To conclude this blog article series on crown hair restoration, we leave the most complicated part to the end. This article combines much of the knowledge that has been presented in the first four parts of this article series into a composite whole so some prerequisite knowledge is assumed. This article will focus on how to distribute grafts across the crown to achieve maximal density. Since grafts can be uniformly placed across the crown, the question would be why should a surgeon attempt to place them non-uniformly? The answer is simply to create maximal aesthetic impact. The reason for this is that there is only a finite number of grafts that can be transplanted at any one time and as the earlier article on the “billboard effect” stated, the surgeon is always in need of more grafts than imagined to get the best results in the crown region. Therefore, it is imperative to apply the grafts in an artistically sound manner to create the best visual density possible.

The numbers in the accompanying figure describe priority areas to focus on density based on location, as will be explained in a moment. When talking about density, density can be achieved through two methods: using larger sized grafts like 3 to 4 hair grafts and by placing these grafts more tightly together. For the sake of simplicity, consider that density in each of the prescribed areas will be achieved through a combination of both methods for best results.

This article will strive to explain why the priorities on density have been labeled as diagrammed. Priority 1 is assigned because the hairs in this area serve a triple purpose. First, they arc upward into the area where the hair parts (shown by the yellow arrows) so that someone viewing the patient from in front should see less baldness coming through the sensitive hair-part area by virtue of the hairs that are transplanted in priority zone 1. Secondly, the hairs also arc upward to cover the posterior midscalp meaning that the hairs also provide density to the entire back of the head when viewed from the front of the patient. Third, the hairs in zone 1 also arc over and cover priority zones 2 and 3 and somewhat into 5 in a so-called “cascade effect” manner meaning that each hair in zone 1 covers at least 2 to 3 other zones near it effectively tripling the effect of each single hair graft in zone 1 when it comes to imparting visual density. Priority zone 2 is next most important because it affects everything that zone 1 does except the hair part. Zone 3 comes next because the hairs here cover the lower arc of the crown but do not cover the hair part or the posterior midscalp. Zone 4 is next most important because it arches upward somewhat to reinforce zone 1. Zone 5 comes next because even though it descends in an area of less cosmetic importance, i.e., the lower arc of the crown, it still rotates over to cover 6 partially. Zone 6 is the least important because it occupies the lower half of the crown (as mentioned an area being less cosmetically important) and it does not arc over any adjacent area to provide additional cover but instead just descends almost straight downward. Accordingly, it is important to think of hair restoration as a strategic and artistic endeavor, especially in the complex area of the crown region.

Samuel M. Lam, MD, FACS is a board certified hair restoration surgeon in Dallas, Texas. To learn more about Dr Lam’s crown hair transplant procedures please visit our website or call 972-312-8105 to schedule a consultation.