Wednesday, September 19, 2007

Crown v/s Frontal HT - alternate approaches

Dear readers,
A long time request of patients is to give as much priority to the crown/swirl area as to the frontal/hairline areas.
Till the scalp donor resources were limited, the obvious choice was to keep the bulk of the grafts for the frontal areas. With advent of FUSE, triclosure, BHT and facial hair to scalp transplants (FHT), the expanded donor resources enable alternative transplanting approaches in suitable patients.
The approach is to use scalp donor hair& various body donor hairs to accomplish hair restoration in crown/ swirl area as well as frontal area.
For sake of convenience, we shall be reffering this patient by nickname SH.
Following are some pre operative pictures of SH.

The patient has 3 options in grafting.
1. To go for a hairline favoring HT. A low wide hairline proceeding back towards the top and crown.
2. To go for a crown HT with a very conservative hairline.
3. To go for a complete transplant including a ambitiously vigorous hairline as well as working in the top and crown.

Option 1 and 2 are possible using the scalp donor hair alone (by strip or by fue).

Option 3 will require a combination of FUHT and FUSE as well as BHT and FHT to complete the graft requirements for all areas at reasonable densities. Of course, Option 3 can be followed in stages too.
This patient,SH, opted for a full length strip FUHT procedure in his first session of HT. SH wanted more focus on the crown area. As a result, the hairline had to be suitably conservative.

The following pictures illustrate the design.

The swirl/ crown area has been used as the back anchor point for HT design.

Videoclip of SH pre preoperative procedure:

SH got 4400 grafts in his FUHT procedure. These grafts were transplanted in the crown, vertex area and a very conservative hairline was formed. Below is the picture taken post operatively.

To get a full restoration,the best way is to get a somewhat low hairline(if you prefer that)and fill as much of the head as possible with strip procedure. Once you have stripped yourself out then go to FUE and get as many FUE grafts as possible to fill the rest of the head. The front being the most dense and fading back into the crown. Finally any areas that are thin fill in with body hair. The body hair works best as filler.

After 10 days post operatively.
SH visit 10 days after his HT. The following pictures depict the look of the scalp at 10 days post HT.