Raphael84

@jackfera Thank you for the update and for the quality images. Very pleased for you and things are really accelerating and progressing now. Still a good way to go and further improvement to look forward to, but your are undoubtedly well on your way and I very much look forward to the coming months and further updates. Very pleased for you.

@ScottyM Good to read that you are doing your due diligence and research and are covering all bases before making any final decision. Just to clarify and to clear up any confusion regarding BHR, and this has been discussed on many previous threads also. Dr. Kostis has been working alongside Dr. Bisanga every day for over 3 years now. For surgery that is performed by both Dr. Bisanga and Dr. Kostis, this will see the punching of grafts shared between both doctors. The making of all recipient sites that are responsible for design, density and direction, is performed solely by Dr. Bisanga. In terms of the role and responsibility of technicians, this has not changed since the clinic opened almost 20 years ago. Technicians do not punch and technicians do not make recipient sites. Protocols are in place with technicians having specific responsibilities to ensure that the team remain fresh and extremely focused creating the best environment to deliver consistently excellent results which includes two placing technicians to place simultaneously to ensure that your grafts are out of the body for as short a time as possible which is one key element of the results that the clinic achieve. I wish you the very best with your onward research and eventual surgery. All the best.

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. 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. In terms of long term planning, the rear occipital donor area that was untouched in this surgery, is the area within the donor that presents the highest density, highest hair groupings and is the richest area of the entire donor. Leaving this area untouched allows thick multi hair grafts from areas with high density to be able to be best utilised if necessary in any future surgery. Whilst all patients are unique, patients routinely experience shed in weeks 5 and beyond and so further shedding may still occur. Thanks for such a great write up and impressive image quality. Wishing you the best.

This patient was actually treated over 3 sessions. As with any repair case that may have presented growth/yield concerns in their initial surgery, the process can require more sessions than a virgin scalp case who may not present quite the challenges and or limitations.

The patient came to us after a bad surgery in his home country resulting in poor growth and an over-harvested donor. With a lot of loss and one subpar surgery already, the challenge was to then harvest the grafts carefully for his advanced loss and blend in beard hair that we had to tap into as a supplementary source. The goal was full coverage, and this meant a lot of grafts and the need for mega-sessions. The result has truly been life changing for him and here he gives his own video and testimony of what it means to him personally! Thankfully, the patient came for a recent check-up to meet Dr. Bisanga in person and was kind enough to allow full face photos and video. This is a rarity and is much appreciated. A big thank you to him!! The result has been very significant for the patient and this was why he was also so willing to share all that he has. As you will see, Dr. Bisanga also noticed a softening of the beard hair on the scalp as detailed in the video. Patient is in his late 30s and uses minoxidil. GRAFT MAKE-UP Scalp: 7867 Beard: 2050 GRAFT TOTAL:- 9917 VIDEO: PRE-SURGERY POST-SURGERY RESULT

Thank you @Gatsby

The patient wanted to treat his recession and work throughout the frontal third for a solid outcome. This has been achieved with 3460 grafts and already has brought about a beautiful transformation at 8 months. The patient will seek to update through to the 12-month period and we are grateful for him allowing us to share his case and photos that he has kindly sent. FU/HAIR 1s 468/468 2s 1908/3816 3s 1037/3111 4s 47/188 TOTAL: 3460/7538 = 2.19 Average. VIDEO: PRE SURGERY POST SURGERY 8 MONTHS COMPARISON

There was no reported or evidence of shock loss post surgery. There was some miniaturisation in the area and some general thinning as can be seen in the pre op images, but with shaving down and surgery creating as little “trauma” as possible, shock loss was not an issue. The patient has used hair dye post surgery.

The patient wanted to address his recession and reinforce the frontal third of the scalp as necessary. This was able to be achieved with 2553 grafts and growth is shown here at 7.5 months post surgery. AGE: Into early 40s MEDS: Regaine VIDEO: FU/HAIR COUNT 1s - 474/474 2s - 1203/2406 3s - 822/2466 4s - 54/216 TOTAL: 2553/5562 - 2.17 Average PRE-SURGERY PLACEMENT 7.5 MONTHS COMPARISON

Just to clarify, Dr. Portelli attended a 2 day course alongside other doctors held by ECAMS that Dr. Bisanga was teaching. Dr. Bisanga is not personally able to attest to the quality of surgery or ability of any doctor based solely on a 2 day group course and without having witnessed any real live surgery performed. This is an important distinction and we would not want to mislead. Attended workshops trained by Dr. Bisanga would be a more appropriate description.

@Tybwl5 We are personally in communication and have shared several emails as recent as today. If you would like to begin your own thread to discuss the recommendations of Dr. Bisanga, then I would encourage you to do so and I will be more than happy to then share detail and accurate information based on requirements and our dialogue etc. When patients share their case and create their own thread, it is always a brave decision to do so and as a patient myself who has shared my journey, it always appreciated to keep the thread on topic and support the patient and their case. I appreciate your intentions are positive, but it also misleading to read that beard and chest hair at €17,000 have been recommended to restore your hairline. Body hair is not used in the hairline and graft demands in your case are extensive and hence the requirement/recommendation to consider body hair to achieve your objectives of more coverage. But again, by all means create a thread and I can detail specifics on your own thread if you would like to do so.

@ItIsTime Thank you for your update and at 4 months growth is really beginning to show now which is great to see. Your hairline is taking shape and there is activity in the crown also, so the next months should be exciting ones and I am looking forward to your further updates.

This is a great example of where having personal data measured and understanding stability of your donor area can present different realities for different individuals. Whilst the side and rear donor are generally seen as "DHT resistant", the idea and definition of a "safe" donor area has evolved somewhat from perhaps a decade ago where very few were talking about levels of miniaturisation within the donor area and it was common to read that the donor was detailed as not being susceptible to decline. From our experience, miniaturisation within the donor is a factor that should be seen as the highest priority in terms of a data point during consultation to assess candidacy and potential approach, because obviously the quality and longevity of transplanted hairs are directly relative to the quality and longevity of the donor area that they have been extracted from. Any patient with extensive loss may want to really utilise all tools at their disposable in trying to achieve the best case scenario. Extensive loss at a younger age can still see progression of lateral humps and lower crown loss which will not only expose more scalp and therefore increase graft demand, but in doing so would also be further restricting surface area of the "safe" donor and therefore reducing graft availability.

Another very positive update and I am personally extremely pleased for you @Neily_77. It has been a real pleasure to assist in any way so far on your journey and as you are only currently at 5 months, the next months will bring further improvement with more to look forward. Here's a little recap of the first 4 months -

Do not miss this! Captivating conversation happening right now on the HTN YouTube channel between Melvin and Dr. Bisangal! Make sure to head over there and dont pass up on this engaging discussion! Click "play" below!

I dont believe that "Chronic" inflammation has been mentioned, and there has not been suggestion that inflammation from minoxidil is killing hair follicles? As said, for specific details in relation to yourself and your case, then I would advise you to discuss all with your patient advisor. Whilst inflammation may be due to topical minoxidil, it may also be that topical minoxidil is exacerbating symptoms of scarring alopecia. Whilst Dr. Bisanga is extremely astute as evaluating scalp health and skin conditions, it is the speciality and entire career of scalp and hair related dermatologists and so whilst a consultation does incur a cost, it is not anywhere near the cost of surgery that may then produce a lesser yield, or potentially worse due to an undiagnosed scalp condition/status. If your preference is to discontinue topical medication and see how you scalp may respond, then discuss this with your advisor and proceed as you are most comfortable. My experience with patients would indicate that those with concerns, would prefer to rule this out and move forward as efficiently in regards to timeframe as possible. For many, depending on location, waiting several months after discontinuing medication and then travelling, often internationally, for a further consultation/follow up with Dr. Bisanga may be more costly. So this is an example of where each individual has a completely unique set of circumstances and therefore should proceed in a way that makes most sense to them. Please follow up with your advisor for any clarity and I wish you the very best.

Thank you for attending your consultation today. I respond to your thread to try and clarify any potential confusion. I am not your advisor personally and so do not know the specifics of your case and your adviser will be best able to explain all that was discussed with you at consultation today. The title of your thread prompted me to read your post. I think the title will cause alarm to many users and I believe it would be best to potentially consider changing that as it is not accurate. Topical minoxidil does not cause scarring alopecia (LPP) and Dr. Bisanga did not suggest that it did. It is important to clear up confusion in that regard. In some patients who use minoxidil, due to the sensitivity of the individual and the alcohol content of the medication, it can irritate the scalp and present itself as inflammation. This is not scarring alopecia, but would still require a change in scalp status and reduction in inflammation prior to surgery being able to be considered. Scarring alopecia also presents itself as inflammation in the scalp and therefore if there is presence of any such inflammation, it is important to be able ascertain the reason behind any inflammation and rule out scarring alopecia before considering proceeding with surgery. This is why consulting with a dermatologist who specialises in hair and scalp disease is in the best interests of any patient who may present such symptoms. In terms of scarring alopecia, it is important to understand that this as a condition can not be cured. The condition will remain even if status becomes inactive due to treatment. This means that any course of treatment that may be utilised is in an effort to reduce symptoms and to control status, however this would not "cure" the condition. Surgery itself can be a trigger to activate and progress the condition which means that not only would this likely influence and compromise growth and yield, but can also have a negative impact on existing hair and therefore individuals with scarring alopecia are generally not candidates for hair restoration surgery. This is a prime example of the importance of in person consultation prior to scheduling hair restoration surgery. Even individuals with very limited loss may still present some concern within their scalp that could potentially influence candidacy and result, and photo assessment would not present the opportunity for a thorough magnified assessment to check this.

Thanks for the updates and you are doing a pretty effective job at concealment at such an early stage and this should get easier with more recovery and length of native hair. Your healing timeline looks very good and in terms of redness, it will require some time. Unique factors to each patient will include skin tone and density placed throughout the recipient, but redness is a sign of more blood flow due to the inflammation of surgery which is a positive in terms of "feeding" the newly placed hairs. Oils such as emu and witch hazel are generally preferred by patients as opposed to a thicker gel like consistency like many aloe vera products available, but by all means use what feels best for you. Be conscious of any alcohol content in many aloe vera gels which you would want to avoid. Redness will require some time and whilst the application of such oils can be beneficial, use sparingly and less is often more in terms of allowing the scalp and skin a natural environment to recover, and as said it will simply require some time. I look forward to your next updates.

Goals were to re-establish the hairline, address the recession and increase density to the crown. This was achieved over two consecutive surgery days. QUOTE: "If any potential clients want to meet me I don't mind. I am by nature a worrier but so pleased with the outcome. Nothing but positivity with my BHR experience. I think you [the rep], were a huge part in that journey." AGE: Late 40s MEDS: Oral Min and Fin GRAFT/HAIR BREAKDOWN: 1s = 540/540 2s = 1784/3568 3s = 1176/3528 TOTAL: 3500/7636 - 2.18 average VIDEO:- PRE-SURGERY POST-SURGERY RESULT SHORTS VIDEO WITH ADDITIONAL PHOTOS:-

Graduation day. Love it! Congratulations on completing your 12 months. Your documentation throughout has been excellent with quality photos that really present transparency. I look forward to your update.

Congratulations for completing your surgery and thank you for the kind words. It has been a pleasure and you have our full support as you navigate these next months of healing and then the more enjoyable months of growth. As a patient myself albeit with a slightly different surgical history and timeline to yourself, I can completely relate in terms of the impact that hair loss presents and the idea of not wanting to have too many photos around. It really shows how despite our age or extent of loss, that hair loss is extremely personal and impacts us all uniquely. Great write up and documentation and no doubt many forum users will find value in your words and experience which is what the forum is all about. You can see from your photos how clean the work is and how the design will really impact facial framing and no doubt any concerns with photos will shortly be a thing of the past. Good look with concealing as much as possible. Once you get past these initial days/week, then with styling, your native hair should be able to cover much of the surface area and as hair length of native hair increases and redness dissipates, then hopefully this will make things easier and growth will not be too far away. Dr. Bisanga performed all of the punching of extraction sites and cutting of recipient sites, and then as is standard his technicians then placed the grafts. Whilst Dr. Kostis was initially scheduled to assist with surgery in terms of performing extractions with Dr. Bisanga, Dr. Kostis was invited to a Trichology Congress in Buenos Aires as a guest speaker and to share knowledge with experts in the field, which will only enhance the experience and expertise of Dr. Kostis, and the opportunity for patients over these days to have surgery solely with Dr. Bisanga has also been well received. I will share clinic images with you shortly and we look forward to following your progress. Thanks again and wishing you the best.

Thanks again to @Whipaway for sharing photos and documenting your journey so thoroughly. It is clear from the interest on your thread that your case and experience has been of great value to the forum and its members, and long may that continue. Again, we are all very happy for you and enjoy your new hairline.

The patient had positive donor characteristics. More so then multi hair grafts was the fact that his average density throughout the donor was around 85 FU/cm2 which is nicely above average . The 2.29 average hair count per follicle is sightly above average, which for frontal hairline restoration which utilises many single hair grafts is around 2.2 hairs per follicle, but 2.29 is not unusual. The reluctance for medication is really quite high from individuals which I can of course understand. Whilst we would all prefer to avoid any type or medication, especially those treatments that require a long term commitment, but if retaining native hair is a priority, then for many a regimen of medication probably should be considered. Medication is very unique to every individual and based on their own history, tolerances and sensitivities, explains why one patient may respond better with one treatment over another or open to consider one treatment over another.

@Whipaway Honestly, absolutely thrilled for you and well deserved. It has been a real pleasure to assist you throughout your journey and your personal approach in terms of questions, research, patience, diligence etc was executed perfectly. You were very thorough and despite the desire to act and proceed quickly, you took the time necessary to ensure that you understood the procedure and the process well, meeting the doctor for consultation to allow an accurate assessment and recommendation. Again, very pleased for you. Keep in contact and wishing you the best and continued success in all of your endeavours.

The patient came to address recession that was clearly more evident once shaved as can be seen in the placing and how far back this was required. The patient wanted a natural hairline that would blend well with native hair and possessed good donor density at around 85 follicles per cm2. AGE: 29 At time of surgery. MEDICATION: Oral Minoxidil 5mg GOALS: Hairline reconstruction and placing through recession. BREAKDOWN HAIR PER FU: 1s 435 = 435 2s 779 = 1558 3s 843 = 2529 4s 293 = 879 TOTALS: 2350/ 5401 = 2.29 Average Hair Per FU. VIDEO: PRE-SURGERY POST-SURGERY 12 MONTHS