Crown Hair Transplant

Article written by Dr. Blake Bloxham 

A crown hair transplant, addresses hair loss in that area, is known by many names: “crown thinning” or “vertex hair loss” or simply “thinning on the top.” But those who suffer from crown hair loss know what it is really called; and it’s really called, the dreaded “bald spot.” 

That’s right; your father had it and his father had it, but you won’t get it. Right? Then, it happens: one day a picture is taken from the wrong angle or a store security camera catches you from behind and you see the same “bald spot” on your own scalp! 

So, it finally happened; however, that doesn’t mean you have to accept it! No, you can treat this loss with a crown hair transplant. But what does a crown hair transplant entail? Is it a large surgery or a smaller one? How long will it take to see the results? Will the crown area continue to thin and should any other treatments be utilized? What does a crown hair transplant cost? Finally, what type of results can you expect? 

Read on to learn the answers to these questions and more. 

The “crown” or “vertex” is a region in the posterior portion of the scalp. It is neighbored by the safe hair transplant donor region below and to the sides, and by the mid-scalp region to the front. Thinning in this region typically occurs in patients with more advanced hair loss or those with “Norwood Pattern” V, VI, or VII level loss (Wirya et al., 2017). However, isolated vertex thinning can be seen in almost any patient with a genetic predisposition to hair loss (this involves adding a “V” designation for vertex to the normal Norwood classification). 

Like the frontal and mid-scalp in front of it, the crown region can be treated with hair transplant surgery. Crown procedures can be done via both the FUT (Follicular Unit Transplantation or “strip”) technique and the FUE (Follicular Unit Excision) technique. Unlike the frontal or mid-scalp, however, there are some very special considerations with crown hair transplants. 

Patients seeking crown hair transplants should be aware or a few important things: 

Hair In The Crown Area “Whorl”

First, the hair in the crown region grows in a very specific pattern called a “whorl.” This is a spiral pattern that (typically) starts from one area in the crown and spreads in a clockwise or counterclockwise direction. In most cases, this “whorl” pattern will need to be rebuilt during a hair transplant. This means the hair transplant doctor and staff will need to implant the new grafts in very specific directions to recreate a natural crown appearance. 

Crown Area Requires A large Amount Of Grafts

Second, the crown region requires a very large graft number. Online, the crown is called the “black hole” of grafts. This is because crowns are often treated with very high graft numbers and still appear somewhat bare or open. Some doctors believe this is because growth yields are lower in the crown; others believe it is due to the shape/curvature of the crown or the difficult whorl pattern or the way the crown may continue to thin. Regardless, patients should expect a very high graft number quote. 

Crown Area Experiences Thinning For A Period Of Time

Third, the crown often experiences progressive thinning for a prolonged period of time. Furthermore, thinning in the crown tends to spread outward in a “sunburst” fashion. This makes crown transplants akin to “shooting at a moving target” and often patients experience frustrating loss in peripheral areas of the crown before the transplant even matures. This is why patients undergoing crown hair transplants should also speak to their doctors about preventive, slowing hair loss medications like antiandrogens (finasteride or “Propecia” and dutasteride or “Avodart”) and minoxidil (“Rogaine”). These may help reduce or slow loss in these areas and help with the overall appearance of a crown transplant. 

So, now you understand the special considerations involved with a crown hair transplant. You reviewed the information thoroughly and have a crown hair transplant performed! Now what? Is there anything different about how crown hair transplants grow and mature? 

Actually, yes, crown transplants grow and mature differently. Specifically, the crown region grows and matures slower or more delayed compared to other scalp regions. Opinions on why this occurs vary, but all agree the crown is “slow.” The consensus? Crowns start to show cosmetically significant growth around 6 months and take at least 18 months to fully mature. Below is a more detailed timeline: 

Week 1-2: The scalp will be healing, and any swelling or redness should start to subside. It’s common for transplanted hairs to fall out, a normal part of the shedding phase.

Month 1-3: During this phase, the shedding process will complete, and you might notice very little hair growth. The follicles are in the resting phase.

Month 4-6: New hair growth will slowly begin, but the hair may be thin and not provide full coverage yet. Crown growth will likely be visible closer to the 6 month mark. 

Month 6-12: Hair growth becomes more evident, with improved density and texture. Most patients see around 60-70% of the expected growth by this point.

Month 12-18: Final begin to emerge. All hair will likely be “popped” or growing through the scalp by month 12, but the crown area’s full density and thickness will not be achieved until at least 18 months. Additionally, the more posterior the area the slower it will grow. 

So remember: hair in the crown area often takes longer to grow compared to other parts of the scalp. The crown typically experiences slower hair growth, and it can take up to 18 months (and sometimes longer) to see full results..

Patience is essential, as the final density and appearance may take longer to mature. But over time the crown will fill out and thicken, hopefully completing the desired look!

Month 6-12: Hair growth becomes more evident, with improved density and texture. Most patients see around 60-70% of the expected growth by this point.

Month 12-18: Final begin to emerge. All hair will likely be “popped” or growing through the scalp by month 12, but the crown area’s full density and thickness will not be achieved until at least 18 months. Additionally, the more posterior the area the slower it will grow. 

So remember: hair in the crown area often takes longer to grow compared to other parts of the scalp. The crown typically experiences slower hair growth, and it can take up to 18 months (and sometimes longer) to see full results..

Patience is essential, as the final density and appearance may take longer to mature. But over time the crown will fill out and thicken, hopefully completing the desired look!

What kind of results can crown hair transplant patients expect? We’ve found before-and-after images provide a visual understanding of the impact a crown hair transplant can have. Typically, patients show a stark contrast between a thinning or completely bald crown before surgery and a natural-looking swirl pattern after full hair growth.

These images are crucial for setting realistic expectations. It’s important to note that crown density may never completely match the hairline or mid-scalp due to the nature of hair restoration, but modern techniques ensure highly satisfactory results.

Special thank you to Hasson and Wong for allowing us to use the images below of their hair transplant crown patients. 

After understanding how the surgery will be done and what to expect, the next thing patients want to know is: How much will this cost? Below is a breakdown of factoring influencing the cost of crown hair transplants. It is important to remember that crown transplants, on the whole, can be more expensive simply because of the number of grafts required: 

Location: Clinics in major cities or regions with high demand may charge more.

Experience of the Surgeon: Top-rated, experienced surgeons often come with a higher price tag.

Extent of Hair Loss: More extensive hair loss requires more grafts, increasing the cost.

On average, a crown hair transplant can cost anywhere from $3,000 to $10,000 or more. Some clinics charge per graft, typically ranging from $2 to $10 per graft. Always consider that quality and expertise are crucial, especially for complex crown transplants.

Crown hair transplants can be successfully. In fact, the success rate for hair transplants in the crown area is often between 85-95%. However, this depends on several factors, such as the skill of the surgeon, the quality of the donor hair, and patient adherence to post-operative care. 

Crown transplants can be more challenging due to the swirl pattern of hair, but when done correctly, they produce a natural and lasting result. It’s true the crown is typically large and has a unique growth pattern, which can make achieving a natural look more complicated. 

However, experienced surgeons can replicate the natural swirl and use large graft numbers to try and create satisfactory thickness. But patients must discuss expectations, timeline, and what happens in the case of additional thinning and the need for more surgery with their doctors. 

When done properly on the right patient and by the right doctor, crown hair transplants can be a successful solution for the dreaded “bald spot.” No one can ever say whether a patient “should” have a hair transplant, but it can be a solution for those with crown thinning. Choose wisely and be patient; before you know it, you will no longer fear those security cameras! 

References: 

Wirya, C.T., et al. (2017). Classification of Male Pattern Hair Loss. Int J Trichology. 2017 Jul-Sep;9(3):95–100. doi: 10.4103/ijt.ijt_46_17