Dr. Patrick Mwamba

Number of grafts on itself doesn't mean anything. In hair transplant two concept are very important : 1.Density = number of grafts per unit surface ( hair surgery covers this aspect 2. Coverage or volume which depends on density , hair caliber , hair pigmentation in contrast with skin color , hair lenght to only name these principal factors . The total surface of the upper scalp is 100 cm2 and the vertex could also measure around 100cm2 If you graft 3000 grafts on top and frontal zone , you will. reach 30fu/cm2 ( which is a very low density compared to our natural density that averages 80 to 100 fu/cm2). If you want to reach that natural density with 3000 grafts , you have to do it in only 35 to 40 cm2 . That' the reason why we concentrate this number of such a small surface . And as Mustang mentioned , to match the hair piece density so you create harmony between natural hairs with the hair piece . And in this specific case , it blends pretty well and I am happy for the patient . And in this case it blends pretty well and I am happy for the patient .

Hello everyone , The topic about Hair transplant surgery in young patient is very very important . I alrready did a presentation about it during a meeting of ISHRS . It is very complex and implies to consider many factors before you take your decision ; it is far away from black and white or yes or no answer. When I started Hair transplant surgery in 2000 , it was forbidden to do HTS on young patient up to 35yo ;it was forbidden to do HTS on female patient : It was not advisable to perform HTS on Afro hairs ,... Slowly the age in AGA patient went from 35yo to 30 yo ; then female were allowed to do HTS under certain circumstances ,etc... AGA or Male pattern Baldness is triggered by the combination of DHT ( a by product of testosterone ) and the Androgen Receptor . The pic of testosterone is between 20 and 30 ( the big one ) and between 50 and 60 ( the small one ). These two period are the most vulnerable where patients suddenly experienced a massive shedding or an acceleration of balding . Hair surgery is just a redistribution of the capital hairs you have in your donor to your balding area called recipient. Hairloss is progressive and never stop .Therefore results are unpredictable on a long run .The early you start the worst you can get ( probable not certainty and I insist ) . The secong big threat for our hairs is stress ( which involves psycholgic factors ).And today we are observing more people suffering from baldness at early ages because of stress level in our society . when it comes to young. patient , you need to wieigh the psychologic impact vs the unpredictability of hairloss progress before you make a decision .Sometimes you need a help of a psychiatrist to take that decision . Now if you take the option of pursuing surgery in such patient , you need to understand the burden and the heavy task you load on your shoulder to keep up with your patient.It is a big responsabilty and a long. journey which can have many psycholigic impact on that patient. THE FIRST PRINCIPLE IS DELAY ANY SURGERY AS LONG AS YOU CAN HANDLE YOUR HAIRLOSS EMOTIONALLY . There is a statistic that we are missing today and I asked it to my colleagues many times with no clear answer : what is the percentage of young patient in their twenties who started medical therapy against hairloss and turned to become NW7 later on ? During my twenty years inthis field , I didn't witness someone under medication who qualifies for it .If it exists , the percentage of such event is low and not common.The risk of side effects with finasteride is low ( we usually claim that only 2% get serious side effect with this medication ).Some physicians forbid their patient to take it and others allow them ( making them sign consent forms ) because it is unpredictable.If you are willing to not let your patient deal with that alone , then you can take the risk . My task as a physician is to determine who is emotionally capable to be qualified for such surgery and it becomes very serious when we have to perform surgery on someone under 30 years old .They are not mature enough and it is a period of insecurity when it relates to self confidence and self esteem .You miss it , you will face catastrophy big time. But you can not exclude them just because of their age ; you need to listen to them and bring them the appropiate therapy to their conditions . Avoid short cut such as give them medical therapy and let them deal with their condition when we all know that medical therapy is not a miracle cure .We need to provide them with proper support : medical therapy , psychologic advices and if necessary surgery as the last resort .

Time line of hair growth after surgery varies a lot from patient to patient . If you read the textbook of hair transplant surgery , it stipulates that : -At 6 months , you should expect 50% growth , at 9 months , 90% of growth and at 12 months , 100 %. we have seen very good result at 6 month and we also witnessed some delayed result up to 12 month. A lot of clinics post their result at 6 month because it has a wow effect .It doesn't mean that all the results have to occur at that time . What is the Hair cycle timeline in general ? Anagen phase ( or growing phase ); 4 to 6 years Catagen phase ( or involution phase 😞 3 to 4 weeks Telogen phase ( resting phase ) : 3 to 6 months . Hairs grow at the speed of 1 cm per month ( roughly ) . After a hair transplant surgery , grafts go through the catagen phase ( that's the reason of hair shedding 3 weeks to 4 weeks after the surgery ) . From that point , it enters the telogen phase;it means , the hairs will start to grow either around 4 months post op or 6 months post op . If it started to grow at 4 month post op , expect to notice it around 6 month; but if it started to grow after 6 months in telogen phase ; the first grow will occur at 7 months post op and you will notice result around 9 months post op . From 9 month to 12 month , it is usually hair maturation that will occur .That's the rationale behind this timeline. We use all means to speed up the process : medical therapy , vitamins intake , etc... If no shedding post op , expect full result by the 3rd or 4th month after surgery . The further you wait , the less the probability of great result but we have cases that surprised us .Again , guidelines purpose is to help us and not to cover our behinds .Patience is a key factor in this particular surgery .

Hello Mr D , Slow growth or poor growth can happen after a surgery . One of my task is to follow the guidelines while assessing your case . We have to find the cause of poor growth ;if we find why it didn't take , we can correct the shot . See you soon for your follow up consultation .

10% ATP in the hypothermosol + ATP solution . In practice :13.5cc hypothermosol + 1.5 cc ATP

LET ME TALK NOW ABOUT TIME OUT OF THE BODY FOR GRAFTS IN HAIR TRANSPLANT SURGERY . STUDIES MADE BY DR BEEHNER . A GRAFT LEFT OUTSIDE THE BODY , AT FREE HAIR , WILL BE DESTROYED IN LESS THAN ONE ,MINUTE . IN A CHILLED SALINE SOLUTION ( THE MAJORITY OF CLINIC IN THIS INDUSTRY ) , THE GROWTH RATE WAS ABOVE 90% , AFTER 6 HOURS . BEYOND 6 HOURS , WE STARTED TO NOTICE DECREASE IN GROWTH RATE . DR COOLEY DID SOME EXPERIENCE WITH GRAFTS KEPT IN HYPOTHERMOSOL AND THE SURVIVAL RATE 24H LATER WAS ABOVE 90%. THAT'S WHY , I AM USING IN MY PRACTICE A COMBINATION OF HYPOTHERMOSOL AND ATP IN MY PRACTICE TO AVOID TIME OUTOF THE BODY LIMITS. SALINE SOLUTION COSTS LESS THAN 5 USD A BOTTLE . HYPOTHERMOSOL COST 120USD A BOTTLE OF 20ML ATP COST AROUND 50 USD FOR A BOTTLE OF 10ML . A LOT OF DOCTORS FEELS LIKE IT IS NOT NECESSARY TO USE THIS EXPENSIVE SOLUTION . I BELIEVE THAT EVERY DETAILS COUNT ESPECIALLY IN A FIELD LIKE HTS WHERE DETAILS MAKE THE DIFFERENCE IN THE FINAL OUTCOME .

This thread makes me hesitant to book Mwamba for a procedure. I dismissed red flags mentioned of my previous surgeon and have paid the price for that. Don't want to make the same mistake. YOU ARE RIGHT ALEX . HTS OR ANY COSMETIC SURGERY OR SURGERY IN GENERAL , WE NEED TO HAVE A MUTUAL TRUST BETWEEN THE DOCTOR AND THE PATIENT . IF THERE IS DOUBT , BETTER NOT TO PROCEED .WHY ? BECAUSE , RESULTS AND OUTCOME ARE NEVER GUARANTEE AT 100% AND IT TAKES TRUST TO CONSENT FOR THAT .

2nd figure : patchy area of poor growth .Most of the time , it is due to poor blood circulation due to deep incision ( doctor responsability ) , or chronic folliculitis .The last one can occur because of MRSA on patient's scalp ( staphylococcus ) ( not the fault of the doctor ) or foreign body reactions ( transection rate ( Dr Dr's fault ) , poor hygiene of the scalp ( patient's fault ) , physical trauma ( patient bumped his scalp on something that dislodged the graft ). Poor growth can occur due to uv exposure for long time 9 patient's fault ) , other major surgery within 6 months post op , etc... That's why we have to do an in person consultation to really understand what happened , determine the responsibility and move forward . there is no winner when such things happen .Let's work together , honestly and with trust .That's the only way we can find decent solutions that will allow everyone to move forward with their lives .

there is a guideline to assess poor growth after surgery : 1. No growth :suspect scarring alopecia such as lichen planopilaris and others .To detect them , you need to do a scalp biopsy .Why don't we perform scalp biopsy on all patients? Because the probability is low . This is not Dr 's fault unless the patient had clear signs of the disease and the doctor missed it at the examination with the dermatoscope . Few signs of scarring alopecia or primary cicatricial alopecia : pores closed, perifollicular erythema , shiny scalp , perifollicular cast , etc... If you do not have these signs , the patient could still have a scarring alopecia that is beginning and this will impair the growth . There was also a debate about lichen planopilaris ( responsible for many poor growth in HTS). Can HTS trigger or induce lichen planopilaris ? Because before surgery , nothing suggested this diagnosis ? In this case , it is not always dr's fault

I care about my patients .This is the first time someone feels like i do not care and I have been in the industry for more than 20 years . Outstanding results is not in every case but patient's care is one of our goal .

The doctor , the patient and the team want to get it done as fast as possible . Hair surgery gives you a result that will last your entire life . I will never rush when I feel that this case is very sensitive . We have thought to reduce to one case per day . Then , financially , it will be unbearable because we will need to compensate it by increasing the price . We prefer to make it a little bit longer ( take enough breaks to recover , recuperate and continue the surgery ).It is never good to work when tired .I take long breaks and when I feel good , I get back to work .Because I am involved in every step of the procedure . Everyday with my team , we are working on how to ease the entire process .Unfortunately , I got a lot of repair cases and those are very difficult cases . If I had to treat only virgin patient and performed the shaven technique , my days will be way shorter . I really thank you for your input and we will try to improve our protocol and procedures to achieve in the limit of our abilities your goals .

Price for surgery is according to the amount of work that will be done and not linked to the result we got to produced . All the patients sign a consent form that clearly mentioned that . Why , when things go wrong , they forgot what they agreed in the first place? We strive to accomplish every time the best in the limit of our abilities . And sometimes it leads to longer surgery .

Hello , Surgery , especially when it is a repair case , takes a lot to get it right . Free touch up makes sense only when a patient comes back for in person consultation .We need to assess the result and try to answer the WHY ? OF POOR GROWTH before we jumped to any conclusions . Poor growth is not always the doctor's fault ?It could be inherent to the patient's condition and in that case , we assess case by case physically , emotionally and financially . We didn't close our door in this case but we can not move forward without an in person consultation .

WHAT IS THE DENSITY FOR FHL IN AFRO HAIRS ? I presented a topic at the ISHRS meeting about the topic . Because we use singles and doubles to build the FHL , you have to do the same density as in caucasian ( 50 to 60 FU/cm2) to got a decent coverage . The curl and the caliber to reduce the density plays for behind .You need to use soft hairs from nape ;otherwise it may look pluggy . Same apply to coarse asian hairs .You can not put them in the hairline.You need to chase fine and soft hairs to make it look natural .Therefore you need to apply the same principle for density in hair line . We can all share others concepts about coverage , hair volume and hair density .

Hello everyone , I read the thread and i would like to tackle some issues . Repair cases is a though call for both the patient and the physician. The donor area was depleted .Surgery outcome depends a lot on donor quality ( density , caliber , pigmentation).And the goal of the patient was to fix the donor and to lower the hairline. My first recommendation was 2000 to 2500 grafts , to couple with SMP. My staff told me the patient can afford only 1500 grafts .I can not expect a full coverage by lowering the number of grafts but I was shooting for an average , decent coverage that could bring us back on track with a little bit camouflage from SMP and other artefacts. For me , this procedure was a first step as we had to deal with harmonizing the look of the donor and lowering the hairline.And I didn't do even 1500 grafts but only 1300 grafts :WHY ? Donor management was my first goal . Communication and misunderstanding of the entire process is the first issue to resolve in our next meeting. Unrealistic expectation usually leads to unsatisfied patients.And it is my role to let the patient know this is not a one shot or a home run procedure .All the ingredients were not present .This is a marathon . And it is my failure if the patient didn't get it correctly.

Looks like some thinning on your vertex . Consult a hair transplant doctor for scalp analysis . In the meanwhile , you can start taking some hair vitamins ( Help Hair vitamins + Help Hair whey proteins ).It won't hurt you and it is always beneficial to slow down hair loss progression and improve hair quality . After the diagnosis , the doctor will adjust the treatment ( adding some others staff if necessary ).

Hi Vinza , Do your homework and follow this steps : 1. Post your pictures in the forum .You will have input and different opinions .But remember , you know what suit you the best .What bothers you the most ( the front , the back or all ).Statistics show that 60 to 70 % of patients will have a second surgery during their lifetime .Don't restrict yourself .There is no guarantee it will work 100% the first time .Be open to do a touch up if needed to get you where you want . 2. Schedule an in person consultation with doctors ( at least 2 or three ).They will do an in depth analysis of your scalp with dermatoscope and propose you a lifetime treatment plan . Medical therapy and surgery ( for me ) is a requirement to achieve your goal especially if you don't want to do many surgeries down the road . 3. Choose your surgeon . 4.Dr Erdogan is a highly recommended doctor ( send him pictures with enough details about your hair loss and you will get his feedback ). We are offering in person consultation in our clinic in Atlanta .( customer.care@mywhtc.com ) or you can also contact me .

Medical therapy at this point will be sufficient for you : 1. Antishedding treatment will prolong your anagen phase ( or growing phase of your hair cycle ) and improve hair caliber, hair lenght and hair pigmentation : Finasteride 1mg once per day for 1 year + Help Hair whey protein ( 3 times per week ) . 2. Stimulants will somehow reverse your hair cycle and improve hair quality ( caliber and pigmentation ) : Minoxidil , laser cap , vitamins for hairs , ... are among products to choose . The treatment will slow down your hair loss progression and improve your hair quality providing you a better scalp coverage .

nice work

you need 2000 in the back and 1000 to 2000 in front + prp + medication A lot of grafts .FUT will be the option if you are sure to keep your hair longer ( because scar is never predictable ) . If you plan to keep it short , go for FUE .The dots are not very noticeable in my sample of black patient .

Prp works but the outcome is person dependent . In my experience , it stopped hair shedding and improve hair quality . I rarely noticed new growth . I used it alone ( 3 times first year and then once a year for maintenance ) or twice a year with Acell. I activated my prp by performing dermabrasion . I encourage patient to combine it with laser cap and Help hair whey protein or minoxidil with help hair whey protein .

As. cosmo said , a little bit thinning on temples points but very good density in hair line . Finasteride works pretty good on young patient .You need to be aware of side effects , rare but real ( decrease libido is the most common ) . If you do not have active shedding ( your hairs all. over the place i.e. on your pillow , computer , shower , etc...) , I will recommend Help HAir whey protein + help Hair vitamins + Minoxidil . Help Hair protein will lower the inflammation around the bulb and prevent your hairs to go in resting phase ( same thing finasteride does by blocking DHT ) and minoxidil will stimulate your hairs and reverse the hair cycle .

2000 grafts to fill in front and top . Patients is under following treatment : Help Hair whey protein + vitamins , Rituel Rene Furterer once a week . Results after one year post op . CX available in ATL and BXLS .

You are wrong in your judgement .I know Dr Erdogan and I admire his work . But when there is a post , we need to stay objective and reveal what went wrong and what went right .It helps each one of us to improve our quality work . The results you are presenting are mine and you are right to point what went wrong : - The first case was a repair case with pluggy grafts .The goal or purpose was to show that you can not at the same time remove grafts and rebuild a new hair line but we made a big improvement .I can post the entire case with many pictures for you to appreciate the work . - The second patient is at 6 months and I totally agree is not awesome .We need to be fair enough to present realistics results .I can choose to present only my best work and that's not right for the patients . There is no jealousy , not competition .Be real with yourself. And you didn't mention I said good result and good coverage in one session ( and we know how it is hard to achieve it in FUE ) .But you just focused on the negative comments I made .It is not fair .Balance your input .Thank you

Yes any inflammatory skin disease can lead to hair loss . Anytime , you got inflammation , you trigger the catagen phase and consume one hair cycle .If the inflammation is chronic , it will consume all the cycles and your hairs won't grow back. That's why it is important to treat skin condition in order to prevent hair loss as a secondary consequence . Whey protein is antinflammatory and anabolic at the same time .You need to find the right balance . The WPI is more anabolic ( that's why we like to use them for muscle gain ) .It means , the testosterone will be high and therefore DHT and hair loss . The WPC is less potent anabolic .But if you exagerate its intake , you will increase the testosterone and DHT to a critical level .That's why it is important to follow the instructions in order to benefit from this product .