Steven Gabel, MD, FACS

Dr. Lindsey and David - I appreciate the positive comments. This patient has been absolutely thrilled with the results and has been great coming into the office for periodic checks and photos. It allowed me to show his progression and growth. Thanks. Steve Gabel, M.D.

Othersyde I put together some of the photos from your surgery showing your before and immediately after photos, photos of the grafts, and photos of the surgery. Let me know if there are others you would like me to post. Steven Gabel, M.D. Gabel Hair Restoration Center

Thanks for the positive comments. In terms of prolonged erythema (pinkness), it varies between person to person. I’ve had some patients that the redness was gone by the time the sutures were out in 7 days; I’ve had others where it lasted several months. I wish I could predict who is going to have longer erythema and who is not, but I explain to patients that it all eventually fades away.

Othersyde I appreciate the kind words and extensive write-up. This will definitely give people an insight into what to expect. Looks like your doing great. I’ll get some photos of the surgery up asap.

This patient is a 61-year-old gentleman who desired to have his hair restored. His main priority was the frontal and mid-frontal scalp. Examination revealed a Norwood Class V/VI pattern. He had only wispy hairs in the mid-scalp. The donor area hair was black with a moderate amount of grey hair as well. The hair caliber was moderate in size. During the initial consultation, I demonstrated to the patient the value of also restoring the temples. Since this patient had significant recession of his temples, it was important to restore that area as well which would help in the overall framing of his face. This patient had 3405 grafts placed in the hairline, frontal and mid-scalp, and grafts to recreate his temples. The breakdown of the grafts: 1’s: 704 2’s: 2045 3’s: 644 4’s: 12 The following photographs show the preoperative planning lines, which were drawn the morning of surgery, the immediate postoperative photographs, 3-month postoperative photographs, and 6-month postoperative photographs. At the 6-month mark, the patient’s hair was really starting to grow well. The regrowth of hair following a transplant is nicely illustrated with this patient. Since he is only 6 months out from his procedure, he can expect to have a lot more growth over the next 12 months. He is currently using minoxidil on a daily basis. He plans it to let the current transplant grow out for at least another year and then return to fill in the crown.

I appreciate the positive comments on this patient.

This is a 59-year-old woman who had naturally deep frontal temporal angles. She consulted with us to fill in the area and to give a more feminine hairline. She desired to be able to wear her hair back; however, because of the lack of hair in the frontal temporal angles, she always wore her hair down to conceal the area. In one session, 2,111 grafts were placed bilaterally into the frontal temporal angles. Photographs show the patient preoperatively, six months after surgery, and one year later. In the six month photographs you can see all the transplanted hairs as they are shorter than the rest of the patient’s hair. When she was in for her one year visit, she said that the transplanted hairs are now long enough that she can tuck them behind her ears and she is happy that she can now pull her hair back and does not always have to wear her bangs forward. A video will follow that shows the one year result. Graft Count Single hair grafts: 521 Two hair grafts: 1,137 Three hair grafts: 440 Four hair grafts: 13 Total grafts: 2,111 Total Hairs Transplanted: 4,167

I agree with Dr. Lindsey that exposure to sunlight may cause the skin to have color changes called hyperpigmentation. However, I do believe that overexposure to the UV radiation at a tanning salon may cause problems with growth if the patients are exposed too long to cause a burn. It is not hard to get over-exposed to the UV radiation in a tanning salon. The intensity of the tanning beds differs from one bed to the other and a couple minutes in one bed which does not expose someone to a lot of UV radiation may be much more UV radiation exposure in another bed causing a burn. I have seen plenty of people who have suffered burns in tanning beds in my practice. I don’t think too many people would argue that burning the skin at the recipient site is detrimental to the grafts.

RCWest Thanks for you positive comments. In person, he did not have an intense red hue, but his skin did have some demarcations of white and red. If you look closely at his preoperative photos, he did have a “blotchiness” appearance to his skin. Certainly after surgery, the scalp does have a more intense red hue, but this fades over time. Actually for him, a little color actually helps the appearance and gives his scalp a fuller look with the contrast difference between his skin and hair color.

Bill That was a nice summary of the topics you listed. Thanks for putting that together.

Thanks Spex.

This patient is a 69 year old gentleman who two years ago underwent a 3129 graft hair transplant to the central aspect of his scalp. Interestingly, he had a nice central forelock/tuft of hair, but the lateral frontal aspect of the hairline was sparse at best. He had a decent amount of hair in the lateral aspect of the scalp (above his ears), which he used the hair in that area to cover and comb over the central thinning. His hair characteristics were thinner for his age. His hair color was a mix of brown to grey, which added to a contrast differential to his skin. He did have a nice wave to his natural hair in the donor area. His skin laxity was average as well. His main goal was to cover the central balding areas adding a natural layer of fullness and hair to the central scalp. Our plan was to transplant into all the areas in the central scalp that were devoid of hair and blend into the thinning areas this way there would not be a demarcation between his natural hair and the transplanted hair. The strip size was 25.5 x 1.5 cm with a trichophytic skin excision and double-layered closure technique. The final graft count was the following: 1 hair grafts: 550 2 hair grafts: 1951 3 hair grafts: 529 4 hair grafts: 99 He is now 2 years following surgery and very happy with the results. Unfortunately, the preoperative photos were not standardized as I do now with all photos, but they give a nice representation of his initial hair loss. I choose the postop photos that were closely matched to the preoperative photos to give the best comparison. He filled in the central scalp very well, and the wavy structure to his hair gives adds to the density of the hair (which helps make up for the thin hair he has).

I recommend to my patients that they avoid unprotected sunlight exposure for 3 months after surgery. Now, is this a hard and fast rule? - no. It is important not to expose the grafted site for some time as the added radiation exposure could cause prolonged redness to the skin at the grafted site. Also, if it is a new transplant, you may risk some poor growth as the new follicles may be “burned” with the sunlight exposure. I suggest to my patients that they wear a hat if they are going to be outside for a prolonged period of time - short bursts of sun exposure, such as getting out of the car and into the house or office or for shopping, in my opinion, won’t cause any problems; however, if they are going to be exposing their scalp to the sun for more then 5 - 10 minutes, I advise some type of protection. Another piece of advice I give my patients is once the hairs have shed (4 weeks after surgery), I recommend that they use sunscreen with at least SPF 15 or SPF 30 on the healing/grafted portion of the scalp.

He is extremely happy with the results and has referred several people to us. Thanks.

Thank you David and Mick for your positive comments. Photos have been updated.

Bill It was nice to meet you at the ISHRS conference this year. Also, I’d like to thank you and Pat for hosting the social gathering on Thursday night. It was a nice venue for people to catch up at. Thanks

Great job!!

I’ve had several people ask me for the breakdown of the graft count for this case. Here it is: 1’s: 1190 2’s: 2352 3’s: 916 4's: 31 Total: 4489 grafts (8766 hairs) in one session Patient sent in some photos recently that I’ll update the post with.

This patient is a 54 year old male who desired the frontal scalp and hairline to be restored. His goal was a mature hairline that was appropriate for his age. He did not want the hairline any lower then the native hair he had, but he desired the frontal area to be filled in with a natural appearing hairline. 3240 grafts were placed in one session to accomplish his goals. The photographs are 2 years out from the transplant. We included intraoperative photographs to show close up the high density placement of the slits.

Thanks for the positive feedback. This patient is extremely happy with the result. I have some HD video that I plan to post in the future that shows his new hairline with a comb through it.

This patient is almost two years out from his only procedure. He was interested in refining his hairline and filling in the lateral frontal scalp. In one procedure, 2615 grafts were placed (600 single hair grafts, 1679 two hair grafts, 322 three hair grafts, 14 four hair grafts). His growth has been excellent. I've included several close up photographs showing the frontal, left, and right hairline details. There is also an immediate postoperative photograph showing high density graft placement. The slits were oriented laterally for this patient. His six month post operative photographs were also posted on the forum: http://www.hairrestorationnetwork.com/eve/137614-dr-steve-gabel-portland-oregon-2615-grafts-hairline-lateral-frontal-scalp-6-months.html Since his six-month follow up, the grafts have grown in and thickened up very nicely.

This patient requested to thicken the entire scalp where he was thinning. Initial examination showed a thinning frontal forelock with severe alopecia in the frontal scalp and moderate alopecia of the mid-scalp and crown. He also had moderate temple recession. 4489 grafts were placed in one session to achieve his desired goals. The photos were taken immediately after surgery. He came to us from out of town and will send updated photos as he grows in.

Thanks Spex I appreciate the positive review.