Here is my case: I am 30 years old, I have been on Propecia for almost 10 years and have a moderate hair loss. I would like to get more density on the crown though. I have tried Rogaine which coupled with Propecia really worked but Rogaine was giving me headaches, so I was forced to stop.

My question: if I get a hair transplantation to get more crown density, the newly implanted hairs will remain on my head while the non-transplanted hairs will keep on vanishing: the result might look poor in 5 years post surgery. What do you think? — S.W.

Thanks for question, S.W. Likely the Propecia has been effective in reducing or stopping your hair loss. If your donor hair is sufficient and it would not put you at risk down the road, a transplant to the crown would be an option. The grafts would be blended into the existing hair to provide a bit of a buffer zone should you continue to lose existing hair around the transplanted hair. If your loss continues, there would be the possibility that another procedure would be required to add hair to the areas exposed around the transplanted area.

For the most part, patients on Propecia usually don’t lose enough hair around the transplants to warrant another surgery in that area. An important factor in the equation is your donor supply and final hair loss pattern. These two variables will ultimately play an important role in determining what is safe to do in your case. If the overall donor supply will meet any potential future demands, grafting in any areas is safe. If the supply may not ultimately meet potential future demand, then we must be careful how we distribute the grafts.

In some cases, a transplant to the frontal zone and mid scalp will provide an excellent cosmetic result, but work for the crown must be avoided when limited donor supply exists. In the end, a careful evaluation of your donor supply and final hairless pattern will determine whether crown work would be a good idea in your case.

You can submit photos for a free hair loss consultation.

— Victor Hasson, MD

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I had a question regarding one of the patients in your photo gallery. In number 37, the patient had 1,200 grafts to the crown only. How old was that patient? I am experiencing hair loss similar to him (i.e., my hair loss is limited to the crown so far). I am 27 years old and have been on Propecia for 1 year. I also use Rogaine. I think I have maintained over the past year, but would like more density.

I understand everyone is different (with respect to density, laxity, etc.), but generally speaking, would it be reasonable for someone my age to have a hair transplant in the crown? I have read, in the past, that most doctors will not transplant the crown first in men under 30.

By way of background, my father (54) has significant hair loss in the crown, but maintained his hairline. Also, I have an older brother (29) that is experiencing hair loss in the crown only. However, I do have uncles (on both sides) with varying degrees of hair loss in different patterns.

If you think it would be reasonable for someone my age with my family history to have a transplant in the crown, I will likely submit the necessary information for an online consultation. — B.A.

Thanks for your question. Patient number 37 was in his early 30′s at the time of surgery. Whether it is advisable to have surgery in the crown in your cases depends on a few factors, some of which you have touched on:

1. You have sufficient donor reserves should you eventually need transplants to the frontal zone. This on its own would be enough to justify crown work.
2. You are taking Propecia. This would be advisable but it alone would not justify working in the crown.
3. You likely are following in the hair loss pattern of your father and older brother. This would be a plus and if the situation was borderline, it may be enough to make a case for reconstructing the crown.

It is a reasonable assumption in your case that a transplant in the crown would be safe based on your information. In the end, it comes down to the donor area. The better the quality and supply, the more options. If you would like to send photos, submit a hair loss consultation form. Please follow our photo guidelines before submitting the form. The photos and detailed history should provide us enough information to determine if you are a good candidate for crown reconstruction.

— Victor Hasson, MD

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