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This 28 year old requested frontal hairline restoration. A session consisting of 2884 grafts was performed using a “stick-and-place” insertion technique and dense-pack placement. Presented are 18-month postop photos, immediate graft placement photos and a 10-day postop photo.

 

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5b32f8fdc8e79_PostopFront.jpg.982411611b00644b38bbba37f114c52d.jpg

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5b32f8ff82818_ImmediatePostopGraftPlacementFront.jpg.ee418269c7d8f40f74b4adb600ef6d02.jpg

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5b32f8ffd5750_ImmediatePostopGraftPlacementLeft.jpg.d6f2ca31bba5f37c162d3db0d769751d.jpg

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Well done dr and clinic. The patient must be over the moon with the results.

Hair transplants don’t get much better than that ??????


Hair Transplant Dr Feller Oct 2011

 

Hair Transplant Dr Lorenzo June 2014

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World class result


3185 FUT with Dr. Rahal on 2/17/16

http://www.hairrestorationnetwork.com/eve/182611-fut-3185-dr-rahal-day-after-pics.html

 

1204 FUT with Dr. Rahal on 3/27/17

http://www.hairrestorationnetwork.com/eve/186586-round-2-rahal-1204-fut-frontal-third-same-area.html

 

---> total of 4389 grafts to my frontal third via FUT

---> 1mg finasteride daily since 1999:)

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Awesome result. Now let's see someone mention how aggressive that hairline is for a 28 year old haha ;) They always do on other doctors posts but never on Hasson Diep or Konior. Hmmmmm

 

I myself love aggressive hairlines though.

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Awesome result. Now let's see someone mention how aggressive that hairline is for a 28 year old haha ;) They always do on other doctors posts but never on Hasson Diep or Konior. Hmmmmm

 

I myself love aggressive hairlines though.

 

 

Couldn't agree more.

 

Result is undeniably excellent but I, too, was struck by how aggressive this restoration is!

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Yep now he has the hairline he had at 15 years old forever haha. I like it myself.

 

With aggressive hair loss like that at 28 i hope he's not heading down a long road of transplants.

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Dr. Konior's stick & place technique + dense packing = grand slam HOMERUN.

The best in the biz!

 

Awesome work as always Dr. K, the patient now has hair and a hairline that makes him look 10 years younger.

Though known for a more conservative approach, Dr. Konior can also go aggressive when requested by the patient, and I'm sure this approach was likely patient requested.


go dense or go home

 

Unbiased advice and opinions based on 25 plus years of researching and actual experience with hair loss, hair restoration via both FUT & FUE, SMP, scalp issues including scalp eczema & seborrheic dermatitis and many others

 

HSRP10's favorite FUT surgeons: *Dr. Konior, *Dr Hasson, Dr. Rahal

HSRP10's favorite FUE surgeons: *Dr. Konior, *Dr. Bisanga, Dr. Erdogan, Dr. Couto

(*indicates actual experience with doctor)

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Awesome result. Now let's see someone mention how aggressive that hairline is for a 28 year old haha ;) They always do on other doctors posts but never on Hasson Diep or Konior. Hmmmmm

 

I myself love aggressive hairlines though.

 

OK, I'll be the one to mention it.

 

What is this 28 year old kid going to look like when he's 58?...68? Almost certainly a little bit odd. Thats about a third of his donor gone at 28, just doing a new juvenile hairline.

 

I can't fault the skill or artistry of the result, I just hope the doc explained to the young man that this is a numbers game and there are only so many grafts on his head to go around. If he is really lucky then whatever meds he's taking will put the brakes on his further loss, hell if a pill or lotion came out tomorrow which was absolutely proven to stop all further loss I'd book in for one of these myself, but with the current medical limitations, he's taking a gamble (and the doc really cannot say otherwise)

 

I think its currently wrong to encourage this.

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This discussion is important as an aggressive approach to the hairline can easily be abused without proper preoperative consultation, presurgical planning and surgical implementation. The definition of “aggressive” is important as this term may mean different things to different individuals. I define aggressive restoration as one that attempts to create something which tends to resemble the original youthful hairline once enjoyed during high school or college days. Prior to initiating this endeavor, the prudent surgeon has to take into consideration many factors, which include: 1) defining the patient goals; 2) predicting the final hair loss pattern; and 3) assessing the lifetime donor stores. For patients with an imbalance between donor supply and recipient demand, i.e. an advanced balding pattern (which is most often associated with limited donor supply), the goal becomes unattainable as the surface area needing coverage is too large to manage given the available donor supply. However, a favorable donor supply/recipient demand ratio in those with a more limited class 1-3 pattern may allow one to accomplish this type of restoration.

 

Unfortunately, having a lower class pattern and a great supply does not fully end the discussion. This statement is based on the unpredictable nature of hair loss progression which can turn a seemingly good idea into a problem should an aggressive restoration be met with the future development of an advanced pattern. This predicament was experienced all too often in the early days of surgical hair restoration when few surgeons factored in aging as they routinely set a hairline along the original adolescent path. Although there is no crystal ball which allows the surgeon to fully predict a final pattern, factoring in details such as family history, patient age, and a careful scalp analysis can help screen for candidacy or non-candidacy. The casual use of aggressive hairline restorations is discouraged, especially in very young men with evidence of widespread miniaturization, as this can lead to a less-than-ideal hair distribution with a low hairline and negligible coverage behind it. However, the selective use of aggressive hairline restoration can provide long term satisfaction to those who truly desire that appearance.

 

With respect to the comments of Mr. Hassler, I question his rational in believing that every man with an early pattern will progress to an advanced pattern as I have many long term patients over a 30 year career who have never progressed beyond a lower graft classification. I question the comment that this patient will eventually look odd as I have many patients with lower classifications who have been restored to a more youthful hairline position while looking quite good for decades. I question the comment regarding donor usage as this becomes a moot point if the pattern does not progress substantially. Finally, I find the assertion of encouraging aggressive hairline restoration in a haphazard fashion to be rather bold in consideration of the detail our practice has historically placed and continues to place on patient assessment and education.

 

With respect to the “forehead reduction” reference, this technique has tremendous potential mostly for female patients with a long forehead and a stable hairline. The technique is not meant for anyone with an unstable hairline, thereby removing most male patients from candidacy. The term is used because many female patients complain not of having a high hairline, but rather of a long forehead. Quite obviously, these are synonymous. The procedure has been well-documented in the hair restoration literature. For those of you with an inquisitive mind, here is a chapter reference from the Facial Plastic Surgery Clinics of North America which I edited along with my colleague Dr. Gabel.“Kabaker SS, Champagne JP. Hairline lowering. Facial Plast Surg Clin N Am 2013; 21: 479-86.”

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With respect to the comments of Mr. Hassler, I question his rational in believing that every man with an early pattern will progress to an advanced pattern as I have many long term patients over a 30 year career who have never progressed beyond a lower graft classification.

 

I don't quite say that ("every man will progress to an advanced state of loss"). If that is how may words read, then I should have phrased it better.

 

I do I agree with your earlier paragraphs stating the need to consider potential future loss, and that nobody has a crystal ball in trying to do this.

 

So on that basis, this patient may be lucky, he may stay at a relative low level of loss, that can easily be managed by a further procedure, or he may not, he could easily hit some really aggressive hair loss in his 30's and 40's, at this stage, the truth is that nobody knows.

 

I think my questioning was around the fact that taking this sort of aggressive line therefore represents a gamble to the patient. Repeat the above * 100 and some of those guys are likely to have a problem further down the line. This is really what I was trying to say. If the patients are informed of the gamble and are adamant they want to take it, then that's fair enough, it's by no means a fait accompli they will hit problems, but they need to be told the risks, and certainly never encouraged to do it.

 

If posting my views makes a few of the young guns who tend to want this type of thing take a step back and consider the *potential* longer term implications, then I'd be happy if I've done that.

Edited by Hassler

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Hey Konior what do you charge for fue? Thanks

 

Contact him personally about his fee structure. He's really good at getting back quickly to each individual inquiry.


HT#1 - Dr. Rahal (Jan 2012) - 4700 grafts

HT#2 - Dr. Rahal (Jan 2014) - 1800 grafts

HT#3 - Dr. Konior (Jan 2018) - 1200 grafts

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Excellent naturalism.


Hair loss patient and transplant veteran. Once a Norwood 3A.

Received 2,700 grafts with coalition doctor on 8/13/2010

Received 2,380 grafts with Dr. Steven Gabel on 9/30/2011

Received 1,820 grafts with Dr. Steven Gabel on 7/28/2016

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I don't quite say that ("every man will progress to an advanced state of loss"). If that is how may words read, then I should have phrased it better.

 

I do I agree with your earlier paragraphs stating the need to consider potential future loss, and that nobody has a crystal ball in trying to do this.

 

So on that basis, this patient may be lucky, he may stay at a relative low level of loss, that can easily be managed by a further procedure, or he may not, he could easily hit some really aggressive hair loss in his 30's and 40's, at this stage, the truth is that nobody knows.

 

I think my questioning was around the fact that taking this sort of aggressive line therefore represents a gamble to the patient. Repeat the above * 100 and some of those guys are likely to have a problem further down the line. This is really what I was trying to say. If the patients are informed of the gamble and are adamant they want to take it, then that's fair enough, it's by no means a fait accompli they will hit problems, but they need to be told the risks, and certainly never encouraged to do it.

 

If posting my views makes a few of the young guns who tend to want this type of thing take a step back and consider the *potential* longer term implications, then I'd be happy if I've done that.

 

So, what is your point? It sounds like you are just talking to hear yourself talk. It clearly wasn't/isn't a "gamble" to this particular patient. Did you even read the first paragraph that Dr. Konior wrote? It clearly states that a number of factors are looked at in determining how good a candidate someone is for a hairline like this. Do you know if this patient was on Propecia? Do you know if he has any family history of baldness? Do you know the patient's personal history of baldness? Did he just start balding last year or did he start balding at 18? Where does he have miniaturized areas? Do you know his amount of donor supply or his quality of hair caliber?

 

I'll answer that for you. No, you don't. You based your uneducated comment on two things and two things only....his age and your self-perceived medical expertise (which you don't have just because you had a hair transplant once:rolleyes:). So, yeah, thanks Dr. Hassler.

 

Your comment about repeating this hairline on 100 people was stupid, too. The whole point of the examination that any surgeon does is to weed out those among the 100 who are not candidates for this type of hairline (due to donor or degree of balding or estimated future degree of loss, etc.) and to weed out those who insist they are good candidates but, in reality, are not (by re-establishing their goals).

 

Quite honestly when I hear stupid comments about aggressive hairlines (and I see them often on this forum), I feel there is some sort of passive-aggressive jealousy on the poster's part regarding the patient's situation (could be the patient's age, density, hairline height, etc.).

Edited by matt3480

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Hi Dr. Konior. Thanks for the through response. As it is an unusually aggressive case for your clinic can you give us some insight into what the pre op conversation was like: meds/ family history etc? I'm sure you're very selective of the types of cases you're willing to tackle with this design. And as a point of curiosity, did the grafts continue to mature from the 12-18 month period by your estimate?

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So, what is your point? It sounds like you are just talking to hear yourself talk. It clearly wasn't/isn't a "gamble" to this particular patient.

 

If you take a long term view then it is a gamble. I’m never going to convince you, but if I can convince some of the 20 something guys out there who will be looking at this result and thinking “Yes....I want that too” to think it through again, and consider the long term implications, then that would be something positive.

 

I would hope Dr Konoir would say the same thing, but if he doesn’t, then somebody else out there should, even if they aren’t a Dr.

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jbl2093 – Prior to developing a surgical plan, all patients are screened with a thorough scalp examination and review of family history, and provided a patient consultation that includes a discussion of goals, risks, limitations, etc. One has to be selective in the creation of any surgical plan as all patients are unique, i.e. the surgical plan must be customized to the individual. Based on the definition of aggressive previously provided, this type of plan is more of a rarity simply because there are more men who either have or are predisposed to a higher class pattern.

 

I believe that grafts require a minimum of 18 months to fully mature, and sometimes longer for certain hair/skin combinations.

 

Hassler – Life and most of its components are a gamble, especially when looked at over the long term. There is never any certainty about predicting long term hair loss, just as there is no certainty that the next flight you take will land safely. However, the odds of having a safe hair procedure and a safe plane flight are high when all proper precautions are taken. I sense that you believe there is a mass haphazard approach being utilized by surgeons for surgical planning and providing advice to patients. Although this may be true in surgical mills, it would be the exception in the hands of most caring and competent surgeons who presumably use common sense and experience to provide reasonable treatment plans that are based on individual needs. Caution is a good thing and I absolutely agree with your belief that it be emphasized to any patient seeking this type of restoration, but caution should be applied to all patients and all components of the procedure, not only hairline location. Even a 60-year old man with a class 2 recession and no evidence of donor, midscalp or crown miniaturization must be cautioned as to long term consequences. Yes, cautionary advice is provided to one hundred percent of patients as all patients are intrinsically subjected to the risk of age-related, progressive hair loss. However, there are those with low risk profiles who can successfully tolerate such a plan if that be their desire.

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This discussion is important as an aggressive approach to the hairline can easily be abused without proper preoperative consultation, presurgical planning and surgical implementation. The definition of “aggressive” is important as this term may mean different things to different individuals. I define aggressive restoration as one that attempts to create something which tends to resemble the original youthful hairline once enjoyed during high school or college days. Prior to initiating this endeavor, the prudent surgeon has to take into consideration many factors, which include: 1) defining the patient goals; 2) predicting the final hair loss pattern; and 3) assessing the lifetime donor stores. For patients with an imbalance between donor supply and recipient demand, i.e. an advanced balding pattern (which is most often associated with limited donor supply), the goal becomes unattainable as the surface area needing coverage is too large to manage given the available donor supply. However, a favorable donor supply/recipient demand ratio in those with a more limited class 1-3 pattern may allow one to accomplish this type of restoration.

 

Unfortunately, having a lower class pattern and a great supply does not fully end the discussion. This statement is based on the unpredictable nature of hair loss progression which can turn a seemingly good idea into a problem should an aggressive restoration be met with the future development of an advanced pattern. This predicament was experienced all too often in the early days of surgical hair restoration when few surgeons factored in aging as they routinely set a hairline along the original adolescent path. Although there is no crystal ball which allows the surgeon to fully predict a final pattern, factoring in details such as family history, patient age, and a careful scalp analysis can help screen for candidacy or non-candidacy. The casual use of aggressive hairline restorations is discouraged, especially in very young men with evidence of widespread miniaturization, as this can lead to a less-than-ideal hair distribution with a low hairline and negligible coverage behind it. However, the selective use of aggressive hairline restoration can provide long term satisfaction to those who truly desire that appearance.

 

With respect to the comments of Mr. Hassler, I question his rational in believing that every man with an early pattern will progress to an advanced pattern as I have many long term patients over a 30 year career who have never progressed beyond a lower graft classification. I question the comment that this patient will eventually look odd as I have many patients with lower classifications who have been restored to a more youthful hairline position while looking quite good for decades. I question the comment regarding donor usage as this becomes a moot point if the pattern does not progress substantially. Finally, I find the assertion of encouraging aggressive hairline restoration in a haphazard fashion to be rather bold in consideration of the detail our practice has historically placed and continues to place on patient assessment and education.

 

With respect to the “forehead reduction” reference, this technique has tremendous potential mostly for female patients with a long forehead and a stable hairline. The technique is not meant for anyone with an unstable hairline, thereby removing most male patients from candidacy. The term is used because many female patients complain not of having a high hairline, but rather of a long forehead. Quite obviously, these are synonymous. The procedure has been well-documented in the hair restoration literature. For those of you with an inquisitive mind, here is a chapter reference from the Facial Plastic Surgery Clinics of North America which I edited along with my colleague Dr. Gabel.“Kabaker SS, Champagne JP. Hairline lowering. Facial Plast Surg Clin N Am 2013; 21: 479-86.”

 

 

 

"With respect to the comments of Mr. Hassler, I question his rational in believing that every man with an early pattern will progress to an advanced pattern as I have many long term patients over a 30 year career who have never progressed beyond a lower graft classification. I question the comment that this patient will eventually look odd as I have many patients with lower classifications who have been restored to a more youthful hairline position while looking quite good for decades."

 

This response is the difference between a doctor that has faith in their work and one who doesn't. No one one would suggest Brad Pitt, Tom Cruise or Clooney look ridiculous with juvenile hairlines into their 50s, in fact it is the undisputed opposite. The only ones to suggest this are surgeons who don't believe they have the talent level to consistently provide strong results for a dense and youthful hairline, or patients who are jealous of what has been achieved in cases like this. The truth is that this man will be slaying into his fifties if he stays on finasteride. He looks a million times better than 99% of conservative cases and on the balance of probabilities will continue to for decades to come.

 

The other comment about long term risk management in general is also very worthwhile and rarely discussed. This is a personal choice and for many individuals the risk/reward and cost/benefit of opting for a transplant or in particular an aggressive transplant in their youth can be a far better option than opting for something more conservative, or not undertaking a transplant at all. If I'm looking for a surgeon I want someone who shows long-term consistency and has faith in their work, not a baby sitter telling me that they can't achieve something others clearly are achieving or that they know better than my own gauge of my personal risks and situation. Certainly Konior would be one of the first I would trust in a case like this.

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If you take a long term view then it is a gamble. I’m never going to convince you, but if I can convince some of the 20 something guys out there who will be looking at this result and thinking “Yes....I want that too” to think it through again, and consider the long term implications, then that would be something positive.

 

I would hope Dr Konoir would say the same thing, but if he doesn’t, then somebody else out there should, even if they aren’t a Dr.

 

I'm not saying this to be insulting, but while your result in regards to yield and density is incredible and you've had a massive cosmetic improvement, its a perfect example of a hairline that clearly looks too high to be natural. In reality men don't have hairlines that straight, even and "perfect" looking at that conservative height. A less conservative approach and lower hairline in your case would actually look more natural, not less with such a level of density. Again not trying to be insulting at all because overall its a very strong result, but you open yourself up to that blatantly visible critique when you are on the offensive on this issue.

 

Same situation for many younger guys, a transplant with strong hairline density but a conservative placement and design on a twenty year old in particular has the potential to look completely ridiculous. Do you genuinely believe they're better off spending two decades "growing in" to their conservative hairline which often doesn't look natural to begin with? It's silly.

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