Don't skimp on graft counts, particularly in the crown. Dr. Lindsey McLean VA

[Dr. William Lindsey]

I routinely tell patients that hair is like money and companionship with the sex of your choice....its hard to have too much. Certainly in the front, lots of singles are needed followed by doubles and triples to effectively camouflage hairloss. In the crown, its even harder to camouflage hairloss due to the way that hair naturally splays out from the center. Even kids with no hairloss have thinner appearing crowns than the rest of their heads. Thus, I usually recommend larger cases, particularly for the crown and even then, I've almost never had someone come back and say it was too thick. In the crown rather I tell folks we can usually make a nice significant change, but in baseball terms we'll get to about the shortstop...not a homerun, simply because of the way the hair splays out and the limited length most guys keep there crown hair doesn't allow as much layering.

 

So when I told this fellow he needed 1500 grafts to the crown, I meant 1500!

 

However he went and got 700 grafts elsewhere and brought me this little certificate admitting I was right. He needed more hair.

 

While some guys may up their graft recommendation to increase their bottom line...usually the money is not THAT different....rather its how do you spend your finite donor hair. My advice...if you are doing an area with surgery, do it with enough hair.

 

Dr. Lindsey McLean VA

[FUE2014]

Good post Dr L.

 

The crown is an absolute b**ch to achieve full coverage with and I happen to be in the minority here in feeling that crown loss is more ageing than frontal loss, especially in a guy in his 20's or early 30's.

 

I think for guys with minor crown loss, doing nothing though (in terms of electing not to have an HT there, but carrying on with the meds etc) is still the best option due to the crown's reputation as a graft "black hole" and propensity to continue expanding. Temporary SMP is probably a good option too for those with minor crown loss.

[Melvin- Admin]

Yea crown coverage is a pain, but the good thing is you only need enough so that you could use toppik, however frontal loss looks more obvious than crown concealment, also you can grow in to crown hairloss but you never grow in to not having a hairline.

[Dr. William Lindsey]

You guys echo my thoughts exactly. Nevertheless I end up doing 10 crowns and 120 fronts a year.... IF you are to achieve any measurable success in the crown it takes more, rather than less, hair.

 

Dr. Lindsey

[Cant decide]

I agree that crowns take more grafts for density but lets not forget with good planning, one can achieve a good looking crown by placing grafts at a density and angle at the midscalp allowing for crown coverage by using midscalp hair in such a way as to style it to cover some of the thin crown. Many do this to great success.

[Dr. William Lindsey]

Cant decide...I agree with you. Layering makes all the difference, which is why the front third is so consistently done well by established practices. In our area however lots of guys do not want to comb hair back over the crown even though that would make a huge change...taking them from the shortstop on a baseball field to well past third base.

 

Its the shorter hair guys with fine hair and a color mismatch that have the worst of it.

 

But I agree with your statement.

 

Dr. Lindsey

[Dr Blake Bloxham]

FUE2014,

 

Actually, I don't think you're alone in feeling this way. I have a lot of guys with frontal and crown thinning who are far, far more interested in restoring the crown compared to the front. I usually discuss the benefits of restoring the frontal portions first and then moving to the posterior portions of the midscalp and vertex after, but many really hate having an open crown and want this fixed above all else.

 

And yes, all of you guys are absolutely correct in saying that it takes a surprising amount of grafts to really do a tight, packed crown. Ironically enough, I had two FUT crown cases that I did a a week or two ago come in for staple removal yesterday. Both were around 2,000 grafts -- and very densely packed. One was a gentleman in his 40s with almost perfect hair everywhere except the crown (he had a very strong family history of this pattern), and the other was a younger guy with minor recession in the front but a very open crown. He, like you were saying 2014, had absolutely no interest in the frontal portions but thought the crown was really affecting him professionally. We mapped out a long-term plan with all of this in mind, and thoroughly discussed the benefits of addressing the frontal thinning first, but did feel comfortable moving forward with the crown now in his case.

 

Interesting stuff!