Raymond Konior, MD | Chicago | Frontal Hairline and Temporal Point Restoration

[Dr. Raymond Konior]

This 36 year old male requested frontal hairline and temporal point restoration. A staged restoration was performed to accommodate his desire for well-defined temporal points and a high density frontal hairline.The first stage consisted of an FUE harvest in which a total of 2815 grafts were used to establish a new hairline and to reinforce his temporal points. A second stage was performed 8 months later at which time FUE harvesting was utilized to obtain 1379 grafts for additional density enhancement within the previously grafted areas. A total of 4194 grafts were used for the entire restoration. Postop photos show his final 8 month result. Also included are pics from his first stage and part views in the hairline which reveal the density match that was obtained between the grafted area and the adjacent scalp.

 

[thatoldchestnut]

Isn't this Matt that posts here? Kinda looks like him. Nice work, regardless.

[Melvin- Admin]

Dr. Konoir, how many grafts does this patient have left? certain doctors have stated that 5,000 grafts via FUE is the maximum that could be obtained. From looking at this patient's donor I don't see any visible donor thinning even with really short hair.

[ontop]

Loving the Temple points it really frames the face well.

great Job Dr.K

[Shadow of the EMpire State]

Don't know that I like the temple points quite as much as some others, but it's a very good job overall.

[mosd]

Over 4k for that area? What happens if he starts loosing more hair?

 

Is there a plan for future hairloss?

[Dr. Raymond Konior]

HTsoon and mosd:

 

It is incorrect to assume that one can emphatically quantitate a potential graft load without defining the state of the donor site microanatomy and the specific microdissection goals for the restoration at hand. One has to have a clear understanding of the terms “Graft”, “Hair” and “Follicular-Unit” in order to get a grasp on the question, “How many grafts are left?” FUE offers the surgeon opportunity to look at a multi-hair follicular-unit as an entity with the potential to produce various graft/hair combinations. Look at the case of a four-hair follicular-unit. With strip harvesting and precise microscopic dissection a single four-hair follicular-unit can potentially result in the following five graft combinations:

1 four-hair graft

1 three-hair graft + 1 one-hair graft

1 two-hair graft + 2 one-hair grafts

2 two-hair grafts

4 one-hair grafts

Using FUE as the harvest option, the surgeon – with the assistance of high power magnification – can theoretically visualize a single four-hair follicular-unit with these same potential graft combinations. I refer to these as “potential” combinations because the complex variables associated with microdissecting a single follicular-unit using FUE may not allow all combinations to be created. However, the safe splitting a follicular-unit into a graft that is essentially a “sub-follicular-unit” is possible when appropriate surface microanatomy is present. The point here is that removing a single hair from a multi-hair follicular-unit will generate a one-hair graft and leave what will appear upon final healing as a three-hair follicular-unit. In this example - as was the situation with my patient who required a significant load of single-hair grafts for temporal point restoration and hairline refinement - there are many more potential grafts available for the future. Thus, suggesting that too many grafts were removed is flawed as many were left behind using this microdissection strategy, which is why the donor pics show good residual coverage.

 

All patients have both short term and long term plans discussed prior to and on the day of surgery. The discussion above summarizes why the short term goals for aggressive hairline and temporal point restoration in this patient were balanced with any possible long term need for additional restoration.

[Melvin- Admin]

HTsoon and mosd:

 

It is incorrect to assume that one can emphatically quantitate a potential graft load without defining the state of the donor site microanatomy and the specific microdissection goals for the restoration at hand. One has to have a clear understanding of the terms “Graft”, “Hair” and “Follicular-Unit” in order to get a grasp on the question, “How many grafts are left?” FUE offers the surgeon opportunity to look at a multi-hair follicular-unit as an entity with the potential to produce various graft/hair combinations. Look at the case of a four-hair follicular-unit. With strip harvesting and precise microscopic dissection a single four-hair follicular-unit can potentially result in the following five graft combinations:

1 four-hair graft

1 three-hair graft + 1 one-hair graft

1 two-hair graft + 2 one-hair grafts

2 two-hair grafts

4 one-hair grafts

Using FUE as the harvest option, the surgeon – with the assistance of high power magnification – can theoretically visualize a single four-hair follicular-unit with these same potential graft combinations. I refer to these as “potential” combinations because the complex variables associated with microdissecting a single follicular-unit using FUE may not allow all combinations to be created. However, the safe splitting a follicular-unit into a graft that is essentially a “sub-follicular-unit” is possible when appropriate surface microanatomy is present. The point here is that removing a single hair from a multi-hair follicular-unit will generate a one-hair graft and leave what will appear upon final healing as a three-hair follicular-unit. In this example - as was the situation with my patient who required a significant load of single-hair grafts for temporal point restoration and hairline refinement - there are many more potential grafts available for the future. Thus, suggesting that too many grafts were removed is flawed as many were left behind using this microdissection strategy, which is why the donor pics show good residual coverage.

 

All patients have both short term and long term plans discussed prior to and on the day of surgery. The discussion above summarizes why the short term goals for aggressive hairline and temporal point restoration in this patient were balanced with any possible long term need for additional restoration.

 

Fantastic explanation Dr. Konoir, I have also had around 4,000 grafts taken via FUE, if I am following along correctly what you're saying is that with the use of a small punch and high magnification you are able to remove a single follicular unit out of a 4 hair follicular unit, leaving the other 3 follicles in tact, this somewhat confirms what I have always thought which is that surgeons are able to cherry pick grafts with FUE.

 

What you have described gives a lot of hope for us FUE patients who's goal is to maximize our grafts utilizing this method. I would imagine transecting the follicle takes a great deal of skill but I have heard of several other doctors utilizing this method.

[matt3480]

How did I miss this post!? This is indeed me!

 

Mosd....I've been on Propecia for almost 2 years now. Also, my family history has some hair loss but not NW 6-7 type-loss so I don't feel I'll ever progress anywhere near that far. My father and older brother have pretty much all their hair.....my grandfather on my father's side is 90 and has a full head of hair and my grandfather on my mother's side was maybe a NW4 (if even that) at age 65 when he died.

 

HTSoon.....my hair on the sides/back was indeed very short in that pic (probably a number 4 guard at the top of the sides and maybe a number 2 at the bottom). You simply can't tell that I had anything done in the donor areas. It's a credit to Dr. K's expertise in managing a patient's donor area.

 

ontop, shadow.....trust me, the temple points helped make these results great.

 

I'm hoping to get one final smaller procedure (basically the cherry on top) and then will be done. I can't say enough about Dr. K and his work....this is why the other Matt (in the UK) and I have been such huge cheerleaders for Dr. K....the results speak for themselves and it all looks completely natural (both donor and recipient). There isn't a better surgeon in the world in my opinion.

Edited November 5, 2016 by matt3480

[Sean]

Bravo! Substantial real estate covered and it looks dense with the number of grafts used.

[mosd]

thanks for reply both matt and doctor K.

 

Matt : Do you know how many grafts went into the temple points?

[mosd]

And can i ask how many hairs was placed on these to surgeries? Instead of grafts?

[NEWHAIRPLEASE]

Man that is a great result. Something's never change. Dr Ks work is on point! I'll bet that was a pretty $$$$ though! Of course it was worth it because it looks incredible!

Edited November 6, 2016 by NEWHAIRPLEASE

[hsrp10]

One of my favorite temple area restoration cases. Awesome work, and makes the patient look much younger.

 

This is my second favorite temple area restoration case also by Dr. K:

http://www.hairrestorationnetwork.com/eve/171144-raymond-konior-md-chicago-frontal-hairline-restoration-1791-grafts.html

[matt3480]

mosd, about 800.....all singles. It was more than the actual points, though....Dr. K also slightly brought out the area above the points. Even when I was an adolescent with all my hair, my natural hairline didn't have much in terms of temple points. As a result, this always made my hair loss look more extensive than it was (because it made my forehead appear wider).

 

Hair-wise....I want to say I had about 8,000-9,000 hairs. I think the more amazing part about my results is the fact that I have fine textured hair. A lot of the HT results I've seen on patients with fine hair have been real mediocre because you just don't get the amount of coverage from a specific number of grafts versus someone who has normal caliber or coarse hair. Luckily, I have a bit of a wave in my hair once it gets over 1.5 inches or so....so it gives me a large appearance of coverage/density all over the place once I'm at that length versus, say, my pre-op pics for my 2nd transplant (where my hair was buzzed down to maybe 1/4 inch).

 

Newhair....best money I've spent. I've seen far too many horror stories on these forums from people who paid probably the same amount I did and had horrible results and now are screwed because their donor is used up. Dr. K is as sure of a bet as there is.

 

hsrp, that other case was definitely impressive. I think a lot of us would kill to have that little thinning at age 50 where a small surgery (1500-1750 grafts) can basically give you a perfect hairline and take literally 20 years off how old you look. Temple points are where the artistry comes in. I think a lot of surgeons won't touch them because if done incorrectly, it can make you look really for the worse....even with a good hairline.

[NEWHAIRPLEASE]

Matt

I completely agree with you! You can't put a price on it. I visited Dr K before going with Rahal. Dr K is too notch! Class act! Great guy.

[Melvin- Admin]

Bumping for incredible temple points 🤌🤌

[mrmane85]

Agree, excellent work

[John1991]

Very well done.

Edited April 14, 2022 by John1991

[OliverAtom]

 

Beautiful result. Really natural and donor looks just perfect 😉