Raphael84

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.

A frontal third restoration generally achieves coverage in a surface area of approximately 70cm2 patient depending. In this patient´s restoration, as you can see further grafts were placed to restore his recession in his temple point which really changes the framing of his face. As you can see from post operative photos, the extraction pattern was a very unique approach in comparison to our general extraction pattern where we would normally utilise the full width of the donor area above the ears. The patient had experienced retrograde alopecia as can be seen in his pre op photos. After a thorough pre surgery consultation and examination, it was seen that miniaturisation was not a concern, but more so areas of low density. This is supported by the fact the patient did not suffer any shock loss or decline to the areas closest to extraction post surgery which would have been the case if advanced miniaturisation was present. All follicles that were extracted were good quality follicles that have resulted in optimal growth and a great result. Looking at these areas of concern post surgery show that there is no discernible difference. As requested, the patient has kindly provided a further photo from above showing how his hair is looking today, some 18 months post surgery (below). As can be seen, the area has filled and thickened up nicely without any concerns and his transformation is really quite extreme. As I detailed in another patient result thread today, individuals decide to proceed with surgery for many reasons. Generally it is due to insecurity regarding their appearance, lack of confidence and anxiety due to their loss. The objective is always patient satisfaction and to allow their result to provide that confidence. The quote that the patient provided at 18 months says it all. "I think the biggest compliment I could pay it is that I don’t even think about my hair any more. Before I was always anxious with the receding hairline, and now it’s not even on my mind which is great. Thanks!"

Thanks for the further comments and interest. As a community the value and necessity to present results is clear. We come here to educate ourselves, but education without results would not motivate any of us to proceed with surgery without knowing and seeing with our own eyes, what can be achieved and thus the community would not offer the value that it does today. Many members prefer patient posted results over clinic posted results as they believe that the clinic will select their best results which has logic. With that in mind and as we have discussed on many other threads, the need and value for patient posted results will always be a high priority. This thread and documentation was presented by a patient. All of the presented photos with consistent angles and lighting to be transparent to a much higher standard than the majority of patient posted results. As a community we need to encourage patient posting. I do not believe that such back and forth provides that encouragement. I do not believe that this is either just or fair for the patient to visit his own thread and have such posts. If I was a patient insecure in the days after surgery and was looking to the community for support and therefore potentially considering posting my case, witnessing this thread I am not sure if I would continue to do so. If I can request please that if anybody would like to continue this dialogue, out of respect for the patient, it be done on a more appropriate thread such as the thread that Melvin previously linked or numerous other recent threads. Again it is not a clinic thread, but to continue with appropriate and on topic dialogue, with any result presentation that shows a timeline of growth and as growth and results will mature as more time passes up until at least the 12 month stage, referencing concerns or disparities at earlier stages than the "final result" when the "final result" images are present probably isn't the most accurate analysis. Regardless, previous to those photos, the patient has been very thorough and again very transparent as can be seen with photos on days 236 and the photo at day 237 with wet hair which would clearly highlight any weakness and this particular photo was dated at approximately 8 months post surgery. The result that this patient has achieved at 12 months is clearly very impressive to the extent that by his own words, it has completely transformed this young mans life. I am thrilled for him. He really is a great guy and he should be able to revisit his thread in time with positivity and as a community we should support him with that. In summary from me, for any individual who may be considering a hair transplant and can find weakness in this result to the extent that they would not be happy if it were themselves, then my honest personal advice is that hair restoration is not for you. You will likely not be satisfied with aspects of your result.

@RonReagonsHairline Whilst other individuals may have been able to conceal a thin linear strip scar at a short length, this in itself may not be the most appropriate "comparison approach". As you have concerns, I would certainly encourage an in person consultation with your preferred doctor so that they can check your scalp laxity, donor density and characteristics. Things to consider would be scar healing and closure quality and technique of your doctor. The surface area of the excised strip will influence how much tension may be on the closure and this will also be influenced by your scalp laxity. This is why understanding your graft demands (amount of loss) and donor density will reflect how much tissue would need to be removed in your strip. Donor density and follicular makeup of your donor that would assist to "conceal" strip scars at shorter length. For patients with naturally higher donor density, concealment would normally be easier than those with average density that presents a more "transparent" visual where scalp can be normally be seen. Physiology and how your body may respond and heal can impact the final dimensions of a strip scar and if any stretching may occur post surgery, as can the all important post surgery healing stage. There are many variables and please just be conscious of these and careful when comparing side by side with other patients. As has already been mentioned, age, medication, family history of loss, levels of miniaturisation etc would all be influential factors in your decision making process. Take your time, don´t rush into anything and I wish you the best of luck.

FUE 0 - 8 MONTHS (18 MONTH UPDATE) 31 at the time of surgery. No regimen of medication pre surgery and therefore FINASTERIDE was recommended & prescribed post surgery.GRAFT BREAKDOWN -1s 660 - 660 hairs2s 1314 - 2628 hairs3s 724 - 2172 hairs4s 302 - 1208 hairsTOTAL 3000 GRAFTS - 6668 HAIRS AVERAGE HAIRS PER FOLLICLE - 2.2The patient wanted to address the frontal third thinning and re-create his temple points. His friend had surgery with us previously and obtained a great result which then influenced the patient to select Dr. Bisanga as his performing doctor.PATIENT QUOTE AT 8 MONTHS -"The growth has come along really well. See attached some progress photos and do let me know your thoughts. I guess there will still be a little left to grow, but I presume I am mostly there. I am very pleased with the results. " The patient´s donor was good density in areas, but as can be seen, above the ears was lower density and thus we were mindful of such data throughout the harvesting process. PRE-SURGERY DESIGN PLACEMENT RESULT @ 8 MONTHS UPDATE!!! PATIENT QUOTE AT 18 MONTHS - "I think the biggest compliment I could pay it is that I don’t even think about my hair any more. Before I was always anxious with the receding hairline, and now it’s not even on my mind which is great. Thanks!"

Any medication will have a list of potential side effects associated with its usage. This we see with all medication and we can use finasteride as an example due to its relevance on this forum, much in terms of side effects will depend on the sensitivity of each individuals physiology. Based on each individuals personal health and family history, a medication that may be effective and appropriate for one person, may not be for another. That is why that we would suggest that as with any medication, you are advised to see your own GP/family doctor who will have the benefit of your medical history and can further advise you and answer your questions with regards to suitability and if there are any concerning side effects in your case. Based on their recommendations you can decide if it may be an option for you, your doctor can then list it on your medical history and if you do experience any side effects, he has knowledge to be able to advise you further. There are many independent studies that have been released that list most common side effects and further details based on clinical trials and conclude the safety of oral minoxidil at low dosage. Here is a thorough video explaining research and conclusions behind various emerging options of medical therapy (regenerative medicine), including oral minoxidil.

@aaron1234 Thanks for your question. I remember following some of your crown restorations back in the day so great to see you active again and doing well. Dr. Bisanga recommends and prescribes 5mg oral minoxidil. Hypertrichosis can be a "side effect" of the medication with increased hair growth in other body areas. Whilst I haven't heard of too many examples of an increase in eye brow hair, I personally feel that I have experienced this but in a positive way as mine were thinner. Some patients use topical minoxidil and apply that to the beard with some success and so the mechanism of the medication would suggest that this is logical.

If native hair were to "thin faster" due to the trauma of surgery and placing grafts amongst native hair, then this would be an issue for the majority of hair transplant patients. Other than extensive patterns of Norwood where patients have lost essentially all native hair on top, then placing amongst native hair is common practice. Even those patients with just a small amount of frontal loss, when restoring the hairline at density it is necessary to transition into native hair behind to ensure of an undetectable result and consistent visual of density. This is not the case when surgery is performed at a high standard and the making or recipient sites, their angles, direction and depth is harmonised with that of the native hair of the patient which ensures that there is as little "trauma" as possible. The "take away" here is the quality of surgery. This is why Dr. Bisanga will request a complete shave down to be able to have complete visuals of hair direction and angle at the exit points, and will use a punch size that does not require the recipient site to be larger than needed, which creates less "trauma" to the surrounding area and therefore has little to no impact on surrounding grafts. If the patient may have miniaturised hairs throughout the recipient area, then this may present a different situation as the native hair has already begun the process/cycle of thinning and loss and depending on the status/extent of the follicle within that cycle, then shock loss may occur. But this is not an accelerated thinning of healthy hair. This is another reason why medication pre surgery to help to stabilise and strengthen native hair can be a very important factor, especially when transplanting amongst native hair.

Hi @TorontoMan Good to hear from you, I hope you are doing well! Dr. Bisanga recommends/prescribes 5mg oral minoxidil. This is based on several important studies from leaders in the regenerative medicine field.

What is more effective, PRP or Mesotherapy + Dutasteride?

@HMSDread Great to hear that your consultation went well and that you are pleased and excited by the hairline design that was suggested. Wishing you the best for your surgery next week.

Patient with the objective to rebuild his hairline and restore his temple recession. Thank you to the patient for his timely updates and always providing such quality images with consistent angles and lighting to allow us to enjoy his evolution. The patient is very happy with his transformation up to this point at 6 months post-surgery and he has explained the value that he found in results posted by previous patients and therefore wanted give back to the community and share his case. AGE: 31 (At time of surgery) MEDICATION: Finasteride + Minoxidil GRAFT BREAKDOWN:- 1s = 420/420 hairs 2s = 1432/2864 hairs 3s = 523/1569 hairs TOTAL: = 2375/4853 = 2.04 average PRE SURGERY DESIGN PLACEMENT DONOR AT 2 MONTHS AT 3 MONTHS AT 4 MONTHS AT 4 MONTHS COMPARISON AT 5 MONTHS AT 6 MONTHS AT 6 MONTHS COMPARISON

@Bailey99 Thanks as always for the update. Comparing your photos shared one month ago to this current update, I would suggest that there has been further evolution. Obviously the difference in lighting as photos being indoor v outdoor can have a dramatic affect and slightly longer hair in these more recent photos will play into your favour as was previously discussed, but side by side things appear to have improved. Still a good way to go and 6 months generally represents around 40-60% in terms of growth. Dr. Bisanga is very much looking forward to seeing you again shortly and is excited for your further progress.

@NTCP8 Congratulations on completing your procedure. Dr. Bisanga was very pleased with how your surgery went and it is great to see your hairline design, overall approach and to get an idea of the area of placement from your photos. Very nice quality which will really go a long way to supplement your thread. As discussed, as soon as I have access to all photos taken from the clinic in the next days, I will be sure to share them with you and they will be great to be able look back and compare as growth begins. For now rest up, heal well and look forward to the months ahead. You have all of our support for anything that you may need.

Looking forward to it. Would be great to see as many as possible attend.

Are patients with finer hair candidates for hair restoration surgery?

Without diverting away from the purpose of this particular thread and this patients specific result, I would always encourage anybody who may be interested in surgery with Dr. Bisanga to make personal contact via our website or by all means contact me privately to discuss details including pricing specifically related to them and their case. Pricing for surgery with Dr. Bisanga is at the same rate regardless of which clinic and is surgery specific in terms of FUE, FUT, repair, graft removal, body hair etc and patients do not pay more in Brussels as opposed to Athens for the same surgery conditions regardless of tax. There are several "pricing tables" that have been independently compiled and posted on the forum and I would imagine that we are not the only clinic that see inaccuracies. Dr. Bisanga is based in Brussels and is performing surgery throughout the year out of BHR Brussels. BHR Athens have their own team of doctors who perform surgery on their own patients throughout the year. Dr. Bisanga may visit infrequently but Dr. Bisanga´s personal focus is in Brussels.

Even being familiar with the case, just looking at the pre and post op comparison image brings a smile to my face. It really is a life changer.

Thank you for all the support. I myself can not take credit for this video. This was compiled by my colleague Stephen who is a great guy and an asset to BHR and I believe that he has represented incredibly well who we are as a clinic, our ethics, our approach and essentially our mission statement and this video presents a very genuine, honest and transparent guide of what we believe to be integral to BHR. Generally Dr. Bisanga is scheduling out several months in advance. Due to Covid and travel restrictions/guidelines and some individuals preference to travel later in the year, we are currently able to offer some shorter-term availability. By all means let me know if you may have interest or any specific dates in mind and we can explore what options may be available. Thanks again.

1 - Firstly our track record is second to none with 20 years of experience with the largest Strip, FUE and most challenging repair cases. We do not live in the past but continue advancing and evolving whilst consistently posting cases and many of our patients sharing their results. 2 - Patient Education is key with a constant stream of videos that cover all aspects of teaching, inside the op room, current and challenging topics explained, live Q+A, close up video and photos of live work, along with articles and comments on the largest platforms. 3 - Peer Credibility/Esteem, Dr.Bisanga is a forerunner in educating and launching the careers of countless other successful hair transplant doctors and a highly sought after speaker with accredited membership and awards. 4 - First class customer service that is attested to by our patients and forum users alike, both in depth of reply and also timely manner of responses. 5 - Accessibility before and post surgery with experienced advisors who are specialists and multi-lingual to educate and prepare the patient for surgery and to be there throughout their journey, to their final result with all surgery photos provided and our BHR ongoing support and review mechanism. 6 - Access to assessments, zoom consultations and international consultations to supplement in clinic also on a daily basis. 7 - Doctor centric approach. Dr. Bisanga is not peripheral but integral to the surgery, beginning with the pre-surgery consultation, hairline design if needed, donor planning with state of the art machinery to analyse the patient with an extensive report issued. 8 - Dr. Bisanga punches every graft, so there is a pedigree here of accuracy and pristine donor with small punches and an educated extraction pattern that will preserve the donor, even on larger cases. All recipient sites are cut to give density, direction, depth, inclination, angles etc. 9 - Natural looking results - Correct deployment of follicular units to really make the hair line look natural and without destroying parts of the donor that should not be used for hair line work.

I would question how long is months after the procedure and how much is a minority of the time? After the significant investment both financially and emotionally in surgery, I would always encourage any patient to ensure the very best environment for their scalp and both recipient and donor area as possible post surgery. It is human nature to "stretch" the boundaries. Sure, if it is a very minimal amount of time, very infrequently and many months post surgery, it most likely would not have any impact. But my understanding from your post was that you were considering wearing a headband each time you were in public for several months, which is quite a different situation. I would suggest wearing a cap that would allow the recipient area some space and present a more optimal environment for your transplanted grafts.

You would really want to avoid this to be honest. Many guys will wear caps or headwear that allows some "air space" post surgery until their result grows in, but to wear a headband directly on top of the recipient area that may cause some friction and not allow the recipient area the best environment would not be recommended.