Q: What are your thoughts on performing a hair transplant to the crown first?

A: It depends upon the person’s age, how bald he is likely to become, and the donor supply.

As a general rule, the crown should not be transplanted in a younger person (under 30) as the extent of his balding is hard to predict and crown thinning at this age often suggests that the person will become at least a Norwood 6.

If a person has enough donor hair (i.e. good donor density) and scalp laxity, so that coverage of the entire bald area can be accomplished if the patient becomes a Norwood class 6 (and it is unlikely that he will become a Class 7), then transplanting the crown before the front is reasonable.

If a person has a family history of baldness limited to the crown, even at an advanced age, and the person in question is following this pattern, then earlier treatment of the crown may be considered.

Lastly, if you do treat the crown in a younger person, or one with whom the extent of hair loss is uncertain, the crown should be transplanted with light coverage only. That way a limited amount of hair will be used up in this area and there will be enough left over for the more cosmetically significant top and front of the scalp.

For a complete review of this topic please read: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84. A copy in PDF format, and other hair transplant publications, can be downloaded at the Bernstein Medical – Center for Hair Restoration Medical Publications page.