Crown Hair Transplants

Men experience different types of hair loss. Crown area baldness is one of them. The crown region of the scalp is also known as the “vertex” or the “bald spot” in the back of the head.

This is a region usually affected by male pattern hair loss – androgenic alopecia. Hence, the patients often seek hair transplantation in this area. As a matter of fact, the crown area hair transplantation is one of the most commonly requested hair transplantations during doctor-patient consultations.

However, the crown area hair restoration is quite challenging. As the hair in the crown area grows in various directions creating a whorl, its reconstruction can be very demanding. Another challenge is creating the donor area large enough to cover the bald spots. 

What is Crown Hair Transplants?

A crown hair transplantation represents the type of follicular unit extraction (FUE) procedure performed in the vertex. That means the surgical removal (extraction) of individual hair follicles from donor regions on the back and the sides of the head and their transfer into the crown area.

Crown hair transplantation is one of the most technically challenging hairs transplant procedures for several reasons. Because the hair in the crown area grows in a circular pattern, referred to as the hair whorl or swirl, this procedure is very challenging. It is difficult to restore hair growth in this pattern and to produce natural-looking results, as is finding enough hair in the donor region. 

The first hair transplant procedure for male pattern baldness was performed in 1952 in New York City by Dr. Norman Orentreich. Although the medical research community initially rejected his few paper submissions on this topic, his study was eventually published in 1959. Dr. Norman Orentreich explained the principles of hair transplantation using the term “donor dominance.” That term says that transplanted hair preserves the same characteristics of the hair from where it was taken. However, these first tries did not give a natural-looking appearance. Therefore, the techniques were improved over time and are still improving. This is especially true for crown hair transplantation considering all the artistic and aesthetic difficulties related to it.

This procedure is quite common today, as crown hair loss occurs as a part of the male pattern baldness. Men often seek help exactly for this type of hair loss. However, not anyone can perform such a procedure. It takes a highly skilled medical doctor, surgeon to restore the hair in the crown area. Even the most experienced surgeons need to take different approaches when performing crown transplantation than restoring a receding hairline hair loss.

Characteristics of crown hair loss

Crown hair loss is one of the earliest and most common warning signs of male pattern hair loss or androgenic alopecia. The bald spot in the crown area is the early sign of balding and usually comes as a shock.

The hair thinning occurs in the crown area on the top of the head; however, the hair growth on the sides of the head usually remains the same. When you experience crown balding, you may notice that the hair in this area may become brittle too. Furthermore, the hair loss on the crown area may be accompanied by a receding hairline.

Pattern baldness is distressing for many men.  It is caused by the sensitivity of the hair follicles to a DHT hormone (dihydrotestosterone). DHT weakens and causes damage to the hair follicles, eventually ceasing the hair growth completely. Most often, the follicles on top of the head are the ones that suffer first, as do those in the hairline.

The extent and stage of the male pattern baldness are represented in the Norwood scale. The Norwood scale is also known as the Norwood-Hamilton scale. It is a measurement scale used to classify the male pattern baldness.

The scale encompasses 7 stages, starting from the first signs of hair loss in stage 1 to the most severe form of baldness in stage 7. The seriousness of hair loss in the crown area differs depending on the patient´s age and becomes noticeable in stages 3-7.

Although one may think that this hair loss type affects only older men, it can occur at any age, even in youth. Furthermore, women may also be affected by crown hair loss. In women, crown hair loss may be genetic. Genetic female hair loss pattern is also known as androgenetic alopecia. The first signs of this hair loss type in females can begin as early as the teen years.

Procedure options

Several treatment options exist for crown hair loss – surgical and non-surgical. When it comes to hair transplantation, surgery to improve the balding or hair thinning in the crown area can be particularly tricky and challenging for many reasons.

However, if properly performed by a highly skilled surgeon and at a clinic with expertise in hair transplantation, the results can be life-changing.

For any hair transplant surgery, it is essential to have a sufficient amount of donor hair, but the crown area can often be pretty large. However, good coverage should be possible to accomplish if the patient has normal hair density. One surgery for crown area hair restoration could be enough. Still, if the patient is completely bold in this area, or the crown area is bigger than average, or if the patient has very fine hair, he or she may require additional surgery in order to accomplish the expected results.

A crown hair transplant can be performed as the FUE (follicular unit extraction) or FUT (follicular unit transplantation) procedure. The FUE procedure involves the surgical removal of individual hair follicles from donor areas on the back and sides of the head, which are being extracted and transferred into the affected crown area. On the other hand, in the FUT procedure, a thin strip of hair is removed from the donor region and transferred to the crown area.

Non-surgical treatments include medical options such as Minoxidil, Finasteride, and in some cases, PRP (platelet-rich plasma) injections. These non-surgical treatments may increase the density of the hair and hide the hair thinning areas, as well as to promote hair regrowth. However, these medications are not always effective, and hair transplantation may be necessary. In other words, it is possible to conceal signs of crown hair loss and balding with non-surgical treatment options.

Crown hair transplantation surgery, however, is not available on the NHS as it is cosmetic surgery.

Donor  area

The donor area is where the hair follicles are harvested. It is on the back and the sides of the head. However, a patient may not have enough lifetime grafts available if he or she is suffering heavy hair loss.

Having full, thick crown hair and suffering from hair loss in the front of it is not something we usually see in nature. On the contrary, seeing men with full frontal hair and thin hair in the crown area is something we see a lot. Therefore, if you have a limited donor area and you can only transplant one area of the scalp, it is better to use it in the frontal line.

Furthermore, if you want to undergo an extensive procedure, body hair transplantation can be an option as well. Using the body hair follicles is considered minimally invasive and requires no sutures.

Cost and graft size

The experienced surgeon calculates the amount of the available grafts and estimate the number of grafts available for each patient. The amount of grafts needed for the successful restoration of the crown area is approximately 3000 to 4000 hair follicles if the crown area is completely bald.

Take into consideration that the average man has about 5500 lifetime grafts available forr donation. So, only around 2000 grafts would remain for any other area restorations. Therefore, the good surgeon will plan accordingly not to use too many grafts if you require them for future use – such as for a thinning hair line.

The cost of a crown hair transplant is usually the same as a hair transplant procedure in other areas of the scalp. However, the cost depends on several factors. In the first place, it is the type of procedure that affects the price.

A 3000 graft surgury would in the UK range from £2,5 to £5 per graft or in the lower range at least £7500 in total. In Turkey the same procedure would cost £0,9- £2 per graft, or £2700 at the lower range in total.

Surgery in the UK vs. Turkey

Deciding to do crown hair transplantation should be a well-thought-out decision. The hair transplant procedure in the crown area is one of the most technically challenging ones for several reasons. Therefore, the most important step is to choose a well-trained surgeon, experienced in crown hair transplantation, as well as a clinic with a good reputation.

You should think thoroughly about all the aspects. As for any other hair transplant procedure, you can choose to do the crown hair transplant procedure domestically or abroad. In any case, make sure your surgeon is licensed and registered, as is the clinic in which they work, whether it is in the UK or elsewhere.

The crown hair transplantation procedure cost in the UK ranges between £2000 and £5500, depending on the type of procedure and the clinic. Turkey also has several clinics performing crown hair transplants. The costs of the surgery vary between £500 and £1800. However, one should consider other factors as well. However, one has to consider the additional costs, such as travel costs, accommodation, insurance, follow-ups, etc. As for the procedure itself, it does not differ much. It is an outpatient, one-day procedure performed under general anesthesia in both the UK and Turkey.

Risks and considerations

Besides the abovementioned considerations, one must think about the possible risks. Like any other surgical procedure, crown hair transplant carries certain risks, although the complications are rare.

Possible complications include noticeable scarring, infection following the procedure, damage to the hair follicles, poor wound healing, bleeding, pain, numbness, swelling, itching, and reaction to local anesthetic. In any case, before the crown hair transplantation, the surgeon should perform a medical examination. He or she will consider your medical history, age, quality of the hair, amount of the hair in the donor area, and anticipate future hair loss. After that, the doctor will decide whether you are a candidate for such a procedure.

However, not all surgeons are the same in their experience and skill. Because this is quite a challenging procedure, the location of the clinic and price of the procedure should not be a primary consideration, but the selection of a capable surgeon, unless you want the unnatural appearance of the crown area in the end.

Crown hair transplant timeline 

The hair in the crown area may take more time to grow than the other areas of the scalp. It takes from one year up to 18 months for the transplanted hair in this area to completely mature following the procedure. The process is shortly described below:

• Week 1 – 2 before the procedure: Consultation and planning of the procedure. You will choose the clinic and meet with a surgeon. The doctor will discuss the procedure with you and determine the number of grafts needed. If you are satisfied with this meeting, you will arrange your surgery date. 
• The procedure – 4-8 hours. 
• Week 1-2 after the procedure: The recipient area appears quite well healed. The dormant period begins.
• Week 4-6: Most of the transplanted hair follicles in the crown area will be shed. It is important to note that this is an entirely normal part of the process. Once the hair completely sheds, the follicles enter a complete stage of rest.
• Month 3-4: Tiny hairs lacking full pigment start to sprout. However, these hairs will not grow at the same time. During the next couple of months, the hair will grow and darken as it matures. It is the time when it begins to look more natural.
• Month 5-8: In this period, the transplanted hair matures, and the donor site should be completely healed by now. In other words, the hair growth cycle has returned to normal, and there is no visible evidence of the transplantation unless you have scarring.
• Month 8-12: The transplanted hair continues to mature, and the thin hair becomes thicker. In this period, you should be able to style your hair. 
• Month 12-18: After 12 months, finally, most of the hairs implanted on the crown will have fully matured, and the final results are visible. However, sometimes it may take up to 18 months for this to be accomplished, as the skin on the crown area is thicker than the rest of the scalp. 

Before and after pictures

Take a look at the pictures of the patients before and after the crown hair transplantation and notice the difference.

• Crown hair transplantation, before and after
• Results of the crown hair transplant procedure
• Patient before and after the crown transplant.
• Noticeable difference: before and after the crown hair transplantation.

Results and aftercare

As for any other surgery, there is a need for aftercare following the crown hair transplantation. During this procedure, the donor and recipient areas are being hurt. Therefore, proper post-operative care is necessary for recovery. The aftercare usually includes sleeping in the upright position during the first two nights. Patients are advised to avoid smoking, drinking alcohol, and taking anticoagulants. Furthermore, they should not touch or rub on these areas. 

After the crown hair transplantation, the patients will go back to their everyday life just a few days following the surgery. The patients need to know that it is expected the hair will fall out during the first week. It takes a few months for new hair to grow. As previously mentioned, the final results should be seen somewhere between 12 and 18 months.