Crown Hair Transplant

Crown Hair Transplant: A Complete Overview

Thinning in the back of the scalp — also known as the “crown” or “vertex” region — is extremely common. It’s typically the second more common area to experience genetic male hair loss (androgenic alopecia or “male pattern baldness”) after the frontal or hairline area.

Hair loss in the crown area leads to the dreaded “bald spot” at the back of the scalp. This spots tends to weigh very heavily not only on patient’s scalps, but also on their minds. For a variety of reasons — association with the “bald spot” on an elderly relative, the inability to see the crown but knowing it is thinning, or a “dip” in the back that makes styling fall flat — crown thinning causes patients serious distress.

Thankfully, crown hair transplants are an option. And transplanting hair into the crown can restore not only a patients hair, but also their self-esteem and confidence. However crown transplants are somewhat unique. There are some interesting elements associated with these procedures and below Dr Bloxham will explain these and discuss “everything” else you, the patient, need to know about crown hair transplants.

Can Hair Be Transplanted on the Crown Area?

It may seem like a fairly straightforward question, but the first thing “you need to know about a crown transplant is that: Yes, hair can be transplanted to the crown area. Okay; now how is it done?

Transplanting hair into the crown area is done through the same process as transplanting hair to the front or middle of the scalp. A surgeon can use either the FUE (Follicular Unit Extraction or Follicular Unit Excision) technique or the FUT (Follicular Unit Transplantation or “Strip”) technique to remove follicular unit grafts from the Safe Donor Area (on the sides and back of the scalp) and individually implant them into the thinning or bald crown regions. Both techniques can be effective for crown restoration.

What is unique about a crown hair transplants is the pattern in which the grafts are placed. The hair in the crown naturally arises from a singular (though it can sometimes be two) point and then spreads in a circular swirl or “whorl” pattern.

The origin point (except in the case of the “double whorl” referenced above) can be in the left, right, or center, and the whorl pattern can be in a clockwise or counter clockwise direction.

Since the native (natural, non transplanted) hair grows in a whorl pattern, a crown hair transplant procedure is typically planned and executed to replicate the natural swirl — ensuring a natural result. While it not always necessary to reconstruct the whorl pattern (especially in cases with extensive loss where patients have limited grafts to use in the crown region), it is typically recommended and leads to good results.

However, this intricate reconstruction pattern requires not only skill and attention from a quality surgeon; it also requires large graft numbers!

How Many Grafts are Needed for the Vertex Area?

Online, the crown is sometimes referred to as the “black hole” of grafts. While this is definitely an exaggeration, the truth is that it takes a surprisingly high number of grafts to successfully rebuild a crown. Just how many?

The number of grafts required for a crown hair transplant will vary depending on factors such as:

The Size Of The Bald Area

Some crowns remain as small, contracted “bald spot” while others tend to “spread” down the sides and back and push forward toward the mid-scalp and create a very large and complex area to address.

The Density Of Hair Desired

Certain patients are okay with “some hair” in the crown region; as long as they do not have the “bald spot” or they have enough hair back there to style with the rest, they are happy. Others want true density in the region and obviously this will require more grafts (and could even take a few sessions). I typically tell patients with the smaller, more contracted spots that density is realistic; however, patients with the larger, more “spread” crowns may want to accept the idea of coverage versus true density.

The Patient’s Hair And Skin Characteristics:

Patients with thick, wavy, hair or a low contrast between the skin tone and the hair color will likely obtain better cosmetic coverage from the same graft numbers compared to a patient with finer straighter hair and a higher contrast between the skin and hair tones (IE: fair skin with dark hair). Patients with favorable characteristics will likely require fewer grafts compared to those with less favorable characteristics.

On average, however, a crown hair transplant may require anywhere from 1,000 to 3,500 grafts. Patients with a small, contracted crown may only need 1,000 – 1,500 grafts; patients with an average sized “spot” in the back are likely going to need approximately 2,000 grafts; and patients with the extensive, spreading thinning pattern in the crown will likely require 2,500 or more grafts.

The large variation in graft numbers also means the price of a crown transplant may vary as well.

Crown Hair Transplant 3400 Grafts

Crown Hair Transplant 2000 Grafts

Crown Hair Transplant 2500 Grafts

Crown "Vertex" Hair Transplant Cost

At Feller & Bloxham Medical, we believe in being transparent with prices. Because of this, we post all of our surgical fees directly on our clinic websites — something nearly unheard of in the field. Furthermore, an interested patient can complete a simple online consultation to receive a graft number estimate and harvesting method recommendation (FUT, FUE, or a combination of FUT/FUE). With this information, a patient interested in a crown hair transplant should be able to look up precisely what they will pay for a crown procedure.

In general, however, two variables will affect the price of the surgery: the number of grafts needed and the harvesting method used. Patients with small, confined crowns who require smaller grafts numbers will pay less patients with expansive crowns who need more grafts will pay more. Patients who are candidates and opt for FUE procedures (which has a higher rate per graft) will pay more compared to those to take the FUT route.

It is also important to remember that sometimes the crown requires a few sessions. As previously stated, it can be a greater challenge to obtain density in the crown area. The crown can also be a rapidly changing environment and sometimes additional procedures are needed to treat newly thinned areas. Additional procedures will add to the overall cost as well. But whorl patterns, graft numbers, and cost variation are not the only unique characteristics of crown transplants .

Does Hair on The Crown Take Longer to Grow?

Crown transplants are unique in the way they grow and mature as well. In general, crown hair transplants take longer to grow. The reasons behind it are somewhat up for debate, but most believe it has to do with a different blood supply that is further from the primary vascular regions of the scalp (and one that is more disrupted during surgery) which may result in a slower growth process.
While transplanted hair in the frontal area may start showing results within 3 months, demonstrate an appreciable cosmetic difference by 6 months, and show good results by 12 months, it can take sometimes take up to 6 months for transplanted follicles in the crown to even “wake up” and start to grow new hair. Below is a more detailed timeline of crown transplant growth and maturation:

Hair Transplant Crown Area Growth Timeline

Here’s a typical timeline for crown hair transplant growth:

Week 1-2

Scabbing, redness, and some swelling are normal. As healing
continues and good washing is initiated, the transplanted region should start to resemble a clean “buzz cut” appearance.

Weeks 2-6

The transplanted hairs shed as the follicles enter a Telogen or “resting” phase.

Months 1-3

A typical Telogen phase lasts around 3-4 months. This is why a
typical transplant begins to grow at month 3-4. However, crown transplants demonstrate a prolonged resting phase beyond this point.

Month 4-6

The Telogen phase slowly ends and the follicles prepare to wake up and grow new hair

Month 6

Typically this is when crown transplants show initial “sprouting” or “popping” of fine hairs (though it can be earlier in some patients)

Month 7-9

Hair penetration accelerates, and the crown starts appearing denser; typically the 9 month mark is the “half way” point with respect to overall maturation in the crown area.

Month 10-12

Popping of hairs continues, but maturation and more visible results during this phase are seen through a thickening and normalizing of the hair shafts (IE: the shafts begin to reach the thickness and appearance of normal hair.

Months 12-18:

Late popping and maturation continues; full results are typically seen by month 18 (though sometimes take longer) Patience and faith is required during crown transplant growth. It is easy to become discouraged or consider the procedure a “failure” early on. However, patients must remember that crown transplants take longer

Hair Transplant Crown Area Success Rate

Thankfully, most of the time this waiting pays off: crown hair transplants have a high success rate, with many patients experiencing natural-looking and long-lasting results. Understanding patient goals and setting good expectations are key to successful
results. Other factors which may help patients achieve a good result are:

The skill and experience of the surgeon

Crown transplants are not as straightforward; a doctor with more experience performing crown transplants should be able to execute a more strategic procedure and set a patient up for the best result possible.

The patient’s overall health and hair characteristics

No two patients are the same; some are simply in “better shape” to have a good result in the crown. A patients with favorable hair and skin characteristics and good, minimally interrupted vascular supply is likely to have a more successful crown transplant.

Proper post-operative care

This cannot be understated: patients who follow the post-operative instructions carefully (especially with regards to cleaning) are
likely to have better results in the end. Regardless of strategic, physiology, or patient compliance, studies indicate that crown hair transplants boast a high growth yield (the number of transplanted grafts that survive and grow) in general — despite some belief to the contrary.

The estimated growth yield likely ranges between 85% to 95% — especially with FUT surgery. So while it may be a greater challenge —and longer timeline — to obtain a dense, natural result in the crown region, patients should rest assured that grafts transplanted in the crown do grow.

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Hair Transplant Crown Aftercare

As previously stated, proper post operative “aftercare” is crucial for a good crown transplant result. Patients who ignore the post-operative instructions may dislodge grafts, damage grafts, or create an environment where grafts simply have a lower likelihood of “anchoring” and growing. All Feller & Bloxham patients will be provided with detailed post-operative instructions; however, below are some quick aftercare tips to help optimize results:

Protect the Grafts

It takes approximately 4 days for transplanted grafts to anchor strongly. Before this time, they can theoretically be dislodged by contact
from the wrong type of hats, touching, scratching, towels, head “bumps” et cetera. Take precaution to protect the grafts and avoid trauma during this crucial period.

Follow Washing Instructions

Cleaning a transplant properly can be the difference between a good result and a bad result in the end. The crown area is no different. If a patient prevents excessive scabbing, dryness, and the potential for bacteria and fungi to build-up on the scalp, the grafts have a better chance of surviving and growing.

Alter Physical Activities

Physical activity should be restricted during the firs four days post-op to avoid trauma to the grafts. After day 4, physical activity can
be increased. However, it still should be monitored to prevent excessive sweating which can lead to bacterial colonization and infections. By day 10, normal activity can be resumed without restriction.

Sleep Elevated

Sleeping at a 45 degree angle with something “wrapped” around the shoulders (like a travel pillow or rolled-up bath towel) for the first
nights will help minimize the potential for graft dislodgment during sleeping (and reduce swelling).

Avoid Blood Thinning Agents

These include alcohol, vitamins, supplements, and some pain medications like Ibuprofen and Aspirin. These thin the blood,
which may prevent the grafts from properly anchoring and increase the changes of dislodging a graft for the first 4 days (they can typically be resumed after)

Avoid Topical Treatments

The grafts/scalp really cannot be touched forcefully for the first four days. Additionally, it may be especially sensitive to irritants like alcohol-based liquids. Because of this, topical treatments like minoxidil should be avoided for the first 4-10 days post-op. Some clinics may have restrictions o medicated shampoos (like ketoconazole-based shampoos) as well.

Be Mindful of the Sun

It takes time for transplanted grafts to develop the same UV protection as the native skin and follicles. Because of this, they can become
damaged by a sunburn even up to 6 months after surgery. Sun protection (such as a hat) must be utilized during any prolonged period in the sun.

Be Patient

Hair growth takes time, especially in the crown area. Follow up with your surgeon for regular check-ins.

Crown Hair Transplant Before And After

Crown Hair Transplant Before and After 2000 Grafts

This gentleman, in his 40s, experienced significant hair loss. He first visited Dr. Bloxham for a hair transplant focused on the frontal half, which was successfully performed using the FUT method. Later, he returned for a second procedure to refine his temples and, primarily, to restore his crown. This session combined both FUT and FUE techniques. His case is a great example of an average-sized crown that remained relatively contained, allowing for the transplantation of 2,000 grafts.

Crown Hair Transplant Before and After 3400 Grafts

This patient exhibits a more diffuse pattern of hair loss, with thinning extending across the top of his scalp. However, he has a favorable hair type and an optimal hair-to-skin contrast, which enhances the overall result. To address his hair restoration needs, IDr. Bloxham performed a 3,400-graft FUT procedure

Crown Hair Transplant Before and After 8000 Grafts

This patient has experienced extensive hair loss and has undergone multiple hair restoration procedures over the years, performed by both Dr. Bloxham and Dr. Feller. Through a combination of FUT and FUE techniques, we have transplanted approximately 8,000 grafts in total. His case serves as an excellent example of a strategically planned approach to restoring an expansive crown, with a strong emphasis on achieving optimal coverage. Additionally, his favorable hair type has contributed to the success of his results.

Conclusion

Crown hair transplants are an effective solution for individuals dealing with hair loss in the crown area. While the process may take time to deliver visible results, the outcomes are often worth the wait. With a high success rate and the ability to restore a natural look, this procedure has become a go-to option for many. If you’re considering a crown hair transplant, feel free to reach out and see what can be done.

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