Raymond Konior, MD | Chicago Hair Institute | 2884 Graft Hairline Restoration

[JayLDD]

I have no issue opening myself up for critique, I post my own result on here so people are welcome to express their opinions.

 

There was a great post on here a while back titled "Did I make my hairline too high". There was a lot of responses from respected surgeons, and virtually every one said the same thing - that the sensible approach is to be slightly conservative with a first HT, most people have more than 1 procedure in their lifetime, and you always have the option of bringing it down later if you feel its still too high once it's grown in, but once it's down, its down, going back up is a lot harder.

 

Anyway, this young guy made his decision early, he wanted it right down there. If he researched it and knows the risk then he can't really complain if it all goes pear shaped in his later life, only time will tell.

 

 

Agree with your point on first procedures, it's the route I've taken in my case and its worked very well, I am going a tad more aggressive the second time round but not hugely. Especially in your case it wouldn't take an excessive amount of grafts to get things absolutely perfect ( just from my perspective), and you're in a very safe position considering your age and perfecto first procedure.

[hockeyman]

Absolutely awesome result. I always admire how clean Dr. Konior's work is in the immediate post op photos. I agree with Jean LDD that sometimes we see results posted where transplanted hairlines are placed so high that they simply don't look natural.

Here's a question. If a patient had his entire frontal 1/3 transplanted and felt that his hairline was placed too high, would a forehead reduction procedure be a possibility for him?

[Sonoma]

Dr. K is always looking long term. Another great result in his book. It will not hurt his waiting list.

[icehaid]

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

 

Quickly - and also at night, on weekends, and likely while receiving an emergency appendectomy as well. ;-) Dr. K is the best communicating physician I've ever come across. Easily.

[matt3480]

the work looks fantastic but isn't it stupid to go that aggressive at 28?

 

What's gonna happen when he loses a lot more hair next 15 years? He probably only has maybe 5000 grafts left to even use

 

Gee, thanks for your opinion, Doctor (er, I mean poster who hasn’t even had a HT). :rolleyes:

[alessi]

On 2/17/2018 at 2:22 PM, Dr. Raymond Konior said:

[...]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.

Hi Doctor K

If the patient has parents, siblings, etc. who are bald  - wouldnt it be risky to pursue this aggressive hairline?

[mayhem]

On 2/17/2018 at 2:22 PM, Dr. Raymond Konior said:

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.

The patient was 28 when he had the surgery, correct? Everyone is different, but is his advanced horseshoe pattern not a red flag? 

Put it this way, if this patient were your son and they had the same NW3+ advanced hairline - would you have given them a juvenile hairline as a 28 year old?

 

[mayhem]

On 4/13/2018 at 11:18 PM, matt3480 said:

 

Gee, thanks for your opinion, Doctor (er, I mean poster who hasn’t even had a HT). :rolleyes:

Matt, no doctor can PREDICT a person's future hair loss. 

You're implying that we all must ignore our common sense here.

Dr. Konior gave him a juvenile hairline when he clearly is going to lose more hair down the line.

He brought the guy's hairline down an inch. 

Edited November 8, 2020 by mayhem

[1978matt]

8 hours ago, mayhem said:

Dr. Konior gave him a juvenile hairline when he clearly is going to lose more hair down the line.

I disagree on this point.  It's NW1 but not Juvenile.

An example of juvenile might be Steven Gerrard, or R Reagan.

Basically zero temporal recession.

[Curious25]

10 hours ago, mayhem said:

Matt, no doctor can PREDICT a person's future hair loss. 

You're implying that we all must ignore our common sense here.

Dr. Konior gave him a juvenile hairline when he clearly is going to lose more hair down the line.

He brought the guy's hairline down an inch. 

Have you not read Dr K’s comments earlier in this thread, providing his justification? 
 

 

[mayhem]

42 minutes ago, Curious25 said:

Have you not read Dr K’s comments earlier in this thread, providing his justification? 
 

 

Yes I did. 

Dr. Konior's response seems bizarre. He acknowledges that an ethical doctor would consider the patient's family history, current hair loss, age, regime, etc. 

Yet, if one were to do all those things - how could he justify giving this patient a juvenile hairline?

Hair loss can strike at any age and it is unpredictable. Dr. Konior cannot predict this young man's hair loss.

As others have said, you can always lower the hairline - but if you start off by giving a patient a NW1 or juvenile, then you take away any consideration for further loss. 

I wonder how much donor this person has left. 

 

Edited November 8, 2020 by mayhem

[JayLDD]

Just now, mayhem said:

Hi Matt, yes I did. 

Dr. Konior's rationale seems bizarre. He acknowledges that an ethical doctor would consider the patient's family history, current hair loss, age, regime, etc. 

Yet, if one were to do all those things - how could he justify giving this 28 year old with advanced hair loss a juvenile hairline?

Hair loss can strike at any age and it is unpredictable. Dr. Konior cannot predict this young man's hair loss.

As others have said, you can always lower the hairline - but if you start off by giving a patient a NW1 or juvenile, then you take away any consideration for further loss. 

I wonder how much donor this person has left. 

 

Do you think that when someone hits 30 that their hairloss magically stops, becomes completely predictable and controllable?

Your argument makes no sense. 90% of patients on this forum have progressive hairloss and aren't completely bald yet. You could say the same to them, age has absolutely nothing to do with it.

[mayhem]

6 minutes ago, JayLDD said:

Do you think that when someone hits 30 that their hairloss magically stops, becomes completely predictable and controllable?

Hair loss is unpredictable. 

However if someone has advanced hair loss when they're young, then it's not a good sign. We can't predict when they will go bald or whether they will go bald at all. 

But no one would look at this patient pre-op and bet confidently they'd have no further loss until 40. 

 

6 minutes ago, JayLDD said:

Your argument makes no sense. 90% of patients on this forum have progressive hairloss and aren't completely bald yet. You could say the same to them, age has absolutely nothing to do with it.

Can you support this statistic with some evidence please? Can you say whether this statistic, if valid, generalizes to the rest of the male population outside the forum?

Age isn't the issue in and of itself. TIME is the issue.

If you have an advanced pattern at a young age, then you have much more TIME to keep potentially losing more hair as you get older and older. 

 

Edited November 8, 2020 by mayhem

[Gasthoerer]

This case is 3+ years old...

Maybe Konior still is in contact with the patient and can ask for further pics to see if the loss has progressed. 

[JayLDD]

37 minutes ago, mayhem said:

Hair loss is unpredictable. 

However if someone has advanced hair loss when they're young, then it's not a good sign. We can't predict when they will go bald or whether they will go bald at all. 

But no one would look at this patient pre-op and bet confidently they'd have no further loss until 40. 

 

Can you support this statistic with some evidence please? Can you say whether this statistic, if valid, generalizes to the rest of the male population outside the forum?

Age isn't the issue in and of itself. TIME is the issue.

If you have an advanced pattern at a young age, then you have much more TIME to keep potentially losing more hair as you get older and older. 

 

Right, and balding in the crown with a strong hairline is a totally natural hairline pattern. Having a youthful hairline is incredibly important to people in their twenties, this patient is likely to have still 4-5000 FUE grafts left and the option of FUT and BHT beyond that. That is quite frankly highly likely to be enough to get full coverage across his entire head as a NW5 if he exhausts all surgical options. Even if it was the case that he could not cover the entire top of his scalp, he will absolutely be able to cover the vast majority of it even if he ends at a higher NW. Worst case scenario is he is left with a strong frontal third and some thinner areas in the midscalp and crown, which again is a completely natural situation for men in their 40s and 50s. 

You present this as if he is moving towards an armageddon scenario, the clock moving tick tock until doomsday. Have a 30 second think about the likely outcomes here and what the worst case scenario is. The worst case scenario is still going to look perfectly natural and suit this patient while they're younger. Stop fear mongering and think about what you're actually saying and whether it makes any sense, because it doesn't. Even if he loses more hair that isn't the end of the world and it won't look unnatural. 

I'm not going to babysit you with statistics when what I said was totally uncontroversial. Most men go for hair transplants prior to being completely bald. Your subsequent sentence has absolutely nothing to do with anything being discussed in terms of relevancy. 

You're right time IS the issue, and this patient has bought substantially more of it in the years it matters most. Even if he progressively loses significantly more hair he will be in a good position going forward and the worst case situation is a bald crown and a strong frontal third. Do you think the patient is going to cry about that when they're 45 years old? No, they're not.

[1978matt]

2 hours ago, mayhem said:

Hair loss is unpredictable. 

However if someone has advanced hair loss when they're young, then it's not a good sign. We can't predict when they will go bald or whether they will go bald at all. 

But no one would look at this patient pre-op and bet confidently they'd have no further loss until 40.

The patient here doesn't have an advanced pattern.  I'd say he was a NW3 and the doc would have looked at the remaining hair on the top of his head to see if it was exhibiting signs of thinning.

Evidently, whatever he saw was not significant enough to rule out the agrressive approach taken.  Also, the 18-month post op photos do not appear to show any noticeable deterioration behind the transplants.

[mayhem]

1 hour ago, JayLDD said:

I'm not going to babysit you with statistics when what I said was totally uncontroversial. Most men go for hair transplants prior to being completely bald. Your subsequent sentence has absolutely nothing to do with anything being discussed in terms of relevancy. 

I was being facetious.

You have absolutely no data to back up your claim. You've conducted no survey.

You have an 'impression' that does not even rise to the level of anecdote. 

Even if you did, the sample size is this forum. Hair loss affects most men to some degree, not just those who talk about it on THIS particular forum. 

Didn't think I needed to state the obvious.

 

1 hour ago, JayLDD said:

[...] this patient is likely to have still 4-5000 FUE grafts left and the option of FUT and BHT beyond that. That is quite frankly highly likely to be enough to get full coverage across his entire head as a NW5 if he exhausts all surgical options. Even if it was the case that he could not cover the entire top of his scalp, he will absolutely be able to cover the vast majority of it even if he ends at a higher NW.

You're erring on the side of optimism. IMHO, I think all doctors should be cautious. Especially when it comes to a finite resource like hair. 

 

1 hour ago, JayLDD said:

Stop fear mongering and think about what you're actually saying and whether it makes any sense, because it doesn't. Even if he loses more hair that isn't the end of the world and it won't look unnatural. 

I'm voicing my opinion on this case.

Just because someone disagrees with you does not make them a fear monger.

 

1 hour ago, JayLDD said:

 

You present this as if he is moving towards an armageddon scenario, the clock moving tick tock until doomsday. Have a 30 second think about the likely outcomes here and what the worst case scenario is. 

[...]You're right time IS the issue, and this patient has bought substantially more of it in the years it matters most. Even if he progressively loses significantly more hair he will be in a good position going forward and the worst case situation is a bald crown and a strong frontal third. Do you think the patient is going to cry about that when they're 45 years old? No, they're not.

Completely irrelevant. 

Once again, I'm not looking at this from the perspective of what the patient wants.

I'm sure there are doctors out there who will provide the patient with whatever they desire even if it's not in their interests.

While Dr. Konior is one of the best HT surgeons around, I do not think this case was ethical. Dr. Konior's rationale was very weak too.  

I'm looking at this from the perspective of the doctor, who should be operating ethically. 

 

 

[mayhem]

5 minutes ago, 1978matt said:

The patient here doesn't have an advanced pattern.  I'd say he was a NW3 and the doc would have looked at the remaining hair on the top of his head to see if it was exhibiting signs of thinning.

Evidently, whatever he saw was not significant enough to rule out the agrressive approach taken.  Also, the 18-month post op photos do not appear to show any noticeable deterioration behind the transplants.

Matt, what exactly do you think a doctor can SEE during a consult?

Sure he could check for miniaturization but that doesn't preclude future hair loss. 

If he is indeed going to be stuck as a NW3, then this is awesome.

I just don't see how Dr. Konior (or anyone else) can predict that. 

It's irresponsible to suggest that he can. 

 

[aaron1234]

2 hours ago, mayhem said:

However if someone has advanced hair loss when they're young, then it's not a good sign.

I agree, but the patient in this case is not an example of someone with advanced hair loss at a young age.  As someone who was NW5/6 in his mid-20's, I can assure you that Dr. K would have never given me this hairline.  It's a case by case basis.  Miniaturization in the donor and/or starting signs of retrograde alopecia would be noticeable to the doctor under magnification.  These are indicators of future hair loss that we cannot see based on forum photos.  

[1978matt]

On 11/8/2020 at 3:29 PM, mayhem said:

Matt, what exactly do you think a doctor can SEE during a consult?

Sure he could check for miniaturization but that doesn't preclude future hair loss. 

If he is indeed going to be stuck as a NW3, then this is awesome.

I just don't see how Dr. Konior (or anyone else) can predict that. 

It's irresponsible to suggest that he can. 

 

I'm not saying he wont need another HT at some point or will stop balding.  I would always tell someone to consider having to get 3 or 4 over a 20 year period.

You also have to be willing to accept bald or thin areas to stay thin either now or later in life, e.g. a thin crown.

If you cant accept that then I guess you're just not ready for a HT.

Edited November 9, 2020 by 1978matt

[Gasthoerer]

3 hours ago, mayhem said:

While Dr. Konior is one of the best HT surgeons around, I do not think this case was ethical. Dr. Konior's rationale was very weak too.  

I'm looking at this from the perspective of the doctor, who should be operating ethically. 

 

 

In general I agree, that conservative is the best way to go forward (just see my own case as a reference :-)) 

But I think you are over critical here and you are using a very aggressive language ("very weak", "not ethical"): 

If someone is a low NW (like this patient) with a strong Donor, no signs of further thinning at the age of 28 (which is not really young) and a positive family history, then how high is the risk that he will end up a NW5+ and run out of grafts? I think it is very low, especially if you accept a thinner crown when being over 50. 

That said: I myself would have not gone that aggressive in one step, but I understand that not everyone is like me 😉

[mayhem]

27 minutes ago, Gasthoerer said:

In general I agree, that conservative is the best way to go forward (just see my own case as a reference :-)) 

But I think you are over critical here and you are using a very aggressive language ("very weak", "not ethical"): 

If someone is a low NW (like this patient) with a strong Donor, no signs of further thinning at the age of 28 (which is not really young) and a positive family history, then how high is the risk that he will end up a NW5+ and run out of grafts? I think it is very low, especially if you accept a thinner crown when being over 50. 

That said: I myself would have not gone that aggressive in one step, but I understand that not everyone is like me 😉

I really don't know how else to describe Dr. K's reply, because it seemed like a dictionary definition of what we all more or less understand regarding family history, donor strength, current age, current regime, etc. 

It did not seem to me to address this particular case. 

Instead, Dr. K referred to past patients (not specifically) who did not progress further in their hair loss. I questioned whether that has any bearing on this case (or to each other). 

But of course, if this patient is meant to stay at a NW3 with either zero or minimal further loss then he's really fortunate and I'm worrying for nothing. 

I just don't see how anyone can know that for certain. 

Mind you, I'm not saying this patient should never get a hair transplant. 

I'm just saying why go so low right away. Again, from the doctor's perspective. I'm sure the patient wanted this. I would too if I knew I wasn't going to lose more hair. 

[JayLDD]

14 hours ago, mayhem said:

I was being facetious.

You have absolutely no data to back up your claim. You've conducted no survey.

You have an 'impression' that does not even rise to the level of anecdote. 

Even if you did, the sample size is this forum. Hair loss affects most men to some degree, not just those who talk about it on THIS particular forum. 

Didn't think I needed to state the obvious.

 

You're erring on the side of optimism. IMHO, I think all doctors should be cautious. Especially when it comes to a finite resource like hair. 

 

I'm voicing my opinion on this case.

Just because someone disagrees with you does not make them a fear monger.

 

Completely irrelevant. 

Once again, I'm not looking at this from the perspective of what the patient wants.

I'm sure there are doctors out there who will provide the patient with whatever they desire even if it's not in their interests.

While Dr. Konior is one of the best HT surgeons around, I do not think this case was ethical. Dr. Konior's rationale was very weak too.  

I'm looking at this from the perspective of the doctor, who should be operating ethically. 

 

 

 

Here was my point:

"You present this as if he is moving towards an armageddon scenario, the clock moving tick tock until doomsday. Have a 30 second think about the likely outcomes here and what the worst case scenario is. The worst case scenario is still going to look perfectly natural and suit this patient while they're younger. Stop fear mongering and think about what you're actually saying and whether it makes any sense, because it doesn't. Even if he loses more hair that isn't the end of the world and it won't look unnatural. "

Here is your response:

"Completely irrelevant. 

Once again, I'm not looking at this from the perspective of what the patient wants."

Its quite literally the *only* thing that is relevant. You are fear mongering about a scenario you clearly haven't even considered.

You are arguing for the sake of arguing at this point. Its obvious you haven't giving basic thought to the fact that if the patient ended up with a thin crown and midscalp and a stronger frontal third in the long term that is perfectly natural, its also the worst case scenario. When you say that you're not looking at this from the perspective of what the patient wants you've lost all credibility. When someone is as thoughtless as yourself you are the LAST person who has a perspective relevant to this patient or any other. The patients short and long term desires are the only thing that matters, and with a surgeon like Konior who is clearly world class they have a track record to show they can attain them to the best degree which its possible.

When you say you're looking at this from the perspective of the doctor you are  delusional if you think you know better than both the patient and Dr. Konior. End of story.

[JayLDD]

14 hours ago, 1978matt said:

I'm not saying he wont need another HT at some point or will stop balding.  I would always tell someone to consider having to get 3 or 4 over a 20 year period.

You also have to be willing to accept bald or thin areas to stay thin either now or later in life, e.g. a thin crown.

If you cant accept that then I guess you're just not a ready for a HT.

Your comment is spot on and I'm not sure how its so hard to understand. What you are mentioning are not even "risks" as Mayhem seems to think, they are facts of life that are absolutely worth accepting for short term benefit and winding back time, which is ultimately what all transplants are doing.

[BDK081522]

@mayhem That's a relatively bold stance you're taking here. If I'm reading your intent correctly you are calling Dr. Konior's ethics into question here. You don't believe it to be ethical to place this hairline on a 28 year old man, referencing it as juvenile. Firstly, let's correctly assess this situation. This would be a solid hairline for any non balding man. It is not juvenile. There is slight recession in the correct areas. You would never notice this man's hairline in the general population and think anything other than it was God-given and he's a lucky SOB to be almost 30 years old with such great hair. It is perfectly placed and expertly grafted to show a slightly thinning gradient in the temporal areas. It's not a wall of dense thick hair smacking you in the face screaming unnatural. Secondly, I can only assume you've never had any direct interaction with Dr.Konior. To call him unethical is just blasphemous. He does his very best to integrate patient desires with his experience in hair loss to give the results that are in everyone's best interest. You are correct in stating that nobody knows how hair loss will progress. We can only guess. However, I think the opinion of a surgeon that has been dealing with hair loss and restoration for around 30 years has generally a better guess than you do. Of course you take into account family history, miniaturization, medical therapy, and you make your educated guess. I would just trust his guess over yours in every way possible. 

Edited November 9, 2020 by BDK081522