Raphael84

@Melvin- Moderator This instagram was actually requested and set up by Dr. Sethi and so was never aired in its entirety on our platforms. There was some great content and so we wanted to be able to share the most interesting and valuable segments and share them via our Bitesize series.

We are pleased to present our latest blog post regarding FUE surgery and what happens when things may go wrong. With the demand for repair surgery at an all time high, we encourage all prospective patients to really do their homework and conduct thorough research. With limited donor availability, patients don’t get many bites at the cherry, so choose wisely as this may be the only real opportunity to avoid issue. --- What happens when FUE surgery goes wrong? You don’t get many bites at the cherry, so choose wisely as this may be your last chance for redemption! We live in a world of expectations, there are ones others or society puts on us, or even more harshly, the ones we put on ourselves when we survey the modern world in which we live today. Society is more interested in beauty than morality, that seems strong language, but I can prove it, we can see this in our spending habits. While we will spend thousands to look better, we won’t spend pennies to be better. I am not saying it is wrong, but this is the world we live in and it ain’t gonna change anytime soon, if anything it will intensify. The world is about equality, equality at work, socially and now in beauty! Men are rapidly closing in on females and and we are seeing that to look your best is not taboo now, be it from body to facial and not least, you guessed it, hair! In fact hair transplantation has gone from a pluggy doll’s look and all of the associated shame, to undetectable and something to be proud of in the space of two decades and of course only in the right hands! The ones you notice when you are out and about and draw your attention are the ones that have not gone well, you do however walk past many hair transplant patients without even knowing it! Thankfully, and for a host of reasons, hair loss and hair transplantation and treatments are becoming less of a taboo and especially as more celebs and influencers also undergo hair transplant surgery. FUE is becoming a term that even the TV are aware of, when it was prior just for the target group it attracted. When things go well it is truly life changing, yes, you heard that right, it changes every aspect from looking in the mirror to doing the shopping and not the least, work, social events and romance, from the mundane to the insane, it is with you, you take it everywhere and it is on display 24/7. This is exciting and it should be, especially when we think in centuries past, even the world’s most powerful had no chance to change their hair as we do or to deal with hair loss in any positive way. The social and mental impact of it was there and it struck without discrimination. Julius Caesar wore a laurel leaf, others wear hats, but today you can wear your own natural hair, and wear it well, if it all goes to plan! What was unimaginable now is possible and we have many success stories. Hair is not just for protection and to keep you warm, it is part of your vigour and identity, it gives you confidence and a semblance of youth. No-wonder it is sought after, that elixir that makes us attractive, both to self and to others and often self- confidence is a priceless positive side effect. Many hair transplant clinics however will play on this, their adverts will be emotion based and it is tailored to the “click now” approach to secure your new future, without any real pedigree or track record in the hair transplant industry, with come and go salesmen for unknown FUE doctors and hair-mill clinics. The dark side, like all industries, exists. Attracted by the glossy photos and polished reviews and the celeb endorsements, many fall victim to hair-mill type FUE clinics, your dreams can be achieved at a click of a button and for a low cost, fully endorsed and guaranteed for life! So, why pay more and why wait more? Your passport to happiness is here, so come on in and enjoy the ride. It is a trap that many fall into and is surrounded by a wall of silence, the previous victims will not warn the next and so the conveyor belt is fired up and the rotation continues on, for what essentially is a life changing decision, in the good and in the not so, you will be changed. Here in this video, Dr.Bisanga shows beyond the click and into the op-room some of the real technical aspects needed to repair poorly thought out and executed hair transplants and address when FUE goes wrong for the hair transplant patient, who rather than becoming the poster boy they dreamed of, are often a shadow of what they were before. Looking unnatural is worse than looking bald, you may get attention but not the type you want, and the end product is confidence is eroded not grown and mundane things become challenges. The hope is, that most are not beyond repair, but the approach will be different and an ethical and highly skilled surgeon will be needed. Well I have said enough, over to Dr.Bisanga, click and see the approach and the more technical aspect in the video description. Take home message, research well, don’t go for cost alone and don’t become another hair transplant victim! Now has never been an easier time to research, and remember, you may not get a second chance! Written by stephen@bhrclinic.com Copied from - https://bhrclinic.com/2021/07/17/what-happens-when-fue-surgery-goes-wrong/

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses the importance and necessity of using magnification and state of the art hardware and software, FotoFinder TrichoLab to thoroughly assess and attain empirical data in his consultation in Brussels. Amongst other influential data points, miniaturisation and the percentage of miniaturised hair that may be present in the donor is calculated to determine patient candidacy.

@Bailey99 Congratulations on your recent surgery and thank you as always for your updates and honest and clear photographs. At one month post surgery, more shedding may yet occur but based on the above photos and comparing them to pre and surgery, you are doing great. I look forward to your further updates.

Thanks for your questions and thanks Stephen for filling in for me. If I begin by addressing your original question - Not at all. This is exactly the "model" that BHR Clinic strictly oppose. Pricing for surgery with a BHR doctor is not inline with pricing for surgery performed by Dr. Bisanga and all such details are very transparent on all booking documentation. The process of pictorial assessment and the subsequent graft recommendation summary based on any enquiry present clear details who will be performing each process such as punching grafts and making recipient sites. A full pricing breakdown will be provided based on the preference requested. The majority of our enquiries are submitted/received via our www.bhrclinic.com website which is representative of Dr. Bisanga in Brussels and all pictorial assessment and graft recommendations are provided by Dr. Bisanga and pricing provided based on Dr. Bisanga punching all grafts and making all recipient sites. If an enquiry is received via the website of another location (i.e. Athens or Israel for example), then recommendations and pricing would be provided by the performing doctor of that clinic and presented by the relevant BHR patient advisor. I couldn't agree more and couldn't have put it better myself. Dr. Bisanga has been an industry leader and elite surgeon for 20 years. Many doctors have dedicated their entire careers to hair restoration surgery without being able to achieve the same surgical quality and/or consistent results as Dr. Bisanga, therefore attempting to match the quality, artistic ability and technique of Dr. Bisanga without having his experience is not possible, and this is something that we are very transparent about. Dr. Bisanga has personally trained all of his staff including his team of doctors and has the highest standards and demands of all of his team. Does surgery at a BHR Clinic with another doctor at a lower price point guarantee the same quality of result as Dr. Bisanga? No. If that was the case then there would really be no demand for Dr. Bisanga. Dr Bisanga is the president of ECAMS, a member of the ISHRS and the IAHRS whilst also being recommended by the American hair loss association. His patient first approach has earned him an unparalleled reputation as one of the very leading surgeons in the field. He has worked extremely hard over the past 20 years to build such a reputation for consistent quality results and the very best in patient care. The hair restoration industry has changed significantly in the last decade due to the prevalence of FUE surgery. Many patients consider low cost markets, where the quality of surgery is generally poor and their approach and lack of respect for unique designs and donor management cause many issues for many men and women and the industry as a whole. In an effort to give these individuals a genuine option of being able to afford quality and ethical surgery at a more competitive price, Dr. Bisanga has trained his team of doctors to be able to offer exactly that at their respective international clinics. Dr. Bisanga is an elite coalition member of the hair restoration network and all results that we share here are for surgery performed by Dr. Bisanga. I am personally focused and responsible for surgery with Dr. Bisanga in Brussels which is where he is based and located throughout almost all of the year. At the time of launching other locations, he has offered several weeks of his calendar to assist with surgery and schedule his own patients who may have found those locations more convenient. As the founder of BHR Clinic (Bisanga Hair Restoration), he will continue to visit each clinic at specific times throughout the year and/or when necessary and may be available for surgery when at those locations. Hopefully that offers some clarity and by all means dont hesitate to contact me if you may have any other specific questions.

Hi @ced80 Thank you for sharing your photos and case. You have received some great support and advice already. My recommendation would definitely be to visit your preferred doctor in person before committing to any surgery to allow them to thoroughly examine and evaluate your donor area and your recipient area as a repair surgery revisiting the same non virgin scalp, and to be able to provide real live data in terms of your donor density, hair groupings and also very importantly levels of miniaturisation. As you have explained that transplanted hair from previous surgery has thinned, this may well be likely due to the decline in quality of your donor area in this interim period due to not being able to take medication and your donor not presenting a stable environment. If this is the case, then regardless of your doctor and regardless of your budget, growth and yield may well be influenced as well as the longevity of any potential result from a further surgery. This is well worth an in person consultation in my opinion, regardless of the inconvenience of travel and potential expense, to allow you to be accurately informed on what may be the most appropriate next step for you. I wish you the very best.

#BHR Clinic Newsletter! In this latest edition we cover the following topics - * Super-fast #FUE growth * Hair line design musts * Understanding symmetry Take a look - https://mailchi.mp/23857677b2ad/summer-2021-edition

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses the dangers of over harvesting and the concerns regarding clinics who support punching from technicians and non-doctors.

Excellent result already at this stage. What a transformation and a huge thank you to @cbc3113for consistently updating with clear and honest photos that really help us to understand your journey and evolution. You hair cut and style really seem to compliment your procedure and you look great. Could not be happier for you.

A very interesting topic and some great points have already been made. It has been performed as has been mentioned, to different levels of success and it really does present quite unique challenges. You may have heard pubic and armpit hair sometimes referred to as "wet" hair. This is due to glands in the localised area such as sweat glands and sebaceous glands. One of the roles of the sweat gland is to remove waste by secreting water, sodium salts etc and the sebaceous gland is to produce and secrete oils/sebum. This would suggest that surgery would present a sweaty and "wet" environment which isn't necessarily ideal during the procedure and can have quite an effect post surgery as due to further sweating and secretions, healing may not be so good in these areas. Due to such factors and the potential discrepancy in hair characteristic/texture, it generally isn't the ideal donor source. The beard and chest in appropriate candidates would normally present a greater and much more reliable source of donor hair that may in some individuals have more favourable hair groupings and so has more logic and would more routinely be considered. Not to mention other potential "uncomfortable" situations such as physiological reactions in the pubic area (it has happened). For more in depth detail regarding body hair, there are some great points in the following video -

Absolutely Melvin. As soon as we have the video cut and edited I will be sure to send it over to you with all relative information. It would be great if you are able to share on HTN platforms to further educate the community. Im looking forward to it.

@MachoVato Here in Europe, inclusive of Belgium things appear to be ever-changing in terms of travel guidelines and restrictions. Therefore we recommend all individuals who may be considering traveling for consultation or surgery to please familiarise themselves with all travel specifics relevant to their country and understanding that further changes may be implemented between now and the date of travel. Currently government website suggest that the US is classified on the "orange" list. This can be seen at the following link with more specifics detailed on the second link - https://www.info-coronavirus.be/en/colour-codes-by-country/ https://www.info-coronavirus.be/en/travels/ Travel restrictions appear to be easing within the EU generally with some exceptions. US citizens are "encouraged" to consider travel to some European countries/destinations and rumour would suggest that others are due to follow shortly with specifics such as vaccination/PCR testing being met. I would recommend to consult with your advisor on any specifics and they will be able to guide you to the best of their ability and provide links to most recent government sources etc. It can be somewhat challenging as there is uncertainty and so the patient must always be comfortable with their decision to travel.

Thank you for your comments and support. In regards to your questions - Oral minoxidil was recommended to the patient at the time of surgery. The patient comfortably has a further 3500 - 4000 grafts without putting too much demand on his donor area. Placed density varied throughout the recipient area with the initial hairline singles being placed at a density of around 50 FU/cm2. The straighter broader design of the hairline would not be appropriate for many patients. Due to this patient`s facial shape, bone structure and facial landmarks along with his preferred design which was enabled based on his hair and donor characteristics, meant that such a design was appropriate in his case. The following video is great and further explaining the philosophy behind hairline design.

Thanks for your kind words @RandoBrando517 We actually have a patient at the clinic this week who has been undergoing treatment of mesotherapy and dutasteride and so with his permission, we intend to present his case and provide deeper information regarding such an emerging treatment that Im sure will prove very interesting.

This patient wanted to restore his frontal loss with a broader and straighter hairline design that was deemed appropriate considering his facial dimensions. Dr. Bisanga made recipient sites following the natural direction of the patient´s native hair, which as can be seen from the “in the op room” image, presented quite a unique cowlick that in this instance changed the direction of the hair placement toward the left as it approached the frontal hairline. Suffice to say that the patient is extremely happy with his transformation at the current 10 month stage and upon sharing his most recent update and comparison images, he quoted - “I didn’t know it was that bad before!!! What a difference!! Couldn’t be more pleased🙏🏻” Dr. Christian BISANGA Age: 28 Technique: FUE Donor density: 80/80 FUs/cm2 Hair Caliber: Medium Fine 2494 Graft Follicular Unit breakdown:- 1s - 455 2s - 1247 3s - 792 TOTAL: 2494 2494 FU = 5325 Hairs Average = 2,13 hairs/FU PRE-SURGERY PLACEMENT COMPLEX FRONTAL SWIRL RE-CREATED AT 6 MONTHS AT 10 MONTHS AT 10 MONTH COMPARISON

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses donor scarring and elaborates on the difference between shock loss and over harvesting in the donor area.

Thank you for posting and for your kind words and very happy to hear that you had a positive experience and good growth from your surgery. Hair fall and regrowth is a physiological aspect based upon the active and dorment phases that the hair cycle will present at various times and can be influenced by diet, stress, hormones, medication and climate to name a few. From what you are describing, it is a more rare phenomenon that seems to be more locally to the transplanted hair and although less common is not unknown for the transplanted areas to cycle differently, fall and come back. Essentially as said, it is not something that is directly controllable assuming that there is no change in meds of any other environment that will effect hair cycles. I can imagine it causes anxiety to see hair fall and then come back but the transplanted part is safe and will in all probability not cause any long term issues while going through this stage. Feel free to contact whomever your advisor was with us, and they would be happy to further liaise with Dr. Bisanga regarding this and to take look at any photos and further details. Thank you.

Thanks Kieran. I have responded via DM.

Great question and I think the most important point to highlight is that you asked regarding quality doctors. It is very important that it is understood that not all FUE is performed to the same standard and this hugely influences the percentage of successful results. I would suggest that with very elite physicians, that is an accurate range. There are many elements to a successful surgery. To begin with we need to ascertain, what does successful mean for each individual case. What may achieve satisfaction in one patient may not be possible for another, and so therefore it is important that a thorough consultation is performed to be able to provide both the doctor and patient with the necessary data to be able to understand what may or may not be possible, and if surgery is even feasible. If a thorough consultation is not sufficiently performed, then naturally the chance of potentially unsuccessful surgery will increase as surgery may be performed on patients with high levels of miniaturisation for example that may not be good candidates. Without thorough education provided by the clinic regarding each individual case and ensuring realistic expectations are understood, then a great result could be achieved which may not satisfy the patient, as his/her objectives were not in line with that of the clinics and what could realistically be achieved. Providing all of the above are met, then I would suggest that rates of success are very impressive with the elite. Your choice in doctor will be the biggest influence on the success of your result.

Thanks for the kind words @Melvin- Moderator. @Kieran2020 Great to see that you are doing your research and please continue to do so. You can never be "too" educated in something so important. I appreciate that it can be frustrating to be recommended to attend an in person consultation as opposed to receiving an approximate graft count. From the clinic´s perspective it would be easier to provide an approximate recommendation allowing the patient to potentially schedule their surgery, but this is not our personal approach and our code of ethics is always at the forefront of any of our recommendations and consultations etc. which is always in the patient´s best interests. I wish you the best and you have our support in your final decision.

All doctors will have their own post surgery protocols and instructions that can differ somewhat from other clinics. As patients we invest so much of ourselves into hair restoration surgery in terms of the emotional side and of course the time investment in consulting with doctors and researching and educating ourselves. The financial aspect is also a significant factor in the process for each of us. With this in mind, the importance of presenting the most optimal environmental factors that allow a healthy scalp pre surgery, and the best opportunity to heal and recover post surgery, as well as a clean and healthy scalp post surgery can be influential. All users have a different idea of what an appropriate amount of fibres may be. The very nature of fibres is that with more hair loss, more fibres must be applied. This isn't ideal especially post surgery as individuals may be attempting to conceal redness or larger areas of scalp and therefore as a result, apply more fibres than preferred. I dont suggest that fibres harm hair follicles, but they do neither present the healthiest scalp environment post surgery with so much at stake after a transplant. I have seen on numerous occasions patients present themselves for consultation be it pre or post surgery, and despite having washed their hair and scalp, fibres are still present meaning that in such cases, they are likely constantly present to some degree. They stick to the scalp as opposed to hair follicles as they should. This is obviously not optimal and can negatively impact the scalp and therefore potentially influence growth.

The terminology "growth guarantee" is really quite misleading. Medicine is not a perfect science and any certificates of guarantee issued by clinics have no real standing as each patient presents their own physiology and there can never be a "guarantee of growth". Far more genuine and realistic is to understand what your preferred doctor/clinic perceive as acceptable growth, and in the event that growth does not meet this standard (generally a percentage), then they would agree to a "touch up". In terms of "repair" surgery, this may present quite a different scenario. Many patients are able to achieve impressive growth when revisiting the same recipient area. It is more common now due to low cost poor quality clinics and "repair" surgery is more in demand than ever and results can be extremely impressive. Having said that, patients who have had poor to no growth from a previous surgery must attempt to understand why that occurred. If it was due to the poor quality of the previous surgery, then it is important to appreciate that if intending to revisit the same recipient area that is no longer "virgin scalp", this may create additional challenges due to potentially compromised skin and scarring which is now part of the patient´s physiology when beginning "repair" surgery and so depending on the status of the patient, growth may not be "guaranteed" in any way. Poor growth in a subsequent surgery may be due to the "damage" done from previous surgery. This is also in relation to the donor area. If previous surgery was aggressive with a poorly managed extraction pattern, decline may have occurred in the donor area. This may not be overly visible in terms of obvious over harvesting, but if too much demand was put on blood vessels below the scalp in the donor area due to a focused and heavy extraction pattern, follicles that were "untouched" may have been effected due to a compromised blood supply and therefore experienced some kind of miniaturisation.This is unfortunately one of the realities of repair surgery and highlights the importance of selecting the right surgeon first time round. In virgin cases, poor growth with a quality physician is uncommon, but it can happen. Crucial factors to consider are - *The patients health *Skin conditions such as dermatitis, psoriasis, arena, scarring, erythroderma, iron dificiency, ongoing chronic illness, lupas, cancer, medication *Hair characteristics (viable candidacy) *Donor is very influential such as follicular grouping, donor density, hair calibre, miniaturisation *Operative day factors *Choice of surgeon, equipment and techniques *Patients skin, does the patients characteristics result in extreme popping or bleeding causing complication to surgery *Correct post op care *No chemical usage such as dyes or other products, Toppik or fibres post surgery As you can see, undiagnosed skin conditions can be a cause. Therefore if a patient is not seen prior to the surgery for an in person consultation, then it is harder to rule out any conditions. In the case of poor growth, one needs to understand why it happened and attempt to rule out any physiological influences such as some of the above.

In this episode of "Bitesize with Bisanga", Dr. Bisanga discusses the difference between manual and motorised extractions and emphasises the importance of having a skilled surgeon to conduct the important harvesting process.

Very pleased to be able to provide a further update from the patient which represents his current situation at 12 months post surgery. Patient Quote:- "Hair line is still thickening and a stark difference to before surgery. Dr.Bisanga had done a great job."

A very good question to be honest. At times it is necessary to work amongst existing hair and when it is good quality and also if the patient is on medication to give it stability and longevity then we would work around and amongst it with no problem at all as has been alluded to above. This is why it is usually recommended to shave down, and allows the doctor to match the angles of native hair and to ensure not transect native follicles and blending well with confidence that the best result can be achieved. For some patients, where there is miniaturisation present and perhaps the patient is not using medication, we know that such hair is not permanent and the patient is looking for the hair transplant to achieve a stand alone result that is not dependent on them keeping poor quality native hair that presents little cosmetic value. In such cases the most appropriate approach is to place with the knowledge that questionable hair will be lost in the short term and therefore adding density into these areas. This highlights the unique and bespoke approach in every situation and shows why an in depth consultation pre surgery is key to understand the optimal approach and to be able to achieve the most optimal result.