Raphael84

Early months can be the most frustrating with some post operative redness and awaiting those first signs of growth, but you are looking good, exactly as expected and with some further patience you will have some exciting months ahead.

Thank you for the update.

Thanks for the question Melvin. 

My personal experience Melvin is that they were really quite different.
Obviously different techniques, different clinics and ten years apart so I was expecting a different experience, but in all honesty it was quite vast.

Obviously FUE is much less invasive. FUT was an overall "heavier" surgery in terms of anaesthetic, discomfort during surgery with my body feeling heavy and numb, I left the clinic feeling quite nauseous. Sleeping was more problematic with a strip as to be expected and having stitches removed two weeks later was again another responsibility that was necessary. 
I experienced a lot of shock loss in my first surgery. Throughout my entire recipient and in areas around the strip which was hard.

FUE on the other hand despite two surgery days and also despite using beard as well as scalp was much "easier". Anaesthetic injections still weren't "fun", but other than that the days were more comfortable and post surgery it was just a matter of following post op instructions and working the scabs off. I didn't experience any shock loss this time round and other than wanting some length to hide the strip, there really wasn't any concerns.
 

Continued -

Hi @Cainhurst73

As Stephen has said, please don’t hesitate to reach out to me. If you would like to share photos and relative information to my email address, it will be my pleasure to then discuss your case with Dr. Bisanga and provide relevant recommendations based on pictorial assessment.

Any other questions, don’t hesitate to ask.

ian@drchristianbisanga.com

Thanks

Ian

Always a hot topic for debate and we will all have our own preferences and perspective regarding such techniques. Some interesting points made. 

10 hours ago, Melvin- Moderator said:

Here’s another BIG reason why FUE has grown in popularity. The biggest age demographic for hair transplants has always been 30-49 years. This age demographic is changing, 10 years ago someone who was 49 at the time is now 60. Baby boomers 10-20 years ago we’re still the biggest demographic, but now it’s millennial and gen x. Both groups have grown up with short hair. 

Very much agree with Melvins point above. I believe that this also down to the pressures of always looking your best due to social media and IG and the constant digital world that we now live in. Everything is media and photograph related nowadays and the younger generation do now know any different. 

10 hours ago, Melvin- Moderator said:

To be honest, it seems to be a real problem. Very few new surgeons are learning strip. Beyond that though, finding technicians who can sliver grafts is becoming harder and harder. There needs to be a conscious effort in the future. 

It’s like driving manual. My first car was a manual, so I learned how to drive manual and most of my cars except recently were manual. But these new kids growing up now don’t have a clue about manual and won’t know how to drive manual. Unless there’s a conscious effort FUT could become obsolete in the same way.

Also agree. 
Below is copied from a previous post based on a similar discussion but potentially was more pricing related.

“Newer” doctors who may have “arrived” in the industry in recent years may not feel that it worthwhile to invest and dedicate x amount of years to really learn the intricacies of FUT due to the “dying” demand, which is understandable, and certainly one reason why FUT will continue to phase out each year. Such doctors would prefer to invest this time into improving their craft in FUE. However in doing so, it is fair to say that they will have a different understanding and potential limitations in serving each patients individual needs.

I feel that any doctor who may say that FUT provides better yield, they are speaking about their own experience and in their own hands. Leading FUE surgeons who have been in the industry for a long time and have much experience with FUT and FUE, generally have another view. FUE in the hands of a skilled surgeon produces optimal yield inline with FUT.

Considering the evolution of FUE over the last 5 - 10 years, very few patients now request or are even open to the idea of FUT surgery, with its more invasive nature, longer healing and recovery and of course the linear/strip scarring.

Therefore due to such a shift, the majority of hair restoration clinics have had to evolve with the times, and with the preference and demands of their patients.

Initially when FUE was introduced, it was more expensive than FUT due to the time demands of the doctor who would have had to invest significant time to learn the complexities of punching on patients with different hair characteristics and skin types.

FUE demands that the doctor(at least in reputable clinics) to personally punch each and every graft and to cut each recipient site, meaning a much greater demand on their time in comparison to FUT. Another very important point is that an FUE surgery may require only 3 technicians.

With FUT, the doctor will excise and suture the strip and prepare recipient sites. Depending on the graft count(FUT surgery is generally always a significant graft count), a patient may require 6+ technicians, to dissect, clean and appropriately sort and store grafts before beginning to place. FUT is very technician reliant with more demands time wise on the team over the doctor.

Just as “newer” doctors may not see the value in investing their time into learning to perform FUT, the same applies to technicians/nurses. This means that in general, a smaller percentage of technicians have training and experience in the technicalities of FUT surgery, meaning staffing FUT surgery can be also be a challenge for many clinics.

The reality of this, is that with FUE  “leading” the market over FUT, clinics no longer require the same quantity of technicians as they once did as the vast majority of patients decide to proceed with FUE surgery. When FUT is scheduled, more technicians are required, meaning more expense to be covered, which will be absorbed into the cost of surgery for the patient, oftentimes meaning that FUT may now present a higher price than FUE, and is no longer the more economical option, which in turn results in FUT becoming even less attractive to many.

I am very happy to be able to present the following result, currently at 7 months post surgery on behalf of the patient.

The patient is already showing very good growth at this early stage with a very natural outcome and still has more to look forward to.

Further updates will be provided over the next months.

Goals of Surgery - Rebuild hairline, increase density behind hairline and into existing hair.

Challenges - Direction of hair with slight cowlick in the hairline

Total - 2507 Graft

Graft Breakdown:-

1s 403 = 403 Hairs
2s 875 = 1750 Hairs
3s 1040 = 3120Hairs
4s 189 = 756 Hairs

Total: 2507/6029 = 2.4 Average hair per graft.

Pre-Surgery

Placement

Donor

7 Months All photos provided by the patient 

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses how and why a hair transplant surgery should never be rushed. That successful surgery is dependent on specific protocols that take the necessary time frame to be performed optimally and that surgery should be considered as a marathon, and never a race. He also shares the factors that impact the duration of a high-quality, professional hair transplantation procedures. Learn more how picking poor quality "hair clinics" can destroy your donor area and cost you more over the long run.

@LeBerry Thank you for your post. Very nice documentation and thank you for sharing your photos. It is important that we as patients give back to the community and I have no doubt that many individuals will find value in your thread and journey.

Your early photos look great and very clean. You clearly did a good job with scab removal.

I look forward to your updates and am excited for you for the months ahead. You are in great hands with Hilde.

On 9/17/2021 at 11:04 PM, follically challenged said:

But i do wonder, won't this donor area look asymmetrical if only taking grafts from the back and just one side?

To copy from previous posts where Dr. Bisanga´s extraction approach has been discussed and explained -

Recently on the forum there has been some discussion and possible misunderstanding regarding the pattern of extraction that is often employed by Dr. Bisanga. This is where Dr. Bisanga will harvest on one side of the donor area and not the opposing side

There are various motivations why Dr. Bisanga will at times take the approach of only extracting from one side of the patient´s donor.

If we start by explaining that much more commonly, we will see patients who have undergone FUE surgery, and the main focus of their extraction pattern is centred on the occipital (back) donor region, oftentimes not extending even slightly to the parietal (side) area.

The reason that this is a common approach is that the occipital donor area has the highest density, higher hair groupings and is the richest area of the entire donor. When a doctor is looking to achieve the best result possible, he has therefore chosen the best quality grafts. The concern with this approach is that the strongest area of the donor has been heavily relied upon in that first surgery, meaning that subsequent procedures do not have the advantage of utilising this area to any extent.

One of the beauties of FUE surgery, is that it allows the doctor to “cherry-pick” the most suitable and appropriate hairs for specific areas of the restoration. This is essential for designing hairlines and temple points. The most appropriate soft and single hair grafts can be found in the parietal/temporal area of the donor (above the ear). This is one of the reasons why Dr. Bisanga will look to extract from this area. To be able to provide natural and optimal single hair grafts, as opposed to having to dissect thicker multiple hair grafts from the occipital to meet the necessary demands/count of singles for the hairline for example.

The question of why we may only extract from one side of the donor, and not the other comes down to several factors. The most simple and obvious is the total graft count of surgery. Taking into account the reasons explained above why Dr. Bisanga will avoid harvesting only from the occipital region, and also prefers to harvest the most appropriate follicles from the temporal/parietal area, due to spreading the extraction pattern over this significant band, there may be no need to extract from both sides. If the desired graft count can be achieved with a very well distributed extraction pattern, then there are more positives to leave an untouched area of donor, with a more specific type of follicle, that can be better utilised for a potential subsequent surgery.

We do not from any of our surgeries have cases whereby the extracted side shows visibly less density than the non touched area, and as explained, this is due to still in keeping with an extraction pattern that is sufficiently spread to not contribute to any real visible concern and especially not when the hair has any length.

Additionally, before extraction, the donor area must be well numbed. Administering anaesthetic and epinephrine to a donor area can in some patients cause shock loss. As we have already explained that the temporal/parietal area has more softer follicles, and is also an area that can be prone to hair loss and recession the closer to the temporal point. This means that some patients may be more susceptible to shock loss in this area.
If a particular patient has a significant graft demand that requires harvesting from both sides, then the reward far outweighs the risk of temporary shock loss. However, in patients whose graft demands can be met by utilising and extracting from just one side, then there is no need to “disturb” both sides at this time. As long as the extraction pattern can be managed in a way that no real visible distinction can be made from one side to the other, then this is Dr. Bisanga´s preferred approach with appropriate patients.
Should a patient then in the future experience further loss into his temple points for example or would like to “tweak” his hairline, then we have the advantage of being able to again harvest the most appropriate single hair grafts from that untouched donor area.
Our approach also allows a second pass even on previously harvested areas, so does in essence maximise the donor without over harvesting and choking any area or over spreading with needless extra injections, swelling and potential shock loss.

It is an approach that has served Dr. Bisanga well in many of his patients.

I will link some cases below where this approach has been used. There are many more on the forum. The cases below show hair at different lengths throughout the growth phases to reinforce that there are no donor concerns.
I think that it is fair to say that the quality of these results and the appearance of the donor area post surgery are optimal. 

Its a good question and one that is difficult to really quantify.

Effective treatment of oral minoxidil in males is seen between 2.5mg and 5mg. The generally recommend dosage is 5mg which obviously presents more active ingredient to increase efficacy. 
Im not aware of any studies that increased dosages from 2.5mg to 3.75mg and as we know all individuals have their own level of sensitivity both positively and negative.

Wish you the best at consultation Kieran.

Thank you for the support and comments.

Considering the graft count of less than 3000 grafts that would be typically used to restore only the frontal third, the patient is very happy with the coverage and density achieved at only 5 months.

One important consideration with any medication and approach in regard to hair loss is that there is no definitive answer that is appropriate for all cases. As we know with such medications as finasteride and minoxidil, all individuals will tolerate them uniquely based on their own physiology and sensitivity. This is to say that what may be most effective for one patient, may not be the case for the next.

Based on the question and the options listed, topical finasteride or a treatment of mesotherapy + dutasteride, I would suggest that in our experience with the treatment of PRP/mesotheraphy + dutasteride that we perform, results have been impressive and this would potentially be the better option. Having said that, depending on location of the patient and the quality of treatment at a local facility (not all PRP mess treatments are equal) and with the requirement for frequent visits, this will also be the more costly of the options and so this must be factored in to "efficiency" and viability for the patient.

With this in mind, my suggestion would be begin topical finasteride at a lower dosage and see how you may tolerate it as this can be a regimen that you can commit to, and then you can still consider additional supplementary treatments such as PRP/meso + dutasteride.

I wish you the best.

14 hours ago, JohnAC71 said:

Also check out this thread: 

This is a nice resource @JohnAC71
One key point that I believe should be added for FUE surgery is who performs the punching of grafts. Several clinics here are detailed as techs place the grafts which is industry standard, but without any reference to if the doctor will punch all grafts and make recipient sites, which I believe is a key detail.

11 hours ago, digi23 said:

Do anyone know if there is any relation between early shedding = early growth?

Shedding of transplanted grafts is essentially shock loss that the follicles experience due to the process of surgery and we do not support that there is a correlation between shedding time and growth time in patients.
Almost all patients who have had surgery with any clinic will shed, regardless of quality of surgery and even in cases of lower yield and poor growth showing that shedding and growth are not correlative. 

Early growth is one of the most discussed topics/asked questions recently which is completely understandable in terms of patients getting back to normal and moving forward post procedure, but as mentioned in the video, it can be a real source of anxiety for some individuals if they haven't achieved significant growth in those very early months which may not be realistic for them. 

We all proceed with surgery with the longer term result in mind. I have seen patients on this very forum who experienced impressive early growth but their final result was somewhat lacking.

Early growth is a bonus for those who experience it, but far more important than early growth is the final result at 12+ months.

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses how and why many of his patients are able to achieve early growth following a hair transplant procedure.

Hi Melvin

The treatment of mesotheraphy and dutasteride that we perform at the clinic is injected along with PRP.

I don’t know the specific products in the photos but it would appear that these products are topical formulations of such treatments much like a compound of topical Finasteride.

In this latest presentation from our "Inside the Op Room" series, Dr. Bisanga shows and explains his approach to cutting recipient sites, discussing angles, feathering,  hair groupings and light penetration to best achieve the desired "illusion of coverage".

This is a very educational video and even more valuable is that we have this very patient´s own documentation and result thread to show the evolution and growth of this procedure (below).

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses the challenges and considerations when performing an FUE procedure on patients who have had previous FUT surgery.

@New_Barnet_Please
Thank you for presenting such an excellent and thorough write up regarding your history and experience.
I would also agree regarding your hairline design and having seen your photos, this shapes your face incredibly well and I have no doubt will achieve quite the transformation.

I have great respect for those who decide to share their case with the community after taking so much value from other members doing so over the years and your case will be a great example of that also.

Early days but a lot to look forward to and I am excited for you in regards to the months ahead. Stay patient these initial months and you have our full support as you well know.

@Bailey99
Thank you for the update. Im sure many will have been waiting for this one.

Things are looking very positive and promising. I can see early growth showing in your crown which is great at only 3 months post surgery. Im looking forward to your next updates over the next months as things continue to evolve and you have some exciting times ahead.

Thank you for sharing.

5 hours ago, Moe N said:

Thanks for sharing your amazing progress. Also great to see you at the instalive with Dr. Bisanga 😃🤟

Thank you @Moe N
 

1 hour ago, aKaWonderKid said:

Does anyone know what bisangas waiting time is

@aKaWonderKid
By all means send me a dm or email and we can discuss your case with Dr. Bisanga and provide specifics and potential dates. Currently scheduling is completing its final dates in 2021 with more availability beginning in the second half of January 2022.

14 minutes ago, Gatsby said:

What an excellent write up Ian. At 5 months you have achieved an incredibly impressive and natural result already. Lots of more happy days of growth even still!! Thanks for sharing!

Appreciate your support and kind words @Gatsby. Thank you.

Hi @Kieran2020

Good to hear that you are conducting your research and communicating with several doctors to appreciate their recommendations and suggested approach.

Great that you will be meeting Dr. Bisanga for consultation in October. There are no foolish questions. 
“The man who asks a question is a fool for a minute, the man who does not ask is a fool for life.”
Any question that is important to you and that you would like to seek clarity about, then you should ask.

Whether transplanting into a patient´s crown in their first surgery is appropriate or not will depend on many specific factors.  
As you have already mentioned, age being one as crown loss may progress and the younger the patient, the harder this may be to predict. Some others include -

* Medication /stability of native hair (risk of shock loss)
* Graft demands (both in the front and crown)
* Donor density and hair groupings (can the donor safely meet graft demands for both frontal and crown requirements in one surgery)
* Progressive loss (Could the extra grafts being used in the crown be better utilised if more frontal loss is experienced in the future)

Below your scalp in your donor area you have small blood vessels that will play a crucial part in donor area healing post surgery. It is important not to make too many extraction sites in one surgery that would put too much in terms of demand on these blood vessels which could compromise healing.
In patients whose graft demands are higher and their donor may not be able to support this in one procedure, planning surgery over two sessions will encourage optimal healing and would allow further grafts from your donor area in a subsequent surgery.

Being too aggressive in extraction in your first surgery resulting in less than optimal healing, could mean less total graft availability.

Dr. Bisanga looks forward to meeting with you and will be able to discuss all such matters.

@Maballack
Thank you for your interest in surgery with Dr. Bisanga.

If you would like to send me your photos and relative details to allow Dr. Bisanga to assess and present his recommendations, that would be the suggested first step.

We will then be able to provide feedback from the doctor and a proposed surgery plan if appropriate with a breakdown of pricing and availability.
Depending on your hair calibre and graft requirements, surgery may require one day or two consecutive days which will then be reflective of earliest surgery dates.

Dont hesitate to reach out and you can contact private message me here or send your photos and details via email - ian@rchristianbisanga.com

Thanks Maballack

5 hours ago, Curious25 said:

Hairline and temple reconstruction artistry is largely subjective , however certain surgeons have a better grasp of understanding ones facial features, that determine the correct hairline design - @Raphael84 has a good video on this somewhere. 

Thanks Curious

I imagine this is the video that you may be referencing -