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Raymond Konior, MD - Chicago - 2683 Graft, Multi-Staged Hairline Repair


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This presentation is the summary of a five year journey that began when my patient underwent a failed hair restoration at the age of 21. Since his multi-staged repair with me, he has moved back to his home in California. He has been very open about his experience and was kind enough to forward me recent photos of his repair restoration. He has also been gracious enough to allow his photos and story to be presented.

 

His initial procedure was performed at the age of 21. That procedure, which consisted of 1200 grafts, failed to yield the density and appearance he had hoped for. Rather than getting the hairline of his dreams, he was converted into an obligate hat-wearer to hide the stigma of his mistake. The following is a chronological description of my patient’s long journey.

 

April 2008 – The photos from this time were first presented by the patient to this community in 2008. His original 1200 graft procedure occurred about 15 months earlier at the age of 21. He saw me in consultation in September 2008 as which time we discussed his options and concerns. His concerns included: 1) the grafts looked unnatural; 2) the grafted area lacked density; 3) his hairline was placed too low on his forehead; and 4) the donor scar was wide and difficult to hide. I agreed that his hairline was too low and that he would develop an even more unnatural look as his balding progressed with age. We discussed correcting the low hairline using one of two options: 1) a direct hairline excision via a forehead-lift approach; and 2) thinning out the unnatural frontal and temporal grafts via FUE removal. We agreed that the FUE approach was more suited to his needs and concerns. That approach would not only help raise the hairline, but it would also selectively eliminate unnatural grafts from the hairline and temporal regions. Following the staged removal of unsightly grafts, the surgical plan would be finalized with a hairline graft session to enhance frontal density, soften the hairline and revise the donor scar.

 

August 2009 – A small FUE test session was performed. The purpose of this “test” session was to determine: 1) if unsightly grafts could be removed intact; 2) how the exposed hairline extraction sites would heal, i.e. detectable or undetectable; and 3) what the survival and appearance characteristics of the transplanted grafts would be. Photos at this time show unsightly grafts at the hairline and in the temples. Also shown is the original donor scar. The test consisted of 14 extractions. These were placed in the right donor scar.

 

March 2010 – The initial test session was successful in demonstrating acceptable healing characteristics. A more aggressive extraction session which included the removal of low hairline grafts, large grafts, and misdirected grafts was performed. Small extraction sites were left open to heal on their own while larger sites were sutured closed. The goal of the extraction component of the repair plan was not to remove every graft from the low hairline, but rather to remove just enough grafts to adequately soften the hairline and assure a natural end-result. A total of 112 grafts were created from the extracted tissue and these were placed further back in the right frontal region.

 

September 2010 – Wound healing and graft regrowth were determined to be successful from the March 2010 session and another extraction session was performed to further soften the area. A total of 139 grafts were created from the extracted tissue and these were placed in the central frontal zone.

 

October 2010 – A final extraction session was performed to fine-tune the restoration zone of any remaining large, low or misdirected grafts. A total of 55 grafts were created from the extracted tissue and these were placed in the central frontal zone.

 

December 2010 – Restoration Day. Preop transplant photos show how the proposed graft zone has been soften by the removal of large, low and misdirected grafts. The dilemma at this time consisted of the fact that scar revision was a priority for the patient. His wide scar, in combination with limited scalp flexibility, limited our ability to obtain a large harvest without taking the risk of leaving another unacceptable scar. The patient was informed of his density limitations. We established a goal to take a conservative strip and strategically distribute the limited harvest in the most efficient way possible so as to maximize the “illusion” of density. A total of 2377 grafts were used to complete the restoration. A total of 306 grafts had been relocated into the frontal region from the prior graft extraction sessions, thereby giving the restoration zone a final total of 2683 grafts.

 

May 2011 – Five month postoperative photos reveal respectable early growth with a homogeneous graft distribution, softening of the frontal and temporal regions, and good camouflage of the donor site.

 

December 2011 –These are one year postop “about-town” photos which were forwarded to me. They reveal his current hair style.

 

March 2012 – These are 14 month postop photos which were most recently forwarded to me.

 

A final comment – A valuable lesson to learn here is that no one, particularly young men, should venture into surgical restoration without achieving a full understanding of the process they will be undergoing. Many debates have transpired over what age surgical restoration is considered safe. There is no clear cut answer, but technical and planning mistakes are much more likely to occur in young men. I.E. – young men take caution before jumping into the chair.

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  • Regular Member

whoe my god!!!!!! i think konoir gunna be the way i go since he has the most convincing frontal hairline pictures, unless i just can find them on shapiros page. konoir really understand how to lower the front like and do a good dense pack. which is what im wanting. great job dr konoir.

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Interesting case Dr K. I am particularly impressed by his scar that has, for all intents and purposes, vanished. You mentioned that you placed the 14 test FUE grafts in the right side donor scar and then took a conservative strip to get 2377 grafts. Has his hair simply grown over the scar and camouflaged it? Even with his hair cut very short in the back there is no sign of the scar.

 

Great advice in your final comment to younger candidates for hair restoration to completely understand all the dynamics involved before saying yes to surgery.

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Typically great work by Dr. Konior. I too had to once choose between a hairline incision forehead-lift and FUE punch outs to fix an unnatural transplanted hairline. The punch outs healed well for me. Great surgical planning and execution here.

 

I would like to see some post-op pics of this patient (with the grown out hair style) without the flash. Straight on flash photography can actually make the hairline look more dense than it really is. I've noticed this is some of my own pics.

Edited by aaron1234

Dr. G: 1,000 grafts (FUT) 2008

Dr. Paul Shapiro: 2,348 grafts (FUT) 2009 ~ 1,999 grafts (FUT) 2011 ~ 300 grafts (Scar Reduction) 2013

Dr. Konior: 771 grafts (FUT) 2015 ~ 558 grafts (FUT) 2017 ~ 1,124 grafts (FUE) 2020

My Hair Transplant Journey with Shapiro Medical Group

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Dr. Konior,

 

This is pure magic! Thank you and, most of all, I thank the patient for allowing his photos to be presented. This goes to show that, in the hands of a masterful hair transplant surgeon, even repair patients can receive stellar results.

David - Former Forum Co-Moderator and Editorial Assistant

 

I am not a medical professional. All opinions are my own and my advice should not constitute as medical advice.

 

View my Hair Loss Website

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This guy's hairline looks like Vanilla Ice. Impressive results, dense great hairline design and very natural looking. Thats why I still believe that Dr. Konoir is the best HT doctor in Illinois and the whole US central area. Dr. Konoir, Dr. Ron Shapiro and Dr. Feller are my top 3 US surgeons IMHO. All of that with only 2683 grafts. Whats the density of his hairline? Any idea?

Plug removal + Strip scar revision - Dr. Ali Karadeniz (AEK)- May 23, 2015

Plug removal + 250 FUE temple points- Dr. Hakan Doganay (AHD)- July 3, 2013

Scar Tricopigmentation- Dr. Koray Erdogan (ASMED)- May 3, 2013

2500 FUT (Hairline Repair)- Dr. Rahal- July 26, 2011

 

My Hair Treatments:

1- Alpecin Double Effect Shampoo (Daily)

2- Regaine Solution Minoxidil 5% (2 ml once a day)

3- GNC Ultra NourishHair™ (Once a day)

4- GNC Herbal Plus Standardized Saw Palmetto (Once a day)

 

My Rahal HT thread http://www.hairrestorationnetwork.com/eve/164456-2500-fut-dr-rahal-hairline-repair.html[/size]

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Consistently a very high standard of work.

 

Good job.

2 poor unsatisfactory hair transplants performed in the UK.

 

Based on vast research and meeting patients, I travelled to see Dr Feller in New York to get repaired.

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  • Senior Member

Look at this young man, finally able to go out on the town, without a hat. He looks so happy in his photos, and deservedly so! You gave him back the confidence to live life like someone in their mid 20's should. Thank you!

 

The hair transplant is the standard great work as usually presented by Dr. Konior. Very natural, and much denser than I was prepared to see after reading the presentation. Outstanding!

Finasteride 1.25 mg. daily

Avodart 0.5 mg. daily

Spironolactone 50 mg twice daily

5 mg. oral Minoxidil twice daily

Biotin 1000 mcg daily

Multi Vitamin daily

 

Damn, with all the stuff you put in your hair are you like a negative NW1? :D

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StaggerLee123 – The test grafts were placed because the patient was not sure what route of repair to pursue when I first met him. He was upset with the appearance of his original scar and was reluctant to use another strip because of his first experience. Initially he was leaning toward an FUE-only approach. Although he did experience good regrowth in the scar with the test grafts, the several month wait that was required to evaluate the success of his healing helped him solidify his overall goals. He felt that we would be able to get to the finish line quicker and with a better overall result using the final plan that was decided upon. The scar is still there – as one should expect – it’s just that it is now thinner and easier to camouflage with a relatively short length of hair.

 

Aaron1234 – I also wish I could have seen him for the one year follow-up so that I could have taken postop photos using the same perspective and lighting that were used for the preop photos. However, that was impossible as he and I are now 2000 miles apart. I was happy to receive the photos he forwarded to me and felt that they were sufficient to present his interesting story.

 

HARIRI – I do not have a precise hairline density, but it is relatively low based on his overall graft distribution. Our primary goal was not density, but rather naturalness. He had relatively strong, high caliber hair shafts which helped maximize his apparent density and coverage. I believe his hair characteristics are primarily responsible for the high volume appearance he achieved. This would never have been possible with fine, lifeless hair.

 

RCWest – You make a great observation in recognizing what appears to be a happy appearance in his postoperative photos. My greatest satisfaction with this case has been witnessing his transformation from being someone he wasn’t - an unhappy, hat-wearing, hair transplant failure - to becoming himself again – that being a positive, upbeat, and fun-loving guy. I have long recognized how “bad surgery” can alter or devastate one’s sense of self and diminish the quality of one’s life. His attitude and personality transformation has been very inspiring.

 

Thanks to all for such positive feedback.

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  • Senior Member

 

Aaron1234 – I also wish I could have seen him for the one year follow-up so that I could have taken postop photos using the same perspective and lighting that were used for the preop photos. However, that was impossible as he and I are now 2000 miles apart. I was happy to receive the photos he forwarded to me and felt that they were sufficient to present his interesting story.

 

Totally agree doc! Again, just terrific and life-changing work. Well done!

Dr. G: 1,000 grafts (FUT) 2008

Dr. Paul Shapiro: 2,348 grafts (FUT) 2009 ~ 1,999 grafts (FUT) 2011 ~ 300 grafts (Scar Reduction) 2013

Dr. Konior: 771 grafts (FUT) 2015 ~ 558 grafts (FUT) 2017 ~ 1,124 grafts (FUE) 2020

My Hair Transplant Journey with Shapiro Medical Group

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Dr Konior,

 

Your words and work are pretty inspirational.

 

You are so right in the warning to younger patients, it is a pity that so many will not heed these words or be sold the dream by so many unscrupulous practices.

 

Mick

Patient coordinator for Dr. Bessam Farjo who is an esteemed member of the Coalition of Independent Hair Restoration Physicians

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  • 9 years later...
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  • Senior Member
2 hours ago, BaldV said:

I wish Dr Konior was still around so he could give us some info about how FUE punchouts from the hairline should be treated

What questions do you have in particular? I could ask in my consultations. 

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12 hours ago, HairRun said:

What questions do you have in particular? I could ask in my consultations. 

Mainly interested in this:

 

lets say a 0.9mm implanter was used to create the hole of the grafts to enter(so scar diameter is 0,9mm), would punching out the graft with the same diameter or a slightly smaller one punch and then stitching it provide seemless invisible to the naked eye scars?

 

e.g. you made the initial hole with a 0.9mm punch and then you punch it out with a 0.9mm punch and stitch it, would the new scar have a diameter of lets say 0.5mm?

Edited by BaldV
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  • Administrators

One of the best repairs ever, shocking this was 10 years ago.

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I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice.

Check out my final hair transplant and topical dutasteride journey

View my thread

Topical dutasteride journey 

Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube.

 

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8 hours ago, BaldV said:

Mainly interested in this:

 

lets say a 0.9mm implanter was used to create the hole of the grafts to enter(so scar diameter is 0,9mm), would punching out the graft with the same diameter or a slightly smaller one punch and then stitching it provide seemless invisible to the naked eye scars?

 

e.g. you made the initial hole with a 0.9mm punch and then you punch it out with a 0.9mm punch and stitch it, would the new scar have a diameter of lets say 0.5mm?

 

The entering holes are made with punches? I thought they made slits? At my first transplant he used a block with a bunch of metal sticks/knifes and he rocked it on my scalp to create the slits. 

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1 minute ago, HairRun said:

 

The entering holes are made with punches? I thought they made slits? At my first transplant he used a block with a bunch of metal sticks/knifes and he rocked it on my scalp to create the slits. 

Either slits or implanter pen, there is a certain hole-scar diameter regardless

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3 minutes ago, BaldV said:

Either slits or implanter pen, there is a certain hole-scar diameter regardless

I'm looking at my implanted grafts, and I don't see any scarring. I think since skin isn't removed, scarring is very minimal. 

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  • 1 year later...
  • Administrators

I’d love to get an update on this patient. The repair was a work of art, wonder if he’s gone back. I’m sure he’s probably lost some additional hair. I’d guess he’s probably pushing 40.


I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice.

Check out my final hair transplant and topical dutasteride journey

View my thread

Topical dutasteride journey 

Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube.

 

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  • 3 weeks later...

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