Crown (Vertex) Transplant / 12 months post-op / Dr. Bloxham, Feller & Bloxham (NY)

[Dr Blake Bloxham]

Crowns can be tricky. There is a reason why they are often referred to as the "black hole of grafts" online. The large surface area requiring coverage and the twists and turns of the "whorl" pattern call for a lot of grafts. On top of this, they notoriously thin in a circular spreading pattern that is tough to keep up with.

 

However, they are also very often a crucial area for hair transplant patients. Although I do believe the frontal/midscalp regions are more cosmetically significant, many patients don't feel like their transformation is "complete" without crown work; or they can't stand thinking that they still have a "bald spot like my father/grandfather" back there.

 

So crown HTs are important. They must be planned thoroughly and lifetime grafts must always be kept in mind, but important nonetheless.

 

The patient in this video is a good example of what crown patients should expect. He underwent 3,300 grafts total over two passes (the first to address the upper crown, and the second to address the whorl pattern and the lower crown after he had further receded) and now has a very full and natural crown.

 

Here is his "comb-through" video. Tried to be as transparent and thorough as I could here, because expectations are important!

 

 

Enjoy!

[wibbles180]

Can I ask why you did the procedure in 2 separate sittings whilst working the same area?

[wibbles180]

Also was this fue or fut ?

[Dr Blake Bloxham]

Hi Wibbles,

 

Both procedures done as FUT.

 

The reason why it was done in two settings is because the crown continued to recede -- as it often does. The first procedure addressed the upper crown, which is where the patient's thinning was most predominant at the time. The second addressed the lateral part of the lower crown (below the whorl) and some of the whorl pattern itself because he continued thinning and these areas were now more visible.

 

This is a reality I always try to impress upon my crown patients: they continue thinning and you may need to touch up a few areas down the road. Especially because they thin in a circular, spreading pattern.

 

Hope this makes sense!

[Melvin- Admin]

Great job Dr. Bloxham, two questions can you post the results of the first surgery, and how many grafts the patient had? Do you know around what month the patient experienced growth? I know the crown is notorious for growing slower.

[wibbles180]

Would be great to know if the patient was taking any meds and still carries on to loose hair ?

[Dr Blake Bloxham]

HT,

 

Thank you for the kind words.

 

He had 3,300 grafts total; 2,000 in the first and 1,300 in the second.

 

You're correct, the crown is notoriously slow. I frequently have patients come back at 9, 10, etc, months and tell them the crown is still immature and to "hold tight" and visit me a little down the road!

 

I know his second grew in quicker than his first because the blood supply from the first transplant was already established back there. But I did see him 9 months after his second procedure, and while he was already very happy with the result, I told him there was still more to come and to visit in a bit. I'm very pleased to say he matured a lot between months 9 and 12 and looks pretty fully matured in the video (which was 12 months post the second crown HT). But even that -- final maturation between months 9-12 -- is pretty quick for a crown and was probably quicker than most because of his blood supply from the first surgery.

[Dr Blake Bloxham]

Wibbles,

 

He is not on any preventive hair loss medications. I do think his crown is fairly stable at this point. He dropped well below the remnants of his whorl before the second procedure; while this indicates a more advanced pattern -- and more work for us HT docs! -- it makes me believe that he's dropped as far as he's going to for his pattern and it's likely to remain for now.