Raphael84

Thank you to @MachoVatofor such a well documented journey and for staying consistent with high quality and transparent images.

As a nice addition and thank you for the patients permission, the following video with walk through commentary is nice touch to summarise this thread in video format.

Many thanks and @MachoVato, you look great.

Great that you have a regimen of preventative medication in place and feel that your loss has stabilised over the last years. That is important.
 

At 26 you would still be a younger patient and therefore any surgery must be mindful of this in its approach.

Your posted images don’t present your loss to be able to comment on that specifically, but back to your original question, your donor would appear fine from these photos without any obvious concern.

I wish you the very best in your next steps and however you may proceed.

Thanks for additional photos.

Your sides appear healthy and you have retained your natural temporal points and shape it would seem which is positive.

In terms of graft recommendations, the photos that you have shared do not show/expose your loss to be able to understand surface area of decline and how many grafts may be appropriate.

Are you using any hair loss preventative medication?
At 26 and considering a hair restoration procedure, without having yet seen your pattern of loss and the area that you are intending to restore, but with your crown also opening, hair loss preventative medication would likely be key and influential in terms of your best interests over the long term.

Without medication, it is safe to say that your loss will likely evolve, as is the nature of a progressive condition such has androgenetic alopecia. With your crown opening, should this progress and your lower crown experience decline and drop, then what may be deemed your "safe" donor area today, may not be the case in 10-15 years due the advancing of crown loss, meaning that any grafts extracted from higher in you donor, may suffer decline and have concern regarding longevity.

Depending on the extent of your current loss and potential progressive pattern, maintaining native hair is generally the first step and oftentimes essential, and in doing so and with a positive response, long term graft demands should hopefully be less with a healthier and "larger" donor area over the long term to be able to meet those demands.

The following video details the need for medication and the "safe" donor area -

Hi @Bonek

Based on this single image, your donor does not appear to present any obvious concerns and looks reasonably good.

Your crown appears to be opening and so whilst this appears to have maintained its height, depending on your age, regimen of hair loss preventative medication and potential frontal loss that cant be seen, these factors would all be considered and influential in any extraction approach.

By all means share full side profiles also to be able to see the strength above the ears which is a common area that presents a drop in density, and also to see how your temporal area has maintained.

Additional information such as age, regimen and extent of loss would also be helpful in terms of a better understanding of current hair status and potential candidacy.

Thank for the photos and update Joe.

Unusual to see a patient with a skin fade just weeks out of surgery but I think the photos speak for themselves. 
This really shows the importance of a managed extraction approach and what can be achieved in the right hands.

Whilst we are all conscious of the donor, in most cases the emphasis is naturally put on the front / recipient area, but such a donor approach really allows patients to maximise their donor availability over the longer term which really should be a priority for us all

Looking great and your temples are slowly coming in too.

Some good months ahead to look forward to.

On 4/22/2022 at 8:19 PM, Whipaway said:

Thanks Raphael 84.

I really appreciate all your help and I’m so pleased you think it looks good

It has been an absolute pleasure. I remember how I felt pre and post surgery and there are so many emotions.

After the initial 10 days when the most intense healing has occurred and post operative scabbing has been removed, you will slowly return back to your pre op status albeit with some additional redness. 
Then as you have said, not becoming obsessed and just carrying on as normal is the best way just to let time take its course and allow the process below the scalp take action as we await newly placed follicles to transition into their anagen stage and we start to see progress.

You obviously also have great support from the community.

@Whipaway

Congratulations on completing your surgery. I am honestly thrilled for you.

The work looks great and to be honest, looking at the depth of recession and placement, you styled and hid loss very well. Very shortly that will be a thing of the past.

As said, I am very pleased for you and throughout our correspondence it is clear that you are a very genuine guy and really performed your diligence which the importance of cant be emphasised enough.

Hairline design looks on point and very appropriate and no doubt these 3000 grafts will create really quite an impressive transformation in 12 months time.

I will share clinic photos with you shortly and I for one am very much looking forward to following your progress and taking this journey with you.

Rest up and let healing take place. As you know patience is key over these next months, and at the back end of summer you will be well on your way.
 

Many thanks for your post Christopher and congratulations. At only 6 months you are showing great improvement and an already impressive transformation.

You clearly had a challenging starting point pre surgery but considering only 2400 grafts were used, this would appear to have achieved a very nice coverage and appropriate density throughout your frontal area.

I wish you the best in your upcoming subsequent surgery with Dr. Bisanga and I look forward to following your updates.

You look great.

Like everybody else, each of us is looking for that ideal and natural solution to hair loss. Melvin poses this very question to Dr. Bisanga, who provides more specifics in terms of topical Minoxidil and the concerns many users should be aware of and most likely aren't,  and discussed the possibility of a tricho test.

Thanks @Ad1987

Ill dm you to discuss London and to address your further questions.

I was directed to this thread by a former patient who detailed that Dr. Bisanga was potentially being considered.

@Ad1987 Completely understand the minefield that hair restoration presents and you have received some good advice  throughout. Some if its may be conflicting and therefore adds confusion but the very fact that you have created your thread and now understand the pros and cons to any potential surgery is invaluable in itself, and being as informed as possible is key for any patient regardless of starting status.

With that being said, as alluded to above, you clearly do not NEED any restoration surgery and therefore if you were to proceed your choice in doctor will be defining so take things slow, reach out to several clinics and meet for in person consultation when possible to really get a feel for the doctor and their potential approach and if they recommend and agree to proceed with surgery.

As has been detailed previously in the thread, Dr. Bisanga is in London for consultation at the end of May (29th and 30th) and so if you may have any interest and those dates may be feasible by all means reach out and we can explore appointments for you.

My main motivation to post was based on reading you mention 500 grafts. The below video jumped to mind to really present an idea of graft numbers and soft delicate hairline work that requires mother nature singles. 

Dr. Bisanga performs surgery based on candidacy and graft requirements and is more than happy to proceed with smaller sessions when appropriate. 
The clinic commonly schedule patient of 1500 +/- grafts. In all honesty, less than this is less common as most individuals who may be motivated for surgery have more significant demands, but when less than 1000 grafts is the optimal approach and graft number, then surgery will be scheduled as normal.

Many thanks and I wish you the best in your onward research.

UPDATE -

Wet and dry hand and comb through video which really adds another dynamic to the result and really shows the naturalness and density of the transformation.
Many thanks for the patient for sharing.

Some clinics recommend purchasing a USB microscope to be able to present magnified images. This can present a more realistic and detailed hair status than standard photos and we have use this with specific patients and cases in the past and it is great that some clinics in the industry are taking that extra step/precaution.

Of course even with magnified images, there are still question marks regarding data in terms of measurements of the donor area, surface area of "safe" donor zone, ruling out any skin issues/concerns,  potentially compromised skin if a repair patient perhaps with tenting, pitting, ridging, evaluating scalp laxity, miniaturisation throughout the scalp etc.

It is a difficult balance and as a patient myself, I completely empathise with the challenges of travelling for consultation only. It is not convenient for most and not cost effective. However we do need to be conscious of the fact that hair restoration is a medical procedure and neither the industry nor any clinic has a 100% success rate (and never will) and none of us as patients want to be "that patient" where "things did not work out as planned". Being thorough and having an in person consultation prior to confirming surgery can go a long way in terms of due diligence and making an informed decision on provided recommendations based on accurate data.

This is great and valuable discussion and what the community is all about.

Great discussion and conversation here.

Not at all based on your case or comments @aKaWonderKid but in response to other ideas posts, not all of us are great or even good candidates for surgery and I am the perfect example of this (by all means check out my own result thread), and for some of us whose donor is below average and for those who may have specific challenges, perhaps being a borderline candidate and being able to achieve an overall improvement will suffice in regard to our expectations and objectives.

For others, this will not be the case and despite more extensive loss and below average donor for example and therefore potentially a borderline candidate, expectations are  not appropriate and desires are an aggressively low and straight hairline that their "situation and status" is simply not able to support.

I was fortunate able to achieve an incredible result despite being a repair case, having below average density, strip scar, retrograde alopecia and having fine hair. The positive that I had was that I had a regimen of medication in place and had no concerns of miniaturisation.

Dr. Bisanga takes on some of the most challenging cases and most extensive patterns of loss. This can be seen throughout the last 15 years of his career. One thing he doesn't do is proceed with surgery on patients who are not candidates and this is for their best interests. This is a question of ethics.

Thanks for the update Joe.

At one month post op, you may experience some further shedding for a week or so but the majority appears to have already passed.

Healing is looking great. Some residual redness as expected but from your posts this is not bothering you and on your photos without flash or too much light, this doesn't even appear too noticeable. 

In terms of hair maintenance and increasing vascularity to the scalp, oral minoxidil can be a great tool and as you know, Dr. Bisanga is a proponent of this.

I look forward to your next update.

22 hours ago, Tricko said:

Nice results! But it looks like dr. Kostis is not working in Athens/Brussels anymore or am I wrong?

Dr. Kostis is a resident doctor at BHR clinic Brussels and is performing surgery on patients each day in Brussels.
He has surgery scheduled throughout the remainder of the year and beyond and will be a mainstay in Brussels.

Here is a recent post regarding the need for consultation in some cases and further explaining and discussing this very point -

Great new bitesize to further detail and reinforce this exact subject -

Much has been discussed in recent weeks and months regarding the requirement for an in person consultation for many individuals. 

Whilst some cases may be more clear with a lesser graft requirement and a clinic may be happy to proceed based on pictorial assessment, the reality is the vast majority would hugely benefit or in many cases it is absolutely essential to have a thorough evaluation in person under magnification. This allows empirical data to be attained, removes any of the guess work and is really in your best interests.

For details regarding upcoming UK consultation in May, feel free to contact me - ian@drchristianbisanga.com

21 MONTH UPDATE -

The patient has kindly remained in contact with the clinic and continues to share his updates.

See below his updated photo and video and he explains that his hair is still improving at 21 months. It really is great to see. He was a great patient and we at BHR are all extremely happy for him.

Long may it continue!!!

Impressive early evolution.

Beautiful hairline design. It is very refreshing to see a natural and appropriately placed hairline design that is not only optimal and ideally suited at current, but will be absolutely fitting with age. 

Very pleased for you and looking forward to further updates.

The patient's goals were to address the recession and to feminize the hair line to go in synergy and complete her transition process.

Challenges included a previous hair transplant and also a brow life with resulting scars as visible.

The patient was very happy at 9 months and one aspect of this was to be able to wear her hair up and backwards without having to be concerned about how it looked.

In a recent conversation she has now been able to move on in her life without even thinking about the hair transplant as it has become a natural part of her life with the result that she was able to achieve.

GRAFT BREAKDOWN:-
1s 500
2s 1349
3s 667
4s 131
TOTAL:- 2647

CHALLENGES:-

VIDEO:-

PRE-SURGERY

IMMEDIATE POST-SURGERY

3 MONTHS

9 MONTHS

COMPARISON

Thanks @aKaWonderKid

It is great that you have posted your consultation summary. You often hear Dr. Bisanga speaking about the importance of in person consultation and being able to provide honest feedback based on empirical data that he is able to attain which is completely objective, as opposed to the often cited subjective donor evaluation of "4/5" or "good/strong donor".

A big factor in being able to achieve consistently excellent results is based on thorough assessment and evaluation pre surgery and whilst the patient at times may feel frustrated by such a summary detailing that candidacy is not currently recommended, the frustration of less than optimal yield post surgery or concern with longevity of any result is far more impactful.

I wish you the best moving forward and with a positive response to medication such as oral minoxidil having a positive impact on your donor area, you may find yourself in a more favourable position in 12+ months.

1 minute ago, NARMAK said:

I saw this earlier and it's not even just DHI vs FUE really if we're honest. 

Super, Duper Diamond Dragon Blade FUE giving you 200% graft survival and Doctor uses a single graft, but you magically get 5(!)

Exactly. With a 100% growth guarantee and a lifetime warranty.

The young know no better. The concern is that I see on facebook groups that guys are willing to take the risk due to more economical pricing, with the frame of mind that they can get repaired in the "small" likelihood that it goes wrong. 

The amount of disinformation that gets thrown around by so called authority and educational figures is scary and they are happy to challenge you on it.
The industry really has taken a questionable direction with such marketing.

Hi Joe.

Thanks for the update. Healing looks on point.

Great that you went to a party at less than 2 weeks post op and nobody notice a thing. Really speaks volumes for the quality of surgery to be honest.
Thrilled for you Joe and for what is to come.

Stay patient and look forward to the exciting months ahead.