Is it ever a good idea to do HT on your crown?

[noobineub]

Hi guys, my question is 'Is it ever a good idea to do HT on your crown?'

 

If your hair is receeding and if it is thinning on that area, wouldn't it make it worse if you go ahead with a HT and risk having shockloss?

[raulbrammin]

It is quite possible noob... although I have had a mega sesssion with dr. radha, I am expecting the chance of hair going into shock, or catching folliculitis. But I know she has done a good job so it will be a good base to move ahead with another transplant in the future.

[Shampoo]

Hi guys, my question is

'Is it ever a good idea to do HT on your crown?'

 

Yes many times it can be a good idea to transplant hair into a crown,

but success can depend on lots of things.

 

Depends on your age.

Depends on what your over-all hair loss level is.

Depends if you are willing to take meds post op.

Depends on how much hair loss you have elsewhere.

Depends on your donor hair supply.

Depends on your budget.

 

Crowns can eat up a lot of limited donor hair, so one must be careful. Each case is different and a proper assessment can be made by a top notch hair surgeon as to whether you are a good candidate for a crown hair transplant. Many of the top notch surgeons achieve great crown results on the right candidates.

[Dr. William Lindsey]

Shampoo summarized it quite nicely and in particular his concluding paragraph summed up my philosophy a little more politely. I think crowns are a black hole that can suck up all available hair and still only give you improvement...rarely perfection.

 

I encourage people to worry about the front, which is what everyone else sees, and only deal with the crown if they are not likely to lose significant hair up front.

 

We do about 8 crown cases a year out of 120-130 cases, but I'd bet that 20% of patients walking in initially bring up the crown as their primary concern area...only because they see it in pictures.

 

Out of that 20% half come to understand my reasoning on the front. A third say they only want the crown, and if they are a reasonable candidate I'll offer them surgery, and the remainder often say they have seen someone else who says they can "do the entire head" at one time...and I never see them again.

 

Dr. Lindsey McLean VA

[scar5]

Interesting notes Dr. Lindsay,

 

I wonder if you have noticed a trend over time - and this has to do with acceptable fashion trends viz-a-viz willingness to buzz cut etc.

 

Have you noticed that for older patients consider 'framing the face' to be most important and that younger men are more concerned with the dreaded 'donut look' - the hole appearing in their crowns.

 

Since the 90s, when buzzing became acceptable for a bank clerk, it seems that receding hairlines are less important and that an empty crown is more important. Of course individuals differ and age makes a difference as does the need to have a good front on 'facebook' picture.

 

Still, I can't help thinking the crown will become more important and that you are losing a lot of customers by suggesting that the crown is less important.

 

In my personal case, I have found that come operation day, many docs shy away from the crown by suggesting that shock loss will kill what little minaturizing hair is still hanging on in there. Even so, they suggest elsewhere, that shock loss is temporary. Seems they are hinting to me that permanent shockloss in crowns is a major concern.

[noobineub]

Just to revive this thread again because again I am contemplating getting a HT on my crown. It has been 4 years since this thread and my crown has definitely thinned albeit slowly. But it is at the point where I want to do something about it. I agree with you scar5, to me the crown is more important than a receding hairline. I have consulted a HT doctor and he seems reluctant to do crown HTs too and instead recommends Finasteride and Minoxidil as a solution. But from what I've read, both medications are basically a roll of the dice, works for some, doesn't for others, so I want to stay away from them and don't want to take the risk.

 

So for crown HTs, what's the best technique? The doctor I consulted harvests using strip and then uses a hypodermic needle to make the incisions for the recipient area. This is something new that I haven't read about before, anybody can comment on this?

[Shampoo]

How old are you now?

 

How much loss do you have elsewhere?

 

Do you have good donor supply?

 

How large an area is thinning that you are calling the crown?

 

How many grafts roughly do you think you need?

 

And remember without meds the non-transplanted areas

of your crown will most likely continue to bald.

 

Any chance you can block your face but provide a crown pic and the overall head so better advice can be given.....

or if you dont wish to post your pics, maybe find a similar guy with roughly the same hair loss on one of the dr sites?

honestly it's difficult not seeing anything.

[Al - Moderator]

I encourage people to worry about the front, which is what everyone else sees

 

It is silly to think that people only see you from the front. Are you trying to tell me that nobody sees me when they are sitting behind me on a bus, train, theater, etc? Are you saying nobody is ever walking behind me? What about when I'm with a large group at a party, club, or other function. There are people all around in all directions. Do you really think they only see me from the front? That is so dumb to even suggest that. Of course the crown is important! People DO see it.

[Shampoo]

It is silly to think that people only see you from the front. That is so dumb to even suggest that. Of course the crown is important! People DO see it.

 

Dr. Lindsey is anything but dumb.

 

In hair transplants many times you have to make hard choices.

 

In many cases there is not enough donor hair to cover everything.

 

So doctors suggest where they can be more sure of a long term successful outcome.

 

Respected doctors feel when people are face to face they obviously see the other person's face. Most in person important discussions with other human beings is face to face.....so doctors knowing they can have great success framing the face with a hair transplant usually advise doing a "home run" of framing the face at least first. A crown many times can be less predictable and be a larger area to cover that keeps growing and eating up lots of donor hair.

 

So sure the crown is seen, but most doctors I have studied feel that long term a patient will be happier with a framed face vs a solid less predictable crown, but even Dr. Lindsey states he does do the crown if that's what the patient prefers after being educated to what that really means.

[mahhong]

It is silly to think that people only see you from the front. Are you trying to tell me that nobody sees me when they are sitting behind me on a bus, train, theater, etc? Are you saying nobody is ever walking behind me? What about when I'm with a large group at a party, club, or other function. There are people all around in all directions. Do you really think they only see me from the front? That is so dumb to even suggest that. Of course the crown is important! People DO see it.

 

I think Dr. Lindsey is simply pointing out the realities. If you have extensive crown loss you're simply never going to have enough donor to cover the hairline, mid-scalp and crown with good density.

 

So, with limited options, which option is best? A low-density, high coverage transplant right across the bald head? That's just going to give you a pretty see through, balding look.

 

Focus density on the crown? You'll just look like you've balded at the front, and you won't really have a hairline to frame your face. It will likely look unnatural, or at best just like you're a NW3 or 4, which for most men would defeat the object of a HT.

 

Far and away the most important element of your hair, from an aesthetic perspective, is your hairline. Yes, of course people see you crown, but people will spend the vast majority of time speaking to your face, seeing you from the front, where the hairline and mid-scalp will be most important. This will also make the most impact from the most angles.

 

It's just a reality that for men with advanced balding they're never going to be able to get great density and great coverage throughout, and there's absolutely no doubt that, in that situation, you prioritise the front third of your head when it comes to a HT.

 

If you're repulsed by the idea of having thin coverage in the crown, or no crown work but a frontal third transplant, then it's probably best you just forget the entire thing. But there are some realities that just can't be ignored and the supply/demand aspect of HTs are one of them.

[GRIGRIMAN]

This is an interesting discusssion for me.

 

I had 3,000 Fue 3 years ago and opted for a conservative hairline. I chose Dr Bisanga and I'm so pleased with the outcome.

 

I have coverage in my crown but it's thinning and this discourages me from growing my hair longer so I clip my hair with a #2 (and my thinning crown no longer bothers me).

 

I have considered addressing my crown but I have decided to wait until it matures into a bald spot and when surgery will have a greater impact.

[mahhong]

Sounds like a good plan, Grigriman!

 

It's definitely possible to have decent crown coverage, especially if you've been a bit more conservative upfront and have planned properly. Sounds like if you've had 3,000 FUE upfront and you're happy, you're going to have the donor to address the crown adequately when you decide to do so!

 

The crown is also the area where concealers/SMP can help add an illusion of fullness and thickness most effectively (if you want to go down that route. You obviously need at least some native or transplanted hair to do that, but I'd say the crown is where you can "get away" with illusion the best - it's the hairline and mid-scalp where the illusion of density and having natural hair is most essential.

[Shampoo]

I have coverage in my crown but it's thinning and this discourages me from growing my hair longer so I clip my hair with a #2 (and my thinning crown no longer bothers me)..

 

I wonder since you are keeping it short and your crown is thinning if some SMP might be a "piece of your puzzle"? Once my latest transplant grows out and if my crown is still a bit thin I am planning on further investigation of SMP for my crown as one "piece of my puzzle".

 

Like this picture of crown SMP looks "too good to be true",

but even if it was half that good I might be interested.

 

 

Scalp MicroPigmentation Melbourne - Face and Hair Clinic

[mahhong]

I wonder since you are keeping it short and your crown is thinning if some SMP might be a "piece of your puzzle"? Once my latest transplant grows out and if my crown is still a bit thin I am planning on further investigation of SMP for my crown as one "piece of my puzzle".

 

Like this picture of crown SMP looks "too good to be true",

but even if it was half that good I might be interested.

 

 

Scalp MicroPigmentation Melbourne - Face and Hair Clinic

 

SMP can really make a big impact; particularly in the crown and particularly where the contrast between hair and scalp is quite high.

 

In that photo the crown is brushed forward and that, combined with the SMP, is creating the illusion of density so well. I really like the use of SMP and HTs though, when it's combined well in appropriate patients. It can make a decent density HT look full and really just help blend everything together.

[dobler]

This topic is my life at present.

 

I am NW6 young man (28), suffering hairloss since 20. It all started in crown area only. suddenly 1-2 years ago, front started receding too, and during the recent months, the whole 3rd front became very very thin.

 

Tried all sort of medications, nothing helped in long term. (Minox helped for few years).

 

My only possible solution is HT, but my hair loss is retrograde alopeica, which means very limited donor from scalp.

I spoke with few of the top surgeons that suggest me either forgeting about a HT and start living my life, or getting a ~5000 scalp + beard grafts (3500 scalp) over 2 sessions, for the 3rd frontal area only.

 

And now I find it very hard to get a decision. I am pretty sure that my hairloss will continue, and in the next couple of years I might turn into NW7. But considering funding is not a problem - what would you suggest me to do? Getting a 5000 grafts for front + mid scalp and live with the empty crown? (I will probably stay with short buzzed hair in that case)? Should I think about SMP in crown area? Or... what?

[Shampoo]

Maybe we can get David to chime since it looks like he combined a transplant and SMP with what looks like very nice results:

 

http://www.hairrestorationnetwork.com/eve/173165-dr-hasson-1755-grafts-front-smp-crown.html

[mahhong]

This topic is my life at present.

 

I am NW6 young man (28), suffering hairloss since 20. It all started in crown area only. suddenly 1-2 years ago, front started receding too, and during the recent months, the whole 3rd front became very very thin.

 

Tried all sort of medications, nothing helped in long term. (Minox helped for few years).

 

My only possible solution is HT, but my hair loss is retrograde alopeica, which means very limited donor from scalp.

I spoke with few of the top surgeons that suggest me either forgeting about a HT and start living my life, or getting a ~5000 scalp + beard grafts (3500 scalp) over 2 sessions, for the 3rd frontal area only.

 

And now I find it very hard to get a decision. I am pretty sure that my hairloss will continue, and in the next couple of years I might turn into NW7. But considering funding is not a problem - what would you suggest me to do? Getting a 5000 grafts for front + mid scalp and live with the empty crown? (I will probably stay with short buzzed hair in that case)? Should I think about SMP in crown area? Or... what?

 

It's a difficult one because SMP will only really work in one of two ways:

 

1.) Either you buzz right down to a zero guard (or even wet shave your head) and the SMP just creates the illusion of having a shaved head, with a hairline and density throughout the scalp.

 

2.) You have good coverage but perhaps the density is a little low in one or two areas (usually the crown) and you want to use the SMP to reduce the contrast between scalp and hair and create the illusion of more density.

 

However, if you have very thin hair, but you try and grow it out and add SMP, usually it will look irregular. It will just look like dark dots on your scalp, and won't match up with the places that are more dense. For example if you have a decent hairline and mid-scalp, but no real crown hair, trying to use SMP won't really work for the long hair look, it won't blend well.

 

That having been said, it might be worth getting in touch with some clinics and SMP places and getting their thoughts, as they will know best what could be achieved by combining the two. But usually SMP is good if you have very little hair and what to create the "shaved head" look, or you have fairly decent coverage and density and you're just looking to add a further illusion of density - but the middle ground between those two is harder to gauge.

[GRIGRIMAN]

SMP can really make a big impact; particularly in the crown and particularly where the contrast between hair and scalp is quite high.

 

In that photo the crown is brushed forward and that, combined with the SMP, is creating the illusion of density so well. I really like the use of SMP and HTs though, when it's combined well in appropriate patients. It can make a decent density HT look full and really just help blend everything together.

 

I did consider SMP & I had a consultation last year.

 

If I clip my hair with a #1 (3mm) I think SMP would be a great option.

 

However, I clip my hair to a #2 (6mm) & therefore I don't think SMP would be effective.

 

Please correct me if you think I'm wrong?

[mahhong]

I did consider SMP & I had a consultation last year.

 

If I clip my hair with a #1 (3mm) I think SMP would be a great option.

 

However, I clip my hair to a #2 (6mm) & therefore I don't think SMP would be effective.

 

Please correct me if you think I'm wrong?

 

I don't have loads of experience in SMP so wouldn't like to say for definite, but my understanding that SMP looks best in two circumstances:

 

1) When you shave really short (down to very short stubble) and the SMP blends with that stubble to make it look denser and more even.

 

2) When you have thinning hair but still decent density (either you haven't balded much or you've had a HT which has restored some but not all density) and you're just looking to reduce the contrast between scalp and hair and, in doing so, make the hair look thicker. In this way SMP works a bit like concealer, just creating less visual contrast between scalp and hair.

 

I don't know what a #2 guard would look like on you specifically but, yeah, long story short SMP doesn't usually work that well when your hair is short but not really really short. Usually it will just look like dots in and around your follicles, and there won't be enough to blend with, but too much to create the shaved look. I've seen a few men go for the "buzz" look with SMP and it doesn't always look bad (and is probably pretty convincing at a glance in some cases), but generally speaking it's not the best use of SMP. I think you either need to use it to create a very short shaved look, or have some density and length to your hair and use it as a camouflage and a sort of long-term concealer that doesn't wash out.

[noobineub]

How old are you now?

- Hi Shampoo, to answer your questions, I'm currently 40.

 

How much loss do you have elsewhere?

- I used to have receding at the temples. I say used to because it receded and it stopped and I also had a HT to address that.

 

Do you have good donor supply?

- I would think so, I have had only on HT so far for my temples.

 

How large an area is thinning that you are calling the crown?

OK, these cases are pretty much similar to the stage I'm at:

 

http://www.hairrestorationnetwork.com/eve/136488-photos-crown-anyone-pretty-darn-fast-growth-crown-dr-feller.html

 

https://www.baldtruthtalk.com/threads/3728-32-year-old-thinning-in-crown-considering-HT-pics-attached

 

How many grafts roughly do you think you need?

- Not sure, I'm guessing somebody could tell me a more accurate figure from the cases above?

 

And remember without meds the non-transplanted areas of your crown will most likely continue to bald.

 

- OK here's a little more background about myself, I'm 40. My history of hairloss started in my mid20s, around that time I had noticed that my temples were starting to recede. It wasn't aggressive, rather it was quite gradual. By my early 30s my temples had receded to point where I had a HT done to address it. And so far the receding has not gone any further. I had waited a few years to get the HT because I wanted to monitor how fast I was losing hair. So for my crown, I started noticing it starting to thin at around 5 years ago and throughout the years it has gradually thinned out until its current stage. So my own self prognosis is that my hair loss is quite gradual. Also going by my family history, my dad only started to thin around his crown only 4 years ago and he's now 70, and I'd say he's currently an early Norwood 3 vertex.

 

And that is why I thought I would be able to do a HT and not do meds as I do not think my crown will lose much more over the years. Of course I understand everybody's hair loss is different, even within family. Like the other relatives on dad's or mom's side have no hair loss whatsoever but my own does (my mom's hair also started thinning only starting 2-3 years ago and she's 65). I hit the genetic jackpot I guess .

 

Any chance you can block your face but provide a crown pic and the overall head so better advice can be given.....

or if you dont wish to post your pics, maybe find a similar guy with roughly the same hair loss on one of the dr sites?

honestly it's difficult not seeing anything.

 

Thanks also to the rest of the guys for continuing this discussion If there's anybody out there who has done work to their crown and not taken meds, please feel free to chime in. I'd definitely like to hear your experience.

[Shampoo]

noobineub....going by the pictures you provided that mimic your crown loss I would think you would be quite pleased with 1500 -1800 grafts into your balding crown. And since you anticipate further crown loss a 1500-1600 graft session now should hopefully leave enough donor hair to possibly have another crown procedure in 10 years when you are in your fifties. Thinking ahead you do have to consider that even-though you've already had a frontal procedure....ten years from now without meds it is likely the frontal area may need more grafts to thicken things up again. So save enough donor grafts for frontal and crown "touch-ups" in your fifties.

[Qneedhair]

Unfortunately, people do see the back and I get snide comments like...hey dude, you're getting thin in the back or hey man...you're going bald! Why people want to address it in such a rude manner has been getting to me and I am going to have something done in a few months.

 

I have been using concealer and I get zero comments but still, I'm going to get my vertex done to match the rest of my head. I'm approaching the big 50 and the rest of my head has remained intact thankfully...except the crown. I want to feel comfortable again in public and ditch that concealer!

[Qneedhair]

I wonder since you are keeping it short and your crown is thinning if some SMP might be a "piece of your puzzle"? Once my latest transplant grows out and if my crown is still a bit thin I am planning on further investigation of SMP for my crown as one "piece of my puzzle".

 

Like this picture of crown SMP looks "too good to be true",

but even if it was half that good I might be interested.

 

 

Scalp MicroPigmentation Melbourne - Face and Hair Clinic

 

SMP looks good but what happens when your hair turns gray? the black dots will look strange right? Or do you plan on coloring your hair forever? Just wondering.

[Shampoo]

SMP looks good but what happens when your hair turns gray? the black dots will look strange right?

Or do you plan on coloring your hair forever? Just wondering.

 

Qneedhair good question....I am not sure how SMP deals with graying hair and

I've also wondered how concealers like Nanogen deal with graying hair in all colors?

 

BTW has anybody ever tried this concealer?

It looks effective, but also appears very pricey.

 

 

 

http://www.haircubed.com/gallery

Edited July 19, 2016 by Shampoo

[mahhong]

Qneedhair good question....I am not sure how SMP deals with graying hair and

I've also wondered how concealers like Nanogen deal with graying hair in all colors?

 

BTW has anybody ever tried this concealer?

It looks effective, but also appears very pricey.

 

 

 

Haircubed Gallery

 

You can get grey Nanogen fibres (and other brands too). Although I've never done it, I'm led to believe you could simply use your natural hair colour fibres (say brown, for example) and then sprinkle in some grey as well and spread them across. Might not be perfect but it could help with the illusion of greying hair.