KO

Dear god no.

I wanted to share my recent experience with Dr Lupanzula in Brussels. I've benefited a lot from reading people's experiences and watching their surgeries mature over the years before choosing to take the plunge, and in turn I hope somebody will find mine helpful. Thank you to Dr Lupanzula and team, and I want to give a shoutout to Mickey85 and Joe-who-must-not-be-named. Both have helped me tremendously over the years when I was researching HTs and helped me with my decision. I will follow up with pictures soon. Hotel After arriving from Brussels, I took a cab to the Hotel Catalonia (didn't want to bother with public transport). I had thought the hotel's name sounded familiar, as it turns out, it is directly across the street from Dr. Bisanga's clinic (which looks a little bit like a castle). So it's nice that they regularly get HT patients. The hotel is affordable, and in a nice area. The Area The surrounding area is very picturesque, very old world, and not heavily populated. Most people speak English well, so you can get around. The main language here is French, and it's helpful to know it. But you can get by with English. Near the hotel there is a Chez Frances restaurant for breakfast, and a nice Thai place called Thai Cafe. I chilled in the area for a day before heading to the clinic. The Clinic The clinic is about a ten minute walk directly south from the Hotel Catalonia. Upon entering, I was greeted by the clinic's patient coordinator Giancarlo. Giancarlo is fluent in multiple languages. The clinic has a very modern design, very "Bauhaus", with plenty of white, and clean lines throughout. Consult We then met with Dr Lupanzula. He looked through my donor and recipient, and went over my family's history. He noted that while the area to cover was significant, I was a good candidate for a few reasons: 1) Good donor hair - coarse, wavy hair that aids in the illusion of coverage. 2) Darker skin, which reduces contrast, and 3) A good number of multi follicular units. He snipped off hairs to measure the shaft caliber. Then he shaved my head. I admittedly was not looking forward to this. But it was a good idea, not only does it save time the next morning, it puts you in the "zone" mentally for surgery. What's more, I decided that a shaved head, while not the best look, wasn't the worst one either for me, so it's good to know. Post shaving, he measured my donor density under magnification, with the parietal areas having just below 100 grafts/cm and the occipital around 110. He estimated that my donor capacity, if we harvested 30%, would be around 7,000 units, and if we harvested 40% (which would be on the border of over-harvesting), about 9,000. All in all, he considered me a good candidate. He drew a hairline, which I was fine with. I wanted a conservative hairline, but at the same time we still want to make a visual impact. The plan was to harvest and implant most of the grafts on day 1, with the hairline to follow on day 2. Day 1 Day 1 began early, since you're supposed to eat before, I grabbed some croissants from a bakery right across the corner that happened to be open at 6:30am. The Dr gave me the meds and it was time to roll. After changing into hospital scrubs, he gave me anesthetic injections in the back of the scalp. Btw, I knew anesthetic injections were the most painful part of the surgery, and it was true, I found them to be very painful, and they are required multiple times throughout the surgery as a different area is operated, either for harvesting, or implantation. Then again, they are obviously required, so there is no getting around it. Dr Lupanzula uses a a CIT handle manual punch to score grafts. He harvested grafts from the back and sides, one after another. He has a distinctive punching motion where at the end of the forward twisting motion he pushes in the tool slightly, which was noticeable. Afterwards, the grafts were plucked out. This is a weird feeling, you feel a slight popping sensation, similar to how a grape or a berry is plucked off the stem. Keep in mind, you have to stay very still during the procedure, and notify the Dr before moving. Staying still can get difficult when the parietal areas are being harvested because you are lying on your side. The team inspects the grafts under microscope and prepares them for re-implanting. Grafts are stored in ATP Hypothermosol. After harvesting we had lunch. The clinic eats lunch together in their break room, which is nice. Everybody in the clinic speaks English, so language is never a problem. Implantation Two steps to implantation, recipient site creation and placement. After anesthesia, the doctor used needles to make incisions. This is an interesting process. He moves very quickly in creating the incisions. There is a lot of power, and you can feel the fibrotic scalp being punctured. Given the speed and power, it feels powered by a machine, but it is manual. This process is actually surprisingly pleasurable. Who would think that having 2-3,000 holes poked into your scalp feels good, but it does. Patients who have been operated by the implanter pen also report the same thing. Afterwards, his team places the grafts. This last part takes time. Afterwards they had me bandaged, and I was off to the hotel at about 6pm. Afterwards, I sprayed my grafts every 15-20 minutes with saline. Day 2 This day was going to be shorter by design, as 2K grafts were harvested on Day 1 with 1K to follow. The same process followed as the day before, however we were done earlier. Then the clinic bandaged me up and I headed home. Day 1 Postop Day 1 was the first clinic hair wash. His wife, Sandra washed my scalp, spraying Betadine shampoo on both donor and recipient, and massaged the donor vigorously, and then applied an antibiotic creme to the donor. This is to be done everyday for the first 7 days (which I have done) and afterwards the recipient site should be gently massaged after applying Betadine shampoo. The clinic had a driver take me to the airport afterwards for my flight. I had originally chosen to fly immediately to avoid traveling while swollen, but I didn't experience visible swelling, in retrospect, I would have stayed in Brussels longer, just to give my grafts more time to set before moving. The flight was fine, and to note, it was not uncomfortable or painful to fly after surgery. I had a neck pillow to prevent the donor area from touching the seat rests. I wore a bandanna outside, but took it off when inside the plane, and regularly sprayed with saline. I have finished 1 week postop, and the clinic has remarked that all looks appropriate. Stats: Single: 621 Double: 1,295 Triple: 1,183 Quadruple: 261 Quintuple: 21 Sextuple: 1 Total Grafts: 3,382 2.34 hairs/graft Hair caliber: parietal/temporal: 55-60 mic., occipital: 60-70 mic. Density: 45 grafts/cm in outlined area, 40/grafts/cm behind it. Medications: Finasteride and Dutasteride alternated daily, Minoxidil Foam 1x day.

Nope. Minoxidil's max solubility in propylene glycol is about 7.5%, and when you put it on the scalp it mixes with water etc, so it drops further. 10% won't do you any good.

I've criticized this particular surgeon multiple times in the past, he doesn't brlong here.

You guys think Bhatti is bad? Don't look at Madhu....

^Not saying Karadeniz is the best, but if we're only limiting it to Turkey, he probably deserves a look. That said, I think he is as good as many of the recommended surgeons on this site. But people have vastly differerent expectations when it comes to surgery.

For Turkey: Demirsoy, Keser, Karadeniz. Personally, I would consider Alejandro Chueco over the Turkish surgeons. He's roughly $2-$3/graft. Are people really shopping for the cheapest procedure?

Ok, so while growth was poor, it doesn't visually look like a disaster, so that's good. I'd consult with a few respected surgeons, they'd be able to give you a better answer than forum.

I remember your case. Difficult situation. Did your first surgery turn out well? I'd proceed pretty cautiously, consult with people like Konior, Bernstein, Gabel etc.

I recommend 0 grafts. Don't get an HT.

Lionel Messi got a hair transplant?

I agree, this is the type of thinking we need: find the good clinics you trust, and see who has availability...Konior may be booked a year but Gabel might be available in 3 months..

Also if anyone is a soccer fan, check out Milan keeper Diego Lopez' hairline. Most spanish posters think he went to Couto like his friend Javi Farinos: https://foro.recuperarelpelo.com/viewtopic.php?t=49558 In the future, we may not consider Lorenzo to be a no-brainer. Lorenzo is a pioneer because he was the first to really use FUE to treat high NW cases with video evidence including comb throughs of cases that exceeded most strip surgeries, when most US surgeons were going "oh this is an adjunct/only for minor work". That "novelty" factor won't be there in the future.

Looks like in the old days we had doctors actively discussing techniques. I found this helpful so bumping.

Let's not get too crazy with doctor worship. If Couto can produce a good result on a patient, another great doctor can as well, nobody's hands are magic. Good candidate + good clinic hopefully = good result.

Julieta Peralta Arambulo from the Philippines was recommended here fairly recently but not sure what happened to her. I bet there must be some good clinics in Korea....

I think Couto does all the harvesting and implantation (by implanter) by himself (uses blades for the hairlines). He's good, and he's done a few soccer stars in Spain, so I bet that hasn't hurt his publicity. That said, Vories has the same type of setup as Couto. Same goes for Chueco. There is not "one" doctor that can solve your problems... Rafael De Freitas in Spain is also good. Teresa Meyer is a Bisanga trainee in Spain, but she hasn't produced the same wow results yet.

Can't mention his name here for some reason.

Try Dr A in Delhi. Eugenix also looks interesting.

If you're willing to travel to South America, check out Chueco. Josephitis looks really interesting here in the USA, but again, the cost...what is it with the US?

2wks min

Yeah, 6 months sounds about right. Doing it before will put you at risk for scar stretching.

Lorenzo's clinic recently posted a "Coverage Value Tutorial" which answers your question taking into account hair caliber and FU/cm. It's interesting, looks like more clinics will start thinking like it.

On the topic of "not following post-op instructions". The problem with this argument is that there are so many different post op regimes and they all differ from doctor to doctor. If post-op care was an exact science, then there wouldn't so much diversity of opinion. A few things seem common though - don't dislodge grafts and avoid sun. Obviously, one should follow their doctor's instructions, but I'm highly skeptical of not following post-op procedure as a reason for a failed result.

I personally would not go through with it if I was this uncomfortable. This is not something you rush into. Do research and re-enter with a fresh frame of mind. Have you paid upfront? Is the clinic reputable? The only way to evaluate donor is by a doctor looking at it under magnification.