Doctor Advising Against HT on Crown, Help

[DenverBuff1989]

Hi all,

I am naturally a Norwood 3-temple recession and minor crown recession as well.

Had a 1200 graft hair transplant last year on my temples, and slightly slowered the hairline. The doc did not put enough grafts in, so I am getting a 2nd HT Nov 20 for an additional 300-500 grafts to fill it in, free of charge (there was sooo much drama surrounding this, see this post for background

My crown was not operated on during my last HT, but since I am already going under the knife, I would really like my crown filled in as well. I'm not sure how to rate my crown loss-I guess a Norwood 2- in that my crown clearly has loss, but it is not unbearable. Sort of like how Norwood 2 on the hairline is noticeable, but a lot of people can still get away with it.

Both my doc and another doc in the office looked at my crown. They both advised against getting grafts on my crown. One of the docs said he never operates on the crown on people under 40 (I am 30) because of potential future loss. They also said I do have significant hair on the crown still (albeit miniaturized) and putting new grafts in could shock loss out these already fragile hairs. Essentially, they are saying that while I clearly have crown loss, it is not bad enough to merit a hair transplant for it.

I was very disappointed these docs advised against operating on the crown. My arguments for getting a crown are, if they do grafts on it and I do have future loss, I am prepared to get a 3rd HT. I am currently taking Dut and using Rogaine on this area, so not sure if I would even have more loss.

The docs recommended SMP as an option for the crown. I actually visited an SMP guy Thursday. It just seems like so much maintenance. The tattoo only lasts 4-6 years, have to put sunscreen on it everyday. Nervous it would look unnatural. So don't want to do SMP.

Toppik works VERY WELL on the area, but again, it is still a lot of maintenance. And I would rather have the permanent option of a HT.

I'm kind of confused as well. I'm sure if I consulted other doctors, or went to Turkey, I could find a reasonable # of doctors who would work on the crown. Not sure why both these docs are advising against it.

My questions are:

-Should I insist my doc operate on my crown?

-Has anyone here had any experience with doctors advising not to get grafts on the crown?

-Would you side with the doctors or me in this situation?

-Any advice on how to deal with crown loss? Toppik works very well, but Id rather have the permanence of a HT.

Any other thoughts, comments welcome.

[LaserCap]

The basics of a hair transplant involve the limitation of a donor area.  It is finite and there is typically not enough there to allow for a full set of hair when dealing with an advanced pattern. 

You are young.  You've shown the propensity to lose so the fact is - you will keep losing.  Being on medical therapy is, perhaps, the best thing you can be doing at this time. Medical therapy, however, tends to be far more effective in the back area. So the basic approach of a doctor is to place more importance to the front, (which is the most prominent area.  It is the area you see when looking at yourself.  It is also the area others first look at during any interaction), and allow medications to maintain the back.  When do you attack the back? When you're happy with the front.

You have two things going on which don't help. The first is the color of your hair.  Dark hair - light scalp, will always lead to more contrast. The second issue is the fact we all have a whirl.  The hair grows away from the point Unlike the front and top.  In the front the hair grows forward at an angle.  In the top, (area behind the front), the hair also grows at an angle forward. So as the hair grows it shingles and it gives you the illusion of more density.  From the photos you've shared with us, your crown looks just fine.  Take photos every 6 months and keep records.

Propecia, Rogaine, Laser and PRP are the modalities we typically refer to when dealing with this issue.  The mechanism of action of each is different and thus there is synergism when used simultaneously. It typically takes a full year to see if you'll enjoy some enhancement.  Do as many of these as you can.

 

[Al - Moderator]

The crown is slightly thin, but I don't think you have enough loss there to try doing anything about it at this point. Focus on fixing the front for now.

 

[home1212]

he or she is giving you appropriate medical advice 

[Raphael84]

@DenverBuff1989

Are you on meds?

I feel your pain, but currently would agree with the previous comments. I would hold off a little. 

If you are not on meds try them and, give them 12 months. You may be surprised. Topical finasteride with minoxidil combo, or topical finasteride with oral minoxidil.

Consider quality PRP as you say that you have a lot of miniaturisation in that area.

[E39]

Your crown is not bad at all. I would not go forward with a transplant now. I’d stick with meds, keep using Toppik and give smp a second look.