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First Procedure inc. Crown?

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Hi guys,


Just a quick question with regards to having your first transplant which includes the crown. In my case personally my crown is a little thin but not to the point where it would warrant a mega amount of grafts to be transplanted.


From just general advice around the forum, it probably isn’t best to get the crown included on your first procedure - and I understand the reason because you just don’t know how low your crown will dip in 20 years or so. However having looked at clinics like De Freitas, Hasson & Wong, Eugenix which are all extremely respected clinics on the forum, I’ve seen exceptions of this on patients 25-40 years old. 

If you compare to clinics like Dr Bisanga, Dr Ferreira who seem to usually transplant on the crown on second procedures - who are also extremely respectable clinics. I’m just trying to get clarification if personally I should be asking for a small amount of grafts in my crown.


I have a in person consultation with Dr Bisanga at the start of October (extremely excited by the way 😁) and I just don’t want to seem foolish to ask the question when I meet him. 

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Hi @Kieran2020

Good to hear that you are conducting your research and communicating with several doctors to appreciate their recommendations and suggested approach.

Great that you will be meeting Dr. Bisanga for consultation in October. There are no foolish questions. 
“The man who asks a question is a fool for a minute, the man who does not ask is a fool for life.”
Any question that is important to you and that you would like to seek clarity about, then you should ask.

Whether transplanting into a patient´s crown in their first surgery is appropriate or not will depend on many specific factors.  
As you have already mentioned, age being one as crown loss may progress and the younger the patient, the harder this may be to predict. Some others include -

* Medication /stability of native hair (risk of shock loss)
* Graft demands (both in the front and crown)
* Donor density and hair groupings (can the donor safely meet graft demands for both frontal and crown requirements in one surgery)
* Progressive loss (Could the extra grafts being used in the crown be better utilised if more frontal loss is experienced in the future)

Below your scalp in your donor area you have small blood vessels that will play a crucial part in donor area healing post surgery. It is important not to make too many extraction sites in one surgery that would put too much in terms of demand on these blood vessels which could compromise healing.
In patients whose graft demands are higher and their donor may not be able to support this in one procedure, planning surgery over two sessions will encourage optimal healing and would allow further grafts from your donor area in a subsequent surgery.

Being too aggressive in extraction in your first surgery resulting in less than optimal healing, could mean less total graft availability.

Dr. Bisanga looks forward to meeting with you and will be able to discuss all such matters.

Patient Advisor for Dr. Bisanga - BHR Clinic 

ian@bhrclinic.com   -    BHR YouTube Channel - https://www.youtube.com/channel/UCcH4PY1OxoYFwSDKzAkZRww

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

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