Dr. Wasserbauer inserts hair grafts

I’m 43 years old and I have been slowly losing my hair for the past 15 years. I seemed to have retained a pretty good hairline, even though it is slightly higher than it used to be, however, the baldness in my crown has grown over the years. I recently began using Propecia and noticed less hair falling out in the shower, but I haven’t really noticed any regrowth. I would very much like to fill in the balding area of my crown with a hair transplant. Considering my current situation, would this be an appropriate step to take? Thanks, Tom
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Dear Tom,

Thank you for taking the time to write. Your situation is a common one and I’m pleased to hear that you have already started taking Propecia. This is one of the most significant factors for optimizing your long-term cosmetic results. In my experience, it cannot be counted on to preserve frontal density indefinitely, but Propecia WILL stop crown loss from enlarging appreciably. Besides, it is cheaper than surgery!

It is difficult to make an accurate assessment without seeing you, but at a consult with a reputable hair surgeon you should discuss your goals and expectations for your hair first and foremost. In your case, you seem to have a reasonable goal of filling in your crown. That being the case, there are three factors which will determine whether your situation isappropriate for hair surgery. These are 1) your donor area, 2) the size of your crown, and 3) the hairline and frontal density. Let’s discuss your donor area first.

Assuming you have average density and elasticity, and that you have less than 20% miniaturization in your donor area, a crown can be covered quite well. Before you begin this process, you might want to consider having enough donor area to cover the front should that become necessary. Pick a surgeon who practices trichophytic closure with interrupted subcuticular sutures for the best donor scar possible, and expect to need 1000 +/- 200 grafts to fill it in.

Crown size is a significant factor. If the area at the crown is bigger than the palm of your hand, completely bald, you wear it short, or if you have very fine hair, be aware that you can get good coverage from a first surgery, but you should expect a second surgery to increase the density. If that is the case, look for someone who will remove the first scar with a second surgery so you don’t end up with two in your donor area. If you already use hair from somewhere else to cover the crown, or if there is still some “tacking” hair (wispy hair with low density but it EXISTS) – you may only need one surgery.

Covering a crown is a little like trying to carpet a basketball – there are always spaces in between where you can see what is underneath because the surface is curved. That is why there are hair surgeons who specialize in recreating whorls and “shingling” the hair in the crown for the best cosmetic outcome. If your surgeon knows how to do this (and a good one will), you will end up with a better result.

Finally, consider how dense and how low the hair in the front is. Miniaturized hair throughout the frontal area is a sign that this area may need attention in the future. If you don’t have to use grafts to lower the hairline, it is best to save them for your first priority – the crown. That said, grafts in frontal areas really do give you the best “bang for your buck” so you might want to reinforce the area (or fill it in later to compensate for progressive loss), just remember to use your graft resources wisely.

In the final analysis, “yes” this would be an appropriate step to take given the above parameters. If you have realistic expectations and reasonable density, you can get some fantastic results at the crown. The next step will be to find a respected surgeon who will work with you.

Good luck with your hair goals!

Sincerely,
Sara Wasserbauer MD