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Crown v/s frontal HT - alternate approaches


#1

Dear forum readers,
A long time request of patients is to give as much priority to the crown/swirl area as to the frontal/hairline areas.

Till the scalp donor resources were limited, the obvious choice was to keep the bulk of the grafts for the frontal areas.

With advent of FUSE, triclosure, BHT and facial hair to scalp transplants (FHT), the expanded donor resources enable alternative transplanting approaches in suitable patients.


Following are some pre operative pictures of a patient.

I welcome your comments on the different possible hair restoration strategies here.

Regards,
Dr. A


#2

Dear forum readers,
The patient has 3 broad options in this situation.

  1. To go for a hairline favoring HT. A low wide hairline proceeding back towards the top and crown.

  2. To go for a crown HT with a very conservative hairline.

  3. To go for a complete transplant including a ambitiously vigorous hairline as well as working in the top and crown.

Option 1 and 2 are possible using the scalp donor hair alone (by strip or by fue).

Option 3 will require a combination of FUHT and FUSE as well as BHT and FHT to complete the graft requirements for all areas at reasonable densities.

Of course, Option 3 can be followed in stages too.

Regards,
Dr. A


#3

This patient, nickname SH, opted for a full length strip FUHT procedure in his first stage HT.

SH wants to focus on the crown area.
As a result, the hairline has to be suitably conservative.

The following pictures illustrate the design.
The swirl has been used as the posterior anchor point for SH’s HT design.

Videoclip of SH pre HT

12_file3.wmv

Regards,
Dr. A


#4

Dear forum readers,
SH got 4400 grafts in his FUHT procedure.
He has promised to share his progress.

These grafts were transplanted in the crown, top and a very conservative hairline restoration.
Below is the picture taken post operatively.

Regards,
Dr. A


#5

» Dear forum readers,
» SH got 4400 grafts in his FUHT procedure.
» He has promised to share his progress.
»
» These grafts were transplanted in the crown, top and a very conservative
» hairline restoration.
» Below is the picture taken post operatively.
»
»


»
» Regards,
» Dr. A

To get a full restoration i think the best way to go is to get a somewhat low hairline(if you prefer that)and fill as much of the head as possible with strip procedure. Once you have stripped yourself out then go to FUE and get as many FUE grafts as possible to fill the rest of the head. The front being the most dense and fading back into the crown. Finally any areas that are thin fill in with body hair. I think body hair works best as filler.


#6

Dear Dr. A,

Personally I like this approach. I think the result is more esthetically pleasing to leave recession but improve the forlock and to fill in the crown than to close the temple point in the first session. but I have the following questions.

1: I have to ask the “old chestnut (same old question)”, could you use the same approach using FUE/FUSE.

2: I notice that you have not angulated the crown swirl and most angles seem he same is this true or not / is there a reason for this.


#7

» Dear Dr. A,
»
» Personally I like this approach. I think the result is more esthetically
» pleasing to leave recession but improve the forlock and to fill in the
» crown than to close the temple point in the first session. but I have the
» following questions.
»
» 1: I have to ask the “old chestnut (same old question)”, could you use the
» same approach using FUE/FUSE.
»
» 2: I notice that you have not angulated the crown swirl and most angles
» seem he same is this true or not / is there a reason for this.

Dear JonnyE and Marco,
Different people prefer different options.
As long as there is sufficient donor hair available to carry out the current and future requirements, due weightage must be accorded to the patient’s own wishes.

In case of SH, he has remaining scalp donor hair that he can use for hairline lowering (if he feels like it).
He has scalp, beard and body donor hair to fill in if further hairloss occurs in the crown area.


Dear Marco,

  1. Yes, similar results are possible with FUSE.
  2. I know the picture does not do justice for it does not focus on the swirl but rather the top.
    However, the grafts in the crown and swirl area were placed at angulations identical to what his own miniaturizing hair in that area. If you look in the lower right hand corner of the picture you will notice the gradual chage of orientation of grafts.

Regards,
Dr. A


#8

Dear forum readers,
SH visited us 10 days after his HT.
The following pictures depict the look of the scalp at 10 days post HT.

Regards,
Dr. A


#9

Dear Dr. A

Although preferences are subjective I realy like this HT and look forward to updates. Thank you for engadging with us so regularly and answering questions.

Best Wishes,
Marco.