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Dr. Raymond Konior

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Everything posted by Dr. Raymond Konior

  1. His goals were primarily devoted to hairline restoration. As of his last follow-up he was happy with his hairline and the appearance of a thinning crown. Should he opt for a second session later in life, an FUE harvest would be recommended because of limited elasticity following the strip harvest. You are spot on correct with your assessment. A homogeneous graft distribution with his fine hair would have be certain to leave a less-than-ideal result with a weaker part and hairline. Prioritization of those two areas was deemed high for this man. Gradient grafting is quite rou
  2. This 50 year old male requested hairline restoration along with some conservative coverage in the crown. His exam revealed an advanced pattern of loss and very fine hair throughout the donor area. The limitations of coverage associated with fine hair and an advanced pattern were discussed in detail and a plan was devised to best suit his goals. A 3160 graft restoration was performed with density gradients designed to bias graft distribution in the hairline and left-part. In light of his very fine hair, the strategy of using a thick-to-thin transition along front-to-back and left-to-right v
  3. This 37 year old patient presented with a request for frontal hairline restoration. He requested an FUE harvest in order to maintain the ability to wear short hairstyles in the future. A 2092 graft frontal hairline restoration was performed using an FUE harvest. Presented is his seventeen month postop result. Perioperative graft placement photos, along with preop and seventeen month donor site photos are presented. Density inspection photos show the coverage that was obtained in the graft zone. preop front view preop top view preop plann
  4. This 27 year old female patient presented with a request to lower her hairline. She previously underwent a 500 graft FUE procedure, but that procedure was described as a failure in achieving her stated goal. A strip harvest was recommended because of the large graft number needed for her restoration and because she had no intention of shaving her head in the future. She underwent a 3024 graft hairline lowering procedure. Presented here is her eighteen month postop result. Included are immediate postop graft placement photos. Preop Front Preop Front Tipped
  5. This 46 year old man presented with a history of having undergone a 1500 graft FUE hairline restoration. His previous surgeon promised a “no-shave” restoration so as to comply with his desire to maintain an inconspicuous appearance postoperatively. The patient complained that there was little if any density gain from his first attempted restoration. His request upon presentation was to restore frontal coverage and a reasonably defined hairline. His examination revealed scant frontal coverage with no semblance of a frontal hairline. His donor area revealed two distinct “strips” wher
  6. One would first have to consider the possibility of compromised graft growth arising from an intrinsic scalp scarring disorder such as lichen planopilaris where the skin essentially attacks the follicles with an end-result of low yield. Also, his history of multiple procedures most definitely had to be taken into consideration in that the many scars resulting from plugs, FUE grafting and the scalp reduction would have compromised his baseline scalp circulation. An aggressive graft plan could have been associated with a higher risk for low yield in the face of diminished baseline scalp circul
  7. This restoration was performed over one and a half years, not two and a half years. There was a one year interval after its completion which is when the final photos were obtained for presentation here. There is no reason any ethical surgeon would force a fast-track restoration. First, the patient had been operated on by several physicians with nothing positive to show in terms of graft survival. An experienced surgeon would first question whether the patient had some intrinsic healing predisposition that compromised graft survival. Committing to a one-shot restoration would have proved
  8. This 50 year old man presented with a history of multiple failed hair restoration procedures. At a young age he underwent several large-graft plug sessions and a midline scalp reduction. He reported that the majority of the plugs failed to grow and what did grow left him with unnatural patches of pluggy hair. The scalp reduction resulted in an exposed midline crown scar. More recently he gained knowledge about the use of FUE and underwent a large session hoping to enhance his appearance. Unfortunately, the FUE restoration proved to be a failure with no apparent graft survival. Sadly, his
  9. This 50 year old patient requested hair restoration. A total of 4114 grafts were performed over two sessions using FUE harvesting. First session grafting concentrated on the hairline and temple points. Second session grafting focused on transitioning frontal reinforcement into the midscalp and crown. Presented are one year postop pics along with immediate postop views of the graft placement. Preop Front Preop Left Preop Right Preop Crown Planned Frontal Graft Zone Postop Front
  10. This is a 34-year old patient with a history of undergoing a frontal hairline flap using tissue expansion of the left donor region. He presented to my office with complaints of an abrupt hairline, a frontal hairline scar, an unsightly left-side donor scar, and thinning in the midscalp and crown regions. His primary goals were: 1) create a more natural hairline; 2) camouflage scars along the hairline and in the donor area; and 3) enhance hair density in the midscalp and crown. His physical examination revealed: 1. An overly-thick frontal hairline flap with backward-oriented ha
  11. This 45-year old patient presented to our office requesting enhancement of his frontal hairline. He underwent a 3100 graft frontal hairline and temple point restoration using strip harvesting. Presented are his 22 month postoperative pictures. Immediate postop views demonstrate his graft placement. Preop Front Preop Right Preop Left Planned Hairline Front Planned Hairline Right Planned Hairline Left Postop Front View 1 Postop Front View 2 Postop
  12. It is also possible for grafts not to grow in the healthiest of scalps, but this is most often a result of poor technique. A poorly harvested or poorly placed graft will be at risk for low survival regardless of where it is placed. My experience shows that donor scars can be successfully grafted as long at healthy grafts are carefully placed in a strategic fashion. If you have any concern about graft growth, it may be wise to consider a small test session to evaluate your growth rate. A test session guarantees that you will not waste donor supply should you have a predisposition to poor gr
  13. This 50 year old patient requested frontal hairline restoration. He underwent a 2200 graft session using FUE harvesting in accordance with his request to have the option of wearing very short hair styles. Presented here are 18 month postop pics along with immediate postop views of the graft placement and two-week postop views (provided by the patient). Preop Front Hairline Plan Front View Hairline Plan Tipped View Hairline Plan Left Hairline Plan Right Postop Front View 1 Postop Fr
  14. Point 1: The primary advantage of using FUE over strip for a graft harvest is to allow a patient the option of wearing a very short hairstyle. This patient presented with two prior strip scars, one of which was exceptionally wide. His preexisting donor scars will always prevent him the option of wearing a very short hairstyle, thereby eliminating the decision to utilize FUE as the primary harvest method for his restoration. Point 2: A secondary reason one would choose FUE over strip for the graft harvest is relative donor site tightness, i.e. a very tight scalp will not allow for stri
  15. This 39 year old patient presented with a history of two prior unsuccessful hair transplants in which a total of 3086 grafts had been placed in an attempt to restore his frontal male pattern baldness. He expressed concern that the procedures failed to produce any substantial regrowth or density gain. He was also bothered by a very wide scar that resulted from his second strip harvest procedure. The prior transplant zones demonstrated quite low density in consideration of the prior 3086 grafts that had been performed. His donor area revealed a very wide scar extending from the occipital
  16. There is no single best source for all patients. Hair color and texture matches are important, and it is not uncommon for these characteristics to vary between the donor and recipient sites. Beard hair is a good option when the scalp shows signs of donor depletion and the physical characteristics of the two zones are relatively favorable. Hair for hair, beard is a good camouflage agent because of its high caliber. Each patient needs to be evaluated on an individual basis to determine what is best for him or her.
  17. This 36 your old patient requested density enhancement in his centralized frontal and midscalp thinning zones. A total of 1918 grafts were used to boost density in his priority zones. Presented are sixteen month postop photos. Preop Front Preop Right Preop Left Preop Top Postop Front Postop Top Postop Right Postop Right Tilt View Postop Right Comb-back View Postop Left Postop Left Tilt View
  18. This 38 year old patient requested density enhancement in his thinning frontal and midscalp regions. His exam revealed a diffuse thinning pattern throughout the male pattern zone. The donor area showed low caliber hair and evidence of retrograde alopecia. He underwent a 3088 graft restoration of the frontal and midscalp regions. Presented are fourteen month postop results. These include part views in the graft zones that demonstrate his density enhancement. Preop Front Preop Top Preop Right Preop Left
  19. Why are you dying the hair? It's going to be clipped with a zero guard. A responsible surgeon will dye it to the extent that extraction quality will be maximized.
  20. The patient should not be worrying about dying the hair if the plan is for a buzz-cut FUE harvest. Dying long hair that will be clipped is pointless as the hair will continue to grow after it is dyed. If the procedure is a few days after the dye, all that will be left for the surgeon to see will be a white stubble. Also, even professional dyes have a hard time getting to the base of the hair shaft. The surgical team should dye the white stubble after buzzing and before harvesting. This easily colors the stubble to show hair direction and angle, thereby making extraction as easy as with da
  21. What is my opinion on clinics that utilize technicians for extracting grafts? Hmm… Answer these three questions: 1) Would you allow a tech to remove a brain aneurysm on your mother? 2) Would you allow a tech to perform coronary artery bypass on your father? 3) Would you allow a tech to remove a testicular cancer on you? If the answer is “yes” to any of these questions, you should do nicely in a tech-driven hair restoration facility. If, on the other hand, you answered “no” to all questions, then ask yourself why you would allow a technician to perform
  22. The mostly useless topic of manual versus motorized should be relegated to the trash heap. It may have held relevance at some point in time, but it means little today. Patients should also be leery of dogmatic statements made about how an individual conducts his or her practice as the only person who can provide definitive detail as to what is done and how it’s done is the surgeon himself. The fact is that I use multiple devices for extracting grafts, with the device of choice depending on the situation at hand. There are days when a motorized technique is best and days when a manual techn
  23. My experience shows 300 grafts to be an average amount needed for average strip scars in need of camouflage. There are definitely cases needing fewer and some needing more, but this is a good estimate for most. It is interesting and encouraging that most patients burdened with visible scars can eventually opt for fairly short hair styles if enough grafts are used. I find two staged sessions are needed for most larger scars when one wants to go with the shorter hair styles.
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