sl

Very nice result...well done to the doc on this one.

Hi options. Everything starts with the donor, density, surface area to harvest from, hairs to follicular unit groups help, miniaturisation levels in the donor, surface area to cover, hair coarseness, hair to skin contrast to name a few that will impact on the result. Essentially higher norwood scales have lost most of their scalp hair, so the donor for FUE especially needs to be high in density for larger restoration cases as FUE takes from this. My starting density was high, 100 and even 110 FU per cm2 in areas, so higher than the norm and this allowed for multiple sessions to be undertaken. Clinics will vary on approach and how much can be taken safely and over how many surgeries, so it is worth contacting several to see what could be achieved but as said density is only one part of the equation and a long post could be written on the subject but a patient is wise to be seen in person to have real empirical data on the donor and especially if they are looking for a large area to be covered and make sure their goals could be reached. If the donor density is not high then they may need to look at goals and see what is possible for them.

Hi FUE2014, thank you for the comments also. Patient is approx 32/33 now, was 28 at time of surgery, on medication prior and the transplant has been one stop shopping as such and we have met a few times and the crown has held as has other areas. Certainly it was important for him to be on medication prior to the surgery and especially for the crown also to hold and not be chasing but for him has worked well and nothing further needed. I will get the placement split if possible for frontal third and what went also into crown but would not personally expect to treat the frontal third and crown with 1k less grafts and would guess more than 1k went to the crown also looking at the placement. In some photos the hair is combed and held straight up that will go against the "illusion" that a hair transplant can give, but when in a natural position as in other photos above it gave a nice covering in the areas addressed. I will see if I can have new photos also to show him today.

As KO said well, the techniques are different and do complement each other well in that one will take surface area (Strip) and the other (FUE) density and for more advanced loss can really work well to achieve a good result without over doing one technique as such and will get more than any one technique alone would.

Not a small surgery performed as such. We cap at 3000 FUE over two days and the areas to address took well over but aside from that the patient wanted Strip and budget, hair length they will carry and several factors will also come into play. If his loss progresses then FUE could be used now very well and density is still good for that and the scar is a non issue also for him so all in all for this patient Strip was a good option.

Thank you for the comments. The patient was in late 20s, the loss was diffused through the frontal third and also signs of thinning in the crown which we planned to address in one surgery also. His bone structure also led to a higher design plus the fact we had a lot to cover and go backwards and to lower as such even more would have meant a 5k plus Strip considering the plan to also plant into the crown so not only front load the grafts but address there also. Patient's goals are important and a hair transplant at times is about re-inforcing and going backwards rather than lowering the hair line substantially and happy to say we reached the goals of the patient in one surgery. If he needs future surgery for progressive loss then the donor is there and the scar healed very well so Strip or FUE is possible if needed and he will only grow older but a nice change was attained, it framed his face which is something he didn't have prior as there was no defined hair line as such. Most patients never post cases and in fact it is a very small percentage that will and he was happy enough for us to post so we are grateful to him also for this as it is not an easy decision to share cases for anyone.

Here we have a case that has been kindly provided and well documented by the patient himself and which is our pleasure to exhibit. Patient underwent 3,833 grafts split between the frontal third and also to the crown area. Hair to graft groupings:- 1 Hair – 464 2 Hair – 1,557 3 Hair – 1,393 4 Hair – 419 Total hairs 9,433 equates to 2.46 Hairs per FU Patient's Own Story I first started experiencing hair loss in my early twenties (28 now). I have a naturally high hairline but when I look back at those pictures of my ‘youth’ I was blessed with plenty of hair in those days which allowed me to have my preference of longer hair which I like to play with the most. The recession of the hairline became noticeable first with establishing peaks and then the thinning of the hairline itself. It was a niggle on my mind but nothing more. It was easily disguised with longer hair and I still had good density of hair on my crown and this still allowed me to retain a look I felt confident and happy in – ah the vanity. A couple of years ago, it became more than just a niggle. The hairline had now become very thin, I was losing hair on my crown and the peaks were very prominent. I no longer liked photos being taken of me. I began taking Propecia and using Minoxidil but this was a half-hearted attempt and with no rigour. I never really had faith in these products or any product that claimed to restore hair loss. However, Propecia did work for me for in stabilising hair loss with no noticeable side effects but my hope for growth was dashed. I made my expectations more realistic for this product and continue to use now not hoping that it would grow hair but rather keep it. I began looking at hair transplants Christmas gone. I discussed it with my girlfriend and brother and researched the best surgeons and clinics. I was not going to risk a poor op with such a personal and visible procedure. BHR was consistently highly recommended on forums by other patients and so I took the plunge and sent off the consultation email in early May to which Stephen @ BHR responded to in a matter of hours. He suggested up to 4,000 grafts split as 2,000-2,500 grafts for building the hairline and 1,000-1,500 for the crown. At the time, this was more than I expected but we exchanged further emails over a week and I made the decision to proceed, taking the first available date at the beginning of October. I have to say that communication with the clinic is impeccable; Steven was and is my advisor and buddy throughout the whole process from initial consultation to now. I had many questions pre and post op, I always got a swift answer and I felt really well looked after. Surgery I arrived in Brussels the day before the op and had a cheeky half pint which the good doctor reprimanded me for on the day of the op. Other than that, I followed every other pre-op request to the letter; no caffeine, no aspirin etc. I also chose the Catalonia Forum Hotel as base. I would recommend the hotel too, it is so very convenient for the clinic and is clean and comfortable. The food is awful though! I was very nervous the night before and arriving at the clinic. Coincidentally, I arrived at the clinic the same time as Dr Bisanga who immediately put me at ease. He and his team are very friendly and you know the moment you meet him that you are in a pair of safe and confident hands. My day kicked off at 7.30am. The first component of the day is the consult. Here, Dr Bisanga checked the donor site and clearly explained to me how he checks the quality of hair in this area, why strip remains the better option for me and discussed the design he would like to implement. In all honesty, at this point I was ever so slightly concerned whether the hairline was too high but we discussed this more and I felt reassured. Sitting here now, I don’t know why I was concerned. It is spot on what I wanted… discreet and very natural and perfect for my age now and as I grow older. Dr Bisanga suggested 3,000 grafts would do the trick and 4,000 was too many. Great to hear these comments pre op and reassured me that the clinic has my best interest at heart. Dr Bisanga got the approval of my girlfriend, nice touch From this point on, the experience of the procedure at the clinic really shows, everything is perfected and you feel really comfortable and safe. Once changed into the medical gown pre op pictures were taken and Dr Bisanga reinforced the design sketches with markers. The Dr then prepared the donor and recipient sites with his trusted clippers, his not a great hairdresser! I was then made comfortable in the operating room in what could be best described as a dentist’s chair. The op itself is divided into four parts; the morning session that lasted from 8.30am to noon and consisted of applying the local anaesthesia, removal of the strip and making incisions to recipient areas; and the afternoon session from 12.30 to 6pm when the grafts were placed. The anaesthesia was the worst part of the day; it can be very painful especially when the first injection is applied on a new area. The nurses were compassionate and patient which helped a lot. Rihanna songs tended to lift everyone’s mood with impromptu karaoke but best to be braced and prepared for a painful and lengthy ordeal. It does take a while to get the whole area done but once it is done I really didn’t feel a thing. Except for the occasional pang of pain that is quickly addressed throughout the day with a quick top up of anaesthetic. The strip removal is fairly swift and I did not feel any pain. What I did feel was the pressure but this had no negative impact on me. What I didn’t like was the process of the incision itself as it does make a very unpleasant sound. The strip was removed by Dr Bisanga before he stitched the wound. Once the stitching is all complete you do feel the stretch across the face, I imagine it is a bit like a facelift. The technicians take the strip, I recall 6 technicians in total and they started preparing the grafts under microscopes. Dr Bisanga remained focussed on my head and made the incisions for placement. Post lunch, the grafts were all placed in my head. I have to say it does get very tiring by the end of the day. It is a very long time to be stuck in one room staring at one place but it was by no means awful, I was prepared. I even remember falling asleep for a while! The grafts were all placed by three technicians at a time and there was a rota so the technicians got a break too. Dr Bisanga was always at hand checking and directing and I always felt safe and well looked after. The technicians were fantastic and very friendly and caring. There was a slight hiccup at the end, where I had more grafts than incision and so more incisions had to me made. No complaints The whole operating procedure ends with an optional painkiller injection in the bottom. My advice would be to take it, it is wonderful! Great night sleep! Post Op Post op consultation was with Phil where the documentations and hints and tips were gone through in great detail. Post op pictures were taken and I was given a bandanna to wear around town. The first night was fine, I slept very well and caught the Eurostar back home the next day with no problems. The second night was not so good; I accidentally scratched a couple of grafts out in my sleep. This was not pretty. I lost quite a lot of blood and was very emotional about losing grafts. I had humanised them and so I cried a little bit!! I emailed Steve at 2am and he responded at 4am, that was so helpful. Thanks Steve that mail helped me so much! After that, I took Nytol for the next four nights and tied my hands to the bed. There was no sequel to that horror thank god. My girlfriend was great too helping me mist the area with saline every couple of hours and washing my head. I always try to eat healthy and very active but paid even more attention during the last few weeks with lots of fruit, nuts, lean proteins and plenty of fish. I also supplemented MSM, boosting vitamin c and taking multi vits and calcium. I really feel this helped me. A lot. Kept me upbeat and I had no infections and have seen great growth from the incumbent follicles to help get rid of the shaved head. One thing I will mention is the swelling, it was immense for me and I looked like a balloon for almost a week. I could not go outdoors in this period and did feel poorly but I think that was more to do with looking at myself in the mirror. The suture was removed at my local A & E on day 10. I don’t know why I bothered with going to the GP first, and the day was a boring 5 hours to get stitches removed. The hospital was bamboozled as to how to remove them so I had to mail Steve who advised the doctor as to how to remove. Incredible. Although the hospital was very impressed with the stitching and confirmed the wound was healing nicely. I am almost 3 weeks post op now and the scar has not infected and continues to heal very well. Some scabbing remains on the scar but on the whole I am very happy with the precision and cleanliness of the work. I had my hair cut by a hairdresser 2 weeks post op and that felt great, to be able to style hair again. After about day 11, the scabs from the recipient area all shed at once. I feel I am now at the stage where anyone who doesn’t know me will have no idea of the hair transplant. I couldn’t be happier with the outcome and whilst it has been a testing few weeks, it has been thoroughly worth it. I have not one bad thing to say about BHR, Dr Bisanga, Steve, Phil and the rest of the team who have helped me and kept my experience pleasant and I am so grateful for their help and care. Thank you!! Pre-op Pics & Design Placement Post 11 Months Hair line Front Elevation Crown & Donor Area

Hi KO, yes, I had a very good donor and characteristics as you say, but wasn't so salt and pepper when I began to be honest. That came later but it was a big FUE in graft numbers and many surgeries and Dr.B took it on from 2007 so even back in the day had no problem with larger FUE surgeries if the donor would give and it seems a lifetime ago. Most clinics turned me down then and said Strip and I can see why but I did as you say have everything that allowed a large FUE restoration and I can say one thing that struck me was Dr.B's confidence and even with body hair also. Sure, not everyone will have the same donor, characteristics, so that is more the determining factor as such rather than not believing in FUE for large numbers per se and as stinger99 said Dr.B will examine in person and see what he believes can be achieved for the individual.

For Strip/FUE essentially Dr.Bisanga will look at the patient and especially for those who have advanced loss to see what the best is for them and what is attainable once the donor has been examined and look at the goals of the patient also. FUE takes from density so there is a finite amount that can be taken without over harvesting, how much doctors and clinics take will vary but we take around the 30 percent over multiple sessions as a general rule. Some may take more but again no matter what protocols they may have, the donor still has a finite amount of grafts and some may get to where they want with FUE alone if the donor is good enough, others will need to go the Strip or Strip FUE route or maybe add body hair to the mix. I can assure all that Dr.B has no confidence issues with FUE and larger numbers if the donor will give and speak from personal experience with my own case aside from the patients we have operated on and have cases on this forum on larger FUE surgeries over multiple sessions also and here are a few of the larger ones on this forum also and one of them with body hair also:- http://www.hairrestorationnetwork.com/eve/165574-4-000-fue-dr-bisanga-7.html http://www.hairrestorationnetwork.com/eve/176017-dr-bisanga-bhr-clinic-brussels-3054-fue-0-12-months-then-2040-fue-crown.html http://www.hairrestorationnetwork.com/eve/169814-body-hair-fue-nw6-patient-after-chemo-therapy-bhr-clinic-dr-bisanga.html All the best to all for their research

Hi Swayzedo Thanks for the update and photos shared. At 4 months any growth is a bonus so really very early on and a lot to come but looking very encouraging so far. Much more growth and then softening of the hair line will come as the hair cycles but on track so far.

Fine blonde hair, 1331 FUE to reduce his temples and follow the existing angles of his hair. Here we have Pre Op, 2 Weeks Post Op healing through to 7 months updates. This is not a final result yet as 7 months there is still growth to come and maturing of his hair to increase the thickness around his hair line. I will update when possible with future pictures and technical data. Pre-op [/url] [/url] [/url] 2 Weeks Post-op [/url] [/url] One Month Post-op [/url] [/url] [/url] 9 Weeks Post-op [/url] [/url] [/url] Four Months Post-op [/url] [/url] [/url] 7 Months Post-op [/url] [/url] [/url] [/url]

Dr.Bisanga was birthed in the hair transplantation field with Strip, it was as he says his "first love", so that ability to perform large and high quality Strip surgeries was there prior to entering into FUE. Now he is very known for his FUE for obvious reasons but he still performs Strip month in and out and large ones also so it is not a diminished talent even though we do as said more FUE these days.

A good 70 to 80 percent FUE month in month out.

Thank you for the comments. Not a small surgery as such and we cap at 3000 FUE over two days, so for this patient Strip was the better option, and aside from the sheer graft numbers he also wears his hair longer and has a great donor left for any future loss if needed. FUE will work well as a second option for him now, if needed.

Age: 27 Meds: Finasteride Donor density: 85-90-100 FU/cm2 Medium-Fine hair Breakdown: 1s - 679 2s - 820 3s - 1177 4s - 824 That is 3500 FU = 10.146 hairs -- Average 2,89 hairs/FU Pre-Surgery Placement Post 2 Months Post 3 Month Comparisons Post 4 Months Comparisons Post 4 Months Donor Strip Post 15 Months Wet Post 15 Months Dry Although the patient is very happy with his results so far and has kindly provided and permitted his photos to be viewed, we will however try to obtain a further dry shot that allows the hair line to be seen. We are nonetheless grateful for the photos the patient has updated and sent us at this stage, that clearly demonstrate his transformation so far.

Nice outcome and normality for the patient after previous surgery. Well done to all.

Thank you for the comments and very happy for this patient who had been through a lot already and glad he got to where he wanted to with this result.

Dr.Bisanga will be attending the ISHRS 22nd Annual Scientific Meeting October 8-11, 2014, Shangri-la Hotel, Kuala Lumpur, Malaysia. There will be time for some patient consultations, so if interested then please contact Carmen directly on carmen@bhrclinic.com who will be able to give further information regarding this. It will be an opportunity for a free and without obligation assessment and will include checking donor density, miniaturisation, follicular unit groupings and design aspects etc. Information will also be given as to the best options/technique for you and graft numbers also.

I will be able to send the patient his photos from our September meeting and hope to do so tomorrow and to all that we met that day. Grigriman I am sure will also update his own photos as he has done so thus far.

Has come in well Peter. Happy for the patient.

Thank you for the comments. The video and post op photos are self taken by the patient but we hope to get good updates throughout the growth period.

Age: 31 Medication: Finasteride 1mg. Technique: FUE Donor density: 70 FU/cm2 Hair calibre: Medium-Fine FUs: 2.477 Previous surgeries: No Breakdown: FUs 1 hair: 784 FUs 2 hairs: 748 FUs 3 hairs: 623 FUs 4 hairs: 322 2477 FU = 5437 hairs -> Average: 2.19 hairs per FU.

We will shortly provide more technical data regarding age, medication and graft to hair breakdowns, however, the patient underwent 2477 FUE to establish a hair line and add density to the frontal zone. The photos show updates to 3 months post surgery, while the video shows updates 6.5 months post surgery all provided by the patient. Thank you to the patient for allowing us to post the result so far and we hope to continue to the 12 month stage. Pre-surgery Design Placement Donor Post 2 Months 1 Week Donor Post 3 Months VIDEO at 6.5 Months (including previous pictures) Click to view:-

Just to clarify to all, Dr.Bisanga is indeed seeing Arekk as planned tomorrow in the patient's home country along with the patient advisor for that country to assess in person. Particular thanks to Arekk for his patience and will have a thorough assessment when they meet tomorrow.

Thank you to the patient for allowing this case to be posted. Female Patient Age: 35 Previous hair transplants: No Patient treated congenitally high hair line via 2100 FUT grafts. Photos shown pre-surgery and at 10 months in outdoor lighting also. Hair to graft breakdowns:- 1 hair - 400 2 hair - 803 3 hair - 747 4 hair – 150 Pre-op Donor Placement Suture Post 4 Months growth Post 10 months strip scar Post 10 Months Hair line We will update through to 12 months.