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how to tackle my crown (no more FLAPPY combover!)


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I've been so happy with my hair restoration results but I want to work on my crown next.

 

My HT surgeon (Dr Mohebi) did an excellent job restoring my hair line. We let meds work on the crown (Fin / Minox) and the plan was to potentially do another procedure depending on how well my crown responds to the medications. Well, at this point, 2 years down the road, I think the meds did the best they can do, but I need to go in and do some more HT work on the crown.

 

Currently, my hair stylist's strategy is to leave a longer flappy portion right below my crown that is to be utilised as a "comb-over" for the naked part of my crown. It is a little annoying to me.. and after about 4-5 weeks that flappy part gets unmanageable and sloppy looking, and I'm left needing to get another hair expensive hair cut, fast...

 

I would love to get another HT procedure to attack this crown issue and hopefully get rid of the need for an annoying FLAP! I would like some advice. I'm thinking about going for FUE for my next procedure (but am open to FUT) and hope to keep the operation smaller than my 1st (the 1st was FUT w/ 2710 grafts and rebuilt the whole front of my scalp).

How many grafts do you suppose I would need to cosmetically enhance my crown and eliminate the need for the flappy crown combover?

 

Thank you!

5b32de3f47abf_uploadphoto1-hirescrownissue.jpg.33937c72b14767a3a4cc782904b2d158.jpg

5b32de3f71e79_uploadphoto2-flappycombover.png.442bea1b7a195192dc522c8739984b2f.png

5b32de402a5de_upload3-flapoutofway.png.a3fbbbd16f61b00903ffb0385f533b9a.png

Paulygon is a former patient of Dr. Parsa Mohebi

 

My regimen includes:

HT #1 2710 grafts at Parsa Mohebi Hair Restoration in Los Angeles in 2012

Rogaine foam 2x daily, since 2012 (stopped ~10/2015)

Finasteride 1.25mg daily, since 2012 (stopped ~12/2015)

 

HT #2 3238 grafts at Parsa Mohebi Hair Restoration in Los Angeles in Jun. 2016

Started Rogaine and Propecia in July. 2016 after being off of them for about a year.

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  • Senior Member

Hi Pauly,

 

Crown restorations usually require somewhere between 1,500-2,000 grafts. While I don't have exact calculations based upon the area of your crown and desired density, this just seems to be the most common averages shared on the forums. However, you always have the option of reserving grafts by transplanting at a lower density. This would still provide you with cosmetic coverage but also preserve finite grafts.

 

Both FUSS and FUE are viable options for crown restoration. Many people believe that if you have already undergone one strip procedure you mine as well follow-up with another, but this isn't necessarily true. If you are pleased with your current closure, FUE may be a good choice. However, this means you must find a doctor who is both experienced with FUE and crown restoration - as re-creating the natural whorl is an art in and of itself.

"Doc" Blake Bloxham - formerly "Future_HT_Doc"

 

Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

 

All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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Because of your particular level of loss, offset by a procedure and meds (I feel like meds were a big part of the result) I would personally not tackle the crown, as you and I are both relatively young. If you have plenty of donor and it really bothers you, I would think 1500 would leave you a decent result and leave you grafts for your mid scalp and future touch ups.

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

Pauly, have you thought of SMP to give the look of more coverage?

I think your doctor even offers SMP

go dense or go home

 

Unbiased advice and opinions based on 25 plus years of researching and actual experience with hair loss, hair restoration via both FUT & FUE, SMP, scalp issues including scalp eczema & seborrheic dermatitis and many others

 

HSRP10's favorite FUT surgeons: *Dr. Konior, *Dr Hasson, Dr. Rahal

HSRP10's favorite FUE surgeons: *Dr. Konior, *Dr. Bisanga, Dr. Erdogan, Dr. Couto

(*indicates actual experience with doctor)

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Guys, I really appreciate the personalized feedback. You've opened my eyes a bit more..

 

Blake,

maybe you are right.. since I've already done strip, I'm not losing anything by doing another strip (that strip scar is already on the back of my head regardless). In regard to finding a physician who is capable of the artistry of the swirl of the crown, (that's another thing I didn't think too much about and you opened my eyes to that phenomenon), I'm going to ask Dr Mohebi if I can look into some of his previous work (before/after results) implementing the swirls.

There's been so much talk about FUE on these boards that part of me has been interested in experiencing the smoother FUE procedure.. but I'm open to all options. This HT stuff is an exciting field.. but I need to not jump the gun... gotta pace myself and strategize for future loss.

 

Spanker, you're saying maybe don't tackle the crown since we are relatively young... I looked for photos of your situation.. but I can't find any. Have you uploaded them? Your profile says you were NW2 so you're better off than me. Thankfully, I do have plenty of donor.. but I've heard before that the crown is like a "black hole" that sucks up donor.. I don't want to waste the valuable donor.. especially since I am sure I need some for the front and center (you can see that is a weak area in my first pic of this thread)

 

Hsrp,

Always insightful! I had never even considered SMP for myself!

It actually might not be a bad idea.

Basically, it would replace Toppik.

At this point, for social outings, I usually apply Toppik and the crown is covered nicely. Actually, I appreciate you also considering whether my surgeon, Parsa offers it.. you're right, I remember a while back during a follow up he mentioned that he was doing SMP for a patient that week.

 

The only issue I see is that basically, if for some reason I had to shave my head.. my scalp will show how mutilated I've made it (between the strip scar and the SMP tattoos).

 

Here is a terrible thought, but worth entertaining for 2 seconds.. the only situation where a person is forced to have a shaved / bald head is in Chemotherapy & Cancer cases. I wonder if the possibility of illness/chemo/cancer has caused anybody to become timid in doing combo procedures such as SMP / strip surgery (since the scars and tats would then be exposed).

 

Also, does SMP fade completely over time? I think the answer is no. It just seems like it would be very wierd to have a strip scar in the back and SMP on the crown if ever shaved down. Thoughts?

 

The next step is for me to discuss these things with Dr Mohebi and see what he can offer. I love his track record and his work on me so I'm very hopeful he can help me to address my crown situation.

 

Again, I really appreciate your advice.. without it (and without the forum in the last few years, I would have been a baldy right now)!

Paulygon is a former patient of Dr. Parsa Mohebi

 

My regimen includes:

HT #1 2710 grafts at Parsa Mohebi Hair Restoration in Los Angeles in 2012

Rogaine foam 2x daily, since 2012 (stopped ~10/2015)

Finasteride 1.25mg daily, since 2012 (stopped ~12/2015)

 

HT #2 3238 grafts at Parsa Mohebi Hair Restoration in Los Angeles in Jun. 2016

Started Rogaine and Propecia in July. 2016 after being off of them for about a year.

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Pauly, I have actually thought about the cancer scenario and what I would do in that situation (I have two less-than-ideal strip scars). But I quickly realized that if I were to undergo chemo, just getting healthy would be my only concern.

 

Now, to address your SMP questions. There is permanent and temporary SMP. True temporary SMP is currently only offered by Beauty Medical (Milena Lardi) and the clinics she trains. This pigment is designed to fade 100% from your system. I do think SMP could be effective for your case. However, if I were in your shoes I would definitely be looking to fill-in that crown with a HT at some point. Right now 1200-1500 grafts would probably do the trick. I do see some thinning in your mid area though and that makes me think your MPB could progress past just that spot in your crown. If your surgeon sees other signs of miniaturization he's probably going to need to harvest more grafts to compensate.

 

I would certainly consider another strip, especially since you already have one. Best to consult with Dr. Mohebi and weigh all your options.

 

That being said, your hairdresser is doing a great job helping you conceal the thinning area.

Edited by hairthere

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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  • Senior Member

I personally would not touch that crown. The combover you speak of is very minor and saves you grafts for the future.

My Hairloss Web Site -

 

Procedure #1: 5229 Grafts with Dr. Rahal Oct, 2010

Procedure #2: 2642 Grafts with Dr. Rahal Aug, 2013

 

7871 Grafts

 

http://www.hairtransplantnetwork.com/blog/home-page.asp?WebID=2452

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Thank you hairthere,

thank you cantdecide...

Paulygon is a former patient of Dr. Parsa Mohebi

 

My regimen includes:

HT #1 2710 grafts at Parsa Mohebi Hair Restoration in Los Angeles in 2012

Rogaine foam 2x daily, since 2012 (stopped ~10/2015)

Finasteride 1.25mg daily, since 2012 (stopped ~12/2015)

 

HT #2 3238 grafts at Parsa Mohebi Hair Restoration in Los Angeles in Jun. 2016

Started Rogaine and Propecia in July. 2016 after being off of them for about a year.

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Update-- I had an important consult/meeting with Dr Mohebi, initially about my crown but which got deeply technical.. I looked at some before/after pics of Mohebi's crown work really liked what he has done. I can say with certainty that my next procedure will be with Dr. Mohebi. He did a great job on my frontal portion; because of that.. combined with the before/after pics I've seen of his crown work, and I trust in his good work.. I would love for Mohebi complete his art on my scalp, so to speak.

 

Also, I discussed with him all the options of Strip vs FUE vs SMP. And in conclusion, my next go-round will be a strip procedure again (though I haven't scheduled it yet-- I will hold off for now, as cantdecide said, since its not TOO BAD a crown, especially with the combover.. I guess I made it bigger in my mind). FUE or SMP are decent options, but for me, personally, it makes sense to go with strip/FUT since I've already had that done, have the scar there, and it is more cost-effective. Plus I didn't have any issues with regard to pain/recovery.

 

Also, I got some interesting data from him.. Dr Mohebi is great at tracking results, including any progression of hair loss, in the form of a "Miniaturization study" with a microscope... It appears that hair loss in my crown region has progressed slightly, and the size of my "Crown Edge" has increased from 50x1cm to 50x2cm (interestlingy, however, the hairs themselves have not miniaturized much). See uploaded chart.

 

My consult with Dr Mohebi was so valuable and I learned a lot.. most of all, how important it is for me to keep in touch with him and ask him any questions. Your good surgeon is your first line of medical advice when it comes to hair restoration.

 

In future posts/ threads, I'll be uploading more of what I learned from my Mohebi meeting! Definitely committing to him and his work !

5b32de568ada5_miniaturizationstudy11-1-2010.jpg.30ced1624e73e9b3b7678ac5a98e1ee8.jpg

Paulygon is a former patient of Dr. Parsa Mohebi

 

My regimen includes:

HT #1 2710 grafts at Parsa Mohebi Hair Restoration in Los Angeles in 2012

Rogaine foam 2x daily, since 2012 (stopped ~10/2015)

Finasteride 1.25mg daily, since 2012 (stopped ~12/2015)

 

HT #2 3238 grafts at Parsa Mohebi Hair Restoration in Los Angeles in Jun. 2016

Started Rogaine and Propecia in July. 2016 after being off of them for about a year.

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