Raymond Konior, M.D. - 3665 Graft Hair Restoration

[Dr. Raymond Konior]

This is a 7 1/2 month postop result for a 34 year old male who underwent a 3665 graft hair restoration which extended from the frontal hairline into the crown region. The proposed hairline and graft zone are revealed in some of the preop photos by the blue surgical marking pen lines. He appears to demonstrate a very good density response for 7 1/2 months.

Edited March 13, 2011 by Raymond Konior, M.D.

[TC17]

Your work never ceases to amaze me, Dr. Konior. It is always beautiful. Out of curiosity, why did you transplant into the crown? At this patient's age and his current degree of hair loss, it would seem as though he is destined to advance to at least a Norwood 6 level, and possibly a Norwood 7 level. Thoughts?

[NEWHAIRPLEASE]

Looks great Dr Konior! Looking forward to my July surgery!

Edited March 13, 2011 by NEWHAIRPLEASE

[multiplier]

Out of curiosity, why did you transplant into the crown? At this patient's age and his current degree of hair loss, it would seem as though he is destined to advance to at least a Norwood 6 level, and possibly a Norwood 7 level. Thoughts?

 

But with the new transplants + finasteride, shouldn't that be less of a worry now? He's got great coverage. And if he loses more hair 20 years down the line, surely there will be more advanced methods/meds for hairloss by then?

[hairthere]

He looks to have very solid donor hair (most docs will scrutinize the donor to make sure there is no sign of miniaturization). Also, the hairline looks fairly conservative. Nice work!

[Dr. Raymond Konior]

TC17 – You introduce an excellent point regarding the placement of grafts into the crown. As you know, the crown has been described as the black hole of the scalp. Based on that I believe a very large percentage of patients seeking hair restoration should avoid grafting into the crown region, especially young men in whom it is often impossible to determine how far the pattern will progress. This recommendation is based on the finite nature of donor supply and on the progressive nature of male pattern hair loss, i.e. there is an imbalance between supply and demand. The fact of the matter, however, is that despite prolonged and detailed consultative discussion relating to the risks and limitations of grafting the crown, many men are still adamant about obtaining some crown coverage. Although it is difficult to predict with absolute certainty everyone who is a rock solid candidate, it is possible to weed out the majority of poor candidates and to institute a safe grafting strategy which will avoid future problems for most patients

This particular patient was originally advised during consultation to focus grafting into the front half of the balding zone - more in an attempt to maximize density in the cosmetically important frontal hairline than out of fear of his future progression to an unmanageable advanced pattern. On the morning of surgery, however, he requested some crown coverage after deciding that an overall greater coverage of the entire balding region with lower density was more acceptable to him than focusing exclusively on the frontal region. His examination indicated to me that he was a decent candidate for a conservative crown restoration. The grafting strategy took into consideration his potential for future fringe thinning by managing the graft size and density distribution so as to create a relatively low net density in the crown – one that should never look out of place if the surrounding hair happens to miniaturize. He has excellent hair characteristics in terms of hair texture, color and caliber which facilitate the “illusion” of density and produce a nice cosmetic change in the crown. He also has a tremendous donor area - great density, excellent elasticity, ideal healing properties and plenty of graft reserves.

Multiplier - I would never recommend any grafting strategy based on the hope of future treatments or speculative technological advances that “may” emerge someday to patch up the problems left from an incomplete or poorly planned restoration. I believe that surgical planning should be based on whatever an individual donor supply is capable of providing over the lifetime of a patient.

Thanks for all of your positive comments.

[multiplier]

If I'm reading you right, you're saying you'd rather wait until the pattern is more clear before transplanting to the crown. I assume you are not saying that the crown is beyond help and to concentrate all donor hair to the front of the scalp. Because the result would obviously look freakish after a couple decades.

[Dr. Raymond Konior]

Multiplier – It is logical to defer placing grafts in the crown if the final pattern is not apparent and there is a possibility that an advanced pattern may emerge. I am definitely not suggesting that all donor hair should be concentrated in the front, but rather that the front and midscalp are a higher priority if the donor supply is not sufficient to treat the entire scalp. Staying away from the crown and restoring only the front and midscalp should leave a very natural look it the procedure is implemented correctly. I commonly evaluate repair patients who are a decade or more out from surgical restoration. Many of these patients are trying to correct a “freakish” appearance not because the crown was left alone, but rather because grafts were inappropriately placed in their crowns. These patients are the victims of a mismanaged graft supply and a flawed grafting plan which did not take future thinning into consideration. Their common finding is an unfinished looking transplant and limited or no donor reserves to work with.

[Spanker]

On that note I really hope we have a real cure for baldness in the next decade or so. We are mapping the human genome for crying out loud. We put a man on the moon a half a century ago. AIDS is no longer a death sentence. Surely this will happen.

 

But until then, I think that this is a spot on result. Good job doctor K.

[Mick from Farjo]

Dr Konior,

 

Excellent result and planning strategy detail.

 

Mick