Repair Technique Question

[lawtech]

I am 40 years old. I had my first hair transplants approx. 20 years ago. The technique was the old "rag doll" pluggy look.

 

Over the years, the results have been clearly deficient. I had one repair procedure about 10 years ago.

 

At this point, my hairline is unnaturally low, looks pluggy and is thin.

 

It is now time for me to fix it (as best I can) once and for all.

 

I met with Dr. Konior and was favorably impressed. He is proposing a "Pretrichial lift with transplanting of hair grafts" and then a second hair transplant procedure later.

 

Has anyone had the Pretrichial lift procedure done? If so, with Dr. Konior?

 

Your thoughts and advice would be appreciated.

[scar5]

I don't know about this doctor, but I have had this procedure. It's hard to say whether it would suit you not having seen your pictures. It seems drastic to me, I would have not done it had I another chance, but it might suit you. the scar is not too bad, the head is a little changed in arc but in my case, the worst thing for me was that it left remaining HT hair behind the cut and this hair looked nasty forcing me to spend more money, down time and precious grafts HTing into the areas in front. While that worked, the troops behind were dying. Do your research. If you are hoping to recretae a full head of hair, I would be wary.

[aaron1234]

I believe Dr. Konior has posted a result using the same technique recommended to you. Search for him and you'll eventually find it. The results were incredible. And to be honest, Dr. Konior is one of the best. If you can't trust him, you won't trust anyone.

[rpachigo]

photos would be helpful first before commenting.

[lawtech]

I will post some pictures as soon as I can.

[Sparky]

I had a load moved off my hairline by Dr Bisanga, I've seen results of his repairs on very bad plugs and they were very good.

[lawtech]

Using what technique - the brow lift or plug by plug?

[Sparky]

Plug by plug mate. I'm at 6 weeks post op and my skin is starting to heal nicely. Was worried that it wouldnt be flat, but it is flattening out, just like they told me it would.

[lawtech]

Did you consider the brow lift procedure?

[kaounis]

Although I don't know much about this procedure, I do know quite a bit about Dr.K...He is very honest and passionate about what he does...I don't beleive for one second that he would recomend a procedure that would not be beneficial, or suited to your needs. He is a Dr. who actually beleives and practices the oath he took..." Above all do no harm"...The decision is yours, but you can definatlly trust Dr.K.

 

 

Just a thought from the peanut gallery...

[lawtech]

How about Dr. K compared to the Shapiro Bros. out of MN.?

[aaron1234]

lawtech,

 

It looks like your plugs were placed very low, so I think what Dr. Konior suggested would be very appropriate for this situation. By all means, check out both Dr. Konior and SMG. Both are world class clinics... you couldn't go wrong either way.

[aaron1234]

I'm still trying to find that example where Dr. Konior took a strip out with the pluggy grafts in the front. I think it also took two subsequent FUT sessions afterward to achieve the result. But it was an amazing transformation. Does anyone else remember that one? There might even be a video for it.

[aaron1234]

Ah ha! I found it. Here are the links to the vid and the thread. Enjoy. Amazing.

 

Video:

http://www.youtube.com/watch?v=o1OhN_asY00

 

Thread:

http://hair-restoration-info.c...1087683/m/1121087693

[scar5]

Lawtech, I just saw the video, the youtube video, that Aaron posted. That guy looks good with the comb back, but nothing in that video tells me anything that would apply to your situation judging by your pic. I would suggest a plug-by-plug approach for you rather than a strip reduction.

[Sparky]

No I didnt consider the browlift for a mili-second.

[Topcat611]

Lawtech, I am assuming you are from the Chicago area, same as myself. I have always heard good things about Dr Konior. But I would suggest that you get an opinion from several clinics and hear what their approach would be. In your case I would say at least 10

 

Sometimes as repair patients we dig deeper holes.

[lawtech]

Thanks for the information. Now the "question". Who are known to be the best for repairs? I am talking to Konior and the SMG at this point. Who else would you recommend?

[Topcat611]

Well after being on the forums for 10 years I believe BHR is the best all around clinic.

 

But I would also say that I really like SMG. My case is somewhat different then your case. I will hopefully be able to harvest some body and beard hair.

 

If you were going for a strip, no one can argue with the results of Hasson & Wong.

 

Whatever you choose, in this day and age you can consult with as many clinics as necessary. So take advantage of having that option.

 

If you get a chance read my blog. If you ever want to have a phone conversation, it's not a problem.

[Sparky]

I'm halfway through my repair with BHR, good clinic.

[ccexxp1]

I've had really good results with Dr. Bernstein in NYC. I had 6 "repair" sessions, each one pulling the old plugs, stitching the hole where they came from, dividing them up and replanting grafts somewhere up there. ultimately, I then had a 2350 graft transplant to even things out. I am at week 7 from the transplant, my hair has a natural but thin appearance, still waiting for new hairs to grow. This is the hard part. The good news, though, is that I no longer have a "pluggy" appearance, which was the goal. A long (2year+) process, but well worth the wait. I strongly recommend Dr. Bernstein. I am not tech savvy, so don't have pics of progress, Dr does, and will I will ask them to post for me once I am grown, If you have any questions, or would like to actually see my "head", please PM me, I'm happy to oblige.

[PlugFree]

lawtech:

 

It is my procedure that "aaron1234' posted as an example of DR. Konior's results in hairline plug repair. As documented in my case, the unnaturally low placement of that pluggy hairline was the primary reason to excise the plugs via pretrichial brow lift (to raise the hairline) and redistribute them as FUs.

 

Since you've already expressed dissatisfaction with the low placement of your current hairline, a brow lift is your only option to correct that condition. The best you can achieve with individual plug excision is a softer hairline at the same, or slightly lower, level (due to necessary camouflaging).

 

In my opinion, there are four additional benefits to performing a pretrichial brow lift in situations like ours:

 

1. The most obvious benefit is the aesthetics of raising the hairline to a more natural and 'age appropriate' level (see information readily available re: 'mature' vs. 'juvenile' hairlines).

 

2. By raising the hairline, you leave yourself with less surface area requiring redistribution and, in most cases, subsequent FUE/FUT. In other words, you're able to get desirable results with less transplantation. This benefit should not be underestimated since we all have limited donor supply, especially those like you and me who had the older, more traumatic (i.e., wasteful) donor removal technique used to extract the larger plugs.

 

3. The entire area's vascularity (including the non-transplanted areas between the plugs) is already compromised by the scaring that naturally occurs as a result of the transplant, itself. That random scaring is eliminated and reduced to a localized, thin strip scar. This results in a less 'vascularly compromised' recipient site for the new transplants, which improves the odds of achieving better graft survival rate.

 

4. You get a 'free' brow lift in the process, leaving you with a slightly more youthful appearance.

 

Since I am not a medical professional, but just a satisfied patient, I reached out to Dr. Konior to review my comments (1-3) above regarding the efficacy of a pretrichial brow lift in your situation. I wanted to make sure the information I've provided here is accurate.

 

Finally, keep in mind that what we're discussing here is one part cosmetic surgery and one part reconstructive surgery. While I (and many others on this forum) believe Dr. Konior's cosmetic talents alone to be among the very best, it is his training and expertise in reconstructive surgery that, in my opinion and personal experience, sets him apart from many others in the hair restoration field.

 

One thing I can assure you is that as a board certified facial plastic surgeon and acting member of the teaching staff at Loyola Medical School, you couldn't be in better hands than Dr. Konior's for a procedure of this nature.

 

Whatever your final decision, I wish you all the best.

[scar5]

I would like to reply to this because I must respectfully take issue to some of these points. But first, may I say, Plug free, your hair looks great and well done for achieving your desired look. I want to open up some of the points you made, because I honestly think there are many people in our position and I think people should look very carefully before going down the browlift road.

 

 

 

Yousaid,

" The best you can achieve with individual plug excision is a softer hairline at the same, or slightly lower, level (due to necessary camouflaging)."

 

This is simply not the case. You can take every single hair out and raise the hair line as high as desired bith plug-by-plug. Morover, with plug-by-plug you are free to strategically remove the plugs so that you are not left with a blunt line at the incision. IMO, if you have already had lots of camuflaging done, it is messier to plunch put all the plugs. You may need several procedures. But the benefits outweiog the costs IMO

 

then you went on to list the benefits.

 

"1. The most obvious benefit is the aesthetics of raising the hairline to a more natural and 'age appropriate' level (see information readily available re: 'mature' vs. 'juvenile' hairlines)."

 

see my point above, and note that unnatural linear line , blunt line left behind requires more camoflaging. In your case that worked well, but in my case it required a lot of time and money for reasonable results

 

You said "2. By raising the hairline, you leave yourself with less surface area requiring redistribution"

 

Also not true. Your head is the same size as before. Sure you have defined new boundries by having a higher 'line' but this can also be done plug-by-plug

 

3. YOu said, "The entire area's vascularity (including the non-transplanted areas between the plugs) is already compromised by the scaring that naturally occurs as a result of the transplant, itself. That random scaring is eliminated and reduced to a localized, thin strip scar. This results in a less 'vascularly compromised' recipient site for the new transplants, which improves the odds of achieving better graft survival rate."

 

If the area is already compromised and growing hair, then the circulation is evidently good enough. If it doesn't grow hair, no need to remove it. A linear cut is deep and long and "cuts a lot more wires". It was no surprise to me that shock loss after my brow lift was the worst I had ever experienced.

 

"4. You get a 'free' brow lift in the process, leaving you with a slightly more youthful appearance. "

 

Certainly true, but it is unpredictable. I am no beauty and it didn't help me.

 

 

What you didn't mention, is tha the brow lift cause the skin to "crumple in" so that both sides of the linear excision can meet and be joined. This is necessarily so because the circumference of the cut cannot be divided 50-50, it must be distorted in order for the join to be made and this requires squashing the bottom portion slighly. Same as rear strip but more revaling at the front. In my case, the shape of my head became more elliptical above the cut. Wierd to me, but probably not noticable to anyone.

 

One again congrats to you plugfree and for the Docs good work. I just want to help put some more perspective into the discussion.

 

Good luck to you Lawtech

[aaron1234]

Very interesting points raised by both PlugFree and scar5. I'd most certainly like to hear a doc's perspective. To me, lawtech's plugs looked even lower and more harsh/dense than PlugFree's. That's why I would lean towards the brow lift. But I could be wrong. Docs, HT vets.. feel free to chime in.

[lawtech]

I thought I would add some more pictures. Any thoughts are appreciated.

 

Also, who would you recommend I get a consult with?