The increased efficiency of donor harvesting and the subsequent refinement process introduced by the use of microscopic dissection that we currently have the ability to reproduce natural appearing crowns through surgical means. The challenge that remains however is still one density and the amount of hair required. The total surface area of a typical bald crown is not very large compared to the rest of the scalp. However, due to the nature of hair direction placement required for a natural result the crown takes more hair to get a cosmetically acceptable degree of coverage and density when compared to any other area of the scalp. Some leading hair loss experts believe that the crown takes just as much hair to get a satisfactory result as the front and mid-scalp regions, combined! This is due to the sharp change in graft direction required to create a rotational whorl pattern. The frontal and mid-scalp regions benefit from having a compounding effect from an overlapping of placement similar to shingles on a roof. Such overlap is not possible when each graft is placed with a sharp directional change such as is necessary for natural crown whorl reconstruction. This is why addressing the crown region in any hair transplant treatment plan should be the last consideration. If too much hair is placed into the crown early on then the other areas of need will not have enough hair for a sufficient cosmetic recovery.
Full Hair Restoration
Surgical hair restoration is more popular today than at any time in history. This is due in part to the advent of follicular unit extraction (FUE). This procedure has a lower cost of entry into the industry for new doctors thus more clinics are opening every day. This logically makes the procedure available to more people worldwide. For all of the improvements we see in the industry there is still one thing that cannot be accomplished; full hair restoration
To clarify, full hair restoration means different things to different people but for the sake of this article we will assume that full hair restoration refers to a complete restoration of coverage and density from the front of the scalp to the back of the scalp. We will reference more aggressive cases of hair loss on the Norwood Hamilton hair loss chart as NW5, NW6 and NW7 degrees of loss.
The single rule of hair restoration that dictates the success or failure of every hair transplant surgery is “supply and demand”. The patient’s donor area is the supply and the area of loss is the demand. If a patient has a small area of loss then it is logical to assume that a full reconstruction can be achieved. In some cases, depending on specifics, this is true. With regards to more aggressive cases it is mathematically impossible.