What can I do about hair thinning at the crown?
The most common cause of hair thinning in the crown area is genetic pattern hair loss,
also called androgenetic alopecia. Hair thinning at the crown affects both men and women,
and can be perceived as occurring in isolation, leaving other areas of the scalp appear to be less
affected, or unaffected.. There are similarities and differences in the expression of genetic
pattern hair loss in men, and women, as well. I’ll discuss crown hair thinning in men and women,
and how we treat this issue in my practice. I’m Dr Amiya Prasad. I’m a Diplomate of
the American Board of Cosmetic Surgery and Fellowship-trained Oculofacial Plastic and
Reconstructive surgeon. I’ve been in practice in New York City and Long Island for over 25 years.
I’ve performed hair transplant surgery throughout my career. In 2011, I used a wound healing
material called extracellular matrix by the company ACell to help improve the survival of hair
grafts and healing of the donor area. In addition to the wound healing benefits, we observed that
thinning hair in areas that wasn’t transplanted increased in number and became thicker. This
inspired me to pursue developing a standalone, non-surgical treatment for pattern hair loss,
which we named TrichoStem Hair Regeneration. Since 2011, we’ve helped people from all over
the world have more scalp coverage non-surgically with the TrichoStem Hair Regeneration system.
Although genetics is the cause for 95% of male and female pattern hair loss there
are some important differences to be aware of. Crown thinning in men tends to start in
the central area and expands from where there is whorl or a cowlick. In women,
hair loss tend o be more diffuse throughout the scalp. The crown area can appear to be thinner
due to a combination of the curvature of the bone structure and the location of the cowlick.
Although hair transplantation is a very popular method to address permanent hair loss,
there are limitations when it comes to managing hair loss in the crown area.
Most hair transplant surgeons prefer to allocate the limited number of grafts available for
transplantation toward the frontal hair line and mid scalp as these areas frame your face.
Why is there a a limit to the number of grafts that are transplantable? This is because the true
“permanent” zone in the back of the scalp that is resistant to hair loss is very narrow. Simply look
at a man who’s bald and has a narrow band of hair remaining. There is a mismatch between the area of
donor hair and the area of the scalp, particularly in the crown area. Additionally the density of
hair that can survive transplantation is limited to only 20 hairs per square centimeter, which
is a fraction of the normal hair hair density of 50 hairs or greater per square centimeter.
Hair thinning in the crown area is also characterized by miniaturization of the
hair thickness. Transplanting hair into the crown area can cause permanent loss of many of these
miniaturizing hairs from the compromising of blood supply from the multiple stabs made into the scalp
to implant hair follicles. This permanent loss of native hairs is referred to as “collateral loss”.
As a hair transplant surgeon, I was aware of these limitations and when I was developing
TrichoStem Hair Regeneration, I anticipated that scalp coverage could potentially exceed that of
hair transplant surgery since your existing hair already exists at a higher density than
can be achieved by hair transplant surgery. This materialized as anticipated and we are
helping men and women improve coverage of the crown area without surgery. Further,
since we’re working with your native hair, crown coverage in our patients looks natural as opposed
to the sparse and unnatural doll’s hair appearance characteristic of hair transplant to the crown.
We’ve observed the benefits of the TrichoStem Hair Regeneration treatment sustains for 3-5
years or longer with only 1-2 treatment sessions that are 18 months apart, Additional medial
therapy such as the use of DHT blockers like finasteride for men and hormonal management
for women can also help optimize the longevity of your TrichoStem Hair Regeneration treatment.
Although hair loss cannot be cured, hair thinning can be managed. The crown area can be optimally
managed since oftentimes, the hair in this area is thinning, and not completely lost. Of
further note, thinning in the crown area in men is often accompanied by thinning in the
frontal-temporal area and the mid scalp. This means that treatment does not have to be limited
to the more obvious area but throughout the scalp resulting in more overall scalp coverage.
In women, this is particularly relevant since hair thinning is
typically diffuse throughout the scalp. I hope you found this information from
my experience helpful. If you’re interested in recommendations for your individual situation,
you may contact us through our websites or call our offices to schedule a consultation. Thank you.