Proceed with caution #2. Young guys...Don't waste your precious hair in the crown1st

[Dr. William Lindsey]

First patient of the day....and identical to 3 patients who have emailed me in the last 2 days and one whom I saw in Utah....

 

This young guy has had 3 HT locally. His entire family winds up Class 5-7, and he went in to get a crown filled. Reportedly he had 2500 grafts placed, then the front started to go...so he had 2 more cases, one strip and one FUE. Now he has a medium width scar, donor depletion, and a head full of relatively thinly placed straight hairs. AND FEW OPTIONS.

 

Option 1. Excise strip scar and get maybe 1500 grafts to add to the front 1.5 inches, grow his hair out and look unremarkable except for a sparse crown.

 

Option 2. Excise scar, likely need a small FUE into the residual scar at 1 year...and keep a short haircut so it doesn't look too thin.

 

He's considering his options, but I told him that if he'd have seen me back in 2012...I'd have refused to do his crown, saying he wouldn't have enough hair to then deal with the front. I hear this ALL the time...and this is what happens. He said if I'd have told him that in 2012...he'd have gone elsewhere and gotten his crown done, and only now does he realize the mistake. It would be far better to have that front 60-70% of his scalp done well, and have a bald spot than to have too little hair sprinkled all over his head.

 

Dr. Lindsey

[harin]

Goes without saying,planning and anticipation of future hair loss is so important in every case. How old is he Dr. Lindsey?

[Dr Blake Bloxham]

Dr Lindsey,

 

Very interesting. Unfortunate, but interesting.

 

This is a great example of why patients should almost universally "start in the front" when it comes to a long-term hair transplant plan or a younger patient with signs of progressive thinning. I'm sure you remember from our London consults, but I almost always tell patients a similar thing to what you mentioned above: Starting in the frontal scalp with a new hairline and re-framing the face is almost always the best way to start. If a patient continues to thin behind this area, a rebuilt front still looks natural. Many patients thin in the crown area and not the front naturally. This will not look abnormal if it all thins out behind. However, many patients aren't happy when this occurs and want to fill the back. If we have grafts left to steal, great! We can do it. If not, well, at least the look is natural.

 

The same can NOT be said for those who start with the crown.

 

If a patient fills the crown densely, thins out in the front, and then runs out of grafts to rebuild the front, they are in trouble. This isn't usually something that occurs naturally, so it doesn't look right.

 

Looks like this patient may be in this position. Seems like the combo of FUE and FUT was the downfall with respect to donor supply.

 

My vote would be for option 1.

 

Hope you're able to help this patient out. And thanks for sharing this VERY important topic with the community.

[Melvin- Admin]

One thing that I think of also that is second to rebuilding the front are the lateral humps, imagine you rebuild the crown and don't have enough grafts for the lateral humps, you'll be left with an unnatural pattern, I'd much rather have my hairline midscalp and lateral humps intact with sparse coverage in the crown. Interesting topic Dr. Lindsey whats your view on guys that are 30 that have a Norwood 6 pattern established, do you still recommend holding off on the crown or conserving grafts in case the lateral humps drop?

[harryforreal]

What strikes me is the numerous blonde hairs at the front, left side of his head (pic # 1, top down) and the numerous darker hairs on the front, right side of his head in the same pic. I'm sure it is partly lighting, but still, this is what bothers me about HT to the front - the dark hairs that seem out of place compared to the lighter, softer hairs that should be naturally at the front.

 

Also, his scalp looks rather bumpy - typical after a HT I guess? Maybe also some redness? I'm very pleased with the result of micro-needling to reduce the bumpy, scarred texture following my HT. Also I'm pleased with the result of V-Beam Laser to reduce redness. I really think the HT field should look into the positive results that these two procedures can produce.

[pkipling]

Very interesting thread and great advice.

 

What Blake mentioned about how it's actually natural for guys to thin in the crown and have their front stay in tact rang very true to me. I actually have a coworker who has hair like this. He's in his late 30s and his crown is significantly thinner than the rest of his hair, but it's not always noticeable. Not only that, but it's a relatively easy fix with the right style and product and I've thought before that if you're going to lose your hair, that's the best way/pattern for it to happen.

[Dr Blake Bloxham]

PK,

 

Thinning patterns like this always make my think of my late Grandfather. He had an entirely bald vertex by the time he was in his 30s, but never lost anything in any other regions of the scalp. An interesting pattern for sure, but one that does occur in nature. And, like you said, one that most would probably prefer.

[Spanker]

What about excusing scar, fue, and smp?

[joelk]

This is an excellent topic guys thank you so much.

 

we all get carried away fro the immediate results sometimes neglecting our future hairloss pattern.

 

I am trying to create a new tread for my questions as i am READY to do this.

[Dr. William Lindsey]

I think he's 34 or so.

 

Yeah, I vote option 1 too.

 

I don't think a 30 year old with class 6 will EVER get crown coverage. I'm figuring no big innovations, like cloning, before I retire...probably 2026. So I'd save that third small case for future issues and leave a bald crown. Statistically, on the forums and in my office 1/3 of guys say that is unacceptable..if you are bald in the crown you are bald. 2/3 of guys say a bald crown if fine. Customer choice. BUT what I won't do is sprinkle a little all over then the entire thing is a poor wispy result.

 

Yes Spanker...if we did option 2...part 2 a is an as needed FUE into that scar at a year. To date I have not seen SMP not "bleed" when put into thick donor scar which would be noticeable with this crew cut.

 

Dr. Lindsey

[Melvin- Admin]

I think he's 34 or so.

 

Yeah, I vote option 1 too.

 

I don't think a 30 year old with class 6 will EVER get crown coverage. I'm figuring no big innovations, like cloning, before I retire...probably 2026. So I'd save that third small case for future issues and leave a bald crown. Statistically, on the forums and in my office 1/3 of guys say that is unacceptable..if you are bald in the crown you are bald. 2/3 of guys say a bald crown if fine. Customer choice. BUT what I won't do is sprinkle a little all over then the entire thing is a poor wispy result.

 

Yes Spanker...if we did option 2...part 2 a is an as needed FUE into that scar at a year. To date I have not seen SMP not "bleed" when put into thick donor scar which would be noticeable with this crew cut.

 

Dr. Lindsey

I always value your advice, I'm definitely in the group that doesn't care, I do think though that the lateral humps are a must though.

[HairJo]

Great advise for young guys never do the crown first. I hope this has helped these young guys understand and not make the same mistake