Why wait around for the crown...

[WHTC-7706631290]

Why wait to treat the crown…

 

Certainly, individuals who desire to treat this area are as young as thirty and can be as old as seventy. No crystal ball is at our disposal when we approach corrective measures at the time when significant recession becomes evident in the crown. The crown a.k.a. ‘the black hole’ is far from simple in regard to its natural design. The constant varying angles contained within the whorl offers no consistency in coverage despite the relatively small area that it seems to measure. Those in pursuit of restoring such an area should realize that the crown is really a difficult region to treat mostly because the hair grows in multiple directions at once; there's no shingling effect in this area like the other areas of the scalp. Crowns are most notorious for consumption of hair grafts and display no regard for any patient’s age or background. Achieving density is essentially an attempt to create an illusion of fullness when the hair in an area has no consistent grade. The orientation of the crown is perhaps the reason why it mostly consumes far more grafts than most individuals realize. The crown will usually be the absolute most difficult region on the scalp to restore so conservation of donor resources is paramount in consideration of future loss.

 

After a crown is aggressively treated, the undesirable effects of progressive hair loss fail to yield to the treated areas. Some hair loss sufferers will even be so unfortunate enough to have a double whorl in this particular region. Those hair loss sufferers can only wish to confine the expansion of the receding perimeter. Almost always, the individual will continue to battle the worst of the recession if they are fortunate enough to still have resources remaining to add half of the density that is visible in the surrounding region. An improvement can be noticeable if about half of the density of the surrounding area can be achieved.

 

If an average male has about 6500 follicular units available in their donor supply, conservative restoration is without a doubt an ethical approach. If hair loss is comparable to a great fall, then slowing the rate of the descent is merely the most important aspect of saving what soon may be permanently lost. Keeping a controlled fall is achievable by administration of medical therapy, anagen stimulation, and efficient management of donor resources. Those who don’t make these basic considerations might eventually see the fall in a catastrophic fashion where an abrupt plunge leaves them victim to the limitations of body hair. Body hair is less ideal when compared to scalp hair simply due to the fact that it’s far less predictable in terms of growth and yield. This is the risk that individuals take when they attempt to treat the crown in one session in lieu of an effective regimen for long-term treatment.

 

Waiting to surgically treat the crown to a certain extent and focusing on the front can afford an individual time to effectively manage the progression of their hair loss. As surgical hair restoration patients, individuals should concert all efforts to maintain awareness of what happens on their scalp.

[Spanker]

I know it's easy to say as someone with hair in the crown, but I believe it was Dr. Stough and maybe Beehner too that suggests that one waits til 45 to go into the crown. I also think there is a misconception on where the crown and midscalp stop and start. You can get away with a nice transplant by transplanting to the anterior part of the crown. The problem with the crown is that it grows with time and that it is much less cosmetically significant when interacting with people. I advise to plant the crown when the majority of the rest of your hair has been transplanted and you have the reserves that you need for that area, then look into the crown.

[MrGio-WHTCClinic]

So true, Spanker. The darn crown is notorious for getting bigger over time. I think that the crown has to be the worst area to treat with surgery. We have to leave it alone until the clock ticks enough to allow the thing to expand a little.

[gillenator]

On average, the crown can and will demand up to 60% of the available donor for transplantation in the advanced classes of hair loss.

 

The crown in many men will continue to open and if not careful to consider the potential of loss in the future, there can potentially be an island of grafts left in the center with progression of loss around it.

 

Just yesterday I saw a thread of a younger man with advanced crown thinning working its way toward the mid-scalp and will eventually get to the frontal zone.

 

The temptation is to restore what is visibly missing "at the present time" yet I cautioned him to approach this area with a much lower level of density because when he does eventually lose his hairline, inevitably the frontal zone will become a great concern.

 

Yet he may potentially run out of donor by then if he chooses to get too aggressive trying to restore his crown at the present time...:rolleyes:

[fueshare]

I am probably the odd one here, but I don't understand the logic behind waiting for the baldness to progress once you have a reasonable pattern emerging, especially with FUE. You either have enough donor area to cover everything eventually or you don't. Even at 50 years old it's the same yes/no question. But having hair at younger age is more valuable, so I think people don't have to wait, they just need to do the math and place a bet on the future loss. What if you just don't have enough donor area in the end? You settle with bald spots and poor density? I'd rather shave.

 

Sure some people will miscalculate, but even then they can just work it out with body hair, moving back crown hair a little to the sides with another surgery or just shaving and fitting with micropigmentation if it's so bad. Here is a little picture of me with my bet. I have two whirls. Currently I mostly care about the next 10year window, but I feel it's manageable for more with the meds.

[Dutch]

I am probably the odd one here, but I don't understand the logic behind waiting for the baldness to progress once you have a reasonable pattern emerging, especially with FUE. You either have enough donor area to cover everything eventually or you don't. Even at 50 years old it's the same yes/no question. But having hair at younger age is more valuable, so I think people don't have to wait, they just need to do the math and place a bet on the future loss. What if you just don't have enough donor area in the end? You settle with bald spots and poor density? I'd rather shave.

 

Sure some people will miscalculate, but even then they can just work it out with body hair, moving back crown hair a little to the sides with another surgery or just shaving and fitting with micropigmentation if it's so bad. Here is a little picture of me with my bet. I have two whirls. Currently I mostly care about the next 10year window, but I feel it's manageable for more with the meds.

 

I agree with you- I value hair more now when I'm young. Ten years ago it meant more to me and in 10 years time it might mean less to me than it does now.

I want to enjoy it when I'm reasonably young. Of course you try to plan for the future & keep some reserves but can't predict what will happen & how low the crown will drop.

A balance on things is important, so can't be using a lot of grafts without reaching an advanced balding level & at the same can't keep waiting for years to come.

[Whodat]

I have seen thus topic posted many times. Yes, hair loss is progressive. There are way more people improving their hair lines at an early age than people looking to fill in their crowns. Do they not face the same dilemma as the hair can drop out behind the transplanted hair thus creating wings of hair on both sides of the head? Not a very natural look either. I have seen pictures of this as well.

[Paulygon]

I've heard the phrase that the crown is like a black hole that sucks in donor hairs, and you want to be very careful when addressing the hair loss in this region.

 

Interesting advice guys, thanks!

[home1212]

as a 45 year old male who's got advanced hair loss in the frontal zone and crown, my priority is simply getting a natural, conservative hairline that squares the face, i'm least concerned about my crown at this stage and will use the limited donor area that I have to address the hairline and midscalp .. hopefully Dr. Rahal will agree with me in Sept!

[Paulygon]

hi home1212, good to see you again!

i forgot, will this be your 1st procedure?

good luck mate!

[fueshare]

Hi home1212, when did your hairloss start and when did it become a big issue? I guess there is a difference if it starts late (40s-50s) versus being bald in your 20s.

[gillenator]

As I continue to research and gather information over four decades, some things never change and more things can be achieved.

 

One of the things that will never change is the fact that none of us have enough scalp donor to adequately cover a complete bald surface area front to back. By adequately I mean to completely cover the entire surface area of a Norwood class 7 and even class 6. I have seen some cases of Norwood class 6s that have achieved some pretty amazing results yet those candidates have outstanding hair characteristics and upper ranges of donor density.

 

Be careful of putting too much reliance on BH because it still has a long way to go. I have been awaiting more guys who had beard donor procedures but you rarely if ever see them come back posting their results. Very few FUE doctors have any success with BH and that's a fact.

 

I do agree that having hair coverage in our younger years is important to many of us however trust me, you will still care once you get to 40 something and older about not being bald. I wore hair systems until I pulled the trigger and had my first HT at age 40. I was recently divorced and very concerned about my missing frontal hair line. The MPB continued to progress in the frontal zone even after going on low dose finasteride in 1996. Still taking it too. So to date, I had a grand total of 6900 FUHT grafts compiled in four separate procedures. I heal very well so I still only have one thin strip scar but it is ear-to-ear and can no longer have FUHT. If I did have any more HT surgery, it would have to be by FUE. I am now 59 and do I still care about losing more hair? YES I do, and I still use Toppik in the frontal core.

 

I liked what home1212 stated about keeping the hair line high and not committing to the crown until the frontal third is nicely framed. It's because we are viewed from the front, not the rear. And I have seen too many guys chase their crown loss at an younger age, run out of donor, and panic.

 

Another viable option is to use the grafts for the frontal third and then use a nice high quality "partial" hair piece for the crown. I know dozens of guys who chose this option because they could see after 2-3 procedures that they had very little donor left. They were able to use their remaining donor for the front, achieved some great results, and simple anchor their crown pieces with tape or clips.

 

Some of you older guys may remember an actor by the name of Ted Danson who starred on a comedy series called "Cheers" in the 90's. What many do not know is that he also wore a partial piece over his completely bald crown. Even when his hair went grey, he simply changed over to a grey piece and still looked great.

 

Though none of us can accurately predict the extent of our hair loss in the years to come, the best barometer is family history. If your grandfather(s), father, uncles, brothers, have MPB in the advanced classes of 6 and 7, then chances are, you will too if you experience MPB and especially at a younger age.

 

Remember, the crown on average can take up as much as 65% of your available scalp donor and that leaves very little left for the first 2/3 area of frontal to mid-scalp loss.

 

And anyone with advanced classes of hair loss is going to need up and over 6,000 grafts if not more to achieve a nice frontal core and mid-scalp. If you have that all with FUE, then shaving the scalp in the future may not be as viable as one might think.

 

My advice? Always start with having your complete donor zone calculated because if your density is high, you have more potential, however if it is average to low, then you might want to regroup on your decisions. I have also noted that men who have the potential for advanced loss can and will experience more DHT receptivity in their donor zones. This means that the donor zone which was once thought to be strong in the younger years begins to thin out and/or expand.

 

They key is to plan according to your current limitations as well as your projected potential for further loss according to family history of hair loss because that approach will be more apt to save you from regrets and not being able to reverse the more aggressive or unrealistic decisions that you may make today...

 

And I sincerely wish the guys with upcoming procedures great results!

[Paulygon]

I loved this post! thank you gillenator. and I was a kid when Ted Danson was on Cheers.. I only started to realize that he had some hair issues when his later show "Becker" came on. It is interesting that he covered his hair loss so well on Cheers with a hair piece and then switched over to a gray-ish one. Thanks for that info!

 

per Gillenator: "They key is to plan according to your current limitations as well as your projected potential for further loss according to family history of hair loss because that approach will be more apt to save you from regrets and not being able to reverse the more aggressive or unrealistic decisions that you may make today..."

very true.. my hair loss seems to be similar to my maternal uncle... so that is helping me to plan for my future loss. I think his donor density is pretty nice thankfully.. and Dr Mohebi (my surgeon) says that I have very good donor denisty/quality as well.

[newbie33]

Amen to that, Gill.

 

I've never had a HT, but I've met several surgeons who are quite prepared to put a high of amount of grafts into my frontal third without even checking my potential donor count accurately, or discussing/considering future hair loss. Fortunately - and thanks to this forum - I've not rushed in to get a procedure and feel much more educated about the risks and what I should be thinking about for my own future appearance (even if the docs don't always do that). I've also ruled out many 'good' surgeons on account of their - to my mind - poor considerations and planning for future hair loss.

[gillenator]

You know it is so warming to me to continue to see more and more guys doing their homework and being able to recognize when a doctor simply is willing to do anything that a patient asks without evaluating true density in the donor zone or even discussing future loss and then carefully planning over a lifetime with each and every patient. Kudos newbie33...

 

Paulygon, did you ever see the episode on Cheers when Sam peels off his partial hair piece? He was conned by Carla the waitress into revealing any hidden secrets between them and off it came! That must have taken a lot of courage because not many people knew he was wearing a piece.

 

Did you also notice on Becker that he had a fair level of density lowered in his partial to visually match his overall lower level of density throughout his scalp? He had both the color and density changed and if you see any current pics of him, it was lowered again.

 

Had he not had the density lowered, the piece would have stuck out like a sore thumb...:confused:

[Paulygon]

Paulygon, did you ever see the episode on Cheers when Sam peels off his partial hair piece? He was conned by Carla the waitress into revealing any hidden secrets between them and off it came! That must have taken a lot of courage because not many people knew he was wearing a piece.

 

No, I would have remembered such a scene! Simply Amazing!

Especially interesting since, Sam (Ted Danson's) character was a playboy / ladies man throughout that show.

I'll see if I can find a clip of that scene somewhere.

 

Did you also notice on Becker that he had a fair level of density lowered in his partial to visually match his overall lower level of density throughout his scalp? He had both the color and density changed and if you see any current pics of him, it was lowered again.

 

Had he not had the density lowered, the piece would have stuck out like a sore thumb...:confused:

Hmm.. I definitely noticed that in Becker, Ted Danson 'suddenly' seemed older.. so what you are saying makes sense. I was new to the hair loss scene at that time so I couldn't put my finger on what exactly was going on with his hair. It just seemed like accellerated aging sudden. Thanks for pointing that out.

[newbie33]

And thank you Gill - and to the many others I've read on here, or, more unfortunately, been able to see their poor results. Let another man's shipwreck be your sea mark, and all that.

 

Always thought Danson wore a full hairpiece in Cheers. But looking at his latest hairline pics it appears not - seems to have a naturally low hairline which is now starting to thin. Bloody good hairpiece and haircut to match all of that together, though.

[TommyLucchese]

as a 45 year old male who's got advanced hair loss in the frontal zone and crown, my priority is simply getting a natural, conservative hairline that squares the face, i'm least concerned about my crown at this stage and will use the limited donor area that I have to address the hairline and midscalp .. hopefully Dr. Rahal will agree with me in Sept!

 

Dr. Rahal and conservative hairlines don't tend to be used in the same sentence as per my time on the boards!