“The crown (or vertex) is that circular area of baldness in the far rear of the balding scalp which lies on a mostly vertical plane. If there is an residual hair in this area, it is directed in a swirl or whorl direction, similar to the spokes on a bicycle. When transplanting this area, the transplants are planted in this same pattern and with the same direction and angle as exists in nature.

Our policy is not to transplant this area of the scalp unless a man is at least 35 years of age. Before that age the hair surgeon cannot predict just how bald a given man will become. Many young men with a relatively small area of present crown balding can progress to a much larger degree of baldness later on. If they are transplanted early in life, having a very deformed appearance, with a thatch of transplanted hair which is surrounded by a large halo of bald scalp.

In the men over the age of 35 in whom we do transplant the crown-vertex, in the recent years our policy has been to tackle it as a separate project after first completing the top of the scalp. We made this change in our approach for two reasons: one is that the amount of donor tissue that can be harvested without creating excessive tension on the donor closure is usually the amount necessary to fill in the top region. Secondly, when the entire top of the head is filled in along with the crown it is our experience that the blood supply to the crown area in some patients is slightly compromised and with the growth of the grafts in that area is not ideal. For this reason, our preference in  most cases is to tackle the crown in a separate 1-2 sessions, dense packing anywhere from 800 to 1500 Fur's there per session, depending on the square area of the vertex. When the crown is transplanted by itself, we consistently obtain 90-95% graft survival.

In general, we "under-sell how dense we can make the crown / vertex appear after transplanting. This is for a number of reasons, which we will enumerate and explain here:

1. Because the hairs in this region are in a "whorl" arrangement, going way from the center of the whorl, there is a minimal overlap of hairs, which does not lend itself tot he appearance of the fullness. They do, however, appear very natural in this arrangement.
2. The crown is on a vertical plane and very exposed to the public view. Because of this, only very small FU grafts are used in this region.
3. The crown is not the most important area of scalp. The frontal region and the midscalp are. Therefore, it is always wise and prudent to make sure that whatever donor hair is available is used primarily in these front and top sections first and that enough donor hair is kept in reserve for future needs in these more important zones.

The photos in our “Crown Gallery”, which you can click on and view, show what we typically do in the crown area. In all of these patients, we were at the same time transplanting the frontal and midscalp areas and added in the extra FU’s that were placed in the crown, usually around 300-350 per session.