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Hi Puma The Strip will take from surface area, so FUE is then over a smaller harvestable surface than had you not had Strip so less numbers will be taken ultimately and depending on how the scar heals then above immediately above the scar usually is not harvested as this gives coverage to the scar also as the hair grows but you can harvest above and below with FUE. The positive is that Strip and FUE work well together and having a Strip and assuming it heals well will leave the donor in good condition for then harvesting and taking from density in the second surgery with FUE, or if possible another Strip and then FUE also is workable and you should have harvested a good number of grafts by then and hopefully reached your goals. Scalp hair is king, we do Strip, FUE and body hair but if you can get to where you want to go with scalp then is a good option and use body hair then as a later option, filler etc knowing that the majority of the transplant is scalp. We have done such combinations on patients and both techniques can work very well together indeed and especially for more advanced loss.

Hi grigriman Thanks for the update and interesting point on hair maturing as this is often over looked but is part and parcel of the process that takes time and often differences are seen in the first few years with respect to this aside from growth coming in. Looking forward to seeing you again in London.

Hi grigriman Thanks for the update and interesting point on hair maturing as this is often over looked but is part and parcel of the process that takes time and often differences are seen in the first few years with respect to this aside from growth coming in. Looking forward to seeing you again in London.

Hi bismark This patient had a touch up and as far I can tell moved on with his life since. I never dealt with him personally as an advisor as we had a different advisor in place then for Italy. I deal also with the Italian market as an Italian speaker so any emails would now come to me since the previous Italian rep moved on but I personally have not heard from this patient so hope and am confident he got to where he wanted to get. Distinti saluti.

Hi Ash, this can happen for FUE and usually manifests after a week and can be worse at night. I had it in one of my seven surgeries and in my first ever one. It will pass but applying cold aloe vera helped me, also take painkillers and vitamin b tablets also help to calm nerves. It will go but may be there for another week or so but the above will make in manageable.

Many thanks for updating and taking the time to do so Chris and glad that things are maturing nicely for you.

Good question. If a clinic extracts 2000 grafts and places 3000 then as you say they have split the grafts down into lower groupings. Usually a clinic will get enough singles for a hair line if this is the area being addressed as they can cherry pick singles and then doubles and so on, so on a virgin scalp personally would not see this happening but you would get the grafts in their original state pretty much. For repair work this may not be the case. There may be slightly more extractions than grafts placed depending on the skill of the surgeon punching the grafts and ability to get them without transection. The clinic will usually charge for grafts placed and some will give breakdown of this also with relevant make up of hairs per graft.

Patient age:- 32 No medication taken. Frontal third rebuild, relatively conservative approach, pictures show pre-op, post-op placement, 8 months and 11 months. FU breakdown:- 1 Hair: 631, (631) 2 Hair: 966 (1932) 3 Hair: 1012 (3036) 4 Hair: 138 (552) 6151 hairs average 2.24 per unit

Firstly, we would like to thank the patient herself for providing photos and allowing her case to be viewed. Please note therefore, that the pictures at 2 years 4 months were provided by the patient herself, and so lighting and angles may not always be under the exact same conditions as the clinic photos and include wet and dry hair. The goals of the surgery were to rebuild the frontal zone which had diffused loss. The patient had prior dyed her hair blond to somewhat minimise the contrast with the scalp. We are pleased to say that today, as a result of surgery, she has returned to having her own natural colour. The procedure was FUT (strip) 2504 grafts. Pre-op Design Placement Post-op 2 Years & 4 Months, photos provided by patient Before & After Comparisons*

Nice result and good hair to graft breakdown for this patient and always good to see full face photos.

Hi whathair The extractions are well spread from the photos you've posted even earlier post surgery and here we see the extraction marks healing and the can identify the spread so there will not be a massive density change with the way we spread the extraction over the donor area and another reason why we cap at around 3,000 over 2 days in order to keep to a pattern and tend to use the whole area where possible as in your case. At one week there is the redness of the extraction marks healing and also possible shock loss that will rectify and also some hair at different lengths but no doubt this will heal well as said because the extractions I see are not too concentrated and my own FUE did not look too dissimilar at this early stage. At two to three weeks you can shave and all to a uniformed length and monitor again as things heal.

Photos often exacerbate redness that the natural eye will not see as such and I've met patients in natural light weeks after surgery with no obvious redness and seen photos months later that show redness there not seen in the flesh. Skin tones play a large part in healing, lighter often take longer, density of placement and proximity of recipient sites cut, and how the patient heals generally. 10 Months is excessive and not the norm but most will see an improvement in the first 2 weeks and then it should get gradually better in the next 3 months and fade but there will always be some exceptions to the rule. I was always back at work at 2 weeks with no real issues at all on any surgery from first to last one. Sun and other factors can also exacerbate redness so best to see your clinic on specifics of what to do and what to avoid also and some will say to apply aloe vera, witch hazel extract or even use laser combs to help speed up healing also and offer some good hints and tips for this.

Hi whathair Thank you for your post. I will send clinic photos once obtained and hope you continue to heal well and let me know if anything needed.

Is it possible this could go in the patient not clinic section please as is posted by patient as such so does belong there more than this section.

Hi NG Not sure who your clinic is but this is totally normal, swelling usually comes more from day 2 onwards and will go mostly by day 5. If you have two days surgery then more injections and all that fluid comes down. Massage from the glabella the centre of the forehead outwards to help it drop. Apply ice for 5 minutes at a time and also keep upright as much as possible and drink plenty of fluid. Don't be afraid it will drop and may effect the eyes also. Heal well and relax as much as you can. Steve

Hi Misterhair Thank you for the detailed write up and glad that you were comfortable with the booking process through to surgery and I know Stefan will be always available for you and in contact over the coming weeks and months and when needed. Heal well and looking forward to the updates.

Our Patient had a previous Strip procedure elsewhere. The remit was to repair his hair line and close temple points, use FUE to remove some plugs that had been place into the hair line by previous clinic, and revise the strip scar with FUE. Dr Bisanga slightly lowered the apex to create the correct angle to close the temples, this required 48 old plug grafts to be removed in and on the hair line; and in his old strip scar approx 170 FUE grafts were placed. The hair count per FU was:- 690 single hair, 1053 Two hair, 653 Three hair, 400 Four Hair. Pictures show pre op and design, old graft removal, placement and then progressive growth up to 8 months with wet pictures. Pre-op and design Plug removal Placement and 170 FU into scar 2 Months Post op 4 Months Post op Scar before and after 7 Months 8 Months Post op Hair line close up 0 - 8 Months Comparison

Was a shock to read but wishing you all the best Joe and sure you will be a great asset to Dr.Rahal.

Hi Smokemeakipper Redness from experience looks worse on camera than real life and I have met patients who look red on photos who in person did not, so it is exacerbated and also the light under which photos are taken can have an influence. The patient was unable to come for the touch up as planned due to personal reasons so we will re-book another time convenient for him and I am sure will update as and when we do the touch up.

Exactly, grey can really help the illusion. I am going that way myself and look forward to it for that reason also!

Hi Delancey, from experience it can take longer to come in when not a virgin scalp and even when there is good surgery performed and going over previously grafted areas to add density for example that is visibly in "good condition" then even micro scarring can effect growth speed, yield etc. The area here treated is fairly large and into new areas also. I see the placement spread backwards and then decreasing and it tapers off before ending but as a guestimate then easily over 90 cm2 treated here and if placing at 40 FU per cm2 for arguments sake would be approx 3600 grafts but as said the density tapers off before ending as is common practice. Arekk you have been very patient so far and nothing more could really be asked for so I hope more comes in for you and things even out in the coming months and of course the doctor will see you in around 2 months to assess and nothing beats a personal meeting in terms of assessing. You still have more growing months ahead of you and be assured the doctor will give an honest appraisal when he sees you in person and sincerely hoping for more to come in these months and thank you for the patience shown so far.

BHR Clinic Dr. Christian BISANGA Patient Age: 45 Medication: No Technique: FUE Donor Densities: 70/80/80 Hair type: Medium Coarse, Grey Previous surgery: No Goals:- Patient with advanced loss and the desire like most for as much coverage as possible and was advised this will be over multiple surgeries. First surgery aim was to address back as far as possible with the plan to continue the placement for a second surgery into the mid-section and crown. This meant spreading the placement within reason and the grey hair helped in obtaining the illusion of coverage and allowing for this. A second surgery was then performed some 18 Months after the initial one and we spread back into the crown as far as possible in that surgery also with 2040 grafts via FUE. * Total FU in First Surgery : 3,054 * Hair to graft breakdowns:- - 1s: 866 - 2s: 1488 - 3s: 561 - 4s 139 6081 hairs and average Media = 1.99 hairs per graft. Pre-post surgery 7.5 Months 7.5 Months – Natural light Comparatives Second surgery to crown 2040 FUE Pre-Post Surgery - Wet hair 6 Months

Hi Delancey I believe the patient is in touch regularly with his advisor for his particular country. I am not the advisor as such due to nationalities I deal with so my knowledge is what I get from the advisor for Arekk and I believe the doctor and advisor will see the him in September to evaluate when they visit that country. Apologies to Arekk that my personal input is limited due to me not being the advisor but I know that my colleague is in touch with you regularly and passes photos to Dr.Bisanga and they have tabled to see you and I hope you see more growth in the coming months and still could see significant change at this time and this is especially so for second surgeries also.

Thanks for posting the detailed account. Shedding will continue and then the slow process of growth but it will take also time to mature so patience needed. Skin redness is more abrupt and contrasting than the hair will be when it eventually comes in also. I've sent you also all clinic photos taken Anything needed please let me know.

Hi KO Sorry to only reply now, I try to have weekends away from computer screens as much as possible. Density for a hair transplant is only one factor in the overall result. The follicular unit make up and distribution is an important part and often overlooked. A hair line per se will have higher density initially because it has in the first few rows single haired follicular units, so in essence a fairly high amount will be needed due to this factor and we typically place around 500/600 or more singles in establishing this and this patient had around the 600 mark. Singles and not doubles are used here initially for softness and creating a natural hair line. Then as the hair line goes back into what is defined as a different zone with different terminology used then doubles will be used and this area will help to give "fullness" to the hair line and is an important part in having a soft hair line in front but giving some depth and fullness to it as the patient is observed from the front, so that the hair line is soft but not see through. Then further back density will drop and again larger folllicular units can be deployed including 2s, 3s and 4s if present and at a lower density than the singles in the anterior part of the hair line. They contain more hair and less density needed for the "illusion". The density will decrease as one places back but as said with higher units, so not singles as such and the graft make up that this patient had also reflects this approach. The singles were there for the initial work, then there are larger groups there and a good number of 3s and some 4s also harvested. Had the patient had only 1s and 2s then the distribution, approach and result would also be different but with his groups then it allows for density changes as we place and following the protocol for hair line design and behind. Hair line and indeed placement throughout the scalp could be discussed in several threads and topics and essentially a transplant is about an illusion of coverage and not matching native density or most would run out of donor aside from other issues, so use of follicular units and make up, the lay of the grafts etc is all part of obtaining the illusion and for patients like me who had extensive loss then the density will drop even further as the doctor places backwards. Doctor Bisanga and I will be in London in September and if Grigriman is indeed available and able to meet us again then we would be happy to take again high definition photos at the 9 month stage in the same room, camera, lighting and angles and then the progression will also be easy to see on what was already looking very good at the 5 month mark.