Steven Gabel, MD, FACS

This patient is a 40-year-old patient who had 2548 grafts placed in the frontal hairline 2.5 years ago. He desired to have the frontal hairline restored and to increase the density in the frontal scalp. The photos and video show the results and the patient’s satisfaction and enthusiasm he has received from the procedure.

This patient is a 33-year-old transgender female from Seattle who desired a feminine hairline. Her hair is light brown, medium thickness in caliber, which is excellent for frontal hairline and frontal-temporal recession restoration/transplantation. The reason that her hair is excellent for the transplant is that it is thick enough to give the appearance of nice, natural density, but not too thick which can give an unnatural look in the frontal hairline. In the frontal zone, we strive to put the thinnest hairs in the most anterior aspect of the hairline, and build a gradient to thicker hairs the further back in the transplanted zone. This gives the most natural appearance to a frontal hairline transplant.

This patient had her transplant just over a week ago and was willing to share her photographs on a monthly basis while the transplanted hairs grow. She is from Seattle so the follow up photographs will have a different appearance (background/camera), but the concept will be nicely demonstrated as the transplanted hairs grown throughout the coming year. I want to thank this patient in advance for taking the time and offering to take her photographs on a monthly basis to post her results.

This patient is a male-to-female transgender patient who presented to feminize her frontal hairline. The results show her 1-year result after 3524 follicular unit grafts were placed in the frontal hairline and frontotemporal angles.

At the 1-year mark, she is extremely happy with the results as she is able to wear her hair down and style it in a very feminine manner. She has also enhanced the appearance of her hair by coloring it.

Dr. Parsley

Thank you for showing the results of your patients whom you treated exclusively with medications. You have presented several of these types of results throughout the years. These patients really illustrate the importance of medical therapy to not only preserve hair, but also gain hair as some patients are able to obtain fabulous results with medical therapy only.

For this patient, what was the regimen you used for his success?

Steven Gabel, MD, FACS, Oregon, Washington, 2312 Grafts into the Frontal Zone

Steven Gabel, MD - Portland/Seattle - 3015 Grafts, Frontal Scalp

Yea, I was just curious as to whether the "growth" shown prior to the shed weeks after the newly transplanted grafts are due to the cells actually generating hair, or if it is the shaft of the hair being expelled as the graft goes into telogen phase....

 

I guess I am trying to understand whether a non viable graft would just sit there and not grow (or fall out unless agitated).

Spidey

Great question: I do believe the answer to your question is Yes. If the hairs are "growing" or "starting to advance" because of the impending shift in the cell cycle from anagen to catagen to telogen, the fact that there is movement to me signifies that the follicle has survived the hair transplant and is either/or both continuing to elongate the hair shaft or advancing the hair shaft for expulsion from the follicular unit. Can I say exactly which is occurring: No. However, since the hairs appear longer, that signifies to me that the follicular unit is functioning.

I have put together some photos of another patient that came in yesterday for his suture removal. I did not actually take these photographs with the intension of showing early hair growth so these photos are not 100% ideal for this demonstration, but I think it gets the point across of the length that I have them at time of the transplant.

I prefer to have the hair shaft several millimeters long to see the curvature of the hairs so when I place the grafts, hair curvature is all (as best I can) perfectly oriented in the direction that I intended, as seen in the photograph.

This photo is a close up of the transplanted hairs. Clearly, the hair shafts are longer (or they are transitioning from anagen to catogen). And, at this point, some of the hairs may have been extruded. Along with the early growth of the hair shafts, I am able to ascertain that the hairs are oriented correctly in the desired direction that I intended.

Is that actually true? Regarding initial growth of the freshly transplanted grafts?

So I understand the question, are you asking if I can see that the transplanted hairs are growing, that they are viable?

11 Month Update: Results in Real-Time with Dr. Steven Gabel Patient, 3439 Grafts Frontal Hairline, Portland, Oregon

I have been presenting before and after photographs of this female patient each month to demonstrate the growth of a hair transplant from prior to surgery, immediate postop, her suture removal, and each month afterwards in real-time. Each set of photographs was posted within a couple days of taking the pictures to demonstrate, in real-time, the growth of a hair transplant. I feel this is very educational for people to see the real-time, monthly progress, of a hair transplant and what to expect after the procedure.

This patient is now 11-months after her hair transplant of 3439 follicular unit grafts at our center. She has curly hair which shows with the transplanted grafts as they retain their natural hair structure. She has noticed that the hairs are starting to straighten out as we have expected. Most importantly, they are continuing to thicken, grow, and blend in very well to her natural hair adjacent to the transplanted hair. The goal of hair restoration surgery is to produce a natural result, which we have achieved here.

This patient will return in one month to present her 1 year results. Again, I want to thank this patient for returning each month for these photographs. Because of her busy schedule, we meet at the office on Saturdays to take these photographs.

We are now 10-months following 3439 follicular unit grafts placed into the fronto-temporal recessions of this patient. The hairs are growing longer, and she is going to straighten her hair for the 1-year photos. Overall, she feels her hair is very thick in that area, and it has certainly satisfied her expectations from the procedure. These photos were taken 2 days ago. I also have a video that I will post with these photographs.

She will return in 1-month for her 11 month photographs.

We are now 9-months after a 3439 follicular unit graft transplant to the frontal hairline and fronto-temporal angles at the Gabel Hair Restoration Center. The transplanted hairs continue to grow. Also, the patient is starting to notice that the hairs are thickening up. The hairs continue to have a tiny curl to them, and as the micros-scars soften up, we anticipate that the hairs will straighten up as well. She has curly hair so it will improve, but she will always have a curl to them.

These photos were just taken today, and I also have a video that shows us combing through her hair. I will present the video after I process it, but I wanted to get the photos that we took today to keep the “Real-Time” photos coming.

We are now at 8-months after transplanting 3439 follicular unit grafts to the frontal hairline and the fronto-temporal angles at the Gabel Center. The photos show continued growth and thickening of the transplanted hairs. We see that the hairs have a tiny curl to them: this is due to the fact that the patient has a natural curl to her hair, but also there are tiny microscars that will soften up over the next several months.

We will continue to document, in real-time, her monthly progress.

We are now at 7-months after 3439 follicular unit grafts were placed in the frontal hairline and fronto-temporal angles at the Gabel Center. Her hair is growing so well right now it is difficult to comb through it. In fact, when I was taking the photographs yesterday, she feels that the transplanted area is denser then the non-transplanted areas.

As shown in the photographs, which were taken yesterday, April 25, 2015, (documented with the current Oregon newspaper), her hair is growing and the density is amazing. It is difficult to comb through that section of her hair. Also, note that the hair is wavy which is seen early in the growth period. This is due to the micro-scars that occur when a slit is made. Her hair will eventually become smoother as the micro-scars soften up.

Overall this patient is absolutely thrilled with her progress as it is very difficult to see the scalp in the fronto-temporal angles, which is the reason she had the procedure. She is just anxious for it to grow long for styling purposes, which will take several more months.

We will continue to document, in real-time, her monthly progress.

This patient is a 42-year-old gentleman who wanted to reestablish and thicken up his frontal hairline. He had been slowly losing his hair several years ago, but since starting on medications for hair loss, the loss has stabilized.

The patient had 2478 grafts placed 9 months ago into the frontal hairline and frontal zone of his scalp. We also are presenting very close up macro photographs of the frontal hairline, which demonstrate high-density graft placement in the frontal zone. Overall, the transplanted hairs are growing very well and the patient is extremely pleased with the results so far.

Thank you for the positive comments. She has been thrilled about the result, especially in the last couple months where her hair is growing longer and covering the transplanted areas even better.

My patient is now 6-months following 3439 grafts to the frontal hairline and front-temporal angles. She had severe recession and desired to fill in the areas.

The hair is growing longer, filling in areas of alopecia very nicely and the density of the transplant is showing well. I plan to post video with the next month.

This patient is a 52-year-old gentleman who had a hair transplant 2 years ago. He had 2462 grafts placed in the crown and right fronto-temporal angle/mid-scalp region. The right fronto-temporal area was important to him as he parts his hair from right to left. He desired an age appropriate hair transplant to improve the density in crown, but also to help cover the part on the right. He was very adamant that he did not want the density of a teenager, but he wanted to improve the density in the areas as described above.

Overall the patient is extremely happy, as final results have accomplished the goals that he desired. At this point, he is continuing on medical therapy and has not plans for a transplant in the future. I have asked him to return in one year for a follow up.

Shadow: Great observation!

Women have several types of hair loss patterns, but we tend to see these more often:

1. Central "christmas tree" pattern

2. Diffuse thinning

3. Frontal-temporal recession - this can be congenital (tend to be great candidates for a hair transplant as most have no hair loss except in the frontal-temporal area and therefore have great donor hair)

I have presented many female patients with deep frontal-temporal recession type patterns. For woman with deep frontal-temporal recessions, they feel that they are limited in how they are able to style their hair - specifically, they are not able to style their hair back or to the side as they feel it exposes too much scalp giving a more "male" hair loss pattern. In fact, I just did a hair transplant on a woman 2 days ago that had even deeper recessions then the patient I am presenting for the monthly follow up and the patient below. We transplanted over 3200 grafts just into the frontal-temporal angles. I will put those photos together and show the outline that we transplanted.

Here is another example of a woman that we transplanted a few years ago with deep frontal-temporal recessions. She had no other areas of hair loss with excellent donor density which made her a perfect candidate for a hair transplant. This was congenital meaning that she was born with absent hair in the frontal-temporal areas. (The background is different as she lives out of state and the post operative photos were not taken in my office.)

Here are the 5-month update photos. This patient has been coming into the office each month to display her progress each month.

As shown, the transplanted hairs are all erupting well. She still has a long way to go, but the results are definitely showing. The patient is certainly excited to see this as the transitional period is always the most difficult time since the results are not instantaneous.

It is very interesting to see the progress this patient has made from before surgery, and each month following the procedure. She will be back at show her 6-month result.

Thank you for the positive comments on the results this patient received. This patient lives in the Portland vicinity so I'm hoping that I can continue to update his photographs over the years.

Thank you for the positive comments on this FUE patient. This patient is from out of state so I will do my best to get future follow up photographs.

@hairlosscpa: I agree. When I did a 6-month Skype followup evaluation with this patient, he was able to pull his hair back and show the results to me, but I did not get that view with the photos I was sent. For the 12-month followup photographs, I will specifically ask him to pull his hair back so we can the exact transplanted areas.

Thank you for the positive comments on this FUE patient. This patient is from out of state so I will do my best to get future follow up photographs.

@hairlosscpa: I agree. When I did a 6-month Skype followup evaluation with this patient, he was able to pull his hair back and show the results to me, but I did not get that view with the photos I was sent. For the 12-month followup photographs, I will specifically ask him to pull his hair back so we can the exact transplanted areas.

This patient is a 42-year-old male who desired to enhance his frontal hairline. His preference was to have FUE as there are times that he shaves his head and he wanted to avoid a linear scar.

Exam revealed very medium caliber black hair and definite thinning at the frontal hairline region. We transplanted 2102 follicular unit grafts approximately 6 months ago. When I perform FUE, I utilize between a 0.8 – 1.0 mm round FUE punches depending upon the diameter of the follicular units.

As the surgeon, I perform every punch; afterwards, between my experienced staff and myself ,we extract the grafts. Not infrequently, I will do all the extractions after I incise the grafts with the round blades. Once the grafts are extracted, they are all examined under the binocular microscopes for their integrity. If they are not found intact or transected, they are either used but not counted in the final graft count or discarded. Each graft, once extracted, is also immediately bathed in HypoThermasol. After 500 grafts are extracted, I will make the sites and my team and I place the grafts. We will then put the patient back in the prone position to extract more grafts. We continue alternating between extraction and placement until our plan is accomplished.

The photographs presented show the proposed outline of the frontal hairline and his 6-month growth. The patient does not live in the area so he sent me these 3 photos. He will also send me his 1-year photographs that I will post.

We are now presenting the 4-month update from our patient who has graciously come in each month to document her progress. We have presented each month from the day of surgery through yesterday, January 5, 2015 (the front page of the Oregonian shows the article on the matchup between Oregon and Ohio State for the National Championship, and the lessons to share on legal weed – Oregon approved this in the last election).

The patient is now 4-months out and the transplanted hairs are starting to sprout in a much more vigorous fashion. They are thin at this stage, and there are still many to erupt through the skin, but the results are starting to show.

The transplanted hairs at this stage come out of the scalp rather thin and wavy, and over the next year or more, the hairs will thicken up as the hair shaft diameter increases. She will be back in one month for the month-5 photos.