Steven Gabel, MD, FACS

Mrkneed Do yourself a favor and stop chewing tobacco for a couple weeks prior to and a couple weeks after the procedure (actually completely breaking the habit would be your best option). The amount of nicotine that is absorbed by the body from smokeless tobacco is similar in magnitude to that of cigarette smoking. You are at an increased risk of infection and bleeding (there is a transient rise in blood pressure secondary to then excessive absorption of sodium (salt) in the body which adds an unnecessary level of difficultly during the procedure), and a multitude of other health effects. Now, the amount of blood loss from a hair transplant is not much if done properly, but any excess in bleeding at the level of the recipient sites makes the surgery more difficult ??“ this can lead to graft popping and crush injury to the grafts. I know this is easier said then done, but give it some consideration. What this translates to for the procedure is this: when the surgeon is making slits in the scalp, especially for high-density graft placement, the newly planted grafts rely upon the body to immediately bring oxygen rich blood to ???feed??? the hair follicles and remove the waste products. Smoke and smokeless tobacco impair that process in many ways (blood flow and at the biochemical level) so the overall risk of damage to the newly planted grafts and the donor area is higher. If I have a patient who uses tobacco products, and will not stop their usage during the perioperative period, I make them well aware of the fact that they are at an increased risk of complications of possible poor growth of the grafts and scarring at the donor area. I hope this additional information was useful for you. Steve Gabel, M.D. Portland, Oregon Gabel Hair Restoration Center

Alexjohnson I've been prescribing Propecia (finasteride) for several years and did have one patient who had breast tenderness and gynecomastia(enlarged breasts) after taking the Propecia. The patient elected to continue the medication, and if the problem continued, he was going to discontinue the medication. I do not know of any supplements to counteract this; if it continues to bother you, you may want to consider stopping the medication.

mmhce I am reading your post with interest. Can you please give me the source of your information concerning the adverse effects of epinephrine for hair transplantation? I would like to read the complete post. Thanks.

Yes - add me to the list. Right now I do not believe there is enough evidence to support the use of LLLT for hair restoration. Steve Gabel, M.D. Portland, Oregon 503-693-1118

Dr. Feller I received your phone call last week concerning my use of the LLLT - sorry I was out of town, but will return your call. I too have received a lot of questions from patients concerning LLLT. To date, my response has been that I have not seen adequate studies to support my use of the device (and charging patients) and therefore have not recommended it to patients. In fact, I had a patient who saw another physician and their consultant who recommended they have a hair transplant followed by LLLT for an extra $2-$4000. When the patient indicated that he was not going to travel to the physician's office for the therapy, the doctor responded that it probably did not work anyway. That patient promptly left the office as the physician and consultants completely discredited themselves ??“ they were basically trying to get an extra fee for a procedure they really did not believe in. Steve Gabel, M.D. Portland, Oregon

Dr. Feller I appreciate your positive comments and support. Steve Gabel, M.D. Portland, Oregon 503-693-1118

Thank you very much for sharing your experience. I have posted several of your before, intraoperative, and 1 week postoperative photographs in the photo album section of the forum. http://www.hairrestorationnetwork.com/eve/showthread.php?t=153548 Steven Gabel, M.D. Portland, Oregon 503-693-1118

I believe that the first two weeks following surgery are the most critical. And it is important to understand that each person heals at different speeds; some people look amazing after one week while others take a little more time to look the same way. For the incision, it is important not to stretch it or put any undo forces opposing the edges of the incision. This will just lead to more collagen formation, and ultimately, a larger scar. I tell all my patients to allow the incision to heal well before any strenuous activity. Grafts: After two weeks, the grafts are seeded pretty well. Again, I ask my patients not to put any undo stress on the transplanted grafts for about a month or when they start to shed. I do this for a couple reasons; one, that is a healing area and I don't want anything to compromise the healing process. Living in the Northwest, I've had several patients ask me if they can go skiing with helmets on 2 weeks after surgery (especially this season with fantastic snow). I let them know that I think it is still too early to allow anything to be rubbing on that area. Usually when the grafts start to shed, then I believe they can resume their normal activity. The second reason is that every patient has put a lot of effort into the surgical procedure, not just the time of the procedure, but the time after the procedure caring for the surgical sites. Having them wait a couple extra weeks to insure that the grafts are completely seeded and will not be damaged by outside factors is worth the wait. Steven Gabel, M.D. Portland, Oregon 503-693-1118

I'd like to thank everyone for their positive support for Coalition Membership. It was a pleasure having Pat out to the office to see the work that we perform. Steve Gabel, M.D. Portland, Oregon 503-693-1118

You've certainly named some fine surgeons, but since you live in Chicago, I'd give Dr. Konior a call. He is an excellent surgeon and can show you plenty of examples of his work. He is a recommended physician with the Hair Transplant Network, a Coalition member, and you can find more info about him on this web site. I wish you the best. Steve Gabel, M.D. Portland, Oregon 503-693-1118

Thank you for posting your experience. I have posted your photographs in the patient photo album section of the forums. http://www.hairrestorationnetwork.com/eve/showthread.php?t=147890

Your in great hands with Dr. Shapiro. I look forward to seeing your results. Steve Gabel, M.D. Portland, Oregon 503-693-1118

The time that the grafts seed and are difficult to "pull out or pop out" varies from patient to patient. After transplant surgery, I give my patients a detailed instruction sheet that outlines what they are to do each day after surgery. When patients are finished with surgery, I make sure each graft is in proper position and seeded correctly. I ask them to come into the office the day after surgery to make sure all the grafts remain in the correct position, and if a few need adjusting, we do it at that time. We also do an extensive washing for them so the transplanted and donor area are clean. For the two weeks following surgery, I ask them not to scrub or rub their scalp just in case there are some loose grafts that need more time to lock into position. This time can vary after surgery so when they return for staple or suture removal, I will instruct them on their further post-operative care. Steve Gabel, M.D. Portland, Oregon 503-693-1118

No Buzz This is an excellent question. In my clinic, I make all the incisions and determine the depth that the grafts will be placed at. After the strip is taken, it is slivered and the grafts are produced from the slivers. This is all done under microscopes to minimize any transection and maximize the yield from the strip. Next, I will physically measure the length of the grafts. The measurement can vary between 3.7 mm and 4.5 mm; each patient is different and therefore measurements are taken for each case; and in some cases, I'll take measurements for the different sized follicular units as this can vary as well. As a final step, I will test the fit of the graft for all the different sized follicular units to make sure they sit well before I proceed with making a majority of the slits for the case. Steven Gabel, M.D. Portland, Oregon 503-693-1118

In an earlier post, I was asked to introduce myself ??“ so here I am. My practice is in Hillsboro, Oregon, which is just outside Portland. For those of you that not been out to the Northwest, it is a beautiful part of the country, although a little rainy during the winter months. I've been involved with hair restoration since 1999. I am committed to providing state of the art hair restoration for my patients. I spend a lot of time with my patients during the consultation process to understand their goals and tailor my approach to achieve the goals they are seeking. I appreciate the post by one of my patients who had a positive experience with me. If anyone has any questions, please feel free to contact me. Steven Gabel, M.D. Northwest Surgical Hair Restoration 503-693-1118 DrGabel@nwshr.com P.S. Pat ??“ After reading all the comments about my technician's singing ability, perhaps we need a forum where that can be critiqued along with the surgical experience ??“ just kidding!