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The Crown problem: experts' opinions much appreciated


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  • Senior Member

I just came back from a consultation with a top Dr that I respect. He brought me very bad news that made me pretty depressed. I am not sure I agree with his ideas about what is most aesthetic though, and thus my question.

 

I am currently somewhere around Norwood IV , in the long run will be heading to type VI it seems like it. I am 34.

 

I want to hide the crown because I think it is UGLY! Since I know I will not have enough donor to cover everything on top, I am fine in the future to start from a receding hairline and NOT try to have a low hairline. My best bet is to try to look like Type 3 in the future.

 

The doctor won't operate on me UNLESS if I go for a hairline and completely forget about my crown. He said that it is MORE normal to have a full top/hairline but empty crown than full crown with empty top. I am not sure I agree since type 3 is common. Given my preferences how about instead, using these 4K grafts I have available to instead go for crown now, and when I start thinning more I go for a MUCH lower hairline so I try to look like type 3 instead of looking like female pattern baldness (full hairline, and bald top/crown).

 

Why is it that surgeons prefer to work on the hairline rather than devise a plan according to something less aggressive on top but more aggressive in the back of the head. I do not want to live with a a balding crown.

 

My pictures are here (look much worse than what people see, since wet+flash):

 

http://www.hairrestorationnetwork.com/eve/172505-crown-fue-looking-advice.html

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  • Senior Member

First, did he tell you that you one had 4k grafts? That is not many. Second, I think your crown may bother you most because you don't know what you will look like with a bald frontal third. Seems like you have 3 options. 1, not have surgery, 2, look for another doc, 3, have the surgery that the doc approves of. Good luck man.

I am an online representative for Dr. Raymond Konior who is an elite member of the Coalition of Independent Hair Restoration Physicians.

View Dr. Konior's Website

View Spanker's Website

I am not a medical professional and my opinions should not be taken as medical advice.

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Yeah, I've always wondered about the same thing. For me (NW6-7) it also made more sense to go back to NW3-4, but all the doctors I talked to advised me to address the hairline first. It is true that the hairline frames the face and that it is what most people see when talking to you. On the other hand a youthful/NW1 hairline thinning towards the crown looks very unnatural to me (although not unheard of, like Zidane). I tried to find a middle ground by asking for the highest possible hairline ("conservative" in the HL lingo), but I have yet to see how it will turn out at the end.

Edited by abcd0000
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  • Senior Member

The problem with crown restoration is two-fold. First, because of the position of the crown, the way light falls on it, and the angle of the hair, it's much for difficult to conceal baldness there than in the front. Second, crown balding usually signals advanced loss to a much greater degree than isolated frontal loss.

 

From your pictures, you seem to have acceptable coverage, but there appears to be miniaturization across the scalp. Obviously, that's bad.

 

You're fairly young, so I think you will benefit greatly from coming advances, but I don't think you're a good transplant candidate at the moment.

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  • Senior Member
Second, crown balding usually signals advanced loss to a much greater degree than isolated frontal loss.

 

 

I see isolated loss in the crown pretty often, just as I see isolated frontal loss (not quite as often though). The problem is that it seems that over a long period of time, the two often meet. That said, hair loss is so random. Loss comes at all kinds of shapes, sizes, final patterns, long stalls, etc. It really is pretty unpredictable.

 

After looking at the wet crown photos, I would agree with the assessment that he does not make a great HT candidate, even given his age, which is pretty HT appropriate.

I am an online representative for Dr. Raymond Konior who is an elite member of the Coalition of Independent Hair Restoration Physicians.

View Dr. Konior's Website

View Spanker's Website

I am not a medical professional and my opinions should not be taken as medical advice.

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  • Senior Member

I addressed my hairline and crown with my first HT via 3200 grafts. Then my hairloss progressed and I was left with an island of hair in the crown area. This is not a good look and there's little you can do to style it. So, I went for another HT (2300 grafts) and hit the areas around the crown and bolstered the remaining areas.

 

You look like you have a great deal of crown loss. If you concentrate 4k grafts there it will look very odd when you lose everywhere else. If you are not currently taking meds I suggest you get on meds for a year first (Finasteride, Minoxidil).

 

Then I would recommend 3 possible HT strategies:

 

1) Rebuild the hairline (conservatively) and address the frontal areas. You can grow that hair longer and get some coverage towards the back.

2) Rebuild the hairline (conservatively) and go for light coverage everywhere else.

3) (This is basically what I did) Rebuild hairline, reserving a substantial amount of grafts for the crown and plan for a follow-up HT to hit the middle/front section when it fails.

 

Also, I wouldn't stop at just one consult. Different doctors have different approaches and it's worth exploring several options.

I am the owner/operator of AHEAD INK a Scalp Micropigmentation Company in the New York area. AHEAD INK is a Milena Lardi trained clinic and uses Beauty Medical Tricopigmentation equipment and products exclusively.

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  • Regular Member

Have you consider a doctor who will use body hair? We were suppose to hear news of scar less FUE last month, but I haven't hear anything. If your beard looks a lot like the hair on your head it could possibly provide you with enough hair to do your crown in the future.

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  • Senior Member

Prof101 the crown has traditionally been always thought of as a problem area, because it can eat up lots and lots of donor hair as the balding crown gets larger. There also must be enough donor hair that allows some balance between front and back. Down the road you don't want to end up with a thick "pony-tail crown" with everything gone around it. Because of the challenges a crown presents some surgeons are still very reluctant to do much crown work. I have a friend that is a tech at a full-time hair transplant clinic and she says the doctor practically will not do crown restoration. Of course there are several top clinics that do routinely work on crowns.

 

The crown really depends on a lot of factors. The patient's age, donor hair available, defined pattern/predictable future, is patient on meds, is patient aware more work will probably be needed down the road, ect...

 

I would say at your age and the looks of your pictures your future hair-loss may not be as predictable as one would like. If you are not on meds and begin to have a more rapid balding phase as you enter your late thirties and forties you could run out of scalp donor hair. Sure you could "solve" the crown now, but it's hard to say what your level of loss will be in ten years when you will still be relatively young.

 

I am older than you, but I am willing to trade a high hairline for a restored crown. I think a bald crown really ages a guy. I prefer I high hairline with a filled in cown kind of like a Kevin Costner, Phil Collen of Def Leppard, Sting...ect....To me these guys would look much worse with lower hairlines and big bald crowns.

 

 

 

71f24c85-3353-4304-bcb4-b2b8c9b7b0de_zpsd0d7d106.jpgPhilCollen4.jpg

 

Sting-hairstyles-3.jpg

 

Here is a video of Dr. Wong discussing crown tranplants:

 

 

Dr. Dow Stough - 1000 Grafts - 1996

Dr. Jerry Wong - 4352 Grafts - August 2012

Dr. Jerry Wong - 2708 Grafts - May 2016

 

Remember a hair transplant turns back the clock,

but it doesn't stop the clock.

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  • Senior Member

I understand your sentiment. I too was most worried about the crown when I started looking at Hair Transplants. I spend a LOT of time (over a year) researching and looking at balding people in the street.

 

I kept staring and examining other balding people and their patterns. Even when speaking to clients at work I examined their hair (secretly with my eyes....not hands!!). I eventually changed my mind since there are so many people with a balding crown that look great from the front. And THAT is what people see!

 

Having said that I did NOT want that slick bald crown look so I asked Bisanga to put a scattering in the crown area which he was ok to do. It's done in a weird way (see my posts in my signature) so I'm not sure how it will turn out, but he's a great surgeon so I'll have to trust him :)

 

Spend some time looking at other people and do some research. You'll might surprise yourself. And if you're willing to compromise the density up front, you might be able to get a few grafts in the crown.

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