Raymond Konior, MD | Chicago Hair Institute | 3370 Graft Repair with Combination Strip/FUE Harvest

[Dr. Raymond Konior]

This 39 year old patient presented with a history of two prior unsuccessful hair transplants in which a total of 3086 grafts had been placed in an attempt to restore his frontal male pattern baldness.  He expressed concern that the procedures failed to produce any substantial regrowth or density gain.  He was also bothered by a very wide scar that resulted from his second strip harvest procedure.

The prior transplant zones demonstrated quite low density in consideration of the prior 3086 grafts that had been performed.  His donor area revealed a very wide scar extending from the occipital region to the right temple donor region.  Overall his donor area was deemed compromised because of the past harvests and the resulting wide scar.  The surgical plan devised included another strip harvest in the remaining higher density, core donor region, and a secondary FUE harvest for recruiting grafts from the nape region.  This combination approach was used to maximize the graft harvest while minimizing further cosmetic handicap in the donor region.  The strip harvest yielded 2829 grafts and the FUE harvest yielded 541 grafts, resulting in a total of 3370 grafts for the restoration.  Strip grafts were primarily distributed in the frontal and midscalp regions, while the finer nape hairs were used to create a transitional thinning appearance from the midscalp into the crown.  Presented here are nine month postoperative results.  Also presented are various photos of immediate graft placement and the harvest zone.

Preop Front

 

Preop Top 1

 

Preop Top 2

 

Preop Top 3

 

Preop Left

 

Preop Right

 

Postop Front

 

Postop Top 1

 

Postop Top 2

 

Postop Top 3

 

Postop Left 1

 

Postop Left 2

 

Postop Right

 

Planned Graft Zones

 

Immediate Postop Strip Graft Placement View 1

 

Immediate Postop Strip Graft Placement View 2

 

Immediate Postop FUE Graft Placement

 

Immediate Postop Combo Graft Placement

 

Immediate Postop FUE Donor Site Appearance

 

FUE Donor Site 24 Hours After Surgery

Edited May 31, 2019 by Dr. Raymond Konior
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[paddyirishman]

OUTSTANDING RESULT.  

Why did the patient not op for total FUE?

 

.........Paddy.....

 

[Raphael84]

Fantastic and as always, impressive documentation. Another huge success. Well done Dr K!

[Triple7]

This dude had to be thrilled with this result...especially with 2 unproductive surgeries before this

[Dr. Raymond Konior]

On 5/31/2019 at 6:25 PM, paddyirishman said:

Why did the patient not op for total FUE?

.........Paddy.....

 

Point 1: The primary advantage of using FUE over strip for a graft harvest is to allow a patient the option of wearing a very short hairstyle.  This patient presented with two prior strip scars, one of which was exceptionally wide.  His preexisting donor scars will always prevent him the option of wearing a very short hairstyle, thereby eliminating the decision to utilize FUE as the primary harvest method for his restoration. 

Point 2: A secondary reason one would choose FUE over strip for the graft harvest is relative donor site tightness, i.e. a very tight scalp will not allow for strip harvesting.  This patient demonstrated sufficient looseness in an ideal location of the higher quality donor area, thereby making strip harvesting a viable option.

Point 3:  Planning a procedure has to take into consideration both long term and short term needs.  This patient has an advanced pattern with a disproportionate imbalance between his limited donor supply and the high number graft needs of his large bald zone. A key issue here is what harvest strategy would allow this man the opportunity of yielding the largest number of grafts over his lifetime.  An aggressive FUE harvest that would have yielded the same number of grafts as this combo approach could have resulted in a “one-and-done” session as the diffuse density reduction associated with FUE-only harvesting may actually have worsened his ability to camouflage the preexisting donor scars.   Also, using an FUE-only approach would have forced the harvest into more unfavorable zones at risk for future thinning.

Using a strip harvest for the primary harvest modality in this combo approach has not resulted in any new hair style requirements as the final scar heal from the session presented here was very good, i.e. his current hair style requirement is still based on the prior procedure scar issue.  Additionally, the strip harvest concentrated graft isolation from the highest density and best quality central core of the donor area.

In summary, the combo approach maximized a single-day harvest in terms of graft number yielded and overall graft quality, and it has allowed for another future session by preserving residual follicular-unit distribution in the donor area.  A future session, however, may very well require an FUE-only approach if the limits of his donor area elasticity have been reached.

[paddyirishman]

Thanks for your reply Dr.Konior.

Very well explained reason for your strategy to look at the short term and 1 eye on the long term while maximising doner potential .

Was the patient on medication after his HT?

WITH THIS DOCUMENTATION AND OUTSTANDING RESULT YOU HAVE GIVEN ALL PATIENTS AND ESPECIALLY THOSE PATIENTS WHO HAD REALLY POOR OUTCOMES OF THEIR HT RESULTS GREAT HOPE AND BELIEF FOR A POSITIVE OUTCOME WHILE CHOOSING A SURGEON AT THE TOP OF THEIR PROFESSION JUST LIKE YOUR GOOD SELF.

.................PADDY..........

[Raphael84]

Great explanation Dr Konior. Looking over the result again it looks even more impressive than it did last time.