There is not a day that goes by without my thinking or rethinking or innovating something. I am very passionate about making everything better and even when I think I can’t make it better I try to think how I could be wrong. Everything from the patient experience to the patient outcome is integral to my thought process and I am relentless about pursuing excellence. One of my great passions is crown transplantation, partly because of the challenge it offers in creating results that are of high visual density compared with the front of the scalp. There are so many fundamental points that must be followed in order to achieve improved outcomes. In my course at St. Louis that I run every year I lecture on crown transplant because, honestly, I have not heard anyone else innovate on this topic to my satisfaction.

Since the crown rests on the vertical scalp, the scalp is far more visible to the naked eye than the top of the head. That makes achieving visual density far harder. In addition, since the grafts whorl in a circle, they splay out and make density far harder to achieve. I have written extensively and have recorded a lot of videos of my lectures on this subject, which I will not reiterate fully herein. However, I wanted to address one single point that has changed in the way that I design crowns in the past couple of years.

When a man has a completely bald crown, I have the luxury of designing the crown anyway I so please. I have mentioned before that I like to make sure that the hair part is densely packed from the crown side to achieve better visual coverage even from the perspective of someone looking at you from the front. However, in the past, I argued that it would be better to place the center of the whorl lower and letting the upper arc cascade upward and then back downward to get a double-density effect. However, in the past two years, I changed over to placing the center of the whorl higher and similarly off to the side. By focusing on the lower arc of the whorl, the hairs can cascade downward on the vertical scalp and drop downward to cover the scalp better. This may be a subtle point and one that is hard to communicate to a lay audience. However, to me it has profoundly improved my results and made crown transplants quite a joy.