Raphael84

Thank you to this patient who came to us for surgery and documented his journey and growth very well and has kindly shared the following photos representing 3,6,9,12 months post surgery. His goal was to re-establish a hair line and work back as needed to blend with native hair. We did this with a conservative approach of 3,000 grafts and in preparation of further surgery to address his crown. ☑️ PATIENT QUOTE :- "It’s hard to believe that it has been twelve months already from the procedure in Brussels. While the first few months were slow it has been great to see the progress from 4 months onwards. I am pleased with the transformation and it is great to no longer have to think about the weather and how to style my hair to cover up the front. " VIDEO:- Age: Late 30s Meds: Minoxidil Follicular Unit/Hair Count 1s = 453/453 2s = 1309/2618 3s = 1202/3606 4s = 36/144 TOTAL = 3000/6821 = 2.2 Average. PRE-SURGERY☑️ PLACEMENT☑️ 3 MONTHS☑️ 6 MONTHS☑️ 9 MONTHS☑️ 12 MONTHS☑️

Thanks for the comments. It is very nice to be able to share an afro hair case. Fewer and fewer patients are open to sharing their case nowadays, so a big thank you to the patient and it really highlights the impact that sharing cases can have for the community.

This patient came to us for a Strip surgery. The goal was to re-establish a feminine hair line and work back into the loss areas. Female patients often prefer Strip surgery as it is easier to conceal post surgery. Afro hair does have particular challenges but also benefits associated to it and it does need a specialist approach and a doctor and team who understands skin types, the curl of the graft and hair and also the directions and density they need to be placed in for a natural look. The result here is tremendous at 8 months, showing already good density and naturalness and the patient was very happy to come in for a check-up, record a video and give her testimony of the change to her that this surgery has given her. VIDEO:- FU - HAIR Breakdown 1s - 589/589 2s - 1077/2154 3s - 713/2139 4s - 21/84 TOTAL: 2400/4966 - 2.06. PRE-SURGERY https://i.imgur.com/BF7WCcH.jpg[/img] POST-SURGERY 8 MONTHS

Thanks for sharing your images and details. If I can ask your age, and also what is it that you are actually looking to achieve? Depending on your age, you look to have retained a good amount of hair, but the propensity and potential for further loss at some stage does appear to be present with the lesser density in your crown which can be seen in the contrast from lower crown to rear donor. Some retrograde may be present and showing a lesser density in the side donor. With your regimen of medication in place, you may well present a stable environment now. In your images, with the slightest more length on top, your hair looks pretty good and I wouldn't be rushing into any surgery quickly. Again, age depending it may be best to see how things play out over the next years.

This will really depend on your age, extent of loss, future loss potential, donor availability etc For younger patients with more extensive loss and the propensity for future loss, more conservative will more often than not be in your best interests and allow more donor to be retained for potential future requirements. When a patient researches and narrows down their preferred doctors, generally this will be based on an appreciation of the artistic approach of the doctor and therefore you will feel more confident following the advice and proposed design or somewhat close to that of the doctor. You may appreciate the following video that discussed optimal hairline design -

Another consideration for anybody who may have the approach in mind of having surgery and then beginning medication, is that they never know if they can tolerate the medication. Therefore any surgical approach that may be influenced by the idea of long term commitment to a particular medication, it really is more sensible to begin the medication beforehand to see how you may respond and tolerate the medication. Only then will you know if you are able to and comfortable with committing to it for the long term.

Some great advice above. I completely understand that it is not the feedback that you are looking for your and motivations and desires are to move forward with surgery, but the idea of being stable at 25 even with medication is unlikely to be honest, considering the pattern of decline that your photos present. The feedback provided by other members is intended purely in your best interests and with the long term as priority. I have seen guys at 30 who use meds and feel that their loss is stable and then to be in quite a different situation at 35. You are a young guy with some degree of loss and/or decline essentially from hairline to crown. Good to hear that you are committed to Finasteride and tolerate that well. To maximise the potential benefits of medication and to see if you may be able to achieve any improvement with medication, perhaps consider looking into minoxidil and discuss that with your doctor and hold off the idea of surgery for the next years. Proceeding with surgery at this stage, to experience further decline over the next years may leave transplanted areas disconnected from native hair, a hairline proposed at current may not be what would be appropriate at 30 with additional loss.

@Drumnjake Some great advice has been shared with you above. I have read through your thread, and apologies if I have missed it but I dont see your age mentioned? Good to hear that you are on meds and you feel things have stabilised. From your images, a few considerations are that there appears to be some thinning behind the initial cms of your hairline. Photos are not always completely accurate but depending on your age and stability, these areas may experience some further decline and as you are considering a repair surgery, depending on all specifics, it may be required and in your best interests to reinforce throughout this area to avoid any disparity or need for further surgery in the shorter term. Whilst your rear donor was the only area of your donor that was harvested, with your hair at length, it is hard to get an idea of status of the area. In your pre surgery photos where you back and sides are shorter, you can see that the side donor presents a lower density than the rear (below). It is quite common to have a drop in density in comparison to your rear occipital, but it would be in your interests to get a thorough assessment before jumping in to any additional surgery. These parietal areas generally present the most appropriate finer single hair grafts for hairline work and so with any drop in density in these areas, it really highlights the importance of getting it right this time and to ensure to have appropriate long term planning. I wish you the best moving forward.

I work as a patient advisor for Dr. Bisanga. That is correct. Dr. Bisanga would generally recommend (when appropriate for the patient) to begin oral minoxidil prior to surgery to get a sense of how a patient may respond and tolerate the medication. This will then allow the patient to have more confidence in being able to commit long term which can then have an influence on assessment and recommendations knowing that a regimen is in place. For patients who already use oral minoxidil at the time of surgery, there is no need to discontinue the medication for surgery and they continue as normal. Topicals require a period of time without application, which is normally 2 weeks before and 2 weeks after surgery. Even before oral minoxidil was available at lower dosages and before it was being discussed as an option orally for hair, many hair transplant doctors would recommend patients to begin topical minoxidil 2 weeks post surgery to encourage follicles to transition to their anagen growth stage as soon as possible, so there should be no issue using this medication 16 days post surgery, but always best to discuss all with your chosen clinic. It is also always recommended to discuss with your GP/family doctor to allow them to advise based on your family history, list on your own medical records and can then advise in case of any concerns of secondary effects. All the best.

Always best to check with your operating clinic to ensure that they do not share any alternative approaches, but oral minoxidil generally doesn't need to be discontinued throughout the surgery timeframe, meaning that you will be fine to begin at this stage.

If you are able to travel and meet in person with good repair surgeons, despite the inconvenience this really would be your best option. Repair cases are so unique and depending on your status, quite often there may be further challenges than photos can really accurately represent and so in your own best interests, a thorough consultation will allow data to be attained, some concerns potentially ruled out and a more clear and honest understanding of your current status, challenges, recommendations and realistic expectations to really try and avoid any further disappointment and move towards your objectives.

PRP isn't generally standard within a hair transplant procedure and I believe that any doctor who is achieving consistently excellent results and optimal healing, will explain that this is not due to PRP, or does not require PRP. Many clinics, generally less so in Europe, really get behind and market PRP in a way that patients may feel that they are missing out if they do not take up the option of PRP, when is most cases this is not really true.

There is a lot of nuance in regard to body hair and various sources and so if considering the possibility of surgery including body hair, it is always in your best interests to get a sense of what may be most appropriate and reliable. Body hair can differ in characteristics to scalp hair in terms of colour, coarseness, curl and cycle (growth phases), and also in count (the hair to follicular unit ratio), which is often lower than scalp and finer quality hair in sources other than beard, meaning body hair will present a lower hair count for a comparable scalp graft count. The yield can be slower to grow or lower than traditional scalp hair yield. Usually the growth phase is much shorter for body hair, with the exception of beard hair that cycles much more like scalp hair, so patience is needed when awaiting growth especially with this type of procedure that can often be into scar tissue of a repair patient.

Some good advice above and honestly it is good that you reached out to a surgeon who showed some caution and ethics as opposed to the other clinics who may have proceed regardless. 25 is a young patient regardless of extent of loss. When a patient at 25 presents signs of some decline from hairline to crown and thinning and in the temple point area, then the propensity for further loss is in place and at 25, there are still unknowns regarding potential rate of loss. The last thing that you would want to do is to proceed with surgery now, and then in the next 2 or 3+ years lose native hair amongst transplanted hair so that the area would begin to look thin and then lose behind any transplant, so that any transplanted area becomes disconnected to native hair. This would leave you in a more compromised position than your current position. Try and maintain as much as possible at this stage and optimise your regimen of hair loss preventative medication in an attempt to maximise the benefit, and see how the next several years may evolve. Wishing you the best.

Thank you for your comments. Beard hair was used in constructing and reinforcing areas of the beard. The advantages here are obviously hair type with a natural match to native beard with colour, curl and coarseness whilst also therefore leaving more scalp hair within the donor for the future if needed. The patient being 41 at the time of surgery had a stable hair status overall and good hair quality. A regimen of finasteride and topical minoxidil were already in place. Dr. Bisanga recommended to change from topical to oral minoxidil and the patient has responded well. To add a thank you to the patient for allowing permission to share his case and it was a pleasure to assist and follow his journey. A real great guy and we are all very pleased for him.