Raphael84

If 40-50% of the follicles in a donor area have miniaturisation meaning that they are unstable and no medication is utilised, then this may well continue to decline. Best case scenario is that it doesn't, but then possible surgery outcomes when extracting and placing unstable follicles can impact growth, yield and longevity. If the doctor only extracts the other 50% (non miniaturised), this leaves predominantly miniaturised follicles in the donor area, meaning that the 40-50% pre surgery is now a higher percentage in the donor and with any further decline, the donor will not likely be in the best shape. Either way, such a surgery in our experience would present significant risk and if yield is not acceptable, then a touch up is not particularly ideal as more grafts are being utilised that may again achieve the same compromised yield as the donor is not stable. I would not suggest that Dr. Bisanga is a cautious doctor at all. He takes on some of the most complicated repair cases that other doctors refuse. I would say that Dr. Bisanga is very thorough, vastly experienced (more than most) and that he does not want to jeopardise patients who present cases of high risk where the likelihood for a sub optimal result is more probable and this is always in the best interests of the patient. However we as patients tend to search for options that suit our own narrative. I remember doing the same thing when researching for my first surgery around 2008/2009, and any doctors that suggested areas of weaker density in my donor, I discounted and only then pursued interest in those who feedback were inline with what I wanted to hear. The reality is that those doctors who present concerns are doing so for ethical reasons and out of experience. They present advice that is worth a listen.

Hi @Smacias15 If you would like to dm me with further details and also how and when you left your message, then I can enquire and offer response for you. That will then also allow this thread to remain on topic of the OP and his journey. Many thanks

I do not personally have curly hair at all. In my first surgery, my hair grew in with quite an exaggerated curl which probably lasted around 15 months and then the curl completely dissipated. This may not be the case if the donor area where the hair was taken from has a curly characteristic to it as this is the natural feature of the hair, but without doubt the hairs will mature and settle and part of that process generally relaxes the curl.

Looking great Melvin. That wet image tells its own story. Things really coming along! Thrilled for you mate!

Thank you to the patient for providing these photos as 5 months. The goal was to re-establish a natural hair line and place back into the diffused area within the frontal third. This was achieved with a conservative approach yet as can be seen a very pleasing result even at this very early stage. The density and naturalness is stark and a transformation that cannot be underestimated. This was a shared surgery between Dr. Bisanga and Dr. Kostis. We will endeavour to update as and when the patient is able to share new photos. VIDEO:- GRAFT/HAIR BREAKDOWN:- 1s = 511/511 2s = 1384/2768 3s = 1016/3048 4s = 69/276 TOTAL: 2980/6602 - 2.2 HAIR PER FU AVERAGE. PRE-SURGERY PLACEMENT 5 MONTHS COMPARISON

Dr. Bisanga has discussed the option of US surgery. As you can imagine his schedule can be quite complicated due to scheduling in Brussels but then also he is required to attend countless hair restoration events and seminars as well as training opportunities which he is very passionate about in an attempt to improve the baseline of surgery in the field. With that being said, there are not any specific dates or availability to share and based on recent discussions it isn't a priority at current purely based on Brussels demand.

Thank you @jjsraderfor attending your recent consultation and I hope that you found value in meeting with the doctor. In terms of pricing for FUE surgery with Dr. Bisanga and BHR Clinic, I would always advise that any individual contact the clinic directly, presenting their images and sharing details specific to them to enable them to receive and understand relative pricing for themselves. A big thank you to @jjsrader for sharing his experience and also transparently beginning his post with the fact that he has had "many strips and a small FUE" procedure totalling 8500 grafts. We receive patients at the clinic day in and day out that have had previous surgery, but it is not common for a patient to have previously had 8500 grafts extracted over multiple surgeries, and therefore without citing any personal details to respect privacy, graft availability in such a case will be far less than a virgin scalp patient, or a patent who may have had 2500 grafts in a previous session for example. Therefore the potential challenges of surgery will reflect this. With such a graft count previously having been extracted from the donor, any approach and graft selection must be extremely specific which of course adds further complication than simply harvesting throughout an untouched donor, but also after several strips and a small FUE, strips are able to provide grafts in a more central area throughout the donor and cannot reach the extremities that FUE can. As extraction may therefore require to be more focused in areas that FUT could not reach, such as a focus on the parietal areas, then the majority of harvesting presents a much more challenging process due to the acute angles that these hairs naturally present. Any harvesting in more central areas would not only require careful planning around scarring, but having to respect the density above the strip to ensure that the strip can be concealed as it was prior to surgery, but also conscious that strip closure itself can cause miniaturisation below the strip and therefore this area must also be very carefully and consciously navigated. A patient who may be considering BHR for their first surgery does not present the same hair status, limitations and challenges that a repair patient who has had several previous surgeries and therefore the two surgeries, approaches and requirement of expertise can be vastly different and this will naturally influence pricing. Other considerations for some patients may be hair type. Afro hair for example presents unique challenges and requires specific expertise. As opposed to the mostly straight follicle of Caucasian and Asian patients, typical characteristics associated with afro hair follicles are that the hair tend to be thicker and tightly curled. Such curvature of the hair extends below the scalp. The natural curvature of the follicle can be significant, often to the extent that the follicle when removed is actually in the shape of a letter C, meaning that it is essential to have a surgeon who has knowledge and experience of working with afro hair. Transection presents a higher risk and your surgeon must have the appropriate punches and tools to best handle and manipulate afro hair. For appropriate candidates, surgery options with Dr. Kostis assisting can also be considered which influences pricing and therefore again, why the recommendation would be to contact the clinic directly with your specific details and request pricing. To point out an error in my email @jjsrader, I see that when calculating an estimate of surgery cost I have a typo showing €6.50 despite the fact that the total presented is accurate and inline with the stated €7.00 per graft. After two full days of consultations, I wanted to be respectful to the fact that many patients had travelled long distances to meet with Dr: Bisanga for consultation and therefore wanted to send all summaries out as timely as possible. I apologise for my error. A quick search of elite physicians within the US and their respective FUE pricing for even virgin scalp patients may be an interesting endeavour to be able to compare pricing and understand the difference in such margins. All patients are budget conscious to some degree which is completely understandable as I know I was, and this for some may not be down to their "available" budget, but more so what an individual is willing to spend and what they feel is a worthy price in their perspective, and this is where there are options available for all individuals, understanding that quality, experience and consistency of results will also differ.

As requested, here is a photo exposing the patients hairline to show density and naturalness. This photo was shared by the patient at only 8 months post surgery and so further maturation will have occurred, but the density from areas without hair was already clear at that stage.

@Savemyhairline Thank you for attending consultation with Dr. Bisanga. You and I have been in communication both prior and post consultation and reviewing our initial summary from pictorial assessment, the concerns that were detailed and therefore presented the requirement for consultation, essentially were reinforced at consultation. This thread has presented some very positive and constructive discussion and different opinions and points of view. As we all know, elite doctors may have difference in opinion of what may be in the best interests of a patient just as each doctor would present their own artistic interpretation of an optimal hairline design. All any doctor can do, is use their experience of which Dr. Bisanga has 20+ years of, and make recommendations to the patient as they see in the best interests of the patient. We see at the clinic, week in and week out, individuals who may have opted for surgery at a younger age at other clinics, who find themselves in a very different position at the age of 30 or 35 in terms of how their hair loss has progressed and are now in a regrettable and challenging position. 26 years of age in the right candidate is generally fine, in a lesser candidate, this can present significant "risks" in the future and this is the key point here. It is very patient specific. Either way, 26 years in the larger scheme of adult life is in the early stages. The objective of any restoration with any reputable clinic has to be the long term. Providing a restoration that allows the patient to grow into and that will continue to present a natural appearance over the long term. For any patient around 25 years of age that may have began to experience loss at 18 for example, this represents a timeframe of 7 years. This timeframe represents less than 1/5 of the timeframe between 25 and 60 years and so when a patient in their mid twenties present some concerning other factors and propensity for a larger pattern of loss, then these must be given serious consideration. Restoring temples or hairline currently, with diffuse and likely progressive loss to evolve, may leave any patient in a compromised position with an unnatural appearance/pattern of loss based on transplanted hair becoming disconnected to native hair. When there are clear signs of decline from hairline to crown, then not rushing into surgery and seeing how the next 12+ months may evolve will always be a sensible consideration for any patient. Undoubtedly other physicians will proceed with your case and so therefore you will always have options available to you. Our advice would be to not rush into anything, take some time to digest your consultation and your conversation with the doctor and then take the next steps as you see appropriate. The idea of turning down patients for more simpler cases is not an approach that Dr. Bisanga has ever taken and for anybody who has been in this community or following the industry for any period of time will be aware of this. Dr. Bisanga is often mentioned on this very forum as a recommendation to consider in complicated repair cases. This is due to his reputation in doing so and repair cases would be far more challenging than restoring the frontal area of a diffuse thinner. This is the controversial side of the hair restoration community. We as a community are always fighting for more ethical practices and protocols and imploring clinics and doctors to put patients over profits and quite rightly campaigning for unethical surgeons and clinics to take accountability for their actions and for the lives that they impact in such negative ways. This thread and consultation whilst clearly very frustrating for you @Savemyhairline, and understandably so is an example of where a recommendation has been made on ethical and medical grounds as the doctor sees in the best interest of the patient. One may or may not agree with the recommendation and that is each of our prerogatives, but clearly the intentions of the doctor are on solid ground and there are few doctors in the field that have the experience both in terms of years as an elite doctor and also in terms of patients and range of cases that he has seen and been involved in. As the community are offering their interpretations and advice based on the photos provided, @Savemyhairlineit may be worthwhile to share the further photos that were taken and shared from consultation as I would suggest that they do present a further reality and potentially more scalp than earlier photos that were shared and may therefore present amended feedback. We wish you the best in however you may decide to proceed and have presented recommendations as we see in your very best interests. We can also remain in contact privately and if you do have any further questions, then as always, dont hesitate.

The clinic will schedule either one or two patients each day depending on the specific case/s, its challenges, hair type, session size etc. Daily graft limits are in place at the clinic to ensure quality and hence why rather than schedule a patient with a significant graft demand in one long surgery day for example, the clinic will often break this down over two consecutive days when appropriate. As the most commonly scheduled surgery now also involves Dr. Kostis, this is another factor to consider and some days both Dr. Bisanga and Dr. Kostis may have their own individual patients.

Thanks @WhereIsMyMind This is the clinic email and the clinic have received contact via this email throughout the last week. If you want to provide some more specifics including the email address you sent from and information regarding your enquiry, I can then share this with the clinic to check the status for you. You can do so via dm or you can email me - ian@drchristianbisanga.com Also if you could please check your spam because this can often be the case with unreceived responses. Advise me as necessary and I will proceed accordingly for you. Thanks Ian

Congratulations Melvin. This will be great.

Great to hear that a few of your guys will attend consultation this upcoming weekend. As Melvin said, you cant compare a virtual/pictorial assessment with an in person evaluation. If the industry had a more consultation centric approach that provided actual objective empirical data, the field in general may have far less candidates but would have far better results. As a patient, along with research, in person consultations are a great sign of due diligence and are always encouraged. Also from a personable side, meeting and getting a feel for a doctor can also be hugely influential in knowing if a particular doctor may or may not be the right fit for you. I wish you both the best. Let me know who and when you may have emailed @WhereIsMyMindand I will look into it for you. If you are in contact with a particular advisor then by all means let me know. If you could please check your spam also as that can be an issue and by all means send an email if you are looking for a point of contact or have some initial questions - ian@drchristianbisanga.com

Without knowing any specifics regarding yourself or your case or even the other thread that Melvin referred to, as you have said you began medication that was effective but due to side effects you had to discontinue. Now you have began finasteride and minoxidil. If you were to develop/experince side effects from these medications also having already proceeded with surgery, you really should consider what situation you may then find yourself in. I experienced hair loss at a young age and I can relate, it is very hard. As you say, your peers find it a source of fun and it feels like it is really "robbing" you of your youth. But with experience and being in conversation with patients each and every day, what is also very hard if not harder is when guys in their mid to late 20s or above, have made the wrong decision to proceed with surgery, for whichever reason that may be. One of those scenarios is proceeding with surgery when too young with a hairline that your progressive loss and donor can not support in the future and having an unnatural appearance. This could potentially "rob" you of decades of your life. It is completely logical and understandable, but when in your 20s, you can not relate to being in your 30s and 40s and you believe that things (your hair) will not be a priority at that time, and the time to act is now. Dont rush. Dont make a fast decision that you will regret. As patients we often prefer the advice of a clinic that supports our narrative and tells us what we want to hear. If we stop for a moment, those doctors that highlight concerns and caution are not doing it for their own pocket, but for our own well being. The below video is an extreme example but it presents a young patient that was not able to tolerate medication, but also presented other factors that should have questioned candidacy but were overlooked and the result and consequences are for all to see. Did other clinics potentially point out their concerns and not recommend or offer surgery? Did this patient then select a clinic whose recommendations then suited his preferred narrative?

I am pleased to be able to provide an update regarding this patients case as there had been several requests to do so. In review, this patient had poor surgery in a clinic in Turkey. He came to us and had a very low and pluggy hairline, even at 5cm in places. Like many of these cases the problem is not limited nor does it stop in the hairline/recipient, but usually the donor has also been acutely compromised and therefore making future loss a real problem as it did for this patient. Here we punched out most of the grafts and certainly the larger offending units over two sessions, and the original plan was to then re-build the hair line in restoration. Removed grafts were then also placed back into the donor where possible. The patient in the meantime decided to discontinue medication. His loss evolved and progressed and he has recently made the very difficult decision to embrace his loss due the limitations that his donor know present (supply and demand) and he has now made peace with that. He is truly an exceptional person and not withstanding his own story has still been willing to share his case in the hope of helping others to not make the same mistakes and to be very diligent regarding their choice of surgeon and reinforcing the message of the importance of getting it right the first time. Here are his words also translated into English from the original language sent:- "Hello Lina, I decided to stop the finasteride. It's still a good product but my baldness really goes to the back of the skull. So I've made up my mind and I think I'm going to have to get used to it and shave when that time comes. I hope all is well on your side The healing went well. The problem is that my donor will not be enough to cover the entire skull, I lost too much from my brutal Turkey surgery. My Baldness progressed and I have embraced it and tell myself that finally I do not have to fight against nature!" This is a very sobering case and story considering the journey that the patient experienced with 3 surgeries (initial surgery in Turkey and 2 removal sessions with Dr. Bisanga) and he still finds himself in essentially the same situation as he would have if he had not elected to proceed with any surgery, albeit with some additional scarring both physical and emotional, not to mention the financial implications. This should really be an example of the importance in choice of surgeon. I was speaking to another patient just yesterday who had been to Turkey for a 3500 graft session. Growth did occur but his hairline is pluggy and unnatural and he explained that he thought this may be the outcome, but then his plan was to come to BHR to improve the hairline as he felt that this was the most economical approach. The truth is that he is a younger guy, with a severely weakened donor and few options moving forward, and to think this seemed like a viable approach for him. All we can do is continue to try and educate as much as possible as a community and present such realities in the hope that more people begin to make better decisions.

@J123m Thanks again for your continued documentation, images and transparency throughout your thread both in terms of donor and recipient areas. You are looking great at only 5 months and it has been a pleasure to assist through the process. Im looking forward to further updates over the next months and thanks again for sharing.

I find this 4 month comparison very impressive. 3000 grafts covered a significant surface area and much of that as can be seen in the pre op image is into areas of zero density. To have this growth and coverage at only 4 months is very promising and impressive. @Whipaway I am honestly thrilled for you. You really deserve it. You were very thorough, we shared much communication, you took your time, did your research, ticked every box so to speak and you are now reaping those rewards. Obviously still early and the next months will really present further improvement and evolution but I think its fair to say that you are well on your way.

Hi @SS2382 I assume that you and I may have been in communication regarding US surgery dates. It is great that you have reached out here on the forum and asked advice from fellow members of the community. There has been much interest in the limited US dates and within that interest, there have been several individuals that have explained that they would feel more comfortable with proceeding with surgery with Dr. Bisanga at BHR Brussels with his standard Brussels set up and in house team. This is completely understandable, and one of the most important aspects of selecting your surgeon and proceeding with surgery is that you are completely comfortable and confident in your decision. Proceeding with surgery presents anxiety for many individuals and so the objective in performing thorough research, taking your time, filtering out doctors and deciding on your preferred surgeon and clinic, is really to ensure that you have performed your due diligence and are assured of your decision. If in your case you are more comfortable with Brussels due to the set up and technicians, then that should be your decision. There are other patients who are decided upon the doctor, but their biggest concern is travel and making that long journey back home in those early days post surgery and so they may have a different perspective and the opportunity of surgery in their own country provides them with much more comfort and eliminates some of their worry. We are all unique in that respect and will prioritise based on our own preferences. The technicians that will work with Dr. Bisanga in the US, are of the highest quality and are technicians that not only has he worked with previously, but that he has personally trained and upon him opening BHR Clinic in Brussels, these technicians assisted him in training his Brussels team. The only reason that these technicians did not stay in Brussels was due to their personal circumstances and families and they relocated to the US. One of the influencing factors in Dr. Bisanga considering US dates is due to the availability of these very technicians. If this was not the case then such opportunities would not be considered. As has been mentioned and as the community are well aware of, Dr. Bisanga and his protocols for scheduling surgery are of the highest quality both in terms of application and ethics. Dr. Bisanga has worked tirelessly over the last 20 years to advance the field and achieve the reputation that he has and the consistently excellent results that he is able to achieve. There really would be no logic to offer a few days of surgery elsewhere with an incompetent team. As a patient myself, travel is inconvenient, but having the confidence in your decision is priority.

Excising the skin tissue will of course leave a scar. In some cases this can be preferable and easier to operate/navigate in terms of the restoration step of the repair than placing into heavily ridged and unpredictable skin tissue. It is invasive to do so and along with scarring, completely goes against the attraction of FUE, being minimally invasive and leaving minimal scarring. Again why the choice of surgeon to begin with is absolutely essential and highlights why no individual should rush into surgery and if necessary finances are not in place, then it is best to wait. Such issues can destroy peoples confidence, relationships, careers and essentially spills over in to every facet of their livelihood. We unfortunately see it all too often at the clinic. The patient in the video is a much lesser extent of this in terms of potential hazards and those with more extensive loss and greater graft demands mean more challenges for low cost and poor quality clinics which only increases potential risk factors.

When there are ridges it is always difficult to know what treatment or approach may be effective, if any. In some cases steroid injections may help, laser treatment may be a consideration and some patients have even resorted to excising the scalp. It is such a shame and a crime that such extreme lengths have to even be considered when such complications are completely avoidable with a reputable and quality physician.

This video demonstrates why we as a clinic, among others, spend a large percentage of our time seeking to educate hair loss sufferers on their choices to undergo surgery. We know it is a battle that we collectively will never win, we are pragmatic in this, but nonetheless, still seek to warn people of the dangers of rushing into surgery at a young age an also with what is usually a low-cost hair mill type of clinic. The concern with younger patients may often be budget constraints, but the reality is that subsequent removal and repair sessions are a much more costly endeavour than selecting quality surgeon to begin with. Another common point, is that we as patients will generally look to proceed with a clinic that suits our narrative. We all want to be told that we are good candidates, with good donors and can have that low straight hairline that we may desire. Low cost clinics who schedule on numbers and not candidacy, tell patients what they want to hear regardless of how accurate it may or may not be. Ethical clinics will usually prefer not to book very young patients who really should seek to stabilise their loss rather than commit to surgery, as we realise the progressive nature of hair-loss. Clinics who book such patients and give these results encourage patients to "act now" and the patient usually needs little persuasion that surgery is the right thing to do and not to wait and waste time. The outcomes, as this video shows, is often not what they were bargaining for and then means any repair will require a very experienced surgeon to then correct as much as they can for the victim, usually over several surgeries and again a significant cost, and even then some of the damage cannot be undone. A "repair" is an improvement, not a complete recovery to pre surgery status. There are consequences to choices and patients really do need to be aware of what they are committing to with the instagram click-bait approach they have to surgery. We do hope this will help some to consider more of what they are buying into and what can also go wrong.

Hi @HairT85 Thanks for your interest in Dr. Bisanga. Just to clarify some of your concerns. In general Dr. Bisanga schedules out some 3-4 months in advance on average. Depending on scheduling this may be slightly longer at particular times but dates can typically be presented around this timeframe. Of course at times there may be the odd opportunity where a patient may have postponed their surgery date and therefore a date becomes available sooner and over the last couple of years with Covid presenting a new factor to consider, this has occurred at times but the clinic also have a "list" of individuals who prefer to proceed sooner rather than later and are on standby for such opportunities. For patients who have consultation the day prior as you mention, these are patients/surgeries that are already scheduled and Dr. Bisanga has requested to meet the patient the day before to finalise surgical approach as opposed to consultation and offering surgery on the following day. In terms of waiting times, I would agree that if a particular clinic is consistently able to offer surgery at very short notice, this may suggest a weaker schedule likely in relation to demand or perhaps a different protocol where they are looking to ensure scheduling when an individual presents interest and not miss that opportunity. Having said that, it isn't always due to unscrupulous reasons that a sooner date may be presented and it may simply be a genuine change in schedule. You will find that in the case of BHR, we are normally "associated" with quite a different approach where we may be insistent upon an in person consultation prior to being able to confirm surgery when photos may present that requirement as opposed to looking to schedule quickly. But as has been discussed at length, all clinics have their own approach. Dr. Bisanga travels internationally on a monthly basis to offer in person consultations and in an attempt to be as accessible as possible. If scheduling any interest was our aim, we would simply do so from photos, but this is not our intention and it is due to Dr. Bisanga´s disciplined and thorough approach that BHR are able to achieve such consistently excellent results and therefore this is not a factor that we intend to change. Another thing to consider that is not always spoken of, I know several clinics that do not perform surgery 5 days a week or 4 weeks per month and therefore naturally this will "extend" their waiting list so it is not always accurate to compare one clinics wait time to another when considering their "demand".

The patient wanted to address his frontal recession, re-build his hairline and temple closures. Initial in person consultation saw Dr. Bisanga recommend 2400 to 2600 grafts to address the thinning present deeper into the frontal third. This was ultimately achieved utilising 2500 grafts. The patient has kindly provided the following video to show the true extent of how well his result has come in with a thick and natural appearance and further maturation to come. The patient was on finasteride at the time of surgery and has continued with the addition of oral minoxidil post surgery. Patient Quote:- I’m very pleased with the result and receive lots of compliments, especially from hairdressers. I’m so grateful for the quality and dedicated of the team which has given me such good results. Graft/Hair Breakdown:- 1s = 421/421 2s = 809/1618 3s = 1085/3255 4s = 185/740 Total:- 2500/6034 - 2.4 Hairs per FU average. Video:-

Who did you choose? A natural hairline is really the key to an undetectable transplant. As we know the hairline frames the face which really brings the facial features into harmony and achieves that aesthetically pleasing improvement that we find appealing to the eye. So what is a natural hairline? There is no "one size fits all" and this is seen in many poorly executed hair restoration surgeries today that result in an unnatural appearance, with an inappropriate design that does not correctly take into consideration all of the unique and defining features that differentiate us as individuals. Hairline design is based on not only the more obvious factors such as extent of loss, potential future loss and strength of donor, but from a more artistic standpoint, influencing considerations are bone structure, facial shape, distance between key facial landmarks. Dr. Bisanga then interprets such details to artistically design the most natural hairline that is unique for each patient. Following the agreed design, then it is essential to utilise the correct hair follicle for specific areas of the restoration. An undetectable hairline restoration is achieved by "cherry picking" the naturally finer and soft single hairs generally located around the ears of the patient, and then after placing those initial rows, reinforcing behind with higher groupings, 2s, 3s as the restoration covers more surface area. Appropriate density is another important factor, striking the balance between creating an illusion whilst preserving the donor as much as possible and respecting native density. It is very common for patients to request high density, or "dense packing", but far more important is an appropriate density that achieves a natural hairline as opposed to an overly thick manufactured wall of hair rising from the scalp. The very best results in hair restoration demands high importance on the doctors artistic ability. A restoration could be performed technically very well, but the natural artistic vision is what distinguishes one doctor from another and achieves the most natural hairline.

Some audio issue reported on YouTube. Apologies for inconvenience. We will be reconnecting via HTN Instagram account. Please head there for live viewing. https://www.instagram.com/thehairtransplantnetwork/live/ Thanks