Crown: Area of Concern

Abstract

In a person with extensive hair loss, the first priority is rebuilding the hairline and coverage to the frontal two-thirds of the scalp. As much as some patients may request crown coverage, it is a mistake to spread the grafts out thinner to try and cover the crown because this thinner coverage will produce an obvious transplanted look. After the first transplant, the patient is placed on finasteride and is advised to wait 9 to 12 months to see the growth and density from the transplant. If the patient is happy with the coverage and density with the frontal two-thirds, then if hair supply allows, the crown may be done in the second surgery. The major concern with crown coverage is ongoing hair loss causing a separation between the transplants and the thinning margin. If finasteride showed some regrowth of hair in the crown area, then the patient may be happy to wait and see what finasteride can do in the next 12 to 24 months. For the younger patient, the longer we can delay crown work with the use of finasteride the better. If the crown is transplanted early and should the patient lose down to an advanced Norwood VI or VII, most likely he will not have sufficient hair left to bridge a previously transplanted crown to the receding margin and will be left with an island of transplanted hair. The younger the patient the more difficult it is to predict the degree of future hair loss.