Am I a good candidate for a crown transplant?

[fitwhynot]

38 minutes ago, Rahal Hair Transplant said:

Fitwhynot,

The crown is one of the most controversial and difficult areas of the scalp to transplant with any real degree of density.  In fact, the crown is often referred to as the “black hole“ for grafts because of this.   Well I can’t speak for Dr. Rahal personally, I agree that you may not see much benefit from transplanting the crown at the stage. Allow me to explain.

The crown is a very strange area of a scalp. those who are completely bald in the crown, a little can go along way. But for those who already have a covering in the crown, it will take a significantly large number of follicular units to achieve any real density.  

And then you have the risk of temporary and permanent shock loss. While most shock loss is temporary, any hair that’s on its way out anyway due to male pattern bonus may be permanently shocked and may not grow back.

At this stage, you are only 7 months into using finasteride and thus, it’s too early to tell just how beneficial this medication will be for you.  It’s recommended to take finasteride for at least a year to determine whether or not it’s affective. But in order to reverse the miniaturization process completely, assuming it’s even going to do that, but take more time. Many of the hairs on your scalp and in the crown are currently fragile and transplanting in the area may result in permanent loss of some of the natural hair.

Long story short, I concur with Dr. Rahal that it is likely a bit too early for you and in my opinion, you should give finasteride more time to see just how effective it will be prior to undergoing her transplant surgery.

I also want to say this. I know I’ll tempting it is to blow off a doctors advice because it goes against what you want to do. I’m sure you’re not happy with the thinning you’re experiencing and you want to do anything you can do reverse it. Just keep in mind that top doctors like Dr. Rahal have your best interest in mind and ultimately his advice is for your long-term benefit.

Sure it would be easy for him or any clinic to take your money and perform surgery on you.  But you have to truly respect the doctors that tell you to wait   They are the ones looking out for you and making sure that you obtain a net gain in hair over the long term rather than simply giving you what you ask for which may result in an overall net loss of viable hair   

In my opinion, stay on the medication for another year or two and then reevaluate. By then, if the medication is working, it’ll be working to its max capacity and any miniaturized hairs that exist today will likely be terminal.  As a result, you will experience much less permanent shock loss and then result will be a net gain of viable, terminal hairs instead of a potential net loss.

Best wishes,

Rahal Hair Transplant 

I'm a reasonable person, and can fully understand this logic so I will wait. My disappointment however lies here:

I was initially told during the online consult that my hairline and crown would be able to be filled during one hair transplant. When I arrived to the office the day before the surgery, I was told that only the frontal zones would receive grafts, and that I would have to come back for a second HT with Dr.Rahal for the crown.  Now, I am being told that the crown is not a good candidate for a hair transplant.

Additionally, grafts from a previous botche HT were removed and the hairline was designed higher (based on Dr.Rahal's advice). I was told the skin will heal and the previous hairline design / scar tissue will not be noticeable - but it is, and I've been treated by various Dermatologist with trentinoin, steroid cream and laser but the redness still remains.

Can you understand the frustration on my part?

Dr. Rahal is a great surgeon who does great work, I just wish there would have been more honesty about what is possible with my case, all factors considered.

[Melvin- Admin]

Can you get surgery? Yes, but it’s possible that you end up looking worse for a prolonged period of time. You will need a lot of grafts for that small area. Basically, a big risk for small pay out. Again, the choice is yours. Are you a candidate? Yes. Can you get a hair transplant? Yes. Should you consider all other options first? Yes 

[mafpe]

1 hour ago, fitwhynot said:

Looks really good, but you also had a lot more hair than I have. I hope you have a great result, even if it takes longer (as the crown sometimes does, if I’m not mistaken?). Good luck!

thank you. i'm already on finasteride for... maybe 6-7 years though, i don't recall th exact year.

as dr rahal's rep said though, there is a real risk of shocking weak hair to their death. for now, all i can hope is that it's not growing yet only because of the trauma, and will bounce back later.

 

i also, pre op, it looked really thick because my scalp hair was around 12cm on average, which is why the crown looks filled. my barber told me i was thinning though, so without length, it'd be pretty see through. so to say, my condition on crown is kind of similar to you depend on how i comb it / how wet it is. if you don't mind using concealer though, do use concealer instead. unfortunately i have no idea about shock loss / success rate for HT when it's not bald nor thick like ours.

[GoliGoliGoli]

2 hours ago, hairman22 said:

I disagree that the crown shouldnt be transplanted on this stage.

its more so about whether the patient as the donor supply to meet there possible highest norwood level.

I

The big concern I think is shock loss from transplanting grafts into an area that already has a lot of native hair

[Hairtodaygonetommoro]

On 7/28/2022 at 6:27 AM, Rahal Hair Transplant said:

Fitwhynot,

The crown is one of the most controversial and difficult areas of the scalp to transplant with any real degree of density.  In fact, the crown is often referred to as the “black hole“ for grafts because of this.   Well I can’t speak for Dr. Rahal personally, I agree that you may not see much benefit from transplanting the crown at the stage. Allow me to explain.

The crown is a very strange area of a scalp. those who are completely bald in the crown, a little can go along way. But for those who already have a covering in the crown, it will take a significantly large number of follicular units to achieve any real density.  

And then you have the risk of temporary and permanent shock loss. While most shock loss is temporary, any hair that’s on its way out anyway due to male pattern bonus may be permanently shocked and may not grow back.

At this stage, you are only 7 months into using finasteride and thus, it’s too early to tell just how beneficial this medication will be for you.  It’s recommended to take finasteride for at least a year to determine whether or not it’s affective. But in order to reverse the miniaturization process completely, assuming it’s even going to do that, but take more time. Many of the hairs on your scalp and in the crown are currently fragile and transplanting in the area may result in permanent loss of some of the natural hair.

Long story short, I concur with Dr. Rahal that it is likely a bit too early for you and in my opinion, you should give finasteride more time to see just how effective it will be prior to undergoing her transplant surgery.

I also want to say this. I know I’ll tempting it is to blow off a doctors advice because it goes against what you want to do. I’m sure you’re not happy with the thinning you’re experiencing and you want to do anything you can do reverse it. Just keep in mind that top doctors like Dr. Rahal have your best interest in mind and ultimately his advice is for your long-term benefit.

Sure it would be easy for him or any clinic to take your money and perform surgery on you.  But you have to truly respect the doctors that tell you to wait   They are the ones looking out for you and making sure that you obtain a net gain in hair over the long term rather than simply giving you what you ask for which may result in an overall net loss of viable hair   

In my opinion, stay on the medication for another year or two and then reevaluate. By then, if the medication is working, it’ll be working to its max capacity and any miniaturized hairs that exist today will likely be terminal.  As a result, you will experience much less permanent shock loss and then result will be a net gain of viable, terminal hairs instead of a potential net loss.

Best wishes,

Rahal Hair Transplant 

What if the hair on the crown is not native? Is there still a concern of shock loss in the crown area that already has transplanted hairs?

[Gatsby]

1 minute ago, Hairtodaygonetommoro said:

What if the hair on the crown is not native? Is there still a concern of shock loss in the crown area that already has transplanted hairs?

Yes.

[Jayson1361]

I’ve often wondered about people who are in between a full crown and bald, who may not be candidates for a HT, if they’ve considered escalating there hairloss  with TRT for example or stopping hairloss meds in effort to have a hair transplant at a younger age. Thereby giving themselves a longer time to live with hair…just a strange thought🤦‍♂️

[DrMunibAhmad]

If it effects your personal life immensely, and if you can not live with fibers or other concealing methods, a transplant with a low number of grafts can get your life back on track. 
 

It would need only 800 grafts. This amount isn’t in any way a problem for your future donorbank. The only thing you should really consider is that you would probably need a second procedure if the crown gets bigger.
 

You have to evaluate for yourself which of these 2 situations would have more negative impact on your life. 
 

Shock loss isn’t a problem in your case. I can already tell that these hairs wil grow back after shockloss.