How often do crown surgeries require touch up/repair?

[Yan bio]

It seems to me hairline requires strengthening many times, but how mich is this true for crown?

[Amiele]

I’d also like to know how often crown surgeries require touch ups? More so, how often do patients need a second crown procedure because not enough grafts were used on the first procedure? 

[Al - Moderator]

This is hard to say because most people would rather use more grafts in the front rather than in the crown. You don't have an unlimited donor source, so just because someone has a touch up in the front doesn't mean the crown isn't also thin.

 

[Amiele]

@BeHappyI believe that a Norwood 4 or below who is on medication — stabilized — and has adequate donor caliber, and who starts with FUT for their first two to possibly 3 procedures, shouldn’t have to worry about running out of donor. Using myself as an example because I’ve had two FUTs, albeit on the low-end in terms of graft count, but my crown still isn’t where I want it to be. 

Could fin stop working for me and then have to worry about accelerated loss of native hair? Sure, but then I’d switch to dut. 

[LaserCaps]

It all begins with understanding the limitations we face, how best to proceed, and the overall goal.  

The basis of it all is donor limitation.  There's just not enough to allow for full density to the front, top and crown.  It's for this reason most ethical doctors will concentrate their efforts towards the front.  It's the area you see when looking at yourself.  It's also the area others see when they interact with you.  Now the crown.

In simplest terms, think of the crown as a circle.  You fill it.  Because you've shown the propensity to lose, you'll continue losing.  You go on to lose all the hair around the island worth of hair and now you've created a target area and an unnatural pattern.  Retention of the native hair becomes imperative.  

The crown is the weakest point we all share due to the whirl.  It's the point from which the hair stems. That is, no hair is coming into the area to provide any sort of shingling.  The hair grows away from the point, exposing the area.  Let me illustrate.

Grab a piece of paper and a pencil.  Draw a dot.  Draw an intersecting cross on the point.  Turn the paper ever so slightly in either direction and draw another cross.  Do this until you get tired.  How many crosses would it take to fill the area?  We refer to the crown as the black hole of hair restoration. You'll end up putting all your donor in the crown.  You then lose the front.  I can almost hear you ask, "Why did you put all my donor in the crown when I now have nothing left and still look bald?  It's important to keep in mind it's the front people see when they converse with you.

Review the Norwood chart and notice the progression.  It's perfectly natural to have hair in the front and have a thinning or empty crown.  To have a "dusting" back there is normal.