RECREATING THE CROWN WHORL
RECREATING THE CROWN WHORL - Reprinted from Microtechnology 2000 Vol. 2: 1 Nov 2000
By Robert H. True, MD, MPH, ABHRS -New York
A great hair transplant can accomplished when the surgeon is able to appreciate and reproduce the subtle variations in the architecture of the hair on different parts of the scalp. Appropriately, much has been written about reconstruction of the hairline zone, as it is widely appreciated that this is critical to achieving a "natural" result. Although written about much less frequently, reconstruction of the crown whorl is of nearly equal cosmetic importance.
All people naturally have a whorl or cowlick in their hair
on the crown of the head. The whorl is usually located off
center to the right side, however there are many variations
in location and some people even have two whorls.
Not only does the hair change direction 360° in the whorl, the angle at which the hair emerges from the scalp decreases. Thus, the hair does not stand straight up in the center. Rather, it lays flat along the curved contour of the crown. In some ways, reproducing the correct spiral angle while at the same time creating the appropriate "flatness" angle is more technically demanding for the surgeon than a hairline
Recreating the whorl is essential to treating crown baldness.
A well constructed whorl is as much a credit to the surgeon's
art as an elegant hairline. Both must be approached with equal
finesse and have comparable cosmetic value.
Because it is rarely possible to reproduce high density in
a crown restoration, it is critical to use only microscopically
prepared single follicular unit grafts. Thus with lower density
there will be no "plugginess" or unnatural appearance.
The crown should not be treated without rebuilding the whorl. To do so would be like restoring the front without a hairline. I also believe that in cases where the doctor and patient make the decision to treat the front part of the balding pattern only, the result will look much better from the rear when the restoration has been carried back far enough that it includes the upper half of the whorl. When this is achieved, the hair drapes much better onto the crown.
Since the mid 1990's scalp reduction has fallen out of favor with hair transplant surgeons. One of the major problems with scalp reductions is that they change the hair direction in the crown, making the hair fall away from the middle of the crown. In other words, they eliminate the whorl. Moreover, it was very difficult to successfully recreate a whorl with transplants once reductions had been done. The center could not be placed in the correct location and the hair direction could not be matched to the remaining native hair on the margin of the scalp reduction.
Without scalp reductions, the size of the area remains large. However, because the native hair direction is reproduced in a carefully reconstructed whorl the cosmetic result is more natural and the coverage is comparable.
The decision about where to put the hair is one that needs to be explored thoroughly with each patient, It is possible to use up all of the donor hair in creating a very thick frontal restoration. At the other end of the spectrum the hair can be evenly distributed throughout the entire balding area in low to moderate density. Another choice is to treat the entire scalp, but place greater density in the front and top, lesser to the crown.
Special care must be taken when treating a young patient whose crown is just beginning to thin in the center. Further treatment will be needed as the balding progresses. Control can often be achieved with Propecia® and/or minoxidil preparations. However, even in these cases the surgeon has to anticipate future needs and make sure that an appropriate amount of the donor supply is retained to complete the crown restoration.
While some patients may choose partial restoration focused on the front and top only, those who want full head coverage or those who want the back edge of their frontal restoration to look natural, may achieve their goal in the hands of a transplant surgeon skilled in whorl reconstruction.
Designing the Hairline | Female
| Follicular Grafts |
Hairline Dr Shapiro |
The Hair Replacement Revolution |
Guidelines for Hair
| Hair Restoration for Men
with Advanced Hair Loss
Are Fullicular Units | How
FU Transplants Work | Corn
Row Correction | Hair Transplant