Here is an update for this patient who underwent a second procedure with me one year following his original 1080 graft repair procedure. His second procedure consisted of 1108 follicular unit grafts which were placed to further boost density in the scarred frontal hairline region. The updated photos were taken one year following his second procedure. His total graft count for the frontal repair restoration is now 2188. The graft yield in the scarred region appears to be very high ??“ a reassuring finding for those repair patients who express concerns about graft survival in scar tissue. The original introduction to his first session HTN post follows below.

Original Post Intro:

This young man presented with a history of having undergone a 3000 dense-pack frontal hairline megasession. Based on information provided by him, this restoration was intended to restore the frontal hairline region exclusively with a graft density of approximately 100 follicular-units per square centimeter. There has been much debate about the safety and feasibility of using such high graft densities. The potential risks of this approach are revealing in this patient who demonstrates three unique problems: 1) low graft yield; 2) recipient site scarring; and 3) unacceptable donor site scarring.

Much can be said about the adverse consequences of making too many openings in too small an area. However, the primary concern with this approach relates to the risk of compromising the local blood supply within the recipient area. Reduced circulation decreases oxygen delivery to the recipient area. Vascular disruption can ultimately decrease graft survival, and when taken to an extreme it can cause outright tissue damage. The proposed graft density, if successfully implemented, should have restored the hair density to that comparable of the patient's high school glory days. It is clear from the preoperative photos that this patient continues to have see-through hair. Although 100 follicular-units per square centimeter were implanted, they did not all survive the procedure and the proposed density was not achieved. Even more obvious is the prominent scar located in the graft zone of the right hairline. This scar is the result of tissue destruction caused by an overaggressive recipient site surgical plan.

The patient's primary goal was now to enhance density within the previously grafted frontal region. A conservative approach to repair and restoration was recommended for the following reasons: 1) previous dense-packing had failed to produced reliable high density in the frontal region; 2) the frontal region was now compromised with diffuse and localized scar from the prior procedure; 3) the donor site was compromised with an extraordinarily wide scar from the initial megasession. The patient underwent repair with 1080 grafts which were placed with the goal of supplementing density throughout the frontal region, with special attention on the dense scar in the right-central frontal hairline.

This is truly an excellent result and everyone should spend a minute to read Dr. K's write up as it is VERY important to EVERY potential HT patient. In fact, I would suggest that Bill include this thread in his next newsletter.

Improper dense packing can lead to necrosis of skin, usually in or near the center of the scalp, just behind the hairline. While this problem is usually seen more often in patients who smoke, it is also often seen in patients that have been overly packed.

So how does the doctor know if they are over packing their patient or not?

In my opinion, by definition, 100 grafts per sq cm is overpacking.

I've also notice that if a patient has a significant amount of bleeding during creation of recipient sites that the plan should be immediately changed to decrase the over all density. Failure to do this can result in necrosis of skin throughout the recipient area.

Recently I had a patient in whom I created all the slits for the hairline and just began creating slits for the multi-hair grafts when I noticed a significant increase in bleeding. In response I decreased the overall density of the procedure throughout the rest of the procedure.

One week later he visited for his staples to be removed and low and behold there was a small area of skin necrosis in the area just behind the hairline where I started creating slits at a high density. Had I continued at that density throughout the scalp I'm sure I would have seen far more necrosis.

That hole in the center of the patient pictured above is from the kind of necrosis I describe. But by transplanting at an appropriate density Dr. Konior was able to produce a terrific result and give the patient a much more satisfying result.

Well done.

Dr. F

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Feller Medical, PC
Great Neck, NY

Dr. Alan Feller is a member of the Coalition of Independent Hair Restoration Physicians

Providing Hair Transplants and Platelet Rich Plasma (PRP) Treatments

FANFRICKINTASTIC!!!!!!

Thats an Armani botch job if I ever saw one .

With all my hours upon hours of research you have become one of the small percentage of hair restoration surgeon that I would ever allow to work on me .

If I remember right you are also one of few docs that place all the grafts yourself along with a tech .

I have a REAL problem with docs that you can tell have led posters here for a quick drive by and the ones that show clear immediate post op pics and borderline deceptive final result pics.
You are definitely not one of those guys. You have shown great consistency in every aspect, and to me that means EVERYTHING
I would love to tell every doc how great their work is but this isnt friend finder.com ,its the hair transplant network and Ill always call out these clinics when appropriate.

I can tell this is a doc that grinds it out in the operating room and just lets his work speak for itself.

Every pic you've ever posted has been phenomenal work. Keep it up the great job
We need more like you ,we really do.

Dr. Konior,

This is a perfect example of what has been discussed briefly on a few other threads, that packing large quantities of follicular units in a single area isn't always appropriiate, and furthermore, that graft survival rate goes down significantly if too many are placed in a small area due to reduced circulation and oxygen.

Thanks for such an educational post along with what obviously turned out to be a terrific result.

Sometimes less is more!

Best wishes,

Bill

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Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

View our hair loss articles on Hub Pages

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To learn about how I restored my hair, view my my hair loss website.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

Dr. Feller,

Great idea about adding this information with a link to the thread in the next forum newsletter.

Best wishes,

Bill

__________________
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

View our hair loss articles on Hub Pages

Follow us on Facebook | Twitter | YouTube

Subscribe to our Newsletters | How We Recommend Physicians

-----

To learn about how I restored my hair, view my my hair loss website.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

The write-up on this submission is excellent!!

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take care...

This is truly outstanding planning and execution. A clear understanding of the problem, an appropriate plan, and voila, a great result. Dr Konior's analysis of the problem was spot on. The proof is in the pudding here.

This patient got infinitely better results with 1080 grafts from Dr Konior than he did from 3000 grafts from a previous surgeon.

I agree with Dr. Feller, this post is so important it should be in the news letter. It should be required reading for anyone considering a megasession. The issue of recipient scarring is so under appreciated.

Dr Konior's ability to get excellent growth from a previously scarred area is an undeniable testament to his outstanding care for each and every graft.

The photos clearly show the visible scar, and the hair growing through it. A great set of honest photos. And one of the best write ups of the patient's history and surgical particulars.

Wow, I almost missed this were it not pointed out to me....honestly....perfect HT.....# of grafts, completed result, documentation....perfect....and to happen to a guy who got shafted so viciously by a surgeon without morals OR skill.....awesome!

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*A Follicles Dying Wish To Clinics*

1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash.

Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician.

Enough is enough! Give me documentation or give me death!

great result...... id really love to see a pic showing graft placement...

Another great repair Dr. Konior!! Each time I see a hairline repair by you, I cannot believe how natural the hairline looks.

Also, thank you for you write-up. That should answer a lot of guys question's about why docs do not do that kind of density.

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My initial HT thread:
done and done!! Check it out...