Steven Gabel, MD, FACS
Elite Coalition Physician
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Everything posted by Steven Gabel, MD, FACS
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Slickers and hdude46 I'll check to see the latest postoperative photos I have on this patient and post them. Sorry I did not see your question for the last couple days: as some of you may know, I'm in training for my 3rd full Ironman triathlon, which I'm doing in Arizona this November. It takes a ton of time to train for the event so I'm unable to check the forums as often as I would like. When I get to the office this week, I'll see what we have. I appreciate you asking for follow up photos. -
This patient is a 34 year old gentleman who was unsatisfied after two prior transplants to the frontal hairline at another clinic. He had his transplants at an institution that has centers throughout the country. He felt that the results were not what was promised. Despite the procedures, he felt the frontal hairline was thin to the point that only a small percentage of the hairs grew, and most concerning, was that what grew was uneven. Therefore, as I discussed with the patient, our goals would be to design a hairline that would make it even from the right and left sides, and also increase the density in the first to second centimeter. In one session, 1024 grafts were placed in the first and second centimeter as shown in the photos. It was imperative that the slits were placed in exact locations not to damage the existing hairs, and to make sure that the frontal hairline had the correct angulation and hair direction to blend in with the existing hairs. From a technical point of view, when placing grafts, we put a lot of emphasis on making sure that the natural curvature of the placed grafts are oriented correctly. If the grafts are placed correctly, a more natural appearance is obtained; if the grafts are placed with the natural curvature of the hairs not oriented in the exact direction of the natural hair, the results can be suboptimal. The postoperative photographs show very closeup detail of the results obtained (the most closeup photographs were obtained using a 60 mm macro lens at a distance of a few inches from the scalp). I wanted the photographs to line up as close as possible between the preoperative and postoperative shots so an objective comparison would be possible, which I present to the patients so they can see the changes. Additionally, I placed a ruler in several of the photographs to show the high density slit and graft placement. The patient felt extremely pleased with the results so far. We look forward to continued improvement in growth and density over the next year.
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I would like to thank everyone for their positive comments. In reviewing this case, it is important to note that even though men with thin hair may not obtain the thickest results centrally in their scalp, a positive aspect for them is a natural, soft hairline which can be a very desirable characteristic for many people.
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This 58 year old male was concerned about the progressive alopecia of the frontal area and crown regions of his scalp. He described it as a slow loss over the past 2 decades. He noticed that along with the alopecia, that his hair was gradually thinning as well. When he presented at the clinic, he had significant alopecia of the frontal scalp and some alopecia of the crown. His hair was blond mixed with grey, but very thin. Additionally, the density of his donor hair was on the low side. We discussed his options in detail. He had been on a regimen of minoxidil and shampoos. Although we discussed the role of finasteride, he was not interested. In terms of a surgical transplant procedure, we discussed the potential outcomes given his lower density of donor hair and and the fine texture of the hair. On the plus side, his hair color/skin contrast difference would give him a more favorable outcome as they were similar. If his hair would be black, the result would be much thinner; however, since his hair color is blond, it was to his advantage in this situation. Given these facts, he understood that the end result would improve his appearance, but he would always have a thinner look given the characteristics of his donor hair. The photographs presented are 2 years following surgery which show the transplanted hairs filling the frontal and crown areas very well with the rest of the hair on his scalp. Although the density of his donor hair was low, the 2195 grafts were able to fill in the frontal and crown areas sufficiently to give him a natural, fuller appearance which he ultimately desired.
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Thanks for all the positive comments on the results of this transplant. I agree with BadBeat - the beard balances his facial features nicely and improves his appearance. The patient is very happy at this point. I'll be sure to post the 1 year follow up photos when he returns for that visit.
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This patient desired to have a thicker/fuller beard specifically within the goatee pattern. He is able to grow a beard at the cheek area, but always felt that the area around his chin was sparse. He also wanted to thicken up the mustache area. On examination, the patient’s scalp hair was thinner then his native beard hairs, but pretty good caliber. I discussed with him preoperatively that although I would be able to transplant into that area, the hairs would not be as thick and he may require more then one transplant to thicken the area up to meet his goals. The patient had 1573 grafts placed into the beard region centered in the chin area in the goatee pattern; several grafts were also placed in the superior portion of the mustache. The photographs are 8 months after the procedure where the hairs have been growing for a couple months. I expect it to certainly thicken up over the next year to fill in the area. At that time, we will reevaluate the results to determine if he would need additional grafts.
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Thanks everyone for the positive comments on his results. This patient used to have his hair pretty long to cover up his alopecia, but now that his frontal area has been restored, he has enjoyed his short hair. aaron1234: he has been experimenting with different styles and between himself and his stylist, they have come up with this look. He said it changes every time he sees her. He is definately happy that he now has more options. RCWest: At the present time, he is not scheduled for another procedure. His main concern was the frontal area. He is on medical therapy which will hopefully hold his current look. Slickers: This was a strip procedure.
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This 41-year-old gentleman was concerned about his receding hairline and desired to have it recreated to a more youthful appearance. Although we discussed his thinning mid-scalp, that did not bother him as much as the hairline, which he wanted us to concentrate our efforts on. 2642 grafts were placed in recreating the frontal hairline and frontotemporal angles. Understanding that hair loss is progressive, he also elected to be more diligent with medical therapy by taking minoxidil and finasteride, which he had been using on and off in the past. He feels that since starting medical therapy, his hair loss has slowed down. The results are shown 2 years following the hair transplantation. Just before the last visit, he cut his hair short, which he feels gives him a nice, clean appearance with his new hairstyle, which he is very happy with. Shortly, I will add a video showing his two year results.
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We continue to present Ken's monthly photos and video. We present his 10 month post-surgery photos to illustrate his monthly growth. He feels in the last couple months that the his hair is growing more rapidly. He wanted to show what his hair looks like when it is slicked back wet with gel. He had 2569 grafts placed into the frontal hairline and the frontal mid-scalp. With his hair “slicked” back, one can really appreciate how thick the transplant is. In the video, Ken describes how his family and friends react to his new appearance. Overall he feels the transplant has been life-changing with personal relationships and increased productivity at his job.
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This 49 year old gentleman desired increased coverage in his frontal region of his scalp and crown. 2,272 grafts were placed throughout these areas. The photographs show his results only 6 months after surgery. Further growth and thickening of the transplanted hairs are expected over the next 6-18 months. Since this patient lives out of state, I asked him to send us his 6 month update in specific orientations. The background and lighting are obviously different since he took these at home, but he did a great job at taking the photos at similar angles as his preoperative photos. We look forward to his continued progress and presenting his results.
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I would like to thank everyone for their positive comments. This patient is very happy with his results in just 6 months and I look forward to presenting his growth at 1 year. Bill - photo documentation is very important in this field and I do my best to take the photographs which are consistent between time periods and photo shoots. Thank you for the positive feedback on the photo documentation and presentation.
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This 28-year-old gentleman desired greater density in the frontal and mid-scalp. He had been losing his hair for a few years, but felt it had stabilized. He was started on medical therapy, consisting of finasteride and Rogaine, to further stabilize his hair loss. 3,033 grafts were placed into the frontal hairline and frontal mid-scalp in one session with a high-density graft placement technique with slits oriented in the coronal plane. The photographs, taken six months post operatively, show tremendous growth and increased fullness in the transplanted areas. Since he is only 6 months out, we expect continued growth and maturation of the transplanted hairs. Additionally, some growth can be seen in the crown area, which was treated solely with medical therapy (this is illustrated in the final photo). We will report his one-year results in the future.
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Ken is now 9 months out after transplanting 2569 grafts to the frontal scalp. The before and after photos show how well a transplant can change the appearance of someone. Ken looks younger, he feels younger, and it has had a tremendous positive influence on his life and career. Hair style is also very important; again, his curly hair is a bonus as that adds a layering effect. We have been documenting his progress monthly. Here are his previous links to show the monthly progress of the growth of the transplanted area. Looking at all the previous months that he was posted, the progression is fantastic and life changing. Here are the links to show the prior posts showing his monthly progress: Link to Week 1 Photos Link to Month 1 Photos Link to Month 2 Photos Link to Month 3 Photos Link to Month 4.5 Photos Link to Month 6 Photos Link to Month 7 Photos Link to Month 8 Photos 9 Month Before & After Photo Results
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Thank you all for your positive comments. And yes, Ken is very happy so far with the results. This is most evident with the videos that I have been taking. Spanker: The videos for month 7 and 8 are on their way. It takes me a lot of time to prepare the videos and sometimes the time gets away from me. I'm working on them now. I appreciate all the feedback. Spex: I have been very fortunate that Ken has been coming back every month to document his progress. This has been very educational for my patients to see someone's growth on a monthly basis. At this point, we are now starting to see his hair thickening to give him a fuller appearance. Again, I do appreciate your feedback.
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Ken is now 8 months out after transplanting 2569 grafts to the frontal scalp. These comparative photos show his progress. His hair continues to fill out very nicely, is growing very fast now, and starting to add some density to it giving a fuller appearance. The fullness is definitely improving and really filling out as his hair grows longer. His curly hair is a bonus as that adds a layering effect. We have been documenting his progress monthly. Here are his previous links to show the monthly progress of the growth of the transplanted area. Looking at all the previous months that he was posted, it is very interesting and exciting to witness the transformation that is taking place. His excitement is most evident with his words and emotions that are seen in the videos. The videos for month 7 and month 8 will be added shortly. Here are the links to show the prior posts showing his monthly progress: The Start: Month 1 Month 2 Month 3 Month 4.5 Month 6 Month 7
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Ken is now 7 months out after transplanting 2569 grafts to the frontal scalp. These comparative photos show his progress. His hair continues to fill out very nicely, is growing very fast now, and starting to add some density to it giving a fuller appearance. We have been documenting his progress monthly. Here are his previous links to show the monthly progress of the growth of the transplanted area. Again, I want to thank Ken for taking the time to come into the office every month to demonstrate the monthly progress of a hair transplant. Here are the links to show the prior posts showing his monthly progress: The Start: Month 1 Month 2 Month 3 Month 4.5 Month 6
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This patient is a 57-year-old gentleman who came to me after a failed hair transplant elsewhere in the Northwest. He stated that 2 years prior to my initial evaluation, he had a transplant, which did not achieve the desired result. In fact, he had problems with an infection throughout his scalp and an area in the left mid-scalp turned black. It took almost a year to fill in with scar, which is shown on the close up. On initial evaluation, he had many 4-mm areas of “white scars” which represented plugs that failed and had no hairs. There was an area in the left mid-scalp which was white and thin where the skin died (necrosis), and a white scar eventually replaced it. There were several areas of plugs that were very unnatural appearing. (See photograph with diagrams). The donor scar was wide and unsightly. We were able to perform 2 procedures on this patient with a total of 3570 grafts, with repair of the donor scar. Our goal was to repair the prior transplant by placing grafts where he lacked them, and thicken the entire scalp region with new transplants. We also wanted to make it look natural. I was not sure if the grafts would grow in the prior necrotic area, so these were placed very conservatively in that area to make sure there was adequate blood supply. The postoperative photographs are 3 year after the procedures. The entire scalp has been filled in and he has a very natural appearance to the hairline and scalp.
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Ken is now 6 months after his procedure. He had had 2569 grafts placed into the frontal scalp region. The hairs are now starting to grow. Watching the video is interesting as it gives people a look into the reaction of family and friends to his new hair. At this point, the hair is starting to grow faster. It is slowly starting to fill in. He has a long way to go before he is completely filled in.
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We continue to showcase Ken's monthly progress after surgery. We are presenting his 4.5 month postoperative photos and video. He had 2569 grafts placed into the frontal scalp region. The hairs are now starting to grow. Watching the video is interesting as it gives people a look into the reaction of family and friends to his new hair. Ken’s 4.5 month video update Here is the monthly progress of Ken’s top down photos: Month 1 . Month 2: . Month 3: . Month 4: .
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This patient is one year out from receiving 4489 grafts in one session. He wanted to thicken the entire scalp, particularly the frontal and mid-scalp. He had severe alopecia of the frontal scalp, and mild to moderate alopecia of the mid-scalp and crown. We concentrated the grafts in the frontal half including the temples, but were able to place plenty of grafts to thicken up the posterior scalp. He stated that the hairs started growing about 3 – 4 months following the procedure; recently, he has noticed that they are thickening up. Since he is only one year out, we expect continued growth and hope to report his two year results next year. His immediate postoperative photos are seen in this previous post: This patient is from out of town so the background is not the typical blue background taken in the office, but a brick background outside. Steven Gabel, M.D. Portland, Oregon
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Multiplier Here is a photo of the scar at two months that you asked for. The scar has shock loss around it, and when the transplanted hairs start growing, the hairs around the scar will also start growing. I”ll make sure to continue to put in photos of the scar to watch it mature as well.
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We've been showcasing Ken and his monthly progress after surgery. We are now presenting his 3 month postoperative photographs. Ken had 2569 grafts placed into the frontal scalp region. The majority of the grafts are in the dormant stage, but some now are starting to grow. We've been videotaping his progress as well and the video will be posted shortly. I've included links to the previous posts. Ken's Immediate postoperative photos/post Ken's 1 month postoperative photos/post Ken's 2 month postoperative photos/post Again, I'd like to thank Ken for coming to the office each month and taking the photographs and video. Steven Gabel, M.D. Portland, Oregon
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Ziggy Numbness of the top the scalp is very common after hair restoration surgery. The nerves that innervate the scalp are "stunned" for a while, and most patients experience complete return of sensation to the top of their scalp 2 - 4 months following surgery as the nerves "wake up."
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Multiplier I’m in the office today. I’ll check to see if I have any donor area photos; if so, I’ll put them up.
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I finally was able to get the video up. Ken's hair is in the dormant phase of the time frame after hair transplantation. He does feel tiny hairs starting to grow. He completely shaved his head 2 week ago and is going to let it grow out. Ken will be back next month to follow his progress.
