Dr. Raymond Konior Posted January 26, 2020 Share Posted January 26, 2020 This is a 34-year old patient with a history of undergoing a frontal hairline flap using tissue expansion of the left donor region. He presented to my office with complaints of an abrupt hairline, a frontal hairline scar, an unsightly left-side donor scar, and thinning in the midscalp and crown regions. His primary goals were: 1) create a more natural hairline; 2) camouflage scars along the hairline and in the donor area; and 3) enhance hair density in the midscalp and crown. His physical examination revealed: 1. An overly-thick frontal hairline flap with backward-oriented hair. 2. A disfiguring, hypopigmented scar that traversed the entire length of the hairline. 3. A prominent 1 cm scar in the left and back donor areas that traversed the path of the previously transposed hairline flap. 4. Significant density reduction in the temple region surrounding the transposition point of the flap. 5. Advanced miniaturization in the midscalp and crown. 6. A clinically apparent scar along the back edge of the flap. 7. Disproportionate thinning in the lower left crown which had resulted from this edge being displaced downward during closure of the flap’s donor defect. Surgical Plan: The entire left donor area and left occipital region were eliminated from consideration for donor harvesting because of severely limited elasticity and density reduction that resulted from removal of the flap and because of the preexisting wide scar. In anticipation of a large graft requirement to accomplish the many goals at hand, a multi-stage approach was developed that would begin with strip harvesting and later convert to future FUE harvesting once the donor region elasticity threshold had been fully utilized to preclude any additional strip harvesting. The right temple and occipital donor regions demonstrated sufficient density and elasticity to allow strip harvesting for the initial stages of this restoration. Result: Presented here is the result of two graft sessions that were staged seven months apart and utilized a total of 3,685 grafts procured via strip harvesting. Session 1 consisted of 2292 grafts, distributed into the frontal hairline scar region, the occipital scar, and the midscalp region. Session 2 consisted of 1393 grafts that were distributed into the crown, a gap located between the right end of the flap and the adjacent temporal hair, the right hairline scar, and a thinning left-side donor area surrounding the flap’s transposition point. Postoperative photos demonstrate results nine-months following the second session. Additional density gains are expected. Preop - Front Preop - Left Preop - Right Preop - Top Preop - Back View Planned Graft Zone - Front Planned Graft Zone - Midscalp Planned Graft Zone Session 2 - Crown Postop - View 1 Postop - View 2 Postop - View 3 Postop - View 4 Postop - View 5 Postop - View 6 Postop - View 7 Postop - Top View Postop - Back View 1 Postop - Back View 2 Flap Donor Scar - Anterior Flap Donor Scar Graft Placement - Anterior Flap Donor Scar Result - Anterior Flap Donor Scar - Posterior Flap Donor Scar Graft Placement - Posterior Flap Donor Scar Result - Posterior Graft Placement - Front Hairline Graft Placement - Crown 1 Dr. Ray Konior is a highly esteemed member of the Coalition of Independent Hair Restoration Physicians. Link to comment Share on other sites More sharing options...
Administrators Melvin- Admin Posted January 26, 2020 Administrators Share Posted January 26, 2020 How on earth is a 34 year old receiving a fleming meyer flap procedure? This is absolutely insane. He is lucky to have found you @Dr. Raymond Konior it truly baffles me how some surgeons are still performing outdated procedures, especially for patients who would benefit from the gold standard follicular unit transplantation. 1 I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice. Check out my final hair transplant and topical dutasteride journey: View my thread Topical dutasteride journey Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog. Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube. Link to comment Share on other sites More sharing options...
Senior Member Gasthoerer Posted January 26, 2020 Senior Member Share Posted January 26, 2020 +1 I had to re-read twice to make sure it did not say 34 years ago. He must be over the moon now. 400+ grafts in 2018 and 2900 grafts in 2020 via FUE with Feriduni Link to comment Share on other sites More sharing options...
Senior Member OliverAtom Posted January 29, 2020 Senior Member Share Posted January 29, 2020 On 1/26/2020 at 6:51 PM, Melvin-Moderator said: How on earth is a 34 year old receiving a fleming meyer flap procedure? This is absolutely insane. He is lucky to have found you @Dr. Raymond Konior it truly baffles me how some surgeons are still performing outdated procedures, especially for patients who would benefit from the gold standard follicular unit transplantation. +10000 Totally agree with you Melvin. It´s insane and it should be banned somehow to use other options over FUE when it´s possible. A total pity some clinics are taking advantage of uninformed and desperate patients : ( Link to comment Share on other sites More sharing options...
Pete-from-Farjo Posted January 29, 2020 Share Posted January 29, 2020 What an interesting case. Shocking that he's had a flap procedure in this day and age. He looks so much better now. Completely natural. Great repair job. I am an online representative for Farjo Hair Institute Dr. Bessam Farjo is an esteemed member of the Coalition of Independent Hair Restoration Physicians I am not a medical professional and my words should not be taken as medical advice. All opinions shared are my own. Link to comment Share on other sites More sharing options...
Regular Member Ads Posted January 31, 2020 Regular Member Share Posted January 31, 2020 Fantastic repair work, completely natural looking result. Link to comment Share on other sites More sharing options...
Senior Member stephcurry30 Posted February 14, 2020 Senior Member Share Posted February 14, 2020 What a result. Can someone aware me what a flap is? they cut out a section of hair from the back side (similar to FUT) except they place the entire piece as a hairline? Link to comment Share on other sites More sharing options...
Moderators Al - Moderator Posted February 15, 2020 Moderators Share Posted February 15, 2020 2 hours ago, stephcurry30 said: What a result. Can someone aware me what a flap is? they cut out a section of hair from the back side (similar to FUT) except they place the entire piece as a hairline? That's basically it. It was done mostly in the 1980's and early 90's to fix a receding hairline. This was in the days when hair transplants were done with 4mm plug grafts, so the only way to get somewhat of a natural looking hairline was to do a flap. Once hair transplant grafts got small enough to look natural in a hairline flaps became outdated. Al Forum Moderator (formerly BeHappy) I am a forum moderator for hairrestorationnetwork.com. I am not a Dr. and I do not work for any particular Dr. My opinions are my own and may not reflect the opinions of other moderators or the owner of this site. I am also a hair transplant patient and repair patient. You can view some of my repair journey here. Link to comment Share on other sites More sharing options...
killa Posted February 15, 2020 Share Posted February 15, 2020 I remember back in the day seeing flap Tv ads. Thank god flaps fell out of favor. But believe it or not theyre still performed. Guess maybe for special cases. Link to comment Share on other sites More sharing options...
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