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Dr. Bruno Ferreira

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Dr. Bruno Ferreira last won the day on September 16

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About Dr. Bruno Ferreira

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    Junior Member

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  • Name
    Bruno Ferreira
  • Location
    Porto, Portugal
  • Years in Hair Transplant Profession
    7 to 10 Years
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  1. You're welcome Panamera13. I'm not a big proponent of PRP or ACELL, as their efficacy hasn't been scientifically confirmed. Especially ACELL, which in practice seems to do absolutely nothing. The cost/benefit of PRP is also a bit meh. In my opinion, there are better ways than that of applying 2500USD towards improving your hair. Getting back on finasteride looks like the absolute best bet for you right now. I understand you complained of side-effects, but it's best to understand those better and see if you can/need to adjust the dosage. Diffuse alopecias aren't as easy to classify and the Norwood-Hamilton Scale is just a reference, but I'd say you're on your way to a NW6 (diffuse). Your crown is a bit deceiving as it looks to me from the photos that miniaturization goes deeper down than it appears and your sides look pretty open in the top view.
  2. Hi Panamera13, I see from the comments that I’m risking an unpopular opinion here, but I think Dr. Erdogan’s 5000 grafts was the best estimate. Maybe I’m unsure of your objectives, but I assume you’re looking for full coverage and a new hairline. Looking at your photos, I estimate you’d have a recipient area of about 150cm2 (depending on where you place the hairline). With 5000 grafts you’d get an average density of less than 35 units per square centimeter. Now, the photos aren’t good enough to judge your current coverage, but from the top view you posted, it looks like you don’t have much coverage and you have a lot of miniaturization. So, the ~35 grafts/cm2 together with the hair you have now would be *just* enough to get you close to full coverage. Of course, I can’t say how good your donor area is, how thick your hair is, how many average hairs per folicular unit you have, but from the macro shots it looks okay, even though I haven’t seen your temporal-parietal areas. (CosmoKramer very correctly suggested you post those photos.) That being said, I’d still first put you on finasteride first at a lower dosage, so you can stabilize your alopecia and keep that hair you have there, whilst also lowering the chances of shock loss when it’s time for surgery. At 40 years old, standard dosage would also be an option, to see if you can get some improvement before surgery. (Edit: Just saw you complained of side effects. So it would be of interest to clear that up.) I’d do it in two surgeries though. So, with the info I have currently available, that’s what I’d plan for you. (All would be subject to confirmation in a live consultation, of course.) Also risking sounding biased since we work together (and only because CosmoKramer mentioned him), I’d also suggest Dr. Lorenzo. We do advanced alopecias on a daily basis, so I know he’s very experienced in cases like yours. Quite a few great options and talented doctors were mentioned here though, so I think you’ll be fine with more than one of the choices given. Best of luck! #IMO (I should just go ahead and point out that this is just an opinion and not a medical consultation, since it could never be one.)
  3. In my personal opinion, it's definitely minor, but you're stable on the medication, your hair loss isn't aggressive and you're not happy with how it looks right now (and assuming your donor area is at least average)...I'd say do with your donor area whatever you want to. You'll still have plenty of it for the future and if you'll enjoy your hair and your look better. My recommendation for this type of work is definitely Dr. Rahal.
  4. I mostly agree with what has been said. But I'm definitely a proponent of a case-by-case approach. I don't think there's necessarily a cut-off age. If a teenager has a terrible scar that can be corrected with surgery, or congenital triangular alopecia, why not correct it? Why let them suffer through their teen years (which everyone knows can be pretty hard)? Of course we have to do adequate planning and bear in mind the need for further surgery in the future. But ask any teenager suffering from having this or that ailment that hinders their image-of-self, and I bet you almost all if not all of them will say they would prefer to have a couple of surgeries instead of staying the same for 5 more years, waiting for one in the future. (Unless that one in the future is considerably more beneficial, i.e. better technology, etc, of course) I've transplanted hair into burn scars, congenital triangular alopecias, aplasia cutis congenital scars, craniotomy scars, etc, in young patients. All with good, long-lasting results. This still means we have to be smart of what we're doing. If the scar is on an already low hairline, and you look at the patient's dad and he's a Norwood 7, then maybe you should hold back for a while. For androgenetic alopecia patients, we have to firstly know that they have to be stabilized asap, since alopecias that are very evident at a young age, are usually pretty aggressive, and I'm not afraid of using 5alfa-reductase blockers on young patients. I've done so with very good outcomes. Then, if everything goes ok and we reach stability, we can start talking about a possible transplant. But I'd never do surgery on a young patient without proper stabilization and spending some time talking to him, making sure of his maturity and that he thoroughly understands the implications of surgery. Usually when that talk comes, I'm already pretty sure he's a candidate though. There's also not a cut off point on the opposite side of the spectrum. My oldest patient was 86 at the time of the surgery. And I operated on him...twice! He must be over 90 right now. 😃 Such an enthusiastic and positive man he was.
  5. Some patients get more redness than others and for some it's more persistent. Whilst there's nothing wrong with having redness in the recipient area, all my patients leave the clinic with a bottle of 99% aloe vera gel. It's soothing. Helps with healing and the redness. So that's my recommendation. 🙂
  6. Hi LaserCap, Thanks for checking it out. It's simple, I also did botox on him. Hehe, just kidding. 😁 I'm actually very flattered you'd think that these are two different patients. That's one of the best compliments I've ever gotten. 🙂 Yes, it's true that the lighting isn't the same. I bought some soft-boxes (which I didn't have in the before photos) and I'm always trying different lenses. The camera was the same though, but I've also upgraded my camera very recently, so there may be some slight differences in the future again. Basically, I'm always trying to improve my photography and that means trying different things and sometimes doing things differently. I do fully agree that consistency is very important and do always take photos in the same positions. Gear and lighting may change a bit until I arrive at something I'm happy with. As for seeing the full face of the patient: Patient privacy is a primary concern for me and I take it very seriously. Photos with the full face of the patient is something you probably won't see much from me in the future. That being said, I understand that I'm coming to this forum as a fairly unknown doctor and thus must prove that I'm genuine and that my results are genuine. In this patient's particular case, I know he's okay with it, so I'll leave you with a couple of comparisons. But like I said, I will only post full facial photos of patients that expressively state that it's fine for them. That's why I don't think the density is that "incredible". For 5 months, I'd say he's ahead of the average patient, but I think we'll see some really nice density in the follow-up photos. Yes only one procedure. I'm not sure what to say. I don't think there's any secret to my placement. It just comes from spending many hours looking at natural hairlines and trying to mimic them as much as possible. Hope that clears everything up. 😉
  7. Hey Kramer! 😃 Big fan of the show. 😁 Thanks for checking it out. I'm glad you like how this result is turning out and I do hope to post more cases in the near future.
  8. Hi Raphael84, Thanks for checking it out and for your kind words. I appreciate it. It's not my place to discuss the marketing tactics of different clinics/doctors, but I do very much agree that using very small punches just for the sake of them being small is a mistake. We should always go as small as we can whilst ensuring that it's actually the right punch for that particular patient, and that sometimes means using a bigger punch. No patient is going to come to a doctor and say: "Wow doc, I'm thrilled with how well you treated my donor area. Not much has grown in the recipient, but I'm so happy with how good the donor looks! Right on!" 😄
  9. I fully agree with Dr. Konior. I'm a musician as well (guitar player) and one of the things you'll hear a lot is how "tone is in your fingers" and how, for example, Slash playing through someone else's guitar and equipment still sounds like Slash.