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This 50 year old male requested hairline restoration along with some conservative coverage in the crown.  His exam revealed an advanced pattern of loss and very fine hair throughout the donor area.  The limitations of coverage associated with fine hair and an advanced pattern were discussed in detail and a plan was devised to best suit his goals.  A 3160 graft restoration was performed with density gradients designed to bias graft distribution in the hairline and left-part.  In light of his very fine hair, the strategy of using a thick-to-thin transition along front-to-back and left-to-right vectors was deemed best for his overall needs.  Immediate graft placement views demonstrate the density gradient plan that was implemented.

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preop front

 

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preop top view

 

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preop back view

 

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planned graft zones front view

 

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planned graft zones left-side view

 

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postop front view 1

 

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postop front view 2

 

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postop front view 3

 

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postop comb-back view front

 

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postop top view

 

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postop back view

 

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postop left-side view 1

 

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postop left-side view 2

 

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postop comb-back view left-side

 

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immediate graft placement front

 

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immediate graft placement crown

Edited by Dr. Raymond Konior
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Fantastic results as always 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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Great use of a limited number of grafts in a large area! The graft distribution plan was very clear in the immediate post-op pic.  I assume this was an FUT (?), and that this patient might want another procedure down the road. 

Dr. G: 1,000 grafts (FUT) 2008

Dr. Paul Shapiro: 2,348 grafts (FUT) 2009 ~ 1,999 grafts (FUT) 2011 ~ 300 grafts (Scar Reduction) 2013

Dr. Konior: 771 grafts (FUT) 2015 ~ 558 grafts (FUT) 2017 ~ 1,124 grafts (FUE) 2020

My Hair Transplant Journey with Shapiro Medical Group

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On 12/5/2020 at 5:56 AM, Dr. Raymond Konior said:

In light of his very fine hair, the strategy of using a thick-to-thin transition along front-to-back and left-to-right vectors was deemed best for his overall needs

 

@follically challenged I think what he means is that they placed thicker density in the hairline compared to further back (pretty obvious why one would do that). But also placed thicker density on the left side compared to the right (you can clearly see this in the immediate post-op pics) - this is because the patient would be parting his hair from the left side and so would need stronger density to not show as much skin, whereas the right side can benefit from the combover effect. Very judicious usage of grafts.

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On 12/5/2020 at 9:00 PM, stephcurry30 said:

Terrific result. Will the patient be coming in for a follow up to fix his crown??

His goals were primarily devoted to hairline restoration.  As of his last follow-up he was happy with his hairline and the appearance of a thinning crown.  Should he opt for a second session later in life, an FUE harvest would be recommended because of limited elasticity following the strip harvest.

5 hours ago, giegnosiganoe said:

@follically challenged I think what he means is that they placed thicker density in the hairline compared to further back (pretty obvious why one would do that). But also placed thicker density on the left side compared to the right (you can clearly see this in the immediate post-op pics) - this is because the patient would be parting his hair from the left side and so would need stronger density to not show as much skin, whereas the right side can benefit from the combover effect. Very judicious usage of grafts.

You are spot on correct with your assessment.  A homogeneous graft distribution with his fine hair would have be certain to leave a less-than-ideal result with a weaker part and hairline.  Prioritization of those two areas was deemed high for this man.

2 hours ago, follically challenged said:

Interesting. I would have thought this may look strange but it seems to have worked.

Does Konior have a YT channel? Seems good work but cant find much recent stuff about his work...only videos from 8 years ago...

Gradient grafting is quite routine for the vast majority of men where achievable densities are anything less than dense-pack.  Understand that we almost always graft with an end result that leaves a density deficiency, i.e. we do not restore full density with single-session hair restoration.  Strategic graft distribution aims to make a "little" look like a "lot".  

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