Raphael84

As we see body hair FUE performed much more commonly and become a great tool for patients with extensive loss and/or donor limitations, it is natural for individuals to seek even more potential sources for restoration. With the standard and more reliable body source being from the beard, the chest is then generally the next consideration. Dr. Bisanga, Dr. Kostis and Melvin discuss the potential usage of "wet" hair for restoration and if it is a wise donor source to use via #FUE?

@Henle88 Thank you for posting your case and your experience. The design and quality of the work shown is clear, although understandably based on your thread and details, there is some justifiable confusion. As I personally do not know your case or we have not had any previous communication, I have no knowledge of correspondence or surgery details and so therefore I would advise to follow up with your patient advisor for any clarification. In regard to more general questions about pricing structure and surgery conditions, the clinic have implemented some changes in recent months. As standard, FUE surgery at BHR Clinic will now see punching of extraction sites shared between both Dr. Bisanga and Dr. Kostis. Dr. Bisanga has the upmost respect for the ability of Dr. Kostis, and Dr. Kostis has shown at a recent hair restoration conference amongst doctors where live surgery is performed, that the quality of his punching is optimal and in line with the most highly regarded doctors in the industry. Dr. Bisanga has worked incredibly hard to forge his reputation over the last 15-20 years and as members of the forum will now that BHR is renown for being one of the most ethical and honest clinics today. With that being said, the above surgery conditions are outlined and clearly explained to any individuals who present their interest in surgery with Dr. Bisanga. Obviously patients who confirmed surgery prior to the change in pricing and therefore previously agreed conditions are being honoured and surgery is proceeding as agreed. There was naturally a "change over" and transitional period of where some patients will have scheduled based on previous pricing and surgery conditions, and others the more newly introduced changes. Dr. Bisanga is still available to perform surgery exclusively in terms of making all recipient sites and punching all extraction sites, but as said, this is at a new price point. I can clarify that this change has not been introduced to allow scheduling of more patients each day which I can confirm does not occur. The objectives of the clinic are not to increase quantity of patients. This is reinforced by the amount of enquiries that we refer to consultation before considering any surgical intervention. One of the motivations for such a change, in addition to the ability of Dr. Kostis, is the fact that many individuals who are serious to proceed with surgery have budget constraints which is completely understandable. Moving forward, having such flexibility will present more economical options for quality surgery. I can only apologise in regard to any confusion in this instance and as said I do not know the specifics of this case or the reasoning behind it, but hopefully this helps to explain some of the changes in structure and clarifies things moving forward.

@New_Barnet_Please I hope you are keeping safe and well. As you have reached the 6 months stage, it would be great to see how things have progressed in the last months whenever you may be able to provide an update. Wishing you the best.

This particular case saw Dr. Bisanga perform all punching for donor extractions. We are currently in the process of preparing a video to share in the next weeks regarding BHR punching protocols and showing examples of work from both Dr. Bisanga and Dr. Kostis which should be a very nice addition to the recent content that we have published and so please do keep an eye out for that. When it is complete and ready to share I will be sure to post a thread link here. It is great that the community and individuals in general are beginning to understand the importance of an optimally managed donor extraction pattern and really paying attention to this. Oftentimes results may be presented without any images of the donor area post surgery, or perhaps the entirety of the graft count being extracted in a very focused area in the back occipital region. Not only is this the richest area of the donor with higher hair groupings and more robust follicles, that any long term approach will manage conservatively due to the potential requirement to utilise this area in future surgery and really capitalise on the more favourable hair groupings in the mid scalp and crown where placing density will be lower, but to create the most natural hairline, mother natures most soft and single follicles should be "cherry picked" from donor areas that naturally provide this hair type which is more commonly found around the ears. So much press/social media related to hair restoration focus purely on aggressive and "desirable" hairline restoration at high density, regardless of if this may be appropriate for the patient or not. The richer donor area is overworked to attain higher hair groupings to maximise the illusion of density and therefore extraction protocols are not efficient or in the best interest of the patient. Oftentimes the patient will realise this the hard way when they return for further surgery due to progressive loss behind the hairline or in the crown and they simply no longer have the donor capabilities to meet the demand.

Exactly this Melvin. Ideally we would be able to present a recorded video of each patient result, brushing through and parting their hair etc. The challenge we have at BHR much like some other clinics, is that we are an international clinic. A very minor percentage of our patients actually reside in Belgium and therefore depending on the patients location, it is not convenient nor feasible for the patient to return for photos/videos post op. Oftentimes as can be seen on this forum and various threads, it can be extremely frustrating for the individual to be advised that they would need to travel for consultation prior to confirming surgery, so the challenge of them potentially returning for photos is very unlikely in most cases. Many other clinics such as within Spain for example, work predominantly with a domestic patient, meaning inviting the patient back is much more feasible. Regardless, we intend to share as many cases as possible where the patient is comfortable to share their photos and present their case, giving back to the community and we are very grateful to those that kindly do so. With that being said, sometimes photo quality may not be optimal, but the transformation and result is clear and the quality and naturalness of the procedure is evident and therefore it adds value and has a place on the community forum. Thank you for the support and comments.

The patient wanted to address his recession while being conservative in the approach. He is committed to medication and was prior to surgery also. Dr. Bisanga and the team placed 2507 grafts via FUE to achieve this result that was already looking very good at 5 months as shown below and again at 12 months post surgery. Challenges were that the donor was weaker around the ear areas with a lower than average density, but stronger in the occipital area that compensated and the extraction approach respected this influential factor. All post surgery photos have been kindly provided by the patient. GRAFT & HAIR BREAKDOWN:- 1s = 422/422 2s = 1442/2884 3s = 643/1929 TOTAL:- 2507/5235, average is 2.0 hairs per FU. DENSITY:- (FU/cm2) - 60/85 (Average 72.5) VIDEO:- PRE-SURGERY PLACEMENT 5 MONTH COMPARISON 12 MONTHS FINAL COMPARISON

Dr. Bisanga is no longer personally performing or involved in surgery in BHR Athens. For those who may have a tighter budget or are looking for more economical options, Dr. Kostis is available in Brussels.

Dr. Bisanga and Dr. Kostis explain to Melvin the importance of selecting the necessary fine single hair follicular units for a refined and natural hair line. Yes it takes time, the harvesting is harder and more delicate, but there are really many reasons why you need to get this right first time!

Thank you for the update. Looking great at only 4 months and the next months will show a very nice improvement as hairs mature and settle. Very pleased for you.

You really have come a long way in only 4 months. It is easy to forget at times, especially when you are see the slow progression on a daily basis. The following comparison presents things quite well -

@Marco Van Basten Thank you for the update. You are looking great at 4 months and right on track for an exciting journey over the next several months. At 4 months things are beginning to take shape and you will see new growth, increased density and maturation over the next several months. To thank you for a very nice photo quality also. Very consistent and honest and transparent which is always much appreciated from the community. Im very much looking forward to the next months for you and please do continue to keep us updated.

Congratulations on such impressive early growth @LeBerry You are looking great and able to maintain your hair short both in your donor and recipient and the natural result at such an early stage is impressive and your above quote really says it all! Due to great feedback and interest, we have put together a video presentation of your journey so thank you so much for documenting and sharing your photos so consistently up until now, and things will only get better!

In regard to such products being used on native hair amongst/behind your transplant post surgery, the concern when using hair spray is that it is not only the hair that is receiving it. Hair spray can get on and stick to the scalp and especially those of us that have concern with loss, generally use a little more than we should to help us conceal. With that being said, hair spray and any other such highly chemical based products should not be used on the head for absolute minimum of one month post surgery, ideally longer as they are not assisting the scalp environment which we naturally want to keep as optimal as possible post surgery. Hair wax that can be applied from the fingers directly onto the hair presents a different situation as the scalp itself can be avoided. in terms of using product on transplanted hair once growth occurs, you will be several months post surgery by the time you may feel that products are necessary to use and at that stage initial healing will have long passed and you can consider other products. Hair spray in general is never a healthy choice for the hair or scalp. Concealer is a big no post surgery as again, the tendency is generally to always use "just that little bit more" and whilst designed for the fibres to attach to hair shafts, more often than not concealer will sit on the scalp. Of course many patients post surgery are looking to conceal their procedure and therefore may be considering such products but just like hair spray, concealers are never "healthy" for the scalp and in the case of concealers, absolute minimum of 3 months post surgery before considering usage.

There is a scourge that is causing untold misery to countless victims through the use of hair extensions and relaxers, that inevitably will cause them to lose hair. The pursuit of what is deemed beauty can be very costly and we see it with emails daily and the destruction it causes. Here Dr. Bisanga describes some of the pitfalls and how to avoid them! No wonder this got well over 135k plus views on our French channel in a matter of days and much exposure in the French press.

A hairline can be a blessing to roll back the years, or a curse that you will forever regret! Presenting Bitesize with Bitesize, #47 - Allow Dr. Bisanga to explain some of the common pitfalls in hairline design that you can live to regret. Remember hair loss IS progressive so you need to be wise and personal in your approach and not consider a "YES" clinic, or the brief joy can be outlasted with long term regret. Get it right first time and listen to the experts who have decades of experience in designing a unique hairline that compliments your face shape and bone structure whilst optimally planning based on your donor resources. Continue your education with "Designing a natural hairline" -

I understand the challenges in place and travelling for consultation may not be easy or even feasible for some depending on location and their situation. Hair restoration and its approach is not an exact science and as such is subjective. As said above, all doctors and clinics will have their own protocols and preferred approach and as we see on this very forum, approaches and design can differ quite dramatically which is one of the main motivations for individuals to have interest and preferences for one doctor over another. Dr. Bisanga and every other doctor would all proceed with surgery with their own artistic vision. We see this not only in hairline design, but also in donor extraction management. This also applies to what they may perceive as limitations, "safe" donor area and graft availability etc. Each doctor will have their own "markers" and their own "specifics" that they may assess and measure to determine candidacy. There is no industry standard or set protocols / "check list" for this and that applies even more so for repair patients. Repair patients and their hair situation and status are all very unique depending on their history and previous surgery and repair in general can present very delicate challenges. It is down to thorough and ethical practices that Dr. Bisanga would require to assess repair patients in-person himself to be able to understand the patient´s case and based on those findings, have an in-depth conversation personally with the patient explaining any and all concerns and challenges. If candidacy is possible, this then allows the patient to have been thoroughly informed of any limitations and allows Dr. Bisanga to honestly and transparently explain what he feels may be achievable. It allows Dr. Bisanga to explain that growth can not be guaranteed for example which is the case and protocol in repair surgery and to ensure that the patient has realistic expectations and understands the potential limitations in place. This is a very important part of the process to avoid disappointment or confusion at a later stage when surgery may have already have taken place. Each doctor will not only conduct their consultation and assessment uniquely, they will also explain their summary uniquely and make unique recommendations and this therefore explains why consultations with different doctors presents different experiences and is another reason why patients will make their final decision on their preferred physician. They get a feel for the doctor´s personality and if they are a good fit. The clinic appreciate the potential challenges with travel and this is why Dr. Bisanga offers international consultations, to be as accessible as possible to individuals who present interest in surgery with him. Dr. Bisanga offers consultation in the US each year, just as he does in the UK and many other locations. He is one of the most travelled doctors and performs consultation himself as opposed to non medical staff or non doctor. Any such requirement for in-person consultation is always a medical decision made in the best long term interests of the patient as opposed to a business or financial motivation. If the industry standard were to be more thorough in assessment and requirement of in-person consultation when necessary, the amount of repair surgery or poor results would be much less as a result. As an industry we must improve to protect patients and make decisions based on their well-being.

@Gatsby Great write up and I am wishing you the very best my friend. You are a credit and great value to this community and thoroughly deserve the best result possible. I look forward to following your evolution. Take care and heal well.

@HumbleMan Thanks again for creating your thread and we all look forward to following your evolution of the next months. You have received some nice comments and support which is always great to see and the opening line on your original post is very nice to read. "I create this thread to follow my own development, but also in a large extent to inspire and enlighten others who are considering a hair transplant." As with all patient created threads, it is always appreciated to keep the thread on topic of the patient because after all, the thread is about them and as a community we always want encourage patients from all clinics to detail their experience and growth. As a patient myself, this was by far one of the most valuable factors in considering surgery and ultimately making any decision to proceed and therefore invaluable to this community. In response/discussion to other comments regarding the need for consultation, in an attempt to keep this thread on topic, I have created a new thread where such discussion can be continued.

With the growth and popularity/demand of hair restoration surgery today, all clinics will receive enquiries and interest from all over the world. Whilst it is great that we as patients now have many options to consider, it is also important to understand that when assessing individuals based on pictures and/or video, there is only a certain amount of accuracy that can be known. With the ever increasing demand of surgery and also as the boundaries have been pushed and what can now be achieved with hair restoration surgery being more impressive and dynamic than ever, individuals with all extents of hair loss are searching for viable options and as they conduct their search and perform their due diligence, they contact several clinics. As we know, not all hair restoration surgery is performed to the same quality and all clinics will have their own approaches and thoroughness in terms of consultation and attaining empirical data etc. With that being said, some patients based on their photos may require a thorough in-person consultation with the doctor under magnification so that data can be attained such as donor density, hair groupings, hair calibre and texture, potential levels of miniaturisation, an understanding of hair status and stability and potential progressive loss. Whilst this may seem like a considerable inconvenience based on location and the need to travel etc. it is important to understand that not all individuals are good or even acceptable candidates for surgery and an in person consultation is always in the best interests of the patient. With the state of the art FotoFinder technology that we utilise in the clinic, consultation is able to be much more thorough and also allows an assessment of any skin irregularities. This is even more important for repair patients or those with "non virgin" scalp as it can highlight any pitting, ridging, tenting, cobblestoning etc and oftentimes the patient may not even be aware of this. In the case of BHR and my own experience, several individuals ask why Dr. Bisanga has requested an in person consultation when clinic "x" have not. Whilst I can not speak for another clinic and their protocols and assessment, I wanted to share with you correspondence that I sent to a very nice individual, who requires consultation as we were discussing this exact point. I will copy below the explanation to add further consideration whilst editing/removing any personal details - ---- I do understand your frustrations. To better explain the necessity of consultation for patients that present a specific pattern of loss, many believe that FUE is simply FUE. Removing hair from the donor and placing in the recipient. The reality is that there is much more to consider and to understand before being able to accurately recommend surgery for an individual. Just this week, a 38 year old male visited the clinic for consultation. From his photos, he essentially had a full head of hair with favourable hair calibre, very slight temple recession which was arguable if a transplant was even necessary. The individual had been committed to medication for the past 7 years. Upon inspection and assessment under magnification, it could be seen that his donor presented 30% miniaturisation on average, with other areas actually showing higher than this. This was not at all expected and could not have been known from photos or videos and without magnification. If surgery had been scheduled on this patient as it may have been with other clinics, then yield and growth would have been questionable and also the longevity of any growth as his donor was in decline. This would not have been the right decision for the patient. I explain this story just because it was this week, but this is more common than you would imagine. As a patient myself, I can completely empathise with the desire for surgery but also the anxiety of travelling for surgery, surgery day/s and then the need for patience post surgery. Fortunately in my case, growth was excellent and early, but if growth is not as expected, the further anxiety and disappointment would have been very complicated and difficult to manage. Not all individuals are good candidates for hair transplant surgery. One very important factor (of which there are several) as to why Dr. Bisanga is able to achieve consistently excellent results is due to thorough assessment and ensuring that an individual is an acceptable candidate to proceed with surgery. It is due to such consistently excellent results that you are considering Dr. Bisanga for surgery, and so therefore it is important that such protocols are followed. Every day we receive individuals for consultation who are essentially a repair surgery. Not all of these individuals are repair due to visiting low quality cheap clinics and in many cases, this is because they were not good candidates to begin with and surgery may not have been the best option for them. Any decision to request consultation with an individual is always for the patients' best interest. It is not a business or financial decision, but a medical decision to better inform both the patient and the doctor and allow a more accurate understanding of current status and candidacy. However inconvenient it is to need a consultation prior to surgery, when travelling such long distances, I can assure you that the inconvenience of arriving to the clinic and having paid for surgery, paid for travel and hotels, arranged time off work etc to find that you may not be a candidate would be a far worse and more stressful situation. One which the clinic will try to avoid at all costs/measures. Any such requirement for consultation is genuinely always in the patient´s best interests. ---- Below is a video explaining the importance and process of a thorough hair restoration consultation.

Following up on previous comments related to graft count/requirement for what would generally be perceived as a small surface area, to achieve a completely natural result using the most optimal soft and fine single hair grafts to mimic nature, the following recently posted video very nicely explains the approach and associated graft demands.

There is a still a lot of mis-understanding when it comes to hair transplantation and in particular hair line design and how many grafts are needed. For some it is just Y=MC2 and a simple equation is all you need! This is okay for putting eggs in a tray that are all the same shape and size and just a matter of pure math. For a hair transplant however, it is not so simple in terms of dividing an area by a static density to get the total needed. There are intricate details and protocols to keep to and far more than graft totals/area to get the amount placed as this video will graphically show. Like all things, there are levels in life and this is true in hair transplantation, so if your clinic doesn't understand these basics then don't expect a good outcome and be cautious of sales tactics to the contrary. In this particular case, you can see that roughly the first 3mm of hairline alone, requires 446 grafts.

Very pleased to be able to bring the next episode of Bitesize to you. What is the protocol for smoking? We all know how it can effect healing and recovery and even growth, but there are also other implications in the chair for things such as nicotine, cannabis or other drugs! Here Dr. Bisanga shares his approach and also some light-hearted stories to make you laugh! Yes, everything you hear actually happened! Hard to believe!

Looking forward to your further updates over the next few months. Your are looking great with some real transformation not too far away!

The patient had experienced diffused thinning and wanted to address the frontal third whilst also addressing some of his mid scalp and crown thinning. This was achieved with just over 3500 grafts and has really grown in very well for the 7 month period allowing the patient new styling options that he hasn't had access to for quite some time! We expect more growth and maturity over the coming months and will ask for patient photos to keep us updated. Needless to say, the patient is very happy so far and we thank him for sharing his photos. GRAFT BREAKDOWN:- 1s - 404 2s - 1747 3s - 1004 4s - 348 TOTAL 3503 VIDEO PRESENTATION:- PRE-SURGERY PLACEMENT DONOR AT 7 MONTHS COMPARISON

Excellent. Thank you for your update and great to see your progress has really kicked in. It is always nice to see at such an early stage and a nice indicator of what to expect in the months ahead. Very pleased for you and you are well on your way.