Swooping

Not weird imo. Some docs are really popular and they only have so much time.

You can always apply for a free online consultation.

@Dr. Feller and Dr. Bloxham,

Thank you for your response. I can not speak for Dr. Bisanga, but here is a piece written recently by him that gives an insight behind the philosophy of our clinic.

For the sake of this topic we assume that both techniques are performed competently.

 

Deciding on a transplant is a hard decision; the technique used will play a major factor in your long-term happiness, goals and intentions. Both techniques have their pluses and negatives and so it is important to ensure you choose the correct technique for long term planning and getting the most out of your donor.

 

FUE, the donor surface area is opened to the maximum but that does not mean there are more follicular units (FU) to be taken in comparison to FUT. Every FU removed will reduce the density, the more removed can noticeably drop the density and impair the donor for future procedures, FUE or FUT. Assuming an average density around the safe zone of 80 FU cm2 if the extraction pattern is spread and no areas are over harvested around 4000 FU could be removed according to the protocol we use at BHR clinic, this will drop the overall density down by around 30%, leaving a density near 60 FUcm2 in the donor, and this would then be considered low density on a virgin scalp.

 

To sustain the density in the donor FUE is better suited to lower or mid-range graft numbers for the most, with an educated extraction pattern, no over harvesting or partial shaving then the density change to the scalp can be minimal, if the candidate has an average to good density to start with then around 1500 grafts can be removed and hardly affect the overall density.

 

Larger patterns of hair loss then FUE starts to be less of an option over one or multiple procedures; grown out results of 3500 FUE plus grafts are not the norm and require very good donor characteristics. If high FUE numbers are performed in one procedure, there is a greater risk the yield will not mirror that attained through FUT; a real medical concern of large FUE procedure is the effect on the body to heal multiple open wounds created in the recipient and donor area and how effective the body can sustain and heal whilst not impairing the scar healing in the donor and yield in the recipient.

 

A possible exception to the FUE rule on larger hair loss pattern candidates is when there are limited goals, not looking for total restoration, lower density placement due to specific hair styling, or the “5 o’clock shadow” look for those who want a high conservative hair line to frame the face and frontal area and intend to keep their hair short/shaved; but this is not the normal HT candidate and very important that goals and long term intentions are discussed and understood by the candidate and the doctor.

 

FUT will remove a hair bearing strip of tissue and therefore effectively the hair density has not changed significantly in the donor as the surface area is removed as opposed to hairs removed from the surface area. The scalp laxity allows for a strip to be removed without causing any long-term tension and over time the skin heals well. There are limits to how many times this can be repeated but in good conditions 2-3 times and with good skin healing attributes it will be able to englobe the existing linear scars to leave a single line rather than multiple wounds.

 

FUT removes a high concentrated number of FU from a relatively small area and they are removed still in their natural state of high density on the strip; 4000 grafts in one procedure is an achievable number in the majority of candidates unless the donor density or laxity is particularly weak. For long term planning and high NW stages FUT makes it easier to plan and cover with a good density the largest surface area possible.

 

FUT does have the disadvantage of leaving a linear scar so more visible signs a surgical procedure has been carried out but the advantage of being able to move a greater number of FU either in one procedure or multiple procedures compared to FUE and still sustain a similar density as before in the donor.

 

Conclusion, the advent of FUE means no need to be left with a linear scar for a relatively small to mid-range amount of grafts placed so from a cosmetic point of view it allows the patient to have an HT with little to no obvious signs a HT has been performed.

 

FUE due to the technical demands of the procedure being labour and time intensive as well as the medical healings better suited to smaller sessions for the majority of hair loss sufferers. If the pattern of hair loss is high and the goal is to cover a large surface area with a natural looking density then FUT would be the sensible and obvious choice to achieve the best result for the candidate. The combination of both techniques can be utilised to ensure the original scar quality healing is maintained and using FUE to maximise the donor extraction zone, whilst still allowing the potential for future surgery using both techniques if need be. Combining the two techniques allows the best attributes of both to be used, maximum movement of grafts and opens the donor zone, concentrated high number of grafts from FUT and harvesting outside the traditional safe zone with FUE. What has to be remembered though is with either technique they are both scalp/hair characteristic changing in their own way, hair is being removed and there will always be a consequence to this, be it loss of density or laxity or scarring.

 

 

I have used a bit of make-up a few weeks post-op, was excellent in hiding the redness

Don't know if every doc/clinic allows that though.

Which rep did you speak to?

Anyway, I assume it means indeed a combination of FUE + FUT? I would message the rep for further clarification if I were you.

Are you on finasteride?

Anyway, seems a bit a low amount of grafts. I mean it depends on your goals, but I'd go for a bigger procedure to reinforce your temples and frontal forelock a bit more.

Not heard of them. Be careful with Turkey, some clinics are horrendous there.

Travel over to Belgium or Turkey.

Damian,

 

Obviously I wasn't there to hear your conversation, so I won't make assumptions. However, if we look at what Dr. Bisanga has actually put into print for the entire world to see on his own website, I don't think it's as simple as: there is no difference.

 

If you read through his website, you'll note two very important things:

 

1) He states that FUE is best suited for cases below a NW IV. FUE is only appropriate in candidates NW IV and higher when they have a higher than average donor area.

 

So, how do I interpret this? FUE is best suited for smaller cases unless the patient has an excellent donor.

 

Here's the quote:

 

Larger areas of thinning say NW4 and higher can be treated with FUE but the person has to have better than average donor hair density and good hair characteristics to ensure sufficient FU numbers can be safely extracted and leave options for the future.

 

2) He further states that "hair characteristics" and "FU constitution" play a large role in how suitable a patient is for FUE. It is "misunderstood" that FUE is suitable for all hair types.

 

So how do I interpret this? Not all patients are candidates for FUE.

 

Here's the quote:

 

Hair characteristics and FU constitution can play a large part in how suitable FUE can be; it is misunderstood that FUE is suitable for all hair loss stages and hair types and some may not have the right attributes to ensure a solid result.

 

So, what does it really mean when you break it down? Not all patients are candidates for FUE, and the doctor needs to SCREEN patients and intervene with FUE only when they are good candidates.

 

So I do believe that Dr. Bisanga believes that a good candidate for FUE will have a pretty similar result to one of his FUT patients -- and he is excellent at both -- but this is not the same as saying "they are about the same" if we are to use his written website as his philosophy.

 

As I've said before: what is actually the "best" FUE tool? A good screening tool.

 

Source: https://en.bhrclinic.com/technique/follicular_unit_extraction/

Well, yes, Dr. Bisanga does screen every patient meticulously. So if you are not a suitable FUE candidate he will tell you. Hence, I was only talking about the survival yield he has observed in all patients that were indeed suitable FUE patients and underwent surgery with him.

Good luck! Looking forward to your blog!

Guys,

 

11. Dr. Feller and Dr. Bloxham can speak based on their own expertise and surgical experiences. However, they cannot speak for all doctors and what they experience in their surgery room. Yes, there are some universal truths and hindrances that make FUE more challenging in some ways, in particular regarding getting growth yield to be as consistent as strip. However, other surgeons may have experiences that differ from Dr. Feller and Dr. Bloxham where consistency in their hands may be higher. On the other hand, some may see even lower consistency. While I truly appreciate and encourage Dr. Feller and Dr. Bloxham to continue posting their experiences, opinions and facts, I'd like to hear from other leading surgeons who regularly perform FUE such as Dr. Erdogan, Dr. Bisanga, etc. It would be interesting to hear what some other top notch surgeons say and see what they do and don't agree with related to what these two surgeons say.

 

Best wishes,

 

Bill

Bill,

I have visited Dr. Bisanga in Brussels on Monday. I was very impressed, to say the least.

Anyway, we also talked about FUE. I did bring up the question of growth yield to Dr. Bisanga.

He doesn't think there is any difference in growth yield between FUT and FUE in his practice.

Hope that helps,

Damian.

Here is 6 months. Hoping for more density, but only thing to do is wait!

Oh thought you were longer in the process! Yeah, gotta be patient still very early. Looking forward to more updates .

What body hair is Dr B utilizing, is he sticking to beard or does he use chest hair as well? I look forward to seeing some of those results as it seems like there are so few great docs who do body hair work and having dr B as an option for that would be awesome.

He does both chest & beard hair if appropriate. I'll upload them and will send you the links.

I like Konior his work.

Any update KO? Curious to your progression.

Is a hair transplant going to make a significant impact on your aesthetics? Nope.

That being said if you are occupied with your thoughts for 5 years already and it's bothering you then perhaps it is worth pulling the trigger.

Personally, for me, a peace of mind is priceless.

Hey guys,

I have been making videos for Dr. Bisanga on his patient case reports and put up a channel on YouTube.

Check it out: https://www.youtube.com/channel/UCRkWtd-HA_pcGSrH6J7FlJw

Do note that some pictures we receive are taken by the patient themselves.

There are way more videos to come, including repair and body hair transplant case reports.

You'll see more in the coming weeks, I'm far from finished :cool:.

This topic can be removed, sorry wrong section.

Damian

 

I had the same issue with no response. I will forward my email to you for consultation with BHR clinic. Let me know if you need anything else from me after you view the email

 

Best Regards.

I have immediately redirected your message to Dr. Bisanga personally. You will receive a response very soon.

Thank you.

Update: You got an email.

Fun fact, in Japan sometimes 0.2mg finasteride daily gets prescribed to patients, which can be increased to 1mg daily for androgenetic alopecia. They actually have 0.2mg propecia tablets over in Japan.

0.2mg daily will actually inhibit pretty much the same in terms of serum DHT levels as 1mg daily.

However, 0.2mg daily will be less effective overall as 1mg daily. This is probably due to the difference between serum and local tissue levels, as DHT exerts its biological activity in an endocrine/paracrine/autocrine way to the androgen receptor at the hair follicle.

Point being is, yes there are certainly people who can "maintain" their hair with a lower dosage than 1mg daily.

Hey,

That's weird. How did you contact us?

If you have any questions or wishes feel free to contact me at any time. I'll get your queries through immediately.

Congrats - Dr B is an awesome surgeon and guy !

 

Regards

Spex

Thank you!

Thanks, Swooping. I agree about him being elite and I'm thinking about him for myself.

 

How many surgeries does he do each day? I've heard he does four a day but I'd rather get official confirmation from you. Thanks again.

It depends on the size of the procedure but typically Dr. Bisanga has one small and one bigger case a day. So most of the time he does 2 cases if it's a big procedure he will do 1 a day.

Congratulations. Did you have a procedure with him?

 

Does Dr. Bisanga do all of the FUE extractions himself for every case or does he have technicians that do this for him?

Thank you. I did not have a procedure with him I have always considered him on world elite tier level.

Dr. Bisanga punches all grafts by himself and the technicians only pull out the grafts after he has scored them.

You are welcome.

This video gives a detailed answer to your first question:

 

 

Your second and third question are too subjective so no way for me to answer. But 10,000 available grafts ?! That's a bit far out there.

For your interest, Koray Erdogan collaborated with a medical university in Turkey to determine the damage on to grafts with a 30K RPM motorized system.

Grafts were analyzed with an electron microscope and the findings of that study were that there was no difference in graft quality with a manual punch vs motorized system.

Where have you learned that testosterone levels increase during sexual intercourse? This is not true.

Abstinence from ejaculation actually seems to somewhat increase testosterone levels after a few weeks, but this is understudied.

Either way, whether you have sex often or don't have sex at all. You have nothing to worry about.