Crown Hair Transplant Design

This audio podcast has been transcribed using an automated service. Please forgive any typographic errors or other transcription flaws.

This podcast is on crown restoration or crown hair transplant. The crown is an area that is a bit confusing because people talk about it in different ways. It is also known as the Vertex. The way I describe it, as it sits on the vertical plane of the scalp. It’s the circle, the area on the backside, that empty area looks bad. It obviously extends into the posterior mid scalp and also descends downward. The goal of this podcast really is not to cover all the details because you’ve seen some of my lectures extend 30 to 60 minutes. I’ve written a whole textbook where I have a chapter dedicated talk about crown restoration. So it’s too far beyond this. So the thing that I want you to know about crown restoration is that I don’t perform it for someone too young, because I’m worried about that crown opening up.

And also what I’ve got to do is think about it as a supply and demand issue of how to create the best results in the long end and co provide enough density and coverage there. The problem with density and coverage in the crown is that since it’s on the vertical scalp, you’re looking directly on the bald scalp. So it’s harder to create visual density than the front of the scalp. The second problem with the crown is that it’s world it’s opened up as a circle. So the graft splay open and doesn’t rest in the same direction. So they’re actually fan open so that you can see the bald scalp more easily. So this is a struggle to create enough visual density on the backside of the scalp. So someone feels as if it looks dense enough. The third problem with the crown it’s the idea that I’ve talked about in a podcast called PI R squared, which is the surface area of a circle.

And, you know, the crown is a circle. So if you double the radius, you actually quadrupled the number of grafts that are needed. So what seems like a medium sized crown, once it expands a little bit, takes a lot more grafts to be placed in there. The other concern I have is how that crown is going to look. If the crown expands will look natural, will I have enough grafts to cover it? If your crown continues to expand. So I’m looking at not only addressing your current problem, but also, making sure that we don’t get into a situation down the years. Of course, there’s no crystal ball. There’s always a risk, but down the line of how I can get the best longevity on this. And if it does open up, what can I do to minimize it not looking right? So a colleague of mine in Houston actually advocates the opposite of what I, say he wants to keep the center of the crown relatively open and not too dense cause he’s worried is going to look unnatural. If it’s too dense in the middle, he likes to put the grafts and the perimeter on the outside portion. There are several problems with this, in my opinion. Number one is that if you, the grafts and the perimeter way in the edge, it doesn’t give you visual power. It gives you very little power. Number two is you’re placing grafts around the perimeter, which is, it takes so many more grafts around the perimeter then in the center to create visual density. So now you’re having this dense area way out laterally. Now the third problem is if that area does open up, you have this dense outer portion and then followed by a non dense outer portion beyond that, where it’s receding, that doesn’t look natural either. So I have a whole different philosophy about this, which is you need to leverage every single graft you place on the crown for maximum outcomes.

So how do you do this? First? We talk about the cascade effect. And that’s another podcast I talked about, which is, if you think about a graft in the middle of the crown, as that graft travels outward, it creates a much better visual density because it covers from the middle of the crown all the way to the edge. And if you place a graft only on the edge of the crown, it’s only covering just the edge and beyond. So much less traveled this. And so the impact per graft is not as effective. And that’s an important thing. There’s also a lot of subtleties in terms of how to place the center of the world. That’s very hard to describe in a podcast, look at my lectures to talk about how I design a whorl based on the way that you comb your hair depending on the maximum bald.

This is there’s so many factors there. And also the other thing is when the crown is in a whorl, you want the grafts to actually stick out. Because that way you can dense pack these grafts, where they’re in a whorl, because otherwise with the whorl, as you make those sites to place the grafts into, and they’re very low angled, you don’t create the lift on the backside, but also those grafts compete with one another where you can’t dense pack them. Now, all these things are very hard to describe in a podcast, especially to someone that’s new to this whole idea, but part of this podcast and the short five, six, seven minutes of discussion is to talk to you about the complexity of design and design is King, especially when you’re dealing with a numbers game of trying to make something as good as possible. You want to have the best results per graft that’s placed. So I try to take every graft and leverage in a way for maximum outcomes and also think about long-term safety.