What is the Crown?
The crown is located on the back portion of the scalp. Specifically, where the posterior scalp starts to slope downward. The crown ends where the occipital bone begins – the occipital scalp is where donor hair is usually taken from, especially for follicular unit strip surgery (FUSS). The occipital scalp is not part of the crown. The very top of the scalp, right before the posterior scalp begins to slope downward, is sometimes referred to as the vertex transition point, or simply as the vertex (the term “vertex” literally means “the highest point”). Many people confuse the vertex and the crown as being the same thing, but they are not. In the diagram to the right the vertex is also referred to as the mid-scalp.
The Crown and Male Pattern Hair Loss (MPH)
The Norwood-Hamilton chart is a reference guide that can help identify the most common patterns of hair loss. Each set of pictures depicts varying stages of hair loss, and has an identifying numerical code for easy reference. Crown hair does not have to be lost in order to qualify for MPH. In fact, of the twelve sets of
pictures to choose from, only five types of hair loss patterns are specifically characterized by a loss of hair in the crown region. They are:
- NW3V: This pattern shows deep bilateral temple recession and a small opening in the crown.
- NW4: This stage has deeper temple recession and a larger opening of the crown.
- NW5: For this balding pattern, the hairline recedes anterior of the mid-scalp. The crown has significant thinning or loss and a small strip of hair still separates the two regions.
- NW6: The strip of hair separating the two regions is lost, unifying the two bald areas into one. A small amount of miniaturized hair usually remains on the top of the scalp.
- NW7: The top of the scalp is fully devoid of hair. Only a horseshoe-shaped ring of hair wrapping around the back of the head remains. The sides are lower than those found on a NW6. This is considered to be the most advanced pattern of loss.
For all three of these patterns, the hair on the sides (the temples and temporal point) may also experience varying degrees of loss, though the occipital scalp hairs remain largely untouched.
The Crown and Female Pattern Hair Loss (FPH)
Unlike MPH, FPH is always delineated by some degree of hair loss in the crown area. Whereas MPH may sometimes start as a receding hairline, FPH often occurs as a thinning spot in the center of the scalp that slowly expands outward to encompass all areas of the scalp.
A whorl is a point on the crown that grows hair in a circular direction, either clockwise or counterclockwise. This shape of the whorl is largely what determines the resting position of a person’s hair, otherwise known as their hair geometry. It is possible to have more than one whorl, which can present additional challenges for reconstructive procedures.
Reconstructing the Crown
Recreating the hair’s natural spiral is the greatest challenge of reconstructing this particular region. A physician must be careful to angle each follicular unit in such a way that a natural-looking geometric pattern is formed. The direction of the whorl must also seamlessly blend with the direction of the remaining hairs on the midscalp, if any. Finally, the spiral itself must be tight – a whorl that is not dense enough will be extremely noticeable to others.