When I plan a crown transplant, I need to explain something that a graft number alone cannot show. We can use a substantial amount of donor hair here and still see some scalp under strong light. I want you to understand that before we decide on surgery.
The purple grid in this photograph is one practical part of that planning. It helps me guide the distribution of recipient site incisions across the crown. To understand the purpose of those lines, it helps to look at the shape of the area, the direction of the hair and the limits of the hair available for transplantation.
The crown has a rounded, convex surface. The hair also turns around a natural whorl, changing direction as it travels across the scalp. That combination affects how the hairs overlap and conceal the skin beneath them.
At the front and through the middle of the scalp, the direction of the hair can often create a more consistent overlap. Around the crown, this overlap changes as the hairs turn. The same number of grafts can therefore give a different impression of coverage in the crown and at the front.
Hair characteristics add another difference. Thicker or curlier hair can provide more apparent coverage than fine, straight hair. Hair length and the contrast between the hair colour and scalp also influence the appearance. A lighter scalp beneath dark hair can make gaps easier to see.
If I give you a graft estimate, I also need to explain what I expect those grafts to achieve in your particular crown. The size of the area and your hair characteristics are part of that discussion.
A graft is a small unit of tissue containing one or more hair follicles. Grafts can contain different numbers of hairs, so two procedures with similar graft counts may move different amounts of hair. The thickness of those hairs also affects the result.
A photograph of the crown can help show the area of concern. A safe treatment plan also needs an assessment of the donor area and the rest of the scalp. The donor hair available, its characteristics, any previous surgery and the patient's broader pattern of hair loss influence the options.
Hair used for the crown comes from the same supply that may be needed for the front or middle of the scalp. This matters particularly when hair loss is still progressing. Adding more grafts to the crown now can leave fewer options for other areas later.
During planning, I consider the tradeoff between covering a larger area and achieving more fullness in a smaller area. Some patients have enough donor hair to address their priorities together. Others need to prioritise an area or accept lighter coverage. I explain that choice before surgery, taking your wider pattern of hair loss and possible future needs into account.
Recipient sites are the small incisions made to receive the grafts. The purple lines divide the crown into smaller sections, giving me a reference while creating those sites.
I use that reference to help distribute the incisions evenly throughout the planned area. At the same time, the direction and angle of the sites need to follow the crown's natural hair pattern and blend with the surrounding hair.
The straight grid lines guide the distribution of the work. The hair pattern being recreated follows the whorl. The markings do not mean the hair will be planted in straight rows, and they do not establish the final density or the number of grafts from the photograph alone.
This photograph shows how I guide the incisions. It cannot tell you the final result. That also depends on the grafts, their growth and your hair characteristics.
The crown may contain a mixture of existing hair and areas of greater thinning. Transplanted hair adds coverage, while the surrounding original hair can continue to thin over time. A result that looks satisfactory at one stage can change if more of that original hair is lost.
This is another reason to assess the whole scalp. The plan may include discussing suitable treatment for ongoing hair loss and the limitations of the available donor hair. Medical treatment needs an individual assessment of its suitability, expected benefit and possible adverse effects.
I also want you to understand that treating the crown doesn't stop the wider pattern of hair loss. We need to keep that in mind when deciding how to use your donor hair.
After transplantation, visible hair shafts commonly shed before new growth develops. Early regrowth may appear around months 3 to 4, but those hairs can initially be fine and short. Their appearance is an early stage in the result.
The front and middle of the scalp can begin to look more developed while the crown still appears comparatively thin. Clearer improvement in crown coverage may become noticeable around months 6 to 7, sometimes later. Some patients show changes sooner, and the speed of development varies.
These ranges describe possible stages of visible progress. They do not mean every crown follicle starts growing at the same late month. Hairs need time to emerge, grow longer and contribute to the combined coverage of the area.
Crown maturation may continue over 12 to 18 months. An assessment at six months should consider the stage reached and the changes since earlier reviews. I still need to review your progress during that time. If you are concerned about growth, we should assess it rather than simply wait for a date on the calendar.
Strong overhead light, a different camera angle or wet hair can reveal more scalp than softer light or dry hair arranged differently. Hair length also changes the overlap between strands. These differences can make a crown look better or worse without showing a true change in the number of growing hairs.
When you send me progress photographs, try to keep the lighting, angle, distance, hair length and dry or wet condition as similar as possible. A sequence of comparable photographs is more informative than two images taken under very different conditions.
During your reviews, I consider those photographs alongside the actual growth and the original plan. We are looking at changes over time, including any changes in your existing hair.
Dr. Mehmet Demircioglu
Diamond Hair Clinic, Istanbul, Turkey
diamondhairclinic.com
Hair Transplant Consultation
WhatsApp: 0546 840 41 75
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