would have that much removed at once. Though taking into considerations multiple surgeries, surely that much may be removed.

 

I hope this helps give a laymen's explanation...though I'd be curious what a doctor has to say.

 

Bill

[Guest]

The area that is stretched in order to bring the edges of the incision together obviously includes areas of scalp below and above the incision, possibly including areas beyong the donor area, into bald areas. Where there is hair, the density will be reduced. Where there is no hair, that area will become slightly stretched (larger). Since I chose to use almost all of my grafts to achieve more density on top, I had few placed in my crown. My (nearly) bald spot in the crown is definitely larger than it used to be, after three transplants. The rest of my donor area is also sparser than before. I was not warned, but I kind of expected it. There is no free lunch. I think that this is something that should be discussed more openly.

[the B spot]

On a properly placed incision, most of the tissue is pulled upward from the nape, lessening the crown movement downward.

 

For example, an incision can be made right at the bottom of the occipital protuberance (the little bump in the back of your head in the middle) but when the incision is made, the incision (scar) should sit right at the top of the protuberance or just above it.

 

Obviously, removing 3-4 cm of tissue is going to shift your scalp around a bit, but it is not like a scalp reduction......

 

I will try to get some more info on this after this weekend....

 

I think I have this right, but I want to be 100%.

[NervousNelly]

I appreciate the responses. I would guess that you are going to get the most give when pulling from the area with the most surface area which would be the scalp as there is less surface area on the neck. Plus, it would tend to pull from the insertion area being the nuchal ridge (kind of where skull meets neck) I guess though what I have to remember is that it does stretch because of elastin fibers and maybe reverts back to original area, so therefore in the end, MAYBE THERE IS ACTUALLY NO MOVEMENT AT ALL??? Are you aware that the entire scalp and face can actually be removed like a mask? Not that there is any relevance to that statement, but just wanted to freak some people out.

 

I did send a PM to a couple of docs to see if they could respond.

[nobuzz4me]

Yeah, if you have ever watched a major facelift procedure done on TV it is pretty gross. My HT surgeon does this as well as HT and I asked him which is harder too perform. He said not to discount the difficulty of a HT, but that facelift is much more intense. The patient is put under anesthesia which can be tricky in itself and any damage to a facial nerve will result in a permanent paralysis. Very tricky compared to HT. I will stick to gaining hair and not worry about wrinkles!!!

[Bill - Seemiller]

Are you aware that the entire scalp and face can actually be removed like a mask? Not that there is any relevance to that statement, but just wanted to freak some people out.

 

Ok, I'll warn the faint hearted...the first paragraph below is a little graphic.

LOL...yes, occasionally I watch the medical/surgery channel and I've actually seen some scary things. There was one girl who had her entire face get ripped off because her hair got stuck on some machine. They surgerically tried to sow her face back on...not too bad of a job considering, but she looked far from normal after that.

 

I would venture to say there has to be some movement, otherwise if not, the scar would get just as wide as the donor strip that was taken out. There has to be some movement, but I still doubt as if there will be anything real obvious, at least not negatively. Looking at some before/after pictures, it does seem obvious that there has been some movement...even after my third surgery, I feel my eyebrows are up a little higher since there was a good amount of pulling. Ironically, however, I feel the look had made me look yet a little younger. LOL. So I got an HT with a free facelift .

 

Bill

[endoftherope]

So is the hairline moved back a little as well?

[Bill - Seemiller]

endoftherope,

 

possibly, but again, if that moves at all, it would be so very little I doubt anyone would notice. See my analogy above.

 

Bill

[nobuzz4me]

I asked my Dr. on this and he said there is initial movement but the scalp, over time, stretches back to its normal position. The donor region, is of course, thinner as a result of the strip taken.

 

I recall guys who have had scalp reductions done (barbaric), their sides pulled up after the crown was reduced and sutured. Many of these guys scars stretched as the sides returned back to its normal position. Thank God this is rarely done anymore!!

[Bill - Seemiller]

Nobuzz,

 

I'm not sure how the scalp can really return to normal position...maybe it does a little bit...but if you think about it...it can NEVER be in normal position again...otherwise we'd have 3cm scars to make up for the strip that was taken out. But I'm sure the scalp does move back a little bit overtime, but it can never be exactly the same.

 

Bill

[Salt-N-Peppa]

I think of the scalp stretching like a rubber band. Initially after a HT the scalp feels incredibly tight but loosens enough after a few weeks that you really don't notice it much.

( maybe a balloon analogy would be better?)I guess the trick is to not break the rubber band!!

S-n-P

[FacelessMan]

Innnnteresting...

 

I'm going to infer/assume that good surgeons, when evaluating "scalp laxity" and determining the scope of a given procedure, take into account not only the number of grafts a given scalp will allow them to extract, but the safest strip that they can excise without causing undue stretching, tightness (and related discomfort), and of course scar distortion, later on...

 

"Scar Distortion"...sounds like a good name for a retro hardcore band...

 

Or maybe "The Screaming Follicles"...

 

Benjamin "Plastic Man"

[Salt-N-Peppa]

You got it right----the honest, ethical and skilled Doctors look at your laxity first. Then they can estimate your hairs density under magnification to yield an approximate number of donor hairs. BUT, this is just an educated guess on their part. The client then makes their wish list of where the donor hairs should go first, second... The less than ethical Doctors ( and I unfortunately visited a couple) promise to give you a full head of hair without even checking your laxity. If you have no laxity there can be no donor strip. Typically they over promise and under deliver.

Safety is paramount to me, I wanted as much donor strip taken as could safely, without stretching, be done. I mentioned in an earlier post that I was disappointed that my second HT yielded about 500 fewer FU's than I had hoped for, but this disappointment is temporary....I trust completely the skill of Dr Hasson that safety could be compromised had he tried for more FU's. Why risk safety or scarring??? I'm sure that most of Doctors that are typically mentioned on this forum adhere to these same high ethical standards. Cheers

"Rubberband Man"---(thats a late 70's-early 80's song)

[nobuzz4me]

Yes, laxity is probably the key to take a safe strip. The tightness you feel after HT does go away in a couple of weeks and some laxity is restored. I actually think some of the tightness can be attributed to swelling, I know I had swelling in the donor area and even wondered if that was going to stretch my scar formation! I guess your sutures hold till the swelling stage is over.

 

Bill, I agree the scalp never really returns to normal, perhaps I used the wrong term. My Doc says when all is settled down the movement will not be signifigant enough to notice.

[panther5000]

If I am not mistaken they pull from the neck up and not the crown back to close the donor area.

[NervousNelly]

 

Seems like we have mixed thoughts but I will have to go with NOBuzz on this one as it came from opinion of his doctor.

 

Panther--I think that there is much more rigidity from the incision downward. I would guess that the majority of movement takes place in the opposite direction as they pull from the scalp down primarily. More tissue area equates to more stretchng ability. Or as S&P stated--more elastic band the farther it will stretch. Does that make sense?

 

I'm going with that unless proven otherwise.

[tkerr22]

To throw in my two cents here, and having 3 HT's I would say they pull more from below the scar than above. My reasoning for this is my hair below my scar is thinner than my hair above the scar. My hair above the scar is as thick as ever but my hair below the scar has thinned some from the HT's. Just sounds more sensible to believe that they stretch it more from below than above. But like I said, just my two cents.

[nobuzz4me]

tkerr,

 

I agree, that the neck is pulled higher the the crown pulled down, it may have to do with the scar being below the nuptial ridge. Maybe that keeps the crown from moving as much.

 

I looked at your webblog and you are coming along nice. Should look great for Spring/Summer. If you could get Dr. Alexanders thoughts on this question we would love to hear from the experts on this. Thanks,