Raphael84

Quick update - Due to circumstances beyond our control, there is a slight unforeseen delay and we expect the session to start around 10-15 minutes behind schedule. Thanks for your perseverance. It will be worth the wait - https://www.youtube.com/HairTransplantNetwork

@Marco Van Basten Amazing! Thank you for the update and I must say it was worth the wait. It doesn't get much more honest than these photos. Short and wet. As has been alluded to, it doesn't get more natural than this. Whilst we are all concentrating on the recipient, look at that donor. Untouched! Im thrilled for you and I look forward to the dry photos and will be great to see further updates in the future with some length also if you may grow your hair. You now have a full range of styles and lengths to enjoy.

I would completely agree that hands on time with any leading professional in their field in a private consultation would be expected to be a charged appointment. We even see nowadays youtube influencers and non medical staff charging for their time in a "consultation" session. Dr. Bisanga has offered international consultation in many countries for many years, and it was always the objective of the clinic to offer these as free consultations. The issue that we encountered was that as a free consultation, the interest was far greater than the availability. Whilst this is simply demand and is generally desired, as stated above in this thread, we found that many individuals that even spoke openly on this forum, never had intentions of considering BHR for surgery and simply used the free consultation as an opportunity to experience a thorough consultation and attain summary and donor data to then share with other clinics, which is obviously not what the motivation for our consultations are. The interesting evolution is that by introducing a small charge, even when detailing that this would be discounted from surgery should a patient be deemed a candidate and decide to proceed, is that a good percentage of so called serious interest then declines. The motivation to charge is not to generate income and cover costs per, but more so to allow serious individuals the opportunity to meet with their chosen doctor who has limited time availability as opposed to them missing out on the opportunity to other less serious individuals. As patients, is normal that we would prefer not to have to wait too long for consultation availability and we would rather not have to pay, but the reality is that if all consultations were free, then we would be waiting 5x longer for availability.

Looking forward to this and already some great questions and topics listed above. Should be well worth making time for!

Thats for the update Geo. I will contact you privately.

@Geo You have a solid list of doctors that you are researching and considering which is always a great starting point and no doubt as your journey continues and you being the process of communication and potential consultation, you will begin to align yourself with a particular doctor or approach and one clinic may begin to feel more like the "right fit" than another, so take your time in this process. Whilst not always the most convenient, an in person consultation can oftentimes really accurately inform you of a recommended hairline design and surgery approach and obviously meeting the doctor which can go a long way towards helping that selection process. Im not sure exactly where you are located in reference to your preferred doctors but that will always be a worthwhile endeavour. I would agree that you crown would hopefully require less than the 2000 grafts that has been cited but of course the periphery of the loss would also need to be taken into account to reinforce outwards into native hair as necessary and your images do not show a top down from the front, and there appears to be more thinning moving in a frontal direction which can not be properly seen. Depending on hairline design and such specifics, as you have yourself said a new hairline would require to be rebuilt using the most appropriate soft single hair grafts, this in itself can require around 500 grafts (please see video below), and considering the temple recession that sits that bit deeper, these are all factors that will influence frontal graft numbers and as you are "revisiting" the area, it is paramount to ensure that the optimal approach is utilised this next time round. Below I share a few cases that may be relatable in terms of frontal surface area. Graft numbers will differ due to some of these cases not having any density in recipient areas but they may present an idea of design and result etc. If you would like to see other such results, dont hesitate and I can happily provide them. I have also shared my result thread. My case isn't similar to your own in some ways, but in the fact that your recipient area is non virgin and has transplanted density present albeit lesser than required, and also my crown received grafts so you may find it helpful to review such cases and experiences of growth into non virgin areas. I wish you the best. Ian

Exactly that. If this was what the above post was referring to, its just as easy for the clinic if not easier to shave the entire head without having to stop at would would be the border of the recipient. It is one of the most common questions from prospective patients who only require the frontal area restoring. They ask if they can keep native hair behind which allows them to utilise native hair length to conceal redness in the recipient post surgery. This is not a preference of any kind from the clinic and that would also be the case for other doctors and clinics. Depending on the extent of loss of the patient and the surface area of recipient, then retaining native length behind can be very effective and puts a lot of patients at ease.

Great discussion is what this community is all about. To provide a platform to question approaches, experiences, reasoning and to better educate ourselves. This very forum was a great resource for me as a young individual struggling with loss and trying to feel my way through the minefield of hair restoration. This still exists today with hair restoration not being an exact science in regard to optimal design and surgical planning and therefore whilst we as patients are drawn to different doctors for different reasons. As has been detailed in this thread, much of a doctors signature is his own artistic understanding, interpretation and application. The conversation and topic of requirement for consultation is one that has been discussed many times before, especially in regard to BHR and Dr. Bisanga as due to clinic protocols and thorough data driven approach, then consultation is requested more often than most. I share below a thread of discussion that further explains such a consultation driven approach and if the requirement for consultation is a "deal breaker" for a patient, then that is their prerogative and personal choice that we as a clinic respect. What I would say is that any decision to request or require an in person consultation is never a business or money motivated decision. On the contrary, such an approach adds further "steps" and therefore sometimes challenges prior to being able to schedule surgery. However in an industry that can at times be lacking in ethics, we begin each day knowing that any decision or recommendation for consultation that has been made, has been made in the best interests of the patient and this is an essential part of our protocols and I believe says a lot about the motivations of a clinic. I could honestly share numerous examples of individuals who have presented reluctance to attend consultation due to them having attended other consultations or being told from photo assessment from other clinics that they appear to be great candidates, but upon consultation, the reality can really be quite different. Another consideration is not always candidacy, but ensuring the objectives of a patient are inline with that of their doctor. Hairline design is based on many factors. This includes the standard considerations such as age, extent of loss, progressive loss, medication, stabilisation, miniaturisation, donor density, hair groupings etc. Other important and influential considerations are the facial shape of the patient, bone structure, distance between key facial features (I attached a video below). Photographs alone are not able to present through understanding or attainment of data in regard to many of the above points. Therefore Dr. Bisanga is not able to guarantee a particular hairline design until he has had the opportunity to meet in person with the patient. If a patients objectives and the doctors vision and what he/she may feel is most appropriate is not aligned or the donor will not safely provide graft demands for example, then travelling for surgery to find out that your preferred design will not be considered may be a further "deal breaker" for some patients. Only at this stage when at the clinic for surgery, it is far from ideal and would undoubtedly be a very anxious and negative experience.

You can see from pre surgery images that the hairline design only dropped around 1cm - 1.5cm from native hair in the central hairline point. This area had however thinned and therefore required reinforcement behind into native hair several cms further back which increased as arching around and nearing the temple area and worked back into that recession which was much deeper. Initial recommendations were around 2500 grafts, but post consultation, with the desire to have more aggressive temple points rebuilt which require those subtle rows of singles and then delicately increasing hair groupings whilst cherry picking the most appropriate grafts for this area, meant that each temple approached a demand of 500 grafts. If you were to consider that if you were to place each side of temple restoration together, you would essentially be mimicking the surface area and single hair requirements of that first 1cm+ of hairline restoration. The patients hair characteristics were medium fine and so placing required to be tight to achieve that illusion of density and the homogenous visual with native hair and density behind. Such an approach would not be appropriate for the majority of patients and was only able to be agreed upon post consultation when the doctor had attained all required data, and due to the patents above average donor density and impressive hair groupings (you can see the average for the surgery was 2.4 hairs per graft despite utilising almost a 1000 singles due to the impressive count of triples and quadruples that his donor presented). Facial shape is also a very influential factor in appropriate and optimal hairline design and based on the patients features along with his donor characteristics and capabilities, meant that a less conservative approach was fitting.

The patient wanted to deal with the recession, have a new hair line, close the temples and also re-define temple points. Dr.Bisanga addressed the diffused thinning in the frontal third area and re-constructed the temples. These were fairly long on both sides as shown in the placement and takes also a lot of singles to establish the perimeter and then work backwards to blend into native hair and will explain why the single graft count is also higher than usual. GRAFT/HAIRS BREAKDOWN 1s - 998/998 2s - 547/1094 3s - 1247/3741 4s - 743/2972 TOTAL: 3535/8805 = 2.4 Average VIDEO WITH COMB-THROUGH: PRE-SURGERY POST-SURGERY RESULT COMPARISON

@LurkNoMore Thank you for creating your patient thread. Primarily Im very pleased for you now that you surgery is completed and you are back in the comfort of your own home and healing is progressing nicely. Thank you for the shout out and I am pleased that I was able to help in any small way and ease some of your concerns as your surgery day approached. Your hairline design when considering your facial shape, dimensions and distance between features will be very age appropriate and fitting. Great write up that will be appreciated by many no doubt and will be very nice to have the support of the community throughout your journey. It has been a pleasure and I look forward to enjoying the next 12 months worth of updates and evolution.

Some individuals may believe that the only factor regarding the amount of grafts your donor can provide is only related to density. Density if of course a key factor, and native density is not something that we are able to increase. We can however avoid ways of destroying or damaging the donor so that it can be optimally utilised to give maximum grafts and minimum visual change. Many are destroying their donors today with poorly planned and executed FUE. We have seen with quality FUE surgery, including cases with high graft numbers, you can shave your hair very short, if certain protocols are kept to. The problem we see today is really poor technique that will leave excessive scarring and damage the donor considerably, including to surrounding untouched follicles. So, by consequence, the patient will have very limited options in terms of graft availability for further loss and indeed also limited in regard to how they wear their hair. This video shows footage from 2007 of Dr. Bisanga's FUE and the quality and management in place even way back in FUE infancy when most were new to the technique or indeed had not even learned and performed it at that stage. Today we see a deluge of problems as these protocols are not kept to, so make sure you research and realise not all FUE is the same. In fact far from it.

Thanks Melvin Price changes at the clinic have been well discussed on the forum over the last months and based on the timeline of @LeBerry journey, his surgery was prior to any such changes. The requirement for tax is a Belgian law in relation to elective cosmetic surgery that was introduced in 2016. It is not specific to hair restoration, but is a requirement nonetheless and a patients nationality or country of residence does not have any influence on the requirement. For case or situation specifics then by all means follow up with your advisor who will be able to clarify what may be required, but this is not unique to BHR but to all clinics for all cosmetic procedures within Belgium. For those who are in communication with other clinics, then each clinic should be able to advise in relation to their personal policies. We have been advised that this law may actually be revised later this year. With that being said, @LeBerry has presented his case excellently in creating his own personal patient thread and by the response and interaction from the forum, it has been welcomed and well received and so I think it is only fair that the thread remains on topic of LeBerrys surgery experience and result.

Harry’s struggle with hair loss is no secret, in-fact if you are a royal then it is largely expected for the male line and aggressively so. The family sure have the longevity gene with a far more than average life expectancy but the other side of the royal coin isn't so favourable! Hair loss. So, is Harry a good candidate? We look at the evidence here to assess and take into account factors that may not be considered in other reviews. By going beyond the photos to present new perspectives and understanding and a prediction of further progression. Harry’s hair loss story is not entertainment, but does drive home some real challenges that many will face.

To add some clarity and correct the opinion of the previous post to avoid any misunderstanding, in any 45 year old patient that has been committed to topical minoxidil since the age of 20, whether any changes to their regimen of medication are recommended will be based on the status of their native hair, meaning is the donor stable or may it present any concerning levels of miniaturisation which may impact surgery result and/or longevity of result. Rather than being a case of "sticking to the rules" or not, our approach is what is most appropriate for the patient. Whilst other clinics may proceed with surgery feeling confident of achieving growth and a result but with no regimen in place to stabilise decline that may be present and which has a probability to evolve meaning the transplant may become disconnected to native hair for example or the result may thin in the shorter term, Dr. Bisanga will recommend what he feels is necessary for the best long term approach for his patients and this is based on his 20 years of experience in the industry. If a 45 year old patient's hair is stable with their current regimen, then there is no need to change. If their status presents concerning levels of miniaturisation, then recommendations will reflect this either via candidacy or a change/more effective regimen of medication. Again, always for the patients best interests. Medication is a personal decision and if a patient is uncomfortable with a particular treatment, then the likelihood is that they will not continue with such a regimen regardless. If more doctors "stuck to the rules" then the industry as a whole would find itself in a much better position than it currently does and candidacy would be based on education and appropriate decisions as opposed to sales and numbers. I am a patient myself and used this forum for over 10 years as a patient before working in the industry. I am a patient first and foremost and would rather turn down candidacy and be honest than risk any individuals well being. We see it at the clinic day in and day out. Repair and failed surgery is higher than ever. Not all failures are due to poor choice in doctor. Obviously there are the anomalies but oftentimes failures are related to questionable candidacy to begin with. Medication or lack there of it can be a part of this. It is always a good idea to consult with other clinics and doctors that you may have interest and knowledge of their work and always something that I would encourage. This way you will get a feel for who is the "right fit" for you and your personal case and situation and allows you to be as informed as possible and if you do decide to proceed with surgery, you can do so being as confident as possible in your decision of doctor.

The original question was in regard to the donor area and over harvesting. In terms of the recipient, the higher the placing density in each cm2, the more competition for blood. The most important factor here is the performing doctor, their ethics, their donor management, their approach in terms of design and density etc In the right patient and candidate, 4000 grafts is completely viable. Can the average patient safely reach such numbers? At consultation most patients are more commonly within the 3000 - 3500 range for their own best interests and to allow larger overall graft availability in subsequent surgeries. The reason to limit harvesting appropriately within each patient is to avoid the donor looking thinner. As detailed, below your scalp in your donor area you have small blood vessels that will play a crucial part in donor area healing post surgery. it is important not to make too many extraction sites within any cm2 in one single surgery that would put too much in terms of demand on these blood vessels and could therefore compromise healing. Capping surgery to an appropriate graft number that your donor can safely handle, will encourage optimal healing and would then allow further harvesting of more grafts from your donor area in a subsequent surgery. In the average patient this would then allow harvesting of higher graft numbers such as the 6000 graft example that you have cited and if optimally managed in terms of extraction pattern, then such numbers can be attained without signs of over harvesting in the donor. This is one element that is often overlooked. Many patients choose to "roll the dice" in terms of their chosen clinic, with the mentality of, if I can achieve my objectives at one half or one third of the cost, then I will take the chance/risk, and if things do not go to plan, then I can consider repair surgery. The concern with such an approach is a damaged donor can never be "repaired". Sure you can place some beard or body hair into the area at high cost and with no guarantee of growth to break up the contrast of scalp and hair, but once a donor is negatively impacted, you will never be able to harvest the same graft numbers that a well managed donor could provide. This is without even considering the complications within the recipient. With poor quality surgery, even if growth is acceptable and the patient is satisfied in terms of their result, oftentimes donor management is non optimal meaning if there is a further requirement for surgery in the future due to progressive loss for example, then limitations are in place that may not have been necessary, had the donor been better managed. Any surgery no matter how small or large, should always have long term as priority. This is both in terms of appropriate hairline design as we age, and depending on each patients unique status, planning appropriately for potential future reliance on the donor.

If you would have interest in consulting in person with Dr. Bisanga then of course we can explore convenient dates for you. I will contact you privately and we can discuss further.

Usually the scar will stretch in the first few months while the tensile strength is not there and hence why recommendations are to not exert yourself physically in those early months post op.

Hi @arthurSam At 45 and based on your images, you have retained a decent amount of native hair but have recessed at the temples, which also then evolves reasonably deep behind your frontal forelock as can be seem in all of your images and highlighted in the image below. When you shave down you will see more of a pronounced pattern and your hair length serves a purpose at current in presenting an illusion of more hair and more coverage. Based on your hair and pattern of loss, you really want to ensure that you select the right surgeon first time and do not require further surgery to increase density etc. With this being said, the 1200 graft count that has been quoted is low and based on the design presented, would likely result in an unsatisfactory result. I have attached a video below that shows the demands of soft singles in the hairline alone. Considering the surface area that requires restoring and reinforcement being this, more grafts will be needed to achieve an appropriate density and achieve that "illusion of density". By all means search for other surgeries of such a graft count to get a sense of what they may be able to achieve. In terms of shock loss, if your native hair in the recipient areas including the transitional area of blending between zones without native hair into zones with native hair have miniaturisation, then this can occur. Having said that, to achieve a natural result, these areas will require reinforcement otherwise you will not achieve a consistent aesthetic of density and areas behind may appear thinner and so placing density will have to have this approach in mind.

It really depends on many factors specific to the patient and therefore why a unique surgery approach for each patient is essential. Donor density is obviously an influential factor. Patients with significantly above average density may be able to achieve higher graft counts providing their donor is healthy. Density however is not the only consideration. FUE takes from surface area and therefore patients who may have a dipping or drop in the lower crown or potential retrograde alopecia with thinning from the nape of the neck moving upwards and possibly weakness above and around the ears, may mean that despite a natively higher density, weaker areas limit the surface area viable for FUE extraction. 4000 is pushing the average donor. We would personally prefer to see the patient in person for consultation before recommending or considering a 4000 graft surgery and much more commonly a patient may safely reach 3500 grafts for example. If the donor is pushed too much, then due to the overall negative effect that this can have on untouched grafts as detailed in my above post, this would mean that less grafts would be available in subsequent procedures due to a decline in general health of the donor and that is never the preference. If you have no concerns with dipping in the crown or retrograde alopecia and density is high, then 4000 grafts can be achieved, but again this is not every patient. The following case is a good example of higher graft counts being suitable. You can see the patients rear donor has great height. No signs of decline in the lower crown or anywhere within the rear occipital, and you can see the strength and density moving toward the nape which is not so common. This patient had an average density of 82.5 follicles per cm2 (70 - 75 is an average patient) so he was above average and his donor allowed a "safe" zone of 8cm in height and 32 in length, providing a surface area of 256cm2. Another patient may only be able to consider a surface area of donor of 180cm2 for example, and therefore density is not the only consideration.

In regard to over harvesting, obviously it is the amount of grafts that are extracted that creates the main issue. But the problems created, do not stop there. In most cases, it is due the very large graft numbers being taken in single procedure, which is more than the donor can safely provide. In other cases, graft numbers can be more conservative, but when focus is only in the richer occipital rear donor for example and therefore surface area of donor utilised is much smaller, then if not optimally managed, the obvious moth eaten appearance can still occur. In the punching and extraction process and as follicles are essentially cut from the surrounding tissue, the scalp experiences a level of trauma. The more extraction sites in any cm2 of donor, the more blood vessels below the scalp are disrupted and the more extreme the "trauma". Due to the "over-disruption" of these blood vessels which are responsible for healing and providing "nutrients" to the follicles that are untouched, healing in these areas can be sub optimal meaning not only have too many grafts been taken from a particular area, but the follicles left in tact also experience decline in terms of potential miniaturisation and thinning of the structure of the hair due to such disruption. Below I share two videos with Dr. Bisanga explaining these concerns further. The second video due to some blood being visible means it is only available on the YouTube platform, but it is well worth the watch.

With the phenomenal rise of social media, there is a flooding of experts in any field and this is not necessarily a bad thing. We all like to have entertainment and most of us appreciate education. The danger however is that we can equate online presence, subs, views, likes and comments with competency. Don't get me wrong, some individuals may be very talented and also in our field, that may carry into the operating room as well as on camera, but it would be unwise to listen to "experts" who are great at talking or presenting but really have no pedigree or portfolio of cases to share their own work. We can all be guilty of it. We can be armchair footballer managers and could do better than any referee and find ourselves yelling at the TV, but that is a world apart from actually playing. I have seen a rise of apparent "EXPERTS" conducting consultation and am often left very bemused that the outcome is zero empirical data and certainly nothing to base a hair transplant on. I am not referring to zoom calls or photo assessment but actual hands on in clinic consultation with the doctor, but with no data given aside from a casual "you are a good candidate" take home summary. Always look beyond the videos to see the actual work, the history, the patients, the portfolio, accreditations, peer reviews etc..If they are not able to measure your density then will they be able to perform surgery?

@New_Barnet_Please Thank you for you update. I have been awaiting this one. To be honest you have never looked back from those early months post surgery and I have always appreciated your documentation, photo quality and words as Im sure much of the community has. Good to hear that you have been able to be consistent with your regimen and that you feel that this has stabilised potential shedding that you experienced and overall completely natural. Nobody would ever suspect that you had surgery. It should be an enjoyable summer!

This patient has kindly sent further updated photos and is very happy with the result and is now thoroughly able to enjoy her hair! From worrying about it to forgetting about it with this dramatic change and newly found confidence. VIDEO:- COMPARISONS

Hi @Afro You may find this thread offers some insight -