The crown or region of the vertex along with the hair line is one of the areas of the head that is most affected by hair loss. This information comes from regular consultation by people suffering from alopecia.
Implant Evaluation Process
Unfortunately, the number of follicular units to be extracted is finite and varies greatly from person to person. Therefore, the hair surgeon should use the stock of follicular units (FUs) as rationally as possible. Each patient requires an individual evaluation so that once the doctor has studied the donor area, he can determine the best way to distribute the units without damaging the donor area. The most logical thing is to redistribute the units with varying densities, according to the different areas of the scalp.
The average of follicular units in a Caucasian man is about 70 follicular units (FUs) per cm2. When the patient has good native hair in the donor area, abundance of follicular units with 3 and 4 hairs, a density of 40-45 UFs per cm2 is sufficient to cover the scalp with a natural result. Of course, all this depends on the degree of alopecia; logically, we will always reach a higher density in a patient of Norwood III alopecia level than in a Norwood V or VI.
However, this calculation is made based on the mathematics, and without taking into account the circumstances of the dermis of the area, final number of grafts removed, exact measurements of the receiving area, etc.
The complexity of the crown – Vertex
The crown or vertex is a complex area due to certain characteristics:
- The blood circulation in the area is weak, which leads to poor follicular nutrition.
- Due to the previous point, between 20 and 40% of the FUs transplanted in the crown may not anchor properly in the area.
- In cases of excessive hair loss in this area, the number of follicular units required is higher compared to the number required for other areas of the scalp.
- The “spiral” pattern of the crown makes it a region of the scalp of lower capillar density and therefore a “transparent” area of the scalp. Even people who do not have a male pattern baldness have some parts of the crown depopulated or with a lower density. The goal of a hair surgeon is to recreate the natural look of your scalp.
Crown Implant Planning
In patients with the crown fully open, as shown in the image, to create a new crown, the doctor will first draw the direction of the swirls and implant the follicular units with 1 hair in the lines. The FUs with 2, 3 and 4 hairs will be used in the same direction of the lines to give thickness and density to the area.
Patients have to have realistic expectations. If the donor area is healthy with good quality follicular units, the implant will be a success. But postoperative care requires patient effort, and the doctor will most likely recommend a drug treatment to help the end result of the transplant.
If necessary (in the event that the donor area is not sufficient), extra follicular units may be extracted from the beard areas (neck area) and from the chest. But as the follicular units of these areas are usually of a single hair, for a crown implant (and the upper area) they are not the most useful.
In summary, based on the literature on hair transplants, and on the opinions of Dr. Bernstein and Dr. Jose Lorenzo, to achieve an optimal result on a hair transplant, a density of between 25-50% of the density of the patient’s native hair should be achieved by the surgeon.
In FUECAPILAR, our hair surgeons, Dr. DoganTuran and Dr.Gokhan Gur, have performed hundreds of hair transplants in the crown area (or region of the vertex), so if you are interested in recovering hair in this area, do not hesitate to contact us to find the best solution for your alopecia.