Raphael84

Thank you for your kind words and support @Gatsby The patient is thrilled. Previous surgery included both FUE and FUT surgery but not "punch graft" or other such techniques.

Thanks for your question @bw77 In many frontal restorations, Dr. Bisanga is essentially placing amongst some native hair, especially when transitioning into the "crossover" area of scalp without native hair, into areas of native hair to ensure of a smooth and natural transition and result. This is why Dr. Bisanga will always suggest shaving when possible as the precise exit angles and direction of native hair can be more thoroughly seen and understood to ensure of less trauma to existing follicles when making recipient sites and therefore avoiding/limiting shock loss as much as possible. The strength of the native hair in the recipient area will also have an influential role in potential shock loss as the "trauma" of surgery can trigger weaker follicles that are heavily miniaturised to fall. This is where patient depending, stabilisation with medication pre surgery can be effective. In this patient, no shock loss was reported post surgery, but as this patient presented a repair surgery, placing in the hairline was amongst previously transplanted hair which as long as the donor is strong and healthy (where the hair was extracted from), means that it should in essence be less prone to potential shock. However in repair surgery such as this case, other challenges are present such as previously transplanted hair not being placed at optimal or natural angles and so further expertise is needed to avoid any transection below the scalp and to be able to blend any such hair into the restoration approach to achieve the most natural result.

Hi @Andrei I hope you are well. Im not sure which email you may have contacted the clinic on but dont hesitate to email me and it will be my pleasure to assist. ian@drchristianbisanga.com Thanks

In this video, as part of "Inside the Op-Room” series, Dr. Bisanga reveals a poorly performed hair transplant with complete disregard to natural aesthetics with a lack of professionalism and ethics.

Dr. Bisanga and myself are looking forward to joining Melvin this coming Sunday for a Q&A style session to discuss/answer any topics and questions that you may have. It would be great if you could join us. Sunday 5th September 2021 7pm CET 6pm UK

You looked younger than your age pre HT - WOW! And look at you now. I wish I had that problem!

I wouldn't change a thing. Your hair looks excellent and if you are happy to continue doing so, then why not? One of the many "luxuries" post procedure however is going for your "first" hair cut with your new locks. Thrilled for you!!!

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses the experience of his patient´s and how they have achieved better results when combining oral minoxidil with topical finasteride.

This is the reality of it John unfortunately. Even if some research is done, as with many factors of our lives, we prefer to attach ourselves to opportunities/opinions that suit/support our own narrative. As a young patient with insecurities regarding their hair and a smaller budget, having a clinic with a social media presence tell them exactly what they want to hear for 2-3k is far more comforting than an advisor explaining 10k for a quality surgeon if such pricing is not an option for them. Patience is tough to comprehend for the younger individual and at 24 they can't look past their 30s. Many feel that they need to act now. When things dont work out as they anticipated, patience and budget become far more stretched than the right decision first time would have demanded.

Hair Transplant costs, the hidden dangers! We all have a budget, but what should you look out for when searching for FUE surgery? Often with “cheap deals”, you pay far more, not only per hour, but for life. Let me explain why… Let’s face it, in the modern world of sleek marketing, celeb endorsements and good looking models, this for some is the only level of research they need to do for what is their life changing hair transplantation surgery. Why waste time when others have researched for you and their five star and four line reviews are more than enough to catch you and reel you in. With their glowing teeth and their gelled hair that looks like a scene from Grease, (the movie), not the country, the set is ready, all that is needed now is your part to complete the dream. The price is good so why pay more? In the good old days, you had to leave home to get robbed, now it happens from the safety of your office, your home or anywhere that you are connected. The web that gives us so much, and it gives us a lot of good, is also a fertile ground for grooming the unsuspecting victim. Like many today, time is precious and money is an important factor, so these become the USP or the “unique selling points” for many hair transplantation clinics. Flashy presentations, often on sites and media accounts that are live and then down very frequently, huge marketing budgets, (ironically the larger the campaign the smaller the doctor), and medical professionals who really have no depth or pedigree to show. Aside from the presentation, comes the deal, the price, the clinch…all you can eat, a marketing tool for restaurants in the 90s, has become a tool for modern hair transplantation, they just changed a few words to “all the grafts you need”, and often for a set price or a very cheap price per graft. The focus is on this and less so on the qualifications, recognition, awards, peer review, pedigree and depth of posting history of cases and education to recognised forums. Attracted by this wonderful price and often less than half of what you would expect to pay in a truly bonafide reputable clinic, it seems to be low risk and high benefit. Okay, the stage has been set, now let’s see some of the problems that come. Firstly the number of patients per daythat are being operated on. When most of the top will do one or at most two patients per day, and averaging 8 hours per surgery, these are doing multiple and even I have heard of 8/9 daily!Yes, you read that correctly, a few more and you have a football team! Surgery, this will usually last 3/4 hours for 3000 to 4,000 FUE, and this is an important aspect, the surgery is tech centric not doctor centric, so in essence you have multiple technicians punching the grafts, three at a time is not uncommon, and the same crew placing with implanter pens. So, the whole process is super-fast, the hair implantation happens simultaneously with the sites being cut, and like a quick fit fitter, you are in and out before you know it. The donor is often over harvested, the hair angles, depth, direction and density, rather than being dictated by the doctor are at the mercy of the technicians, most of whom have little to no medical experience of qualifications. In fact, it is shocking but some are part time taxi drivers and illegals in the country with no experience in what is essentially a very complex and life changing surgery. If your tech is left handed you may have different hair orientations placed as opposed to right handed, and trust me I have seen the results of this. To make matters worse, your hourly rate was in all probability more for this than it would have been with a doctor centric, renowned clinic, that due to the doctor punching all of the grafts and cutting all of the sites, you need far more time. So, in essence, your cheap deal per hour is not so cheap financially.The real cost however is far more, the grafts are precious, the donor often is beyond repair and the result is worse than being bald! The cost is emotional, both socially and professionally. I have met many who have left well paid jobs due to this and take anything where they can live under a hat! If things go really wrong then your actual physical health can be at harm, with too many injections and risk of toxicity to even scalp necrosis! At times the last thing to worry about is the end hair transplant result that can be pluggy, lack density and frankly be anything but natural. Take home message, remember a hair transplant is for life, work out the cost difference it will be per year and ask yourself…is it worth it? In short a good surgery is priceless, a poor one is even more costly. Article written be Stephen stephen@bhrclinic.com To see the original article, please visit - https://bhrclinic.com/2021/08/04/hair-transplant-costs-the-hidden-dangers-we-all-have-a-budget-but-what-should-you-look-out-for-when-searching-for-fue-surgery-often-with-cheap-deals-you-pay-far-more-not-only-p/

Haha. Excellent!

Hopefully everything is sorted now @follically challenged Thanks for your kind words @MachoVato Dr. Bisanga is a friendly guy and a fountain of knowledge. Congratulations on your surgery and I look forward to following your progress.

Dr. Kostis! I am so happy for you brother! You have come such a long way and you are looking great. The conservative design, placement and density is excellent and the coverage for the graft count is also significant. Well done for the documentation and for sharing your case, it is great and Im sure that many individuals here will really find real value in your journey. Such a transformation already. I can say that above all, you are a great person who we all have much respect for and it is great to have you on the forum. Great job Dr. B and big thank you to all of the team.

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses the ever popular topic of FUE or FUT. For those who may be unsure of what may be the most appropriate approach in their case, you may appreciate the insight.

The PRP/Mesotheraphy and Dutasteride that I was referring to is a treatment applied at the clinic at specific intervals. In regard to oral medication, several patients have a regimen of daily minoxidil, weekly (Monday to Friday) finasteride and dutasteride at the weekend.

Thanks @Melvin- Moderator Just yesterday I saw photos of a patient who has had treatment of PRP/Mesotherapy/Dutaseride along with beginning oral minoxidil. His improvement is incredible after 12 months of treatment. I have checked with the clinic if the patient has given his permission to share his photos so please bear with me and as soon as I have confirmation, I will share photos if possible.

@Babou1410Thanks for the tag. Dr. Bisanga performs restorations in all extents of hair loss and specialises in both frontal hairline and crown restorations. I would agree that there are more cases shared that present hairline restoration as I believe that this is reflective in demand. I have never met a patient who has requested his crown restored whilst leaving his frontal third without hair. Generally the front is the priority when necessary. In terms of scheduling, the last 18 months with Covid has presented some changes to the pattern of scheduling, with many patients looking to confirm a date later in the year as opposed to the following month or two with the understanding that travel restrictions will have eased. Now that travel is opening up again, scheduling is currently very active. Whilst some travel restrictions and late changes may present a single date here and there, in general a wait time of 3-4 months would generally be able to present a few options. @FernandBy all means reach out to the clinic and request an update of the calendar and we will be able to explore specific dates based around your availability. Drop me a dm if I may be able to help in any way.

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses why and how he applies his unique and artistic approach to design in his patients.

@Elisha I have contacted you privately in relation to this thread and your case. As I alluded to in my message, congratulations for beginning the process of research and being diligent and asking the right questions. Continue your research and dialogue with those doctors who you may be considering and you will quickly get a sense of which doctors have your best interests at heart and may be a good option for you. Take you time and dont rush into any decisions. I look forward to hearing from you. All the best

Thank you for your interest and support guys. I didn't really consider a second strip and based on my scalp laxity and the fact that the closure had pulled and exacerbated the appearance of retrograde and also caused some changes if angles to surrounding follicles, a further FUT would only "intensify" this. Not at all. The intention was never to have a biopsy. This actually added an extra "concern" at the time and resulted in having to skirt around the area of the biopsy when placing so was more of an inconvenience. Dr. Bisanga wanted to rule out scarring/cicatricial alopecia due to some scarring that he could see under magnification. Scarring alopecia is where the hair follicle is targeted in a destructive inflammatory process which essentially kills the hair follicle. In terms of graft survival in non virgin cases, this is very case specific. Dr. Bisanga is able to achieve very successful yield in many of his repair patients, but the physiology of the skin is different than it was before any surgery and therefore it can and does respond differently. Obviously there are many "levels" to repair surgery and potentially compromised skin and scarring and so the extent of the damage to the skin can be relative to what may be expected in terms of yield. Generally if scarring alopecia is present then the patient would be referred to a specialist dermatologist for further investigation and to see if treatment may be able to help or be effective. The concern with scarring alopecia is that it is not curable and surgery itself can trigger the condition further, so this must be well understood by the patient and knowing that it could occur again at any time. Oftentimes due to when weighing up the risk/reward ratio, most individuals with such a type of hair loss would not be good candidates for surgery. Thanks so much Melvin. When I arrive at the 12 month stage, I intend to put together a more detailed presentation of my personal journey from pre any HT.

In my own journey throughout the years and long before I was in my current role as patient advisor for Dr. Bisanga, I have spent many hours and found incredible value in this very forum. Being able to share frequent patient results from Dr. Bisanga is always a pleasure of mine and knowing that in doing so, it really adds to the essence of the community and can help to show what can be achieved. With that being said, I am very happy to be able to present my own case and give back on a personal level. In all honesty I did not intend to present my surgery photos until 12 months post op when I would have been nearer to my “final result”. This was because as many of you will know this was not my first surgery. I had previous strip surgery in 2012 (not with Dr. Bisanga) and was satisfied with my results at that time, however due to progressive hair loss, this meant that this surgery required "revisiting" the same area which was therefore not virgin scalp in the frontal half. Non virgin scalp means that quality of skin will be less due to making of previous recipient sites and subsequent scarring and this can have an impact on yield, and growth can oftentimes take longer to develop in repair surgery. I knew that I may have to be patient, but fortunately that has not been the case. I had FUE surgery with Dr. Bisanga 5 months ago with the following objectives - *Rebuild my hairline and increase density through the frontal third *Strengthen my temple points (as conservatively as possible) *Reinforce my mid scalp and crown *Place beard grafts into my previous strip scar (if possible) This was a lot to ask in one surgery, especially considering my quality of candidacy. In essence, any patient who is a candidate for hair restoration surgery does not have a “perfect” head of hair, but there are different levels to candidacy from excellent through to borderline and then obviously non candidate. We often seen “hollywood” hairlines achieved on patients with focused loss and what would appear to be a great donor. That certainly isn’t my case and isn the case for many. Challenges of surgery were - *Larger pattern of loss/decline *Retrograde alopecia (Dr. Bisanga explained that it is likely emphasised by my strip closure pulling my nape “higher”) *Average/below donor density *Below average hair groupings *Fine hair *Previous strip scarring Surgery was always going to be challenging in terms of achieving the necessary graft numbers but I was well aware of this and understood that we may not have been able to have achieve all of my objectives. This really highlights how realistic expectations are key. As is my intention with all patients who I have the pleasure to communicate with, education is fundamental. My surgery was scheduled over 2 days and I arrived in Brussels the days prior to my procedure for a thorough consultation using the state of the art equipment and software to allow Dr. Bisanga to assess the current status of my hair and scalp and discuss his approach. Due to using oral minoxidil and finasteride, I was very pleased to hear that my donor was stable and without any signs of miniaturisation throughout. I discontinued meds several years back and lost quite a lot of ground at that time. At 38 years of age, I wasn’t looking to lower my hairline at all despite it sitting high at over 8.5cm+ from the glabella. I really wanted to proceed as conservatively as possible in order to preserve as many grafts and achieve as much coverage as possible with an appropriate hairline as I age and inline with the shape of my face and considering my hair characteristics and donor specifics. One concern that Dr. Bisanga did have was some potential scarring on my scalp. Dr. Bisanga wanted to rule out any possible concerns such as scarring alopecia and decided to take a “punch” biopsy to remove a small tissue sample to be sent to the lab for testing. This then required a few stitches which were removed several days later. You can see the stitches in the post operative images and actually as this area did not receive any grafts to allow and encourage optimal healing, you can actually make out a weaker area in my recent photographs. Fortunately my biopsy result came back without concern and without the presence of inflammation or scarring alopecia. Surgery days went very smoothly as expected and after assisting many patients over the last years throughout their journey, it felt great to be taking my place in the chair. Dr. Bisanga explained that I had tough skin and I was burning through anaesthetic which meant the need for more numbing, but he reported easy harvesting despite my follicles sitting quite deep in my donor. We didn’t want to push too heavily or aggressively on my donor as my hair is fine and we didn’t want to further expose my strip, and as with all of us, loss is progressive and being conscious of this it was agreed that we would harvest approximately 2400 from the scalp with further supplementation from my beard using it to great effect in placing into my mid scalp and crown. As expected, all of my beard grafts represented single hairs and due to this being my first beard session, it was decided not to push far beyond 1000 grafts to allow a good distribution in terms of extraction sites and ensure optimal healing. With this being the approach, I was always going to fall slightly short in terms of placing grafts throughout my entire previous strip scar, and so therefore it was decided that we would commit to one side of the scar (approximately 260 - 300 grafts) which was still a bonus. Not the standard approach but in my case, it presented a great opportunity to be able to see yield throughout my scar tissue and at a later date, be able to return for further surgery, shave down and really understand and present what beard into strip scars can achieve by comparing both sides. Healing was very straightforward. I am obviously well versed in our post op care but instructions are simple and all products are provided in the post operative kit and despite a few initial “uncomfortable nights” as expected, recovery was generally quite quick. In fact, I was working and responded to patients in the evening on my surgery days. Being completely transparent, I was in no way expecting such early growth. Especially as despite a significant graft count, hair count with beard was lower and this was placed over a larger surface area, therefore I was/am extremely pleased to see density come in so quickly. Even now, improvement continues and I have several months to go. I am absolutely thrilled and not having to think twice about your hair when you wake in the morning really does have an impact on your day to day life and not having to worry regarding product and styling etc is a game changer. A big thank you to Dr. B and his team of amazing technicians and a shout out to all my colleagues at BHR who have shown their support. It is a special clinic and one that I am very proud to be part of. On a personal level, I genuinely get great satisfaction from supporting patients on their journeys and am thrilled to see their response and how their confidence grows and impacts many facets of their lives. I can honestly say that it has been a hugely positive experience and my results at this early stage speak for themselves and I couldn’t be happier. Many other patients have taken similar steps in their own hair restoration surgery and I remember the first forum case that I read some 15+ years ago. It was overwhelming, daunting, interesting and very exciting to see that there is hope, and there will be individuals who are reading cases today for the first time. Such communities are integral in the journey of many patients, it certainly was mine and I felt it important to continue to pay it forward and support the community. — BHR Clinic Dr. Christian BISANGA Technique: FUE Donor density: 70/70 FUs/cm2 Breakdown of grafts:- 2366 Scalp Grafts + 1100 Beard Grafts (Single hair) 1s - 1714 2s - 1341 3s - 411 Total Grafts :- 3466 Total Hairs :-5629 Average Follicular Unit (Scalp) = 1,91 hairs Average Follicular Unit (Scalp + beard) :- 1.62 hairs PRE SURGERY FRONT TOP ELEVATION PRE SURGERY RIGHT PRE SURGERY LEFT PRE SURGERY REAR PLACING LEFT VIEW PLACING RIGHT VIEW PLACING WITH BIOPSY DONOR REAR DONOR LEFT DONOR BEARD ] 5 MONTHS POST SURGERY LEFT 5 MONTHS RIGHT 5 MONTHS TOP 5 MONTHS REAR DONOR COMPARISON 5 MONTHS

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses frontal fibrosing alopecia. Frontal fibrosing alopecia is an inflammatory hair disorder causing the loss of frontal hairline and eyebrows, and in this video, Dr. Bisanga discussed the need for realistic expectations and what concerns may be in place.

UPDATE!!! Further update at 13 months. Here is a perfect example of continued evolution and improvement later in the growth timeline. This patient´s result just keeps on getting better. Thank you as always to the patient for sharing.

DHI stands for direct hair implantation. It is different to an implanter pen as the site being made and the graft being placed occurs within the same process. Implanter pens are used to place into pre-made recipient sites. DHI is FUE surgery, but simply utilising a different tool. Just like with any tool in FUE and the debate of manual or motorised, the most important element is the controller, ie. the surgeon. Whilst some respected doctors may prefer to use DHI, it is also very prominent in low cost technician led clinics whose goal is to perform surgery more quickly, and with more patients each day as DHI essentially "cuts out" the independent process of placing. When the desire for speed becomes a factor, quality of surgery will also suffer. The risk of cobblestoning, tenting, low density, extensive popping of grafts are just a few of many concerns with DHI. I have known patients and have read reviews on this very forum, from guys who have completed a 4500 graft surgery within 4 hours. Wow. It would take Dr. Bisanga and his team twice as long to complete half of that. The irony is that these cheaper clinics as a result, charge more in terms of an hourly rate than higher end clinics. In general, clinics who use tools to sell their services over their surgeons experience, patient results, patient reviews, stellar reputation etc. do so for a reason. If their unique and strongest "selling point" is the tools that they use, this really presents more questions than it does answers. It is important to correctly match the equipment and procedure to the patient. No two patients are exactly alike so it is important to have a selection of tools and a variety of methods to succeed in ALL patients. Every aspect of any procedure has to be individualised to the patients needs.

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses the current trend of marketing gimmicks such as DHI and Sapphire and how some clinics use them as a mere marketing strategy to attract patients by selling "superior techniques". Dr. Bisanga shares why every single hair follicle matters as a finite resource that must be respected and he details his preferred approach in terms of order of proceedings on surgery day.