Dr. Raymond Konior Posted May 29, 2020 Share Posted May 29, 2020 This 50 year old man presented with a history of multiple failed hair restoration procedures. At a young age he underwent several large-graft plug sessions and a midline scalp reduction. He reported that the majority of the plugs failed to grow and what did grow left him with unnatural patches of pluggy hair. The scalp reduction resulted in an exposed midline crown scar. More recently he gained knowledge about the use of FUE and underwent a large session hoping to enhance his appearance. Unfortunately, the FUE restoration proved to be a failure with no apparent graft survival. Sadly, his scarred and unnatural looking scalp had committed him to a life of wearing a hat or hair piece at all times. His examination revealed a small zone of plug hair in the right and left frontal hairline. The bald frontal scalp showed evidence of many “empty” or nearly-hairless plugs, as well as a large number of small, hairless scars, these a result of the failed FUE procedure. A midline scalp reduction scar was obvious. The donor area was heavily compromised with extensive scarring demonstrated by multiple four-millimeter circular scars from the past plug harvesting and multiple one-millimeter circular scars from the more recent FUE harvest. Although his donor elasticity was judged adequate for strip harvesting, the classic central donor harvest zone demonstrated moderate to extensive circular scarring, as well as poor quality residual follicular-units, these a result of collateral damage from past plug harvesting and his most recent attempt at an FUE harvest. Fortunately, he revealed good quality hair in the chest and beard regions. Recommendation for repair was made which proposed use a multi-stage, prioritization plan to restore hair with the frontal region having the highest priority and prioritization decreasing in a front-to-back fashion moving toward the crown. The plan proposed an initial salvage strip harvest in the lax but scarred central donor area, followed by FUE using selective harvesting from scalp areas continuing to have accessible follicular units and supplemental body harvesting from the chest and beard areas. Presented here is a chronological review of his initial four-stage repair. Session One - August 2017: 2700 Grafts (2400 Strip / 300 Chest FUE) – Front and Midscalp Placement Session Two – January 2018: 1550 Grafts (700 Chest FUE / 850 Scalp Temple Region FUE) – Crown Placement Session Three – July 2018: 1160 Grafts (1160 Scalp FUE) – Front and Midscalp Placement Session Four – February 2019: 1300 Grafts (900 Scalp Nape Region FUE / 400 Chest FUE) – Temple Points, Left Part and Crown Placement Postop Final Pics – One year from the final session; two and one-half years from the first session. Comment: Grafts harvested from the scalp were deemed lower quality because of the extensive prior harvests causing residual scarring in the central donor region and collateral damage to the remaining follicular-unit donor population. Chest hairs, although considered excellent with respect to texture and color, were predominantly low-caliber, single-hair units. Despite these quality issues, the patient was able to achieve adequate density and coverage such that he now lives a comfortable life without any need for a hair piece or hat. Future restorations using additional chest hair and beard hair are in the making. Preop Top View Preop Back View Preop Left Preop Right Hairline Plan Graft Zone Plan Day of Surgery Graft Placement Two-Week Postop Five-Month Postop Front Five-Month Postop Top Session-Two Graft Zone Session-Two Graft Placement Session-Two Body Donor Preop Session-Three Front Preop Session-Three Left Preop Session-Three Back Preop Session-Three Top Session-Three Graft Placement Preop Session-Four Front Preop Session-Four Tipped View Preop Session-Four Top View Preop Session-Four Part View Session-Four Graft Plan View 1 Session-Four Graft Plan View 2 Session-Four Part Graft Placement Session-Four Temple Point Graft Placement Session-Four Crown Graft Placement Final Result Front View 1 Final Result Front View 2 Final Result Left View 1 Final Result Left View 2 Final Result Left View 3 Final Result Left View 4 Final Result Left View 5 Final Result Left View 6 Final Result Right View Final Result Top View Final Result Back View 3 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...
Regular Member experion Posted May 29, 2020 Regular Member Share Posted May 29, 2020 Very nice results...any benefit of splitting over two and half years instead of 3-4 days continuously? Link to comment Share on other sites More sharing options...
Senior Member hairlossPA Posted May 29, 2020 Senior Member Share Posted May 29, 2020 very good result Link to comment Share on other sites More sharing options...
Senior Member CosmoKramer Posted May 29, 2020 Senior Member Share Posted May 29, 2020 Nice work! Link to comment Share on other sites More sharing options...
Senior Member Britanium Posted May 29, 2020 Senior Member Share Posted May 29, 2020 This guy must be happy to get that kind of result after so many outdated and failed previous procedures. Link to comment Share on other sites More sharing options...
Regular Member Happyout Posted May 30, 2020 Regular Member Share Posted May 30, 2020 This is an amazing result from an obviously difficult starting point.If i thought that from afar id imagine the patient must be thrilled. A blinding result Link to comment Share on other sites More sharing options...
Senior Member Future Hair Doc Posted May 30, 2020 Senior Member Share Posted May 30, 2020 Amazing results! My advice does not constitute a patient-physician relationship nor as medical advice and all medical questions/concerns should be addressed to your medical provider. Link to comment Share on other sites More sharing options...
Senior Member hairlosscpa Posted May 30, 2020 Senior Member Share Posted May 30, 2020 Amazing! And pics of the donor pre and post? Thanks 1st Procedure, Oct. 2012 - 1,704 grafts FUT w/Dr. True 2nd Procedure, Sept. 2015 - 2500 grafts FUE w/Dr. Vories FUE Progress - http://www.hairrestorationnetwork.com/eve/180966-my-experience-w-dr-vories-2-500-grafts.html FUE 1 year result - http://www.hairrestorationnetwork.com/eve/184716-1-year-results-2-500-grafts-w-dr-vories.html Link to comment Share on other sites More sharing options...
Senior Member harry_potter1 Posted May 31, 2020 Senior Member Share Posted May 31, 2020 Great result Link to comment Share on other sites More sharing options...
Dr. Raymond Konior Posted June 5, 2020 Author Share Posted June 5, 2020 On 5/29/2020 at 8:29 AM, experion said: Very nice results...any benefit of splitting over two and half years instead of 3-4 days continuously? This restoration was performed over one and a half years, not two and a half years. There was a one year interval after its completion which is when the final photos were obtained for presentation here. There is no reason any ethical surgeon would force a fast-track restoration. First, the patient had been operated on by several physicians with nothing positive to show in terms of graft survival. An experienced surgeon would first question whether the patient had some intrinsic healing predisposition that compromised graft survival. Committing to a one-shot restoration would have proved disastrous should his limited supply have been fully depleted with a resultant low yield as had been experience in his prior procedures. Second, he had a highly compromised donor site with extensive scarring and lower quality residual follicular-units. Attempting the one-shot approach would have risked an over-harvest of the scalp’s donor area with the potential for unacceptable visual thinning and detectable scars. Finally, a staged approach allows the surgeon to strategically build zones of coverage and density gradients based on the perspective of seeing what a prior procedure was able to accomplish. Understand that we are using a relatively small number of hairs to hide a vast expanse of scalp. It is the strategic integration of hair using density gradients, graft insertion angles and prioritization of placement zones that makes a little look like a lot. Thanks for all comments. 10 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...
Senior Member tressful11 Posted June 5, 2020 Senior Member Share Posted June 5, 2020 23 minutes ago, Dr. Raymond Konior said: This restoration was performed over one and a half years, not two and a half years. There was a one year interval after its completion which is when the final photos were obtained for presentation here. There is no reason any ethical surgeon would force a fast-track restoration. First, the patient had been operated on by several physicians with nothing positive to show in terms of graft survival. An experienced surgeon would first question whether the patient had some intrinsic healing predisposition that compromised graft survival. Committing to a one-shot restoration would have proved disastrous should his limited supply have been fully depleted with a resultant low yield as had been experience in his prior procedures. Second, he had a highly compromised donor site with extensive scarring and lower quality residual follicular-units. Attempting the one-shot approach would have risked an over-harvest of the scalp’s donor area with the potential for unacceptable visual thinning and detectable scars. Finally, a staged approach allows the surgeon to strategically build zones of coverage and density gradients based on the perspective of seeing what a prior procedure was able to accomplish. Understand that we are using a relatively small number of hairs to hide a vast expanse of scalp. It is the strategic integration of hair using density gradients, graft insertion angles and prioritization of placement zones that makes a little look like a lot. Thanks for all comments. Having undergone a botched transplant myself, I truly appreciate ethical surgeons like you. Your work including that of many other ethical surgeons on this forum restores my faith in the medical fraternity. I am truly hoping that I can manage to gather enough funds within the next few years so that I can get repair work done at your clinic. 1 Link to comment Share on other sites More sharing options...
Administrators Melvin- Admin Posted June 5, 2020 Administrators Share Posted June 5, 2020 Wow absolutely stunning, this has to be shared with the world 👏🏼 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 HTHope Posted June 5, 2020 Senior Member Share Posted June 5, 2020 11 hours ago, Dr. Raymond Konior said: This restoration was performed over one and a half years, not two and a half years. There was a one year interval after its completion which is when the final photos were obtained for presentation here. There is no reason any ethical surgeon would force a fast-track restoration. First, the patient had been operated on by several physicians with nothing positive to show in terms of graft survival. An experienced surgeon would first question whether the patient had some intrinsic healing predisposition that compromised graft survival. Committing to a one-shot restoration would have proved disastrous should his limited supply have been fully depleted with a resultant low yield as had been experience in his prior procedures. Second, he had a highly compromised donor site with extensive scarring and lower quality residual follicular-units. Attempting the one-shot approach would have risked an over-harvest of the scalp’s donor area with the potential for unacceptable visual thinning and detectable scars. Finally, a staged approach allows the surgeon to strategically build zones of coverage and density gradients based on the perspective of seeing what a prior procedure was able to accomplish. Understand that we are using a relatively small number of hairs to hide a vast expanse of scalp. It is the strategic integration of hair using density gradients, graft insertion angles and prioritization of placement zones that makes a little look like a lot. Thanks for all comments. Dr. Konior what are examples of intrinsic healing predispositions that compromise graft survival ? Link to comment Share on other sites More sharing options...
Dr. Raymond Konior Posted June 11, 2020 Author Share Posted June 11, 2020 On 6/5/2020 at 4:50 PM, HTHope said: Dr. Konior what are examples of intrinsic healing predispositions that compromise graft survival ? One would first have to consider the possibility of compromised graft growth arising from an intrinsic scalp scarring disorder such as lichen planopilaris where the skin essentially attacks the follicles with an end-result of low yield. Also, his history of multiple procedures most definitely had to be taken into consideration in that the many scars resulting from plugs, FUE grafting and the scalp reduction would have compromised his baseline scalp circulation. An aggressive graft plan could have been associated with a higher risk for low yield in the face of diminished baseline scalp circulation. The risks associated with a fast-track approach are unacceptable, especially when graft supply was considered tenuous at best, when a more deliberate and strategic approach would in theory increase the odds of a high graft yield, maximized coverage based on desired hairstyle, and a non-depleted donor area. 3 2 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...
Senior Member Gasthoerer Posted June 11, 2020 Senior Member Share Posted June 11, 2020 Wow, what a journey for this guy. 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 Triple7 Posted June 20, 2020 Senior Member Share Posted June 20, 2020 Truly amazing when you look at before vs after pic. Link to comment Share on other sites More sharing options...
Senior Member Spanker Posted June 26, 2020 Senior Member Share Posted June 26, 2020 Very impressive I am an online representative for Dr. Raymond Konior who is an elite member of the Coalition of Independent Hair Restoration Physicians. View Dr. Konior's Website View Spanker's Website I am not a medical professional and my opinions should not be taken as medical advice. Link to comment Share on other sites More sharing options...
Senior Member forgotpassword Posted May 26, 2021 Senior Member Share Posted May 26, 2021 Based on all the factors this is an incredible result July 2017 - Dr Cooley - 2575 grafts Link to comment Share on other sites More sharing options...
Senior Member stephcurry30 Posted May 27, 2021 Senior Member Share Posted May 27, 2021 The Tom Brady of Hair Transplants. Take a bow Link to comment Share on other sites More sharing options...
Regular Member HTP1 Posted June 18, 2021 Regular Member Share Posted June 18, 2021 I know this is an older topic, but this is incredible work. Link to comment Share on other sites More sharing options...
Regular Member BD99 Posted June 18, 2021 Regular Member Share Posted June 18, 2021 (edited) Still the best result I've ever seen, relative to starting point and available donor. Some true MacGyver stuff. Dr. Konior had a shoe lace and a stick of gum and still somehow ended up in a place where he could give this guy what many consider a luxury (temple points.) Just incredible. Edited June 18, 2021 by BD99 1 Link to comment Share on other sites More sharing options...
Administrators Melvin- Admin Posted June 18, 2021 Administrators Share Posted June 18, 2021 One of the best hair transplant repairs ever posted. 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 Britanium Posted June 18, 2021 Senior Member Share Posted June 18, 2021 Certainly the best repair I have ever seen ☺️ Stunning ! 🙏 1 Link to comment Share on other sites More sharing options...
Senior Member OliverAtom Posted June 30, 2021 Senior Member Share Posted June 30, 2021 On 5/29/2020 at 1:03 PM, Dr. Raymond Konior said: This 50 year old man presented with a history of multiple failed hair restoration procedures. At a young age he underwent several large-graft plug sessions and a midline scalp reduction. He reported that the majority of the plugs failed to grow and what did grow left him with unnatural patches of pluggy hair. The scalp reduction resulted in an exposed midline crown scar. More recently he gained knowledge about the use of FUE and underwent a large session hoping to enhance his appearance. Unfortunately, the FUE restoration proved to be a failure with no apparent graft survival. Sadly, his scarred and unnatural looking scalp had committed him to a life of wearing a hat or hair piece at all times. His examination revealed a small zone of plug hair in the right and left frontal hairline. The bald frontal scalp showed evidence of many “empty” or nearly-hairless plugs, as well as a large number of small, hairless scars, these a result of the failed FUE procedure. A midline scalp reduction scar was obvious. The donor area was heavily compromised with extensive scarring demonstrated by multiple four-millimeter circular scars from the past plug harvesting and multiple one-millimeter circular scars from the more recent FUE harvest. Although his donor elasticity was judged adequate for strip harvesting, the classic central donor harvest zone demonstrated moderate to extensive circular scarring, as well as poor quality residual follicular-units, these a result of collateral damage from past plug harvesting and his most recent attempt at an FUE harvest. Fortunately, he revealed good quality hair in the chest and beard regions. Recommendation for repair was made which proposed use a multi-stage, prioritization plan to restore hair with the frontal region having the highest priority and prioritization decreasing in a front-to-back fashion moving toward the crown. The plan proposed an initial salvage strip harvest in the lax but scarred central donor area, followed by FUE using selective harvesting from scalp areas continuing to have accessible follicular units and supplemental body harvesting from the chest and beard areas. Presented here is a chronological review of his initial four-stage repair. Session One - August 2017: 2700 Grafts (2400 Strip / 300 Chest FUE) – Front and Midscalp Placement Session Two – January 2018: 1550 Grafts (700 Chest FUE / 850 Scalp Temple Region FUE) – Crown Placement Session Three – July 2018: 1160 Grafts (1160 Scalp FUE) – Front and Midscalp Placement Session Four – February 2019: 1300 Grafts (900 Scalp Nape Region FUE / 400 Chest FUE) – Temple Points, Left Part and Crown Placement Postop Final Pics – One year from the final session; two and one-half years from the first session. Comment: Grafts harvested from the scalp were deemed lower quality because of the extensive prior harvests causing residual scarring in the central donor region and collateral damage to the remaining follicular-unit donor population. Chest hairs, although considered excellent with respect to texture and color, were predominantly low-caliber, single-hair units. Despite these quality issues, the patient was able to achieve adequate density and coverage such that he now lives a comfortable life without any need for a hair piece or hat. Future restorations using additional chest hair and beard hair are in the making. Preop Top View Preop Back View Preop Left Preop Right Hairline Plan Graft Zone Plan Day of Surgery Graft Placement Two-Week Postop Five-Month Postop Front Five-Month Postop Top Session-Two Graft Zone Session-Two Graft Placement Session-Two Body Donor Preop Session-Three Front Preop Session-Three Left Preop Session-Three Back Preop Session-Three Top Session-Three Graft Placement Preop Session-Four Front Preop Session-Four Tipped View Preop Session-Four Top View Preop Session-Four Part View Session-Four Graft Plan View 1 Session-Four Graft Plan View 2 Session-Four Part Graft Placement Session-Four Temple Point Graft Placement Session-Four Crown Graft Placement Final Result Front View 1 Final Result Front View 2 Final Result Left View 1 Final Result Left View 2 Final Result Left View 3 Final Result Left View 4 Final Result Left View 5 Final Result Left View 6 Final Result Right View Final Result Top View Final Result Back View Ohhhh my God!!! Look at this repair 😲 What a marvellous work by Dr Konior! Congratulations to both the clinic and the patient who was brave enough to go for this. Love it!!! 😍 Link to comment Share on other sites More sharing options...
Regular Member gentel_man83 Posted July 23, 2021 Regular Member Share Posted July 23, 2021 Outstanding result 👏 👏 Link to comment Share on other sites More sharing options...
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