When is it the right time to begin transplanting the crown area ?

[Guest tim]

I'm 28 and have been thinning from my crown to frontal area since age 19. I began using minoxidil at age 19 and it seemed to minimally stop my hair loss (but loss was still evident ie.shower,bed pillow and brush). However, when I started using Propecia at age 24, my hair no longer fell out. It took 2 years for the hair loss to halt after beginnig Propecia (unlike the time interval Merck suggests - 1yr.). It was well worth the wait and $. Now to my dilemma. I have received approxiamtely 2000 FU's in the hairline and frontal region and it looks great! I want to start transplanting in the top and crown areas to provide more coverage in these areas . I'm scared if I do so that I may not have enough donor hair if I begin losing hair in the front again. Any thoughts or experiences? Please take into consideration that my hair loss seems to of totally halted due to propecia before you comment.

[Guest tim]

I'm 28 and have been thinning from my crown to frontal area since age 19. I began using minoxidil at age 19 and it seemed to minimally stop my hair loss (but loss was still evident ie.shower,bed pillow and brush). However, when I started using Propecia at age 24, my hair no longer fell out. It took 2 years for the hair loss to halt after beginnig Propecia (unlike the time interval Merck suggests - 1yr.). It was well worth the wait and $. Now to my dilemma. I have received approxiamtely 2000 FU's in the hairline and frontal region and it looks great! I want to start transplanting in the top and crown areas to provide more coverage in these areas . I'm scared if I do so that I may not have enough donor hair if I begin losing hair in the front again. Any thoughts or experiences? Please take into consideration that my hair loss seems to of totally halted due to propecia before you comment.

[Dr. William Parsley]

I would advise against transplanting the crown area at your age. Even though Propecia is a valuable drug, you never know what the future will bring. Maybe it will stop working for you, maybe side effects will develop, maybe you just want to quit. If you stay in the frontal and midscalp area, you are relatively safe- but if you work on the crown, you could be asking for trouble later.

I tell my people that losing hair in the front hurts your appearance, but losing in over the crown just hurts your feelings. You should never forget the number one goal - keep it natural. The crown can become the "black hole" for grafts because it can get surprisingly large.

If you stay in front of the area in the anterior crown where the scalp changes from horizontal to vertical (we call it the vertex transition zone) then you will be much safer and still have a nice looking head of hair.

In my opinion it is still a little early to trust Propecia protecting you for the rest of your life.

[Guest AP]

Dr. Parsley,

 

I'm in a similar boat as the poster you answered except that I haven't had grafts placed in the front, it's just noticeably thin but if combed right not a major problem. I've been on Propecia for six months and other than the initial shed haven't lost ground since.

 

So I've thought a little about surgery but I found some of the top docs weren't saying the same thing about where the crown starts. Is it the highest point on the skull (behind which the skull slopes downward), is it the place where the hair changes direction (from going front to going down the back), or is it something else? I'd just like to be clear what it is that people mean by the crown (or vertex, the two are used in each other's place so often).

 

Thanks in advance for your answer,

AP

[Guest]

First of all I would like to that I agree with all comments that Dr. Parsley had. It is more important to finish grafting the frontal area and then move towards the top and crown areas if you have enough donor hair available. The frontal area will always be important, defining your immediate appearence. The crown area will eventually lose some of its importance as a person ages. Some physicians define the crown area as the region posterior(behind) to the vertex(highest point of head). However other physicians have different definitions. The important issue is that you and the doctor you are having discussions with reguarding hair loss and possible surgical hair restoration are on the same page as to where these areas are located.

[Dr. William Parsley]

Unfortunately, the definition of the crown is a little vague. Whereas, vertex means "highest point" or "top of the head" - in reality it is considered synonymous with crown by nearly all transplant doctors. You are right, in my opinion, that it starts at the area where the skull starts sloping downward. If you follow this area with a pen, you will get a curved line that is concave when looking from behind the person.

Normally this line, the "vertex transition zone" is about an inch or more in front of the middle of the center of the whorl for the crown. Usually this center of the whorl is about the center of the crown. The purpose of the vertex transition zone is it is a useful area for ending the transplant for people who don't have enough hair to transplant the crown. Of course, this zone changes in people so it is not a hard and fast ending place. Nearly all agree, however, that you don't transplant below the center of the whorl unless you are going to continue to transplant he crown. Personally, I line to stay safely anterior to this point.

Hope this helps. I may try to post a picture of these landmarks sometime in the near future.

Dr. Parsley