When Is It Appropriate to Address Hair Loss in the Crown with Hair Transplants?

This hair loss question  was answered by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  

The following question, asked by a member of our Hair Restoration Forum and Social Network, is related to patient results posted by Dr. Shapiro in the discussion thread, Dr. Paul Shapiro: 4400 FUT Grafts, 14 Days Post Op:

Can you tell me why you opted to go back into the crown? I ask because I hear of some hair restoration surgeons not wanting to touch the crown until a patient is much older and more progressed. This patient is a class 4 on the Norwood Scale at 28 but, theoretically, his crown could open up much further.

There is no set rule whether or not to put hair in the crown. What is important is that we take future balding into consideration so that, if the patient progresses, there is enough donor to make the hair transplant look natural.

In this case, the patient did not want his hairline very low and was happy with a mature frontal-temporal angle. I kept the front of his hairline high at 9 cm above the glabella and his frontal temporal angles mature. In these patients I will shrink the crown, but not completely cover it. It is usually safe to put hair at the top of the crown. Also the hair in the top of the crown is at a lesser density of around 25 to 30 FU/sq.cm to give it some coverage, but not very dense.

In the photograph of his crown (shown below) I have drawn in green the potential future crown hair loss and in red how far down I would go in his case. So if he becomes a Norwood type 6 or 7 he will still have some crown showing.

I hope this answers your question.

Dr. Paul Shapiro

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David (TakingThePlunge) Forum Co-Moderator and Editorial Assistant for the Hair Restoration Forum and Social Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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