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HairGone29

Just how risky is crown implants during the same procedure as hairline work?

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One or two clinics have suggested a general distribution of implants with higher density in the worst areas.

My temples and hairline are weak, and there is an area on my crown approx 3 inches in diameter of general thinning (but no bald spots). The crown can basically be covered up by growing my hair out at least 1 1/2 inches then combing it forward. That said I like to use Toppik as well.

My primary concern is the hairline which the general estimate is around 2500-3000 grafts. Would it be wise to throw in 500-1000 extra implants on the crown during the same procedure or is the risk of permanent shock loss too high?

I have seen a few cases of Demirsoy doing the above mentioned plan, but some surgeons choose not to.

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Can you share some pics?...that would definitely enable us to give you better feedback.


Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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On 10/25/2019 at 8:38 PM, gillenator said:

Can you share some pics?...that would definitely enable us to give you better feedback.

Hello sir.

Instead of pics i've made a lengthy video trying to highlight my hair in various lighting, from very bright LED to more natural light as well as a view of the donor. please view:

 

 

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Your crown is about the same as mine, maybe fractionally better. 500-700 grafts maybe, but much depends on your age, rate of hairloss, whether on fin etc.

Front 2000-2500 depending on aggressiveness of hairline. 

Donor and hair quality looks quite good.

Permanent shock loss is always a risk.


4,312 FUT grafts (7,676 hairs) with Ray Konior, MD - August 2013

1,145 FUE grafts (3,152 hairs) with Ray Konior, MD - August 2018

500 FUE grafts (TBC) with Ray Konior, MD - 2020

My HT results thread from 1st procedure.

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On 10/25/2019 at 12:25 PM, HairGone29 said:

One or two clinics have suggested a general distribution of implants with higher density in the worst areas.

My temples and hairline are weak, and there is an area on my crown approx 3 inches in diameter of general thinning (but no bald spots). The crown can basically be covered up by growing my hair out at least 1 1/2 inches then combing it forward. That said I like to use Toppik as well.

My primary concern is the hairline which the general estimate is around 2500-3000 grafts. Would it be wise to throw in 500-1000 extra implants on the crown during the same procedure or is the risk of permanent shock loss too high?

I have seen a few cases of Demirsoy doing the above mentioned plan, but some surgeons choose not to.

There are truly no rules when it comes to where to add grafts.  It all depends on you, your pattern, family history and just simply common sense. Can you do it? Of course. Is it prudent?

The basis of it all is the donor area.  It is a limited area with a finite number which we all share.  Once gone, you'll never get it back.  With current techniques, fortunately, we can now accomplish more than ever and really maximize yield. But yet, many still believe there is not enough donor available to allow for a full set of hair, particularly when dealing with an advanced pattern.  Unfortunately your photo was not very good and I was unable to tell what exactly we are dealing with.

So, let's answer your question......

You speak specifically of certain areas, but not the rest of your head. So, you go ahead and work the temporal areas and eventually you continue to recede.  This would leave you with a couple of horns worth of hair.  Typically you'll want the doctor to blend grafts to areas adjacent to where the grafts are placed to avoid this issue and guarantee a more natural result.  Leaving you hanging will only result in you having to return for more grafts.

The front is the most prominent area.  It's what others see when they interact with you.  Can they see the crown? No.  Is it weak? Sure.  But, depending on the pattern, we all share this issue. Why? Because of the whirl.  Unlike the front and top where the hair grows forward at an angle, hair in the whirl grows away from the point.  There is no shingling at all.  It takes tons of grafts and multiple procedures to achieve density. (All those grafts could have been placed in a more prominent area). Hope you get the point.

Once you're happy with the front and top, you can then consider grafts to the crown.  That should be the last goal.  And, honestly, 500 grafts into the black hole is going to do nothing.

You seem to have a good amount of native hair.  Are you doing any medical therapy to help you with retention?

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2 hours ago, LaserCap said:

There are truly no rules when it comes to where to add grafts.  It all depends on you, your pattern, family history and just simply common sense. Can you do it? Of course. Is it prudent?

The basis of it all is the donor area.  It is a limited area with a finite number which we all share.  Once gone, you'll never get it back.  With current techniques, fortunately, we can now accomplish more than ever and really maximize yield. But yet, many still believe there is not enough donor available to allow for a full set of hair, particularly when dealing with an advanced pattern.  Unfortunately your photo was not very good and I was unable to tell what exactly we are dealing with.

So, let's answer your question......

You speak specifically of certain areas, but not the rest of your head. So, you go ahead and work the temporal areas and eventually you continue to recede.  This would leave you with a couple of horns worth of hair.  Typically you'll want the doctor to blend grafts to areas adjacent to where the grafts are placed to avoid this issue and guarantee a more natural result.  Leaving you hanging will only result in you having to return for more grafts.

The front is the most prominent area.  It's what others see when they interact with you.  Can they see the crown? No.  Is it weak? Sure.  But, depending on the pattern, we all share this issue. Why? Because of the whirl.  Unlike the front and top where the hair grows forward at an angle, hair in the whirl grows away from the point.  There is no shingling at all.  It takes tons of grafts and multiple procedures to achieve density. (All those grafts could have been placed in a more prominent area). Hope you get the point.

Once you're happy with the front and top, you can then consider grafts to the crown.  That should be the last goal.  And, honestly, 500 grafts into the black hole is going to do nothing.

You seem to have a good amount of native hair.  Are you doing any medical therapy to help you with retention?

Hi, its not a photo its a video, you need to click it to get a good idea.

I understand what you are saying. Medical therapy:

Minox and fin since age 21

All the usual suspects in terms of vitamins

Microneedling once a fortnight 1.5mm started 1 year ago. This did nothing IMO, still use it once a fortnight at 1mm just to aid in minox absorption.

Current age 28 1/2

Changes in that time frame: None really. My crown used to be a bit worse actually, temples may have receeded a bit since age 21 though, but looking at old photos im not sure. Very slow hair loss progression though (fingers crossed it stays that way). 

So if 500 would do nothing to the crown, i'd at least like to thicken it to the point where I need LESS fibers to cover up the obvious loss of hair. Perhaps 4000 grafts predominantly in the temples and hairline with 1000-1500 spread cross the midscalp working toward the back of the midscalp (crown edge). Perhaps allowing a comb backwards hairstyle to cover the crown a little?

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I'm glad you're doing something - which seems to be working.  Keep it up. 

You can have the doctor work as far back as he can horizontally  so as to minimize the size of the crown. And, as the hair grows, it can help you to cover the crown - which I think is what you're referring to.  That additional hair will also help the fibers work even better.  

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I also commend you for being so pro-active in all of the non-surgical treatments that you are doing.

You have generalized thinning everywhere and I agree with Laser to concentrate in the frontal zone with less density transitioning into the mid-scalp.

Mt greatest concern for you is the risk of shock loss in the crown...if it were me, I would stay with the medicinal regimen and wait out your crown area.  Otherwise if you must add hair in the crown, make sure the grafts are added in a pattern that won't look like an island of hair if or when your crown gets thinner.


Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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