Steven Gabel, MD, FACS

This 33-year-old gentleman had a transplant a few years ago at another clinic to increase the density of his frontal hairline. After the procedure, he felt that the hairline was not straight with the left side higher then the right side. After a thorough consultation, both the patient and I designed his desired hairline that he felt was straight and would balance the left and right sides appropriately. He desired more hair on the left side, but also wanted to augment the entire frontal hairline. We transplanted 1238 grafts into the first couple centimeters with a greater emphasis on the left side to correct the imbalance. The photographs presented are 18 months after the procedure at the Gabel Center. We do not have his original preoperative photographs (prior to his first hair transplant) to show. The photographs here depict his preoperative state with us, photographs depicting the proposed lines, immediate postoperative photographs, and the 18-month results.

Spanker In the outlined photos, the patient was not shaved at that point. That is how she presented on the day of surgery as we did a complete reconstruction of the frontal-temporal angles on her. I agree about the shape: Although I do my very best to line up the head position for every photo, her head is slightly tilted more forward then the original photo giving that appearance. Also, she had been wearing a fitted hat for entire day so her hair was flattened.

Here are her 3 month results, which were just taken 3 days ago on December 22, 2014, as shown in the newspaper she is holding. At this point, her hair is now just starting to grow. It is still sparse, but slowing starting to fill in. Only a small % of the grafts have started growing at this point. This is certainly an exciting time for patients because it is proof that the grafts survived and the results are starting to show.

Here are the month 2 photos: At this point, all the transplanted grafts have shed, which is expected at this point. There is a faint redness where the grafts were placed in a high-density type fashion. The redness is also fading over time.

Excuse me? Can you please elaborate on your definition of unethical practices that you are accusing 2/3 of the recommended physicians of?

I apologize that I have not commented on this thread until now. I only thought it was appropriate that I speak to the patient first, then comment on the thread. First and foremost, I am very concerned about this patient and every patient that I operate on. It is my goal to always obtain the results that were expected and we thoroughly discussed during the consultation process. I would never take on a case or perform surgery on a patient if I though that I would not obtain the results we were expecting, or if I thought they had a process in which there was a contraindication for surgery. If medical treatment is necessary, or a biopsy is needed to confirm a diagnosis, I will always go the medical route before offering surgery. It happens very often those patients who were offered surgeries elsewhere come to me and I make a diagnosis that would have made them a nonsurgical candidate. As I stated, I spoke to the patient for about 45 minutes yesterday and we had a very good conversation. He certainly expressed his thoughts, and I was able to express mine, both in a very respectable manner. Given my doctor-patient relationship with this patient, I will not go into specifics other then to say that I will stand by this patient and do whatever is necessary to make the outcome the best for both of us. Anytime this patient had a concern when he was living in Portland, we addressed it in a very timely fashion and my “open door” policy was always in affect; in fact, in the 6 months that he was here, he desired and came in at least once or twice a month for check ups and to have any questions answered. I do want to address one issue that I did speak to him about and that is something he wrote here so I feel I can comment on: I never told the patient not to read the internet or the forums. I am a sponsor of this site so that would make me a total hypocrite if I did that. I direct many of my patients to this site so they are able to get a sense of what others have experienced during their hair restoration process. There is a ton of excellent material on this site and other sites; however, I do caution all of my patients to be careful of what they perceive as “truth” as not everything that is written on the Internet is fact. Also, each patient has a unique set of circumstances so what is good for one patient may not be good for someone else. I do my best to recommend therapy that has been proven successful in the peer-reviewed medical literature. When patients tell me that they read about some treatment, lotion, or pill that I know has not been proven to be helpful in hair restoration, I don’t discourage its use (unless it will be harmful to them), but I tell them to be careful about it as it may not do anything for their hair. I hope this clears some of the air and I will be in contact with this patient and monitor his progress (in fact, we have a Skype call scheduled for this Saturday). It is also a fact that some patients take longer to obtain their results then others, and I hope people on the forums will respect my long-standing expertise and judgment as a hair restoration physician as we allow time for this patient’s results to come full circle.

This patient is a 55-year-old gentleman who had 2 transplants with us over a 2-year timespan for a total of 5074 grafts to the frontal and midscalp zones. He is frequently on the forums with the username of Biz. When we met over 2 years ago, we had lengthy discussions about the eventual outcome as his hair is thin and he had extensive hair loss as a NW 6/7. At the initial meeting, I was optimistic he would have a nice result, but I cautioned him that the result would be “thin” based on the amount of scalp that would need to be covered and his hair characteristics. He recently send me some updated photographs 8 months after his last transplant which demonstrate very nice frontal and midscalp growth and coverage given his hair characteristics. He has grown his hair out which really adds to the overall look of fullness. I have not seen him since the last transplant as he does not live in the Portland area so the “after” photos were taken elsewhere hence the different backgrounds. When I received the updated photographs, I was so thrilled with how his results have transpired as they certainly have exceeded what I promised in that first consultation with him and I. Since he is only 8 months following his second transplant, we will update this post at his 1-year and 2-year timeframes.

Biz Wow!!!! This is the first time I am seeing your results as well. You and I have not spoken or seen each other since your last transplant (biz lives outside of the Portland area). I am super thrilled with your results. And I agree with hadenough2014, you did start as a NW 6/7 and now you have really nice coverage of the frontal scalp, and it frames your face very naturally. I am really happy for you and most importantly, you are happy with the results of your transplant. Looking forward to seeing you again so I can see the results in person. I'll give you a call soon. Thanks for showing your results.

I am presenting a patient in real time. Here are the 10 day suture removal photos. I tried to attach these to the original post, but I was not able to edit the original post. As seen, the hairs are all growing which indicates to me that the transplanted hairs are all viable. When patients come back for the suture/staple removal at 10 days, I point this out to them because in a short time, over the next 3 weeks, most of the transplanted hairs will fall out. Some patients become concerned about the hairs falling out so I refer them to these photos that show all the transplanted hairs growing. Also at this time, there is a small amount of exudate or crusting that should be almost gone. All patients will develop some type of exudate and it is important that they follow their physician's postoperative instructions for proper care in the postoperative period.

This patient is a 51-year-old gentleman who desired a hair transplant to the crown area. He wanted a conservative hair transplant to the crown and right aspect of the midscalp to improve his hair density. Approximately 1800 grafts were placed in the crown and right part area and the 18 month postoperative results are shown. I included the preoperative photograph showing the planning for hair direction around the swirl with the corresponding postoperative photograph.

I am presenting this patient who had surgery on September 3, 2014, and will display her results every month on this thread to document the progression of growth in hair restoration surgery. This patient had 3439 grafts placed in the frontal hairline and temples to augment and bring down her hairline. She has graciously volunteered to return each month to my office for the next year so we will be able to present her photographs in real-time. I feel this is instructive for patients inquiring about the progression of hair restoration surgery and how they may look each month.

This female patient desired to wear her hair back; however, because of her naturally deep frontotemporal angles, she always wore her hair forward to cover them. She felt the alopecia in the frontotemporal angles gave her a masculine appearance, which she did not like. We densely transplanted 1892 grafts into the frontotemporal angles. As shown in the immediate postoperative photograph, it is vital that the grafts are oriented correctly in a lateral direction, which the hair naturally pointed in those areas. The slits are also made in a very acute manner so the hair “hugs” the scalp in the proper direction. The postoperative photographs were taken only 6 months after the procedure. We plan to have the patient return for her 1-year visit at which time I plan to post the follow up photographs.

Densedream You are correct. I shave my head. Why - simply because it makes me happy and it is a personal choice at this stage in my life. I moved to Oregon in 2001 after finishing a demanding surgical residency, followed by a fellowship in facial plastic surgery, and having passed two rigorous board examinations. After the move, I started focusing on myself for the first time in years and was attracted to athletic events, which are plentiful in the northwest. While training for these events, specifically the Portland Marathon, I decided to shave my head for motivation (which I never thought I would do - but my training group did it together) and quickly realized it worked well for me. I fortunately have a nice shaped head and I really enjoy this look, and for my training, it was also much better. The shaved look is not for everyone for a variety of reasons, and when patients come to my office, if they ask, I am certainly open to the discussion; but at the end of the day, patients are not coming to me to discuss my personal appearance, they are coming to me for my expertise, surgical skills, and commitment to excellence in obtaining their desired results. If I decide in the future that the shaved look is no longer what I personally desire, then I will grow my hair and have a hair transplant done. I have wonderful donor hair, and the results would be fabulous. But right now, I am very happy with my appearance and I would hope patients would not judge me on my personal decisions for the look I enjoy for myself, but on the treatment and results I am able to obtain for them. Do I have any plans in the near future to grow my hair long - no. Since 2009, I transitioned from marathons to long-distance triathlons and absolutely love it. I have since completed many half Ironman events, and three full Ironman events, the last in 2012 at Ironman Arizona. Keeping my head shaved is best for me during training for these events which takes me about a year to prepare for. Here is a photo of me during Ironman Arizona in 2012. I have my sights on another Ironman for 2015. The training has already started. I hope this answers your question. Steven Gabel, MD, FACS

This patient is a 62 year old male patient from Portland who desired increased coverage in the frontal portion of his scalp. He has some scant hair in the front and wanted to redefine the frontal hairline to be able to grow his hair long for a full appearance. The before and after photos are presented which show very diffuse loss in the frontal scalp. His postoperative photos are 15 months after the operation where we transplanted 3099 grafts at the Gabel Center to the frontal hairline and frontal scalp. The interesting feature here is that he is growing his hair longer which adds additional volume to the frontal scalp which ultimately translates to a fuller appearance. Also, he has colored his hair black which further accentuates the fullness. The postoperative photographs were taken in the way that he styles his hair which is to layer it from left to right, again, giving an thicker/fuller result. Overall, the patient feels that his hair makes his appearance look years younger and overall he feels more confident with it. These photographs were taken with as much consistency as possible: I have been using the exact same camera (Nikon D300)/lens system for years, with the exact lighting arrangement without flash, and a consistent colored background which has not changed in years. The exact distance from the camera to the patient's chair is marked with tape on the floor, and we use the same settings on the camera to best obtain as close as possible identical shots. I also go through great lengths to have the patient look at objects pasted in the room on walls, a camera tripod, and light stands so they are facing the exact way for the before and after photographs for each and every patient. The photographs are all taken in hi-resolution which are cropped to fit in the frame I designed for presentation.

We are presenting a 56-year-old gentleman who is 7 months out from a hair transplant to restore the frontal hairline. His goal was to redefine the frontal hairline so it flowed smoothly into his existing hair. We are presenting four views: frontal, top, left and right. Each series shows photos before markup with the hair pulled back to demonstrate the degree of alopecia in the frontal region, the lines drawn preoperatively which will be used to recreate/define the frontal hairline, an immediate postoperative photograph, and a 7-month result. The results show the transplanted hairs appear very natural, and they frame his face very well. The density of the transplant also shows a nice progression from anterior to posterior.

This patient desired restoration of the frontal hairline and the frontotemporal angles. He had been slowly developing alopecia of these areas. He is currently under medial treatment to help slow the progression of alopecia. 2511 grafts were placed into the frontal region of the scalp. This patient demonstrates the steps leading up to the 4 month mark. The patient is planning to return in 2 months to also follow the progression of growth. At this point, the transplants are growing well, but they are still thin compared to the native donor hair. We expect over the next few months continued growth and thickening of the transplanted hairs, which will be nice to demonstrate in this forum.

This patient is a 57 year old gentleman who desired to increase the density of the frontal scalp. He was not interested in lowering the hairline; he only wanted to increase the frontal density without causing a major change in his appearance. The patient is presented 19 months after surgery showing a much improved frontal scalp density. The hair was not trimmed or cut to perform the procedure. We utilized a combination of precut slits, and it was further refined with the stick and place method. The patient is extremely happy with the results and it has certainly met his expectations.

This patient is a 61 year old gentleman who is 6-months following a hair transplant to the frontal hairline and frontal midscalp regions. His overall goal was to thicken the frontal regions to give him a more youthful appearance. The preoperative and 6-month photographs are presented. His hair had a nice caliber, and the color was a mix of black, light brown, and grey which works very nice with his olive skin tone. Overall, the patient is very satisfied with the results at this point. I took some video which will be presented soon. He will return in 6 months at which time his 1-year progress photographs will be presented.

This patient is a 54-year-old gentleman who desired to have hair to help frame his face and obtain a more youthful appearance. Examination revealed a Norwood Class VI with very fine, thin, limited donor. We discussed his options that included no medical/surgical treatment and surgical hair transplantation. The difficulty with this patient is that his hair was very fine and that any result from hair transplantation would be thin. He understood that with such fine, thin hair that he would always see his scalp, but that the hair would help frame his face. He had consulted with several physicians who also echoed the same response. After discussing his options, and knowing that the result would be thin, he elected to have surgery. 11 months ago, approximately 3191 grafts were placed into the frontal hairline and mid-scalp. The patient states that he is absolutely thrilled with the results as it has accomplished his goal of having hair that is natural appearing and which does ultimately frame his face.

Here are the 15-month updated photos. His hair is growing in very well and appears extremely natural. The postoperative photos were taken at the Seattle office and therefore have a different background. The close up shows the actual count for the high density graft placement slits.

This patient had 2752 grafts placed into the frontal hairline and scalp. He is now approximately 15 months out from his surgery and his hair has grown in very well. Most important to him, it is very natural and he has received numerous compliments from his family and friends who he shared it with. The grafts were placed in a coronal orientation and were dense packed (see close up photo actually documenting the clean, dense packing). I include the preoperative drawings the viewer is able to see the hairline design and the final, natural results. The photos were taken in our Seattle office so the background/camera are not the same as in our Oregon office. This patient has posted on his own and I will update his thread with the photos. He stated when I saw him that the results more then exceeded his expectations.

This patient is a 39-year old female who for her whole life has been bothered by very deep recessions in the frontotemporal area. Because of this, she nearly always wore her hair forward to cover the areas which were nearly devoid or had very fine, scant hair. This patient is a very active individual and desired to be able to wear her hair back without being self-conscious. Approximately 8 months ago, 2342 follicular unit grafts were densely packed into the left and right frontotemporal areas. At this point, her hair is growing very well, and she has noticed since month 3 that the hair started to grow. She is now reporting that her hair is filling in more each month. The photographs on the left show her preoperative planning lines and the photographs on the right show the 8 month progress photos. The 8 month photographs were not taken in my office - thus the white background. The last 2 photographs demonstrate the immediate postoperative appearance which shows the dense packing of the grafts, and very importantly, the proper hair direction. It was very important that the hairs are not only placed into the proper depth, but also that they are oriented correctly so they grow out following the natural hair direction. I am planning on seeing this patient at the 14-month postoperative mark and will post her new photographs at that time.

This patient is a 44-year-old gentleman who had a hair transplant with us back in 2006 in Portland, Oregon. He had moved away from the area and was back in town and stopped by the office. He says his current business is in investing, and that the transplant he had with us was the best investment of his life. His confidence was dramatically enhanced with the procedure as he is often in the public eye. He regularly uses finasteride and I’ve discussed with him the use of minoxidil. In 2006, he had 2367 follicular unit grafts placed into the frontal region of the scalp. The preoperative photographs show the outline that we proposed. Even with his thin hair, his transplant result has held up well throughout the years confirming that hair harvested from the proper area in the donor zone is permanent. Also, the way his hair is combed in the photographs is the way that he styles it forward and presented that day in the office. Since 2006, I have standardized the photographic poses and views to get much better, consistent before and after photographic comparisons. At this point, he is now interested in filling in the crown region. For the next procedure, I will also take a larger strip and increase the density in the frontal hairline and mid-scalp with the remaining grafts. Once the procedure is complete, I will post the results.

Dr. Konior The immediate postoperative photograph looks really clean and precise. The 10 month growth is excellent and coming in very well. Great job - looking forward to seeing his 2 year final result photographs.

This patient is a 51 year old gentleman who was born with a cleft lip and palate. At a young age, he had these repaired after many operations, but he always had a moderate scar on his left upper lip which he wanted improved. He grows a mustache to help hide the scars from the lip repair, but he has always been bothered by the fact that his mustache does not completely cover the scars and that there is a noticeable gap. 3 years ago, we transplanted 255 follicular unit grafts into the scar and upper lip mustache. He did well after the procedure, and routine follow up phone calls confirmed that the hairs were growing. I have not seen him in the office since the procedure as he lives a considerable distance from Portland. He recently sent in photographs taken from a cell phone illustrating the 3 year postoperative results showing a nice, natural result with uniform density in the upper lip. He says that the new hairs grow well and cover his upper lip scars ultimately helping out his self confidence. At this point, he has no further plans for any another transplant as he feels the growth has been excellent to achieve his goals.