Raphael84

Hi @futureresearch

Your photos are not the most clear to be honest and your donor is not visible in any images. Your donor area will be influential in regard to if surgery may or may not be the most appropriate option for you so by all means share further quality images showing all angles of your head including full profiles and back donor.

You would appear to still have a decent amount of hair and the first step will be to stabilise and slow/prevent progressive loss if possible which bring us back to meds.

If you were not able to tolerate finasteride well, you can consider topical finasteride as opposed to oral. As you say you are using minoxidil, I would imagine that this may be topical. Oral minoxidil is an emerging treatment with very promising results and at low dosage has a positive efficacy and safety profile. Many patients who are not able to use finasteride now use oral minoxidil and have shown good improvements and stability. Of course, all patients respond uniquely based on their physiology and sensitive but it may well be worth considering in your case based on the information shared above and your age.
 

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses retrograde alopecia and the limitations that it may present and the approach that should be considered understanding potential limitations.

There are several studies that have found that oral minoxidil has proven to be more effective than the topical version/s without the potential skin irritations or having to apply both morning and night which is less practical for many.

1 hour ago, andrewfaliro said:

Ian, can you tell us what calibre his hair is and what cm from the glabella his hairline was restored to?

His hairline was placed at 7.5cm above his glabella and in regard to hair characteristics and calibre, his hair has a slight wave and his thickness is categorised as "fine".

Donor density readings were 85/100 without any signs of miniaturisation.

Considering the patients age and his commitment to meds, he was a good candidate for surgery.

An associate doctor of BHR Clinic, Dr. Muhammed is able to prescribe and ship within the UK.

You can reach out to him at - info@ukhairmeds.com

Thank you for the support and comments.

11 hours ago, Curious25 said:

Extraction pattern higher up than what we usually see from Dr Bisanga, what were the factors that determined this? 

The patient was 38 at the time of surgery, has been committed to medication for some time which has achieved stabilisation throughout his scalp and therefore without any other areas of decline other than his temple recession. His laterals are strong.

Average FU - 2.16 hairs

Dr K.

Looking great. So happy for you and I know the impact that this has had on your day to day life.

You look fantastic. You have definitely reversed the clock and you are looking younger than I have known and what a transformation for less than 3000 grafts.

Very excited to see the next session and your crown restoration. 

Hi @Nolocks

Your January surgery will be in here in no time.
Great that you have your regimen of medication in place that will be influential over the longer term and as you have said has already taken effect in terms of stabilisation.

The clinic will provide a bandana post surgery that we would request you wear for the first 3 days post surgery when outside. From there you are good to wear a loose baseball style cap with enough "air space" to not have any direct contact with your recipient and newly placed grafts.

The first 7 days in terms of post operative care and healing whilst quite straightforward, it is important to follow instructions provided when at the clinic, and then days 8+ post surgery you will be encouraged to work scabs off with gentle massaging. Your grafts are safe and secure at this point.

We look forward to seeing you in the new year.

Thank you for the update @Marco Van Basten

This is Ian. I have emailed you now.

4 hours ago, unfinished_sentenc said:

I was looking at having oral minoxidil, however no joy getting this in the U.K that I know of.

I can provide a UK based contact/doctor who is able to provide prescription and source the medication for you @unfinished_sentenc
He provides brand name Loniten with the UK.

28 minutes ago, Melvin- Moderator said:

This is great news for those of us in the US. Does Dr. Bisanga plan to go to to other states? It would be wonderful if he came to California.

Dr. Bisanga does have plans to offer further consultation in the US.

Current intentions are to offer consultation in Los Angeles, likely to be scheduled in the week between Christmas and New Year.
This will be followed up by further dates in 2022 with other locations being planned.

As soon as Dr. Bisanga is able to confirm dates and further specifics, we will be sure to announce them with as much notice as possible.

Thanks Melvin

I am very pleased to be able to present the opportunity to consult in person next week, Tuesday November 23rd, with Dr. Bisanga in Bethesda, Maryland.

It is a late change to Dr. Bisanga´s schedule, but due to much interest and demand, Dr. Bisanga wanted to make himself available and accessible in his upcoming travel to the US.

If you may have interest to meet Dr Bisanga in person and have him thoroughly assess your hair loss, donor density, follicular grouping, condition of hair, laxity, design etc and provide his recommendations moving forward, this may be a nice opportunity to do so.

Consultations are very limited with only a final few time slots available, so please do reach out at your earliest convenience to avoid disappointment.

Thank you, and Dr. Bisanga looks forward to meeting you.

ian@drchristianbisanga.com

@unfinished_sentenc

Congratulations on completing your surgery and thank you for your documenting your experience and sharing your photographs.
This is much appreciated and I have no doubt that the community will take great value in your journey and offer much support along the way.

It has been a pleasure to be able to assist you and I look forward to the next 12+ months of progress and exciting months ahead.

I will share clinic photos with you shortly and as you well know, you have our full support.

Ian

12 MONTH UPDATE!

A big thank you to the patient for sharing his 12 month photos. 

The patient is very happy with the naturalness of his result and surgery is most definitely undetectable.

From my own experience, I would like to say a big congratulations to the patient. It has been an absolute pleasure assisting from our first contact right through until the 12 month post surgery stage and I couldn't be happier for him.

Thanks as always for your update @Bailey99

You have come a long way since the beginning and at only 5 months post your second surgery there is more to be expected over the next months.

With crown restoration, as the placing angles of follicles change mimicking the natural "swirl" of the crown, it generally takes longer to appreciate growth as scalp is still visible in between these changes of hair direction. 
As growth and hair cycles evolve over the next months, the entire recipient area will continue to see improvement Bailey.

Thanks for your documentation and your honest updates.

I look forward to your next one.

Thanks for the support and reference guys.

Hi @MixedGuyUK 
Welcome to the forum. You have certainly found a place that will allow other individuals in a similar position to offer honest and independent advice and I have no doubt that this will be a big source of support moving forward.

Without seeing any of your photos or being able to understand the extent of your curl, it is true as detailed above that there are less cases shared for afro hair and many of those that are, are female patients.
Afro hair represents a smaller percentage of patients and as you will see has been well discussed on the forum, only a small amount of patients allow their photos to be shared which is understandable, but also a shame in some cases as it is essentially other patient´s photos that would have guided them.

In terms of working with curly hair, it does present unique challenges and therefore requires specific expertise. The natural shape and design of afro hairline can be vastly different than caucasian and asian patients (this may or may not be the case with yourself with Greek lineage). As opposed to the mostly straight follicle of Caucasian and Asian patients, typical characteristics associated with afro/curly hair follicles are that the hair tend to be thicker and tightly curled. Such curvature of the hair extends below the scalp. The natural curvature of the follicle can be significant, often to the extent that the follicle when removed is actually in the shape of a letter C, meaning that it is essential to have a surgeon who has knowledge and experience of working with curly hair.

A profound understanding of the punching and extraction protocol is essential when FUE is the most appropriate technique, as due to the curvature of the hair, transection presents a higher risk. Another crucial element is that your surgeon must  have the appropriate punches and tools to best handle and manipulate afro hair.

For the same reasons that the characteristics of curly hair present unique challenges, when a restoration procedure is performed correctly, these same hair characteristics offer great benefits. The naturally thicker and curlier hair can achieve an impressive illusion of density with a lesser graft count compared to most other hair types.

As you have mentioned that you are 26 and have essentially lost your hairline, you are still a younger patient and with the long term always being priority, Dr. Bisanga would request further details regarding a potential hair loss preventative medication regimen to ensure the best scenario for you.

If you would like to send me an email containing photos and any relative details - ian@drchristianbisanga.com
This will allow Dr. Bisanga to review your case and have a better understanding of the extent of your curl. Dr. Bisanga would then be able to provide his recommendations moving forward and also share other relative case examples.

Thanks

In a previous article we said why FUE extraction patterning is so important, for those who missed it, here it is, and trust me we were not kidding!(https://bhrclinic.com/2021/09/06/three-reasons-why-fue-extraction-pattern-is-important-if-you-get-this-wrong-trust-me-you-will-regret-it/), and here we continue with the demonstration, albeit more visibly, to drive home the message.

Well if a picture is worth a thousand words, then what weight is there to a video? Here we see very vividly and graphically what happens when the basic fundamentals of FUE are ignored. As we know from other posts, the recipient area, the hair line, the growth, the naturalness can be way off and resulting in a very manufactured, unpleasing and devastating result that has the opposite impact on your life for the very reason a hair transplant was undertaken. Rather than being more confident and comfortable in your appearance, you become more of a target of wondering eyes due to the low quality, lack of expertise that now becomes your identity. 

This however, is not only true for the recipient, but also for the donor area. Whereas Strip[FUT], got bad press for the resulting scars, change of hair angles in the donor, possible miniaturisation and the need to wear the hair longer to cover it, FUE, also in the wrong hands can actually be far worse. Both are good techniques, we perform them and done properly are life changing, but when FUE is done badly and to the extend in this video, then the resulting scarring, decimation and damage to the donor is significantly worse.

Here, the richest area of the donor, the area that has the coarser grafts, higher density and better hair to follicular unit make up, that should be used wisely and with thought, has been as said, "robbed". The goal, rather than to give longevity to the patient, keeping in mind future loss, using the correct calibre grafts for the right area, spreading the extractions to ensure good healing and less visible impact of anything taken, it really has been a get in, grab, get out, as quickly as possible and move on the next victim.

Fast forward a few years, the doctors and clinic move on but the problem stays. Now the patient has lost more hair and the richer areas that now should be able to come into play, are gone. The patient has been forced to keep his hair longer to cover the damage in the donor, so this limits his ability to shave closer as the loss progressed, but also the much needed grafts from the best area, are barren. The scarring is there to see, and the majority of the donor area has already been consumed. The goal for the performing clinic was money oriented as you pay per graft and no thought for tomorrow.

If I were to end the story here, it would be a devastating end. So, what can be done? Well, for the donor, now you need a surgeon who can really cherry pick to get what he can, and this video shows the clear quality difference between the work of Dr.Bisanga and the previous clinic, who market as FUE specialists. The scarring can be to some degree camouflaged with SMP, a good practitioner is needed because working into scar tissue has also its own challenges, but for harvesting it is pretty much exhausted. So, the approach now is to extend beyond the ruined area and to tap into the virgin zones, yes they are less dense, harder to harvest from with more acute angles, but an accomplished FUE surgeon, this will not be a problem. Furthermore, we also added body hair into the mix, so beard and chest will for this patient, and thankfully with the colour and coarseness etc, it is compatible to use, and will bring some hope to a man who at 31 has already suffered from his first hair transplant experience.

Hindsight is great, but due to not being able to travel in time and undo poor decisions, we can only work in the now to better his future. Yes, as Dr.Bisanga said, research to get it right first time, and you can see the sincerity in his voice and visage, this is a heartfelt cry, because as a clinic we see now more and more bad work coming to our doorstep and the impact on the patient also, physically, emotionally and financially also.

Take home message, learn from others' mistakes, research well, ask questions, meet previous patients and be comfortable with the doctor and clinic you choose to entrust your head with. FUE extraction is not a hashtag, it is a reality that you need to be aware of and why we will keep teaching on these important topics.

Take care and thanks for reading!

Thank you to Stephen for sharing such an excellent article.

Stephen

stephen@bhrclinic.com

Original article can be found at - https://bhrclinic.com/2021/10/26/fue-how-to-destroy-your-donor-in-a-day-with-smash-and-grab-approach-to-surgery/

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses his approach to donor repair.
He details the challenges in regard to the general situation of the patient as when the donor is destroyed, this commonly reflects poor quality surgery and will often be accompanied by poor status in the recipient. When focusing only on restocking the donor, this may mean depriving the patient from good quality body hair that can be used to fix/improve an area on top.

Learn more about donor farming/restocking -

https://bhrclinic.com/2020/11/07/donor-farming-in-fue/

Thank you for creating your own thread @Marco Van Basten

Congratulations on completing your surgery. 

Your hairline design looks great and this will achieve quite the transformation in restoring your temple loss and framing your face.

You have shared some nice photos yourself but I will be sure to get clinic photos over to you shortly.

Looking forward to following your evolution. Rest up now you are back home in your own environment and as you know, any questions or queries you have our full support.

In this episode of Inside the Op Room Series, Dr. Bisanga shows an example of a recent patient who had undergone poor quality FUE surgery with another doctor, where  his donor area has been completely over harvested essentially destroying the strongest area of the donor in the occipital region, resulting in limiting what can be extracted in repair surgery. This is without even considering the impact and challenge in the recipient.

Dr. Bisanga explains why it is essential to conduct thorough research to select a reputable hair transplant doctor with a track-record of consistently excellent results FIRST TIME to avoid such a traumatic experience and the associated costs and limitations of repair surgery.

The term "repair" surgery in itself can misleading. Scarring and over harvesting can not be reversed or restored back to its original condition/status. Challenges of "repair" surgery are often much greater than understood or appreciated.

It is ESSENTIAL to get your surgery right, THE FIRST TIME!!!

@New_Barnet_Please

Thanks for the recent update. Great documentation and photos that will prove very valuable in latter months when looking back at really seeing the progress that you will have achieved.

Healing is looking good and right on track.

Looking forward to your month 3 update as you mentioned. 3 months is always a nice early milestone and always nice to reach and look ahead.

Thanks again

I had to join the party in congratulating you @Maa

Your hair looks amazing and you thoroughly deserve it. Thank you for updating your thread throughout and undoubtedly you have helped many others on the forum.

Enjoy every minuted of it!