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My doctor said I shouldn’t transplant the crown

I am naturally a Norwood 3-temple recession and minor crown recession as well.

Had a 1200 graft hair transplant last year on my temples, and slightly slowered the hairline. The doc did not put enough grafts in, so I am getting a 2nd HT Nov 20 for an additional 300-500 grafts to fill it in, free of charge (there was sooo much drama surrounding this, see my post history for more info).

My crown was not operated on during my last HT, but since I am already going under the knife, I would really like my crown filled in as well. I’m not sure how to rate my crown loss-I guess a Norwood 2- in that my crown clearly has loss, but it is not unbearable. Sort of like how Norwood 2 on the hairline is noticeable, but a lot of people can still get away with it.

Both my doc and another doc in the office looked at my crown. They both advised against getting grafts on my crown. One of the docs said he never operates on the crown on people under 40 (I am 30) because of potential future loss. They also said I do have significant hair on the crown still (albeit miniaturized) and putting new grafts in could shock loss out these already fragile hairs. Essentially, they are saying that while I clearly have crown loss, it is not bad enough to merit a hair transplant for it.

I was very disappointed these docs advised against operating on the crown. My arguments for getting a crown are, if they do grafts on it and I do have future loss, I am prepared to get a 3rd HT. I am currently taking Dut and using Rogaine on this area, so not sure if I would even have more loss.

The docs recommended SMP as an option for the crown. I actually visited an SMP guy Thursday. It just seems like so much maintenance. The tattoo only lasts 4-6 years, have to put sunscreen on it everyday. Nervous it would look unnatural. So don’t want to do SMP.

Toppik works VERY WELL on the area, but again, it is still a lot of maintenance. And I would rather have the permanent option of a HT. I’m kind of confused as well. I’m sure if I consulted other doctors, or went to Turkey, I could find a reasonable # of doctors who would work on the crown. Not sure why both these docs are advising against it.

My questions are:

-Should I insist my doc operate on my crown?

-Has anyone here had any experience with doctors advising not to get grafts on the crown?

-Would you side with the doctors or me in this situation?

-Any advice on how to deal with crown loss? Toppik works very well, but Id rather have the permanence of a HT.

Transplanting the crown is something that I have been doing for 29 years with no problems. Clearly the issue is skill of the doctor, experience, and proper indications for doing it (never too early if it responds to minoxidil for example). I have had my crown transplanted and it looks great!


2020-02-20 17:47:42My doctor said I shouldn’t transplant the crown

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Can anyone easily pull out strings of hair?

You should not easily pull out normal hairs, but miniaturized hairs easily come out. For people with Telogen Effluvium (mostly women) we call this a ‘Pull Test’ where the number of hairs that come out are quantified.

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My Doctors Are Experts and Have Differing Opinions

Hi,

I am a 41 year old female and have been thinning for several years. My hair loss was triggered by the removal of an ovary and a tubal ligation of the other. I have visited many doctors over the years with no success. Two have indicated that I have androgenic alopecia, the rest indicate I have telogen effluvium because my hair loss has a diffuse pattern and I show no miniaturization. I had the HairDx test done and the results were high androgen sensitivity and low risk of AGA. Both my physicians (an endocrinologist and dermatologist) are considered experts in their field and have a different set of opinions based on the results. One indicating no treatment needed and the other indicating I should go on finasteride. What is your take on this result?

I can not possibly form an opinion one way or the other based on what you wrote. I would need to examine you and make a determination based upon my observations and measurements.

Female hair loss is not as clear cut as male hair loss, so differing opinions are not unusual. Finasteride is not FDA approved for treating female hair loss, but your high androgen sensitivity (as revealed by the HairDX test) means there could be some benefit from the medication. It would have to be prescribed off-label, and is something you and your doctor should discuss in depth.

Ultimately, you may have to go with your gut feeling on this one.

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What Can Be Done? I’m Likely a Future Norwood 7 with the Family History I Have.

I’ve been told by several doctors that Fin isn’t a good idea because I have IBS (Irritable Bowel Syndrome).

Finasteride should not impact Irritable Bowl Syndrome. It might be worth a try. There is a balance between benefits and risks which only you can assess.


2018-06-22 09:04:09What Can Be Done? I’m Likely a Future Norwood 7 with the Family History I Have.

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My Girlfriend Is 5 Months Pregnant, Any Problems With Birth Defects With Me on Finasteride?

I understand you probably get plenty of messages so thanks for taking time to read this. My girlfriend is 5 months pregnant and Ive been on Finasteride for 7 months. I’m just wondering if I can contribute to take Finasteride whilst she is pregnant and also continue to have sex with her without the use of a condom. Will this lead to birth defects?

There are no problems with birth defects caused by you being on finasteride.


2020-01-13 09:45:40My Girlfriend Is 5 Months Pregnant, Any Problems With Birth Defects With Me on Finasteride?

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Can finasteride cause hair loss?

because i always see posts on hear of people saying they loss density on fin cuz of the shed and it didnt get better is this possible because im worried that may happen, Ive seen other ppl say its impossible to lose hair on it.

In my practice, I have never seen finasteride cause hair loss but I have seen genetic hair loss move rapidly evolve while a person is on finasteride.

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My Hair Is Growing Slower — Is This a Sign of MPB?

Hey Doc,
I’m a 21 year old white male, my father is 42 and has a full head of hair. I know my mom’s father was balding but only met him in his 50’s and didn’t know when it began. I’ve noticed a decline in the thickness of my hair. There’s no balding at the crown but there is thinning and receding at the hairline. I’ve always had a naturally high hairline, but I do notice my hair used to grow quicker and be thicker all around. At my age is this a sure sign of MPB? Or can you experience these effects without having the gene? Thank you

Hair that is miniaturizing grows at a slower rate and the more miniaturized it is, the less it grows… until it eventually just stops growing. For those people who miniaturize all of the hairline, for example, their hair will not grow at all and sometimes it takes up to a year to fall out completely. Some men will change the thickness of their hair as they go from childhood into adulthood. The way you tell the difference between changes in hair thickness and miniaturization as an early sign of balding is to:

  1. Use a micrometer to measure the thickness of your hair in the back of your head and at different areas in the front and top.
  2. Have your hair mapped out for miniaturization to see if there are differences between the hairs in any one area which reflect miniaturization.

This way you will know what is happening.


2008-03-26 14:56:45My Hair Is Growing Slower — Is This a Sign of MPB?

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Can Folliculitis Cause Hair Loss?

Hello Doctor!

I have a question about hair loss. I have been diagnosed with “folliculitis”. I’ve seen several dermatologists, and none has helped. Moreover, I am losing my hair. Can folliculitis cause hair loss? Is there any drug that can help me?

Thank you very much.

Folliculitis is an infection of your hair follicles. It can clear up on its own or your dermatologist can prescribe you medications to treat it. You shouldn’t lose hair from folliculitis unless it is chronically infected. Keep in mind though, the most common cause of hair loss in men is genetic hair loss.


2008-06-23 15:00:10Can Folliculitis Cause Hair Loss?

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My Hair Loss Started at 16, but Has Progressed Extremely Slow

Extending on a point you made answering a recent question, about a man who believed his hairloss would progress to a norwood 6/7 because he began showing signs at the age of 19, how accurate would this be as a way of estimating? For example, if I am actually experiencing male pattern baldness, then I have had this same hairline since I was at least 16 (no accurate pictures before) which includes no more than a little lobsided recession.

My progression has been extremely slow, even at a young age when people believe hair loss is much more aggressive. Is it possible that, even past the mature hairline point, a sufferer of hairloss can just stop at any point, say a norwood 3, or just a little overall thinning, and keep what they have left for the rest of their lives?

Hair loss can be aggressive and then stop forever if that is your genetically determined pattern. You need to see a doctor to get that diagnosis done. The doctor can check your miniaturization (if it is present) and your hair bulk, and between the two of those you can get an idea if you are balding. At 16 years old, I do not believe that you can predict a Norwood class 6/7 pattern, nor have I seen that pattern in a 16 year old.

I think a lot of times people write wanting comfort in knowing that simple math will tell them how much time they have to enjoy their hair. Unfortunately, there’s no chart to refer to and I can’t even give an estimate of that time table without an examination of some sort. There’s no way to predict your final hair loss pattern just based on when you started losing hair.

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Can I have my hair transplant under General Anesthesia?

The use of general anesthesia for a hair transplant is not a good idea because a hair transplant takes many hours and general anesthesia risks go up the longer you are under it, plus the costs would be very, very high. The use of local anesthesia like you dentist uses, is the only way to do this. Pain should not be a problem as most people feel nothing once the local anesthetic has been administered.