Dr. Raymond Konior

curlylocks57 - Grafts were obtained using a strip harvest method. PRP was not used.

Jinglealltheway - They will grow at a rate like scalp hair and will require a lifetime of maintenance. Reports from patients suggest that most trim the transplanted brows about once a week and I don’t recall anyone finding any inconvenience with that regimen. Thanks for your comment.

Mickey - Strip, this was discussed in my last post.

Janna – Thanks for your comments. As you know, female brow restoration is a very difficult proposition as there is little margin for error with respect to producing a natural outcome. Graft selection and placement are critical to offset the vagaries of healing that can taint the final appearance. I did use a very small strip harvest from a zone that seemed to have the best hair shaft characteristics for matching the existing hair. As you might expect, many patients continue to use brow pencils to complement their overall facial make-up regimen, and I’m certain that is the case here. The added hairs provide volume and texture to compliment the aesthetic enhancement of make-up. Attempting too high a density in brows such as these would have increased her risk of shock loss in the residual brow hairs. Additionally, the brow design for this case was complicated by her left brow paresis. The left brow hung lower than the right during involuntary motion, but she could raise it to the same level with voluntary motion. The left brow head and tail also moved asymmetrically. All of this led to her needing about 90 minutes to decide on a placement level that seemed to work best for all situations, i.e. resting, involuntary expression and voluntary motion. I don’t think a perfect placement was possible because of the asymmetric movement, but the end result seemed to suit her well. Mickey – I do think the subtleties of a restoration like this are not ideally witnessed in photos. The fact that she still uses brow pencils to highlight the area suggests to me that she would like even more of a pop. Nick’s comment about perspective are very appropriate.

Mickey I have attached another close-up view of the preop and postop brow which shows hair shaft caliber comparisons. All grafts placed had a single hair and those were selected to match the characteristics of the native hair population. To my eye the preexisting hair caliber in her central brow looks larger or equal to the caliber of the transplanted hair population. Graft selection and placement were carefully controlled intraoperatively using high power loupe magnification to assure prime graft characteristics. This is very clear on the high resolution photos and during live inspection of the zone. She was quite thrilled with the outcome. Thanks to all for your comments.

This is a 57 year old female patient who presented with a complaint of thin eyebrows that occurred following a history of aggressive brow plucking over the course of many years. The patient also had a history of having undergone a neurosurgical procedure which resulted in a permanent left side brow paresis. She was unhappy with the thin appearance and desired to restore a fuller look to her eyebrows. A total of 668 highly refined follicular unit grafts were used to enhance her brow density. On the day of surgery the patient was asked to highlight her desired fill zone with a surgical marker to assure that the shape of the brow would match her expectations. Presented here are preop, day of surgery , one week postop and seven month postop photos.

Cant decide - I agree that using 3000 grafts for the crown should not be done without careful consideration to future hair loss and limited donor supply. I routinely take a very conservative approach to the crown because of the commonly recognized “black hole” effect it possesses with respect to the consumption of grafts that can be required to maintain acceptable coverage over time. However, the fact of the matter is that this patient wanted even more density despite the use of 3000 grafts and he would have been more than disappointed with a 2000 graft restoration. His dark hair/light skin combination and relatively fine hair were major contributors in limiting the perception of density and this drove the need for a larger graft number. As mentioned by hairthere, grafting was transitioned into adjacent areas of miniaturization so as to compensate for future advancement of miniaturization.

This is a 50 year old patient who requested redefinition of his receding frontal hairline. He appeared to have a very stable pattern with thinning confined to the frontal region. He underwent placement of 1791 grafts to redefine his frontal and temporal hairlines. Presented are 14 month postoperative views.

This patient was presented here in 2011. He was contacted yesterday and will be coming in for follow-up. I'm quite sure he has been going about his daily life and is not even aware of this thread anymore. http://www.hairrestorationnetwork.com/eve/159957-raymond-konior-m-d-3665-graft-hair-restoration.html#post2259643

This 56 year old patient presented with a history of two prior hair transplant sessions. Although he appeared to have a decent hairline for his age, he was not satisfied with the density that was accomplished in the frontotemporal recessions and felt that some of the grafts looked “surgical”. He requested a hairline "tune-up" and subsequently underwent a session at which time 1827 grafts were placed into the frontal hairline region to boost local density and further refine the area. Presented are one year postoperative photos.

This is a 34 year old patient who requested density enhancement throughout his thinning crown and midscalp regions. A total of 3032 grafts were placed into these zones. Presented here are 2 year postop photos. Various angles and part views are shown to best depict the density gain and overall coverage that were accomplished.

This is a 40 year old female who noticed relatively rapid central hairline recession following the birth of her second child. She claims to once have had a much more defined widow’s peak and wanted to restore her central hairline to its former youthful appearance. She underwent a dense pack central hairline restoration using 1023 grafts. Presented are 10 month postoperative photos.

This is a beautiful hairline and fabulous early growth. Dr. Cooley is to be commended for his creativity and commitment to advancing the science of hair transplantation with the use of innovative modalities that appear to help nourish grafts and enhance follicle growth.

This is a 10 month postop result for a 42 year old patient who had 2708 grafts transplanted into his thinning frontal hairline region. He was not interested in lowering his hairline, but desired a more conservative restoration within the area of obvious miniaturization.

Spanker, MAGNUMpi, GBU – I think he had a bit of both, i.e. some progression of loss over 2 years, but also little density enhancement from the initial graft session. Those were the comments he made to me during consultation. As you know, 800 grafts is a relatively small amount for a comprehensive frontal restoration. Mickey85 – The scar was not revised as he had a snug scalp and was worried about the risks associated with a second procedure. I opted to extend away from that old scar into pristine donor area so as to maximize graft quality and minimize the impact on his overall donor. Thanks to everyone for their kind comments.

This is a 35 year old patient who presented with a history of having undergone a single 800 graft frontal hairline session 2 1/2 years earlier. The chief concern expressed during consultation was his disappointment the density enhancement obtained from that procedure. The patient was content with the shape and location of his hairline and was now very focused on enhancing density throughout his frontal region. His case was further challenged by a wide donor scar and less than ideal scalp elasticity. He underwent a 2158 graft frontal hair line restorative session at which time the recipient area was shaved to assist visualization for graft placement. Presented are one year postoperative photos. A sequence of photos with parting hair is shown to highlight the density gains that were achieved across the entire frontal region. Also presented is a representative photo of the intraoperative graft placement.

This is a 32 year old patient whose desire was to restore his thinning frontal hairline. His examination revealed advanced miniaturization throughout the frontal region. A total of 2805 grafts were used to restore the frontal hairline and advance his thinning frontotemporal recession. Presented here are one year postoperative photos. [/font]

This is a 50 year patient who requested frontal hairline restoration. His goal was to achieve an age appropriate advancement of the recessed frontal and temporal hairlines. A total of 2752 grafts were used to accomplish the restoration. Postoperative donor site photos show complete camouflage of the donor harvest area despite his short hair style.

This is a 72 year old male who presented with a history of having undergone a prior hair transplant session several years earlier. He described that session as being unsuccessful with respect to his intended goals for density and coverage. The patient requested a fairly aggressive hairline design and hoped to accomplish a significant density enhancement within his thinned frontal region. He underwent frontal hairline restoration with a session of 2569 grafts. Presented are 7 month postoperative photos.

This case demonstrates a frontal hairline restoration in a 32 year old patient. A total of 3911 grafts were distributed in the frontal region. A shaved recipient site approach was used to facilitate graft placement.

This is a 45 year old male who requested density enhancement in his thinning frontal and crown regions. His donor hair demonstrated a very fine caliber and the donor region had limited elasticity. Based on the limitations of graft availability and on cosmetic priorities, it was decided that a higher density restoration would be planned for the frontal recessions in an attempt to best balance graft density with his preexisting higher density frontal tuft. The goal for the crown was to diminish the appearance of balding by creating a natural thinning appearance. A 3131 graft session was performed with 2131 grafts placed for a higher density frontal restoration and 1000 grafts placed for a homogeneous, lower density distribution in the crown.

This is a 28 year old patient who underwent a frontal hairline restoration with a single session of 3332 grafts. He was bothered by the thinning and low density in his frontal region. His scalp examination revealed extensive hair shaft miniaturization that was primarily localized to the frontal region. The baseline hair density in the miniaturized zone was relatively high. This prompted me to recommend a shaved-scalp approach for the recipient site so as to maximize accuracy of graft placement and to minimize damage of existing hair. [/size][/font]

Spanker – Yes he opted to go with a shaved recipient site. As you know, shaving is a big issue for most patients because of the sudden change in appearance that reveals one has “done something” to their head. This patient had no reservations about sharing his experience with others, so shaving was not at all a big deal for him. My primary purpose in recommending a shave for his graft placement was based on his decision to use a lower graft number than what I had recommended. The shaved scalp allowed for a more homogeneous graft distribution so as to best balance density throughout the graft zone. The shaved technique also allowed other advantages to be realized. These included the optimization of placement time (which benefits graft survival) and the accuracy of incising the graft insertion sites (which helps reduce the risk of shock and adjacent follicular collateral damage). HARIRI –As you might imagine, graft number is only one factor that contributes to the end result. Great hair and excellent healing characteristics also contributed significantly to his result. There is nothing like great donor hair characteristics when planning a restoration. Slickers – I have included a 10 day postop image which shows early graft growth. Thank you to everyone for their positive comments.

This is a 44 year old who requested restoration of his frontal hairline. It was recommended that a session of 3000 grafts be performed for achieving optimal density, but he opted a smaller session in the range of 2000 grafts. A total of 2344 grafts were used to restore his frontal hairline and provide density enhancement throughout the frontal tuft region. Presented here are 18 month postoperative photos.

This is a 40 year old male who presented with isolated frontal hairline recession. The remainder of his scalp demonstrated excellent hair density without evidence of miniaturization. He requested restoration of the recessed frontal region. A total of 2345 grafts were implanted into the thinning frontal region so as to achieve a high density, single pass restoration. Presented here are one year postoperative photos and immediate graft placement photos. Density inspection of this dense-pack restoration can be assessed by views which show a part directly through the right, left and central graft zones.