LondonRamen

Taking a super close up with my mole/beauty spot as a reference point so that I can compare the results/density down the line, since the way it is now, roughly represents the optimal result. Got a bit of the hairline that was 'bare' and only has grafts and a bit of the native hair behind it that had extra grafts transplanted.

2 weeks Post-Op

Hi Gang, scabs came out fully around day 8/9. This is what it looks like at the 14 day marks

Seems okay so far for me.

Donor area has a few red pin-prick like red marks in some areas where the grafts were extracted, but otherwise looks pretty clean. Still applying aloe dilligently and hoping they go away soon.

Only like 5-10% or so of scabs came out with hair and, I commented this in another thread, if I presume the majority of the grafts survive (>90%) then this is what the final result will roughly look like (if you mentally subtract the inflamation/redness). If so, I'd be pretty pleased.

In fact, BF does provide a guarantee that >90% grafts should survive, but I've yet to hear anyone claim this in any HRN thread for any doctor unless it's obviously a super bad result because I imagine it's hard to accurately measure the % grafts that survived on your own.

I am a bit worried the inflamation on my recipient areas looks a bit purplish rather than red, almost like bruising, compared to the more clear red/pink on my donor area. Is that anything to worry about? Not sure if just the higher density of hairs or my skin complexion that could be causing this.

Also, any advice when I can begin to do some exercise? I don't plan to go ultra heavyweight straight away, but I'm thinking some resistance band exercises and push ups and some 25-30 min jogs here and there (~5k)

Looks pretty good and clean! Assuming >90% of the grafts survive, then presumably what it looks like now pre-shedding is roughly what the final product will look like (minus the reddening/inflamation).

I don't think you can go wrong with Dr Bisanga if that's who you want. Very good results from him. Just be realistic in your expectations of what to expect from a HT. I'm sure to the general public, your hair post-HT with him will look natural and good without any evidence work was done, but to yourself... we are our own worst critics.

I personally had mine done with Dr Ferreira a couple of weeks ago and can't fault it so far, but it is early days for me. I don't think you can go wrong with either.

Just now, MachoVato said:

Try using the rear camera (not selfie camera) and use the timer function to give you a few seconds to get into position.

oh yes, I forgot about the timer function. Will try to utilise that next time!  Cheers buddy.

D'oh, just realised I was facing the wrong way in the light so one side is darker shaded. Please pay attention to the brighter side

I'm slowly getting better at this and will try to get better pics in more consistent lighting once I am back home in London. Once I have BF's reference pics he took of my pre-surgery, I will try to set up lighting similar to it and try take similar pics to them to make for easier tracking.

on another note, how are you guys so good at getting clear pictures of your back donor. My one took me forever to get! I suppose once I'm home I can have someone lend me a hand

1 Week Post-Op

Just came back from the Dr's office where I had a head wash. Most of the Donor scabs came off. Recipient scabs are still there as we were more gentle in that area, but quite a few have come off in the last couple of days. Most scabs from the recpient area that came off had no hair strands so I guess I will shed a bit later. He expects the remaining scabs will come off by the 10-15 day mark.

Mixed it up a bit by going outdoors onto the balcony where the light was brighter to see how visible the scars are here. Can just about see them, but still recovering so I expect it to get better in time. Dilligently applying the pure aloe BF provides twice a day all over to help with healing.

What do you think?

Scalp

Donor Area

48 minutes ago, Curious25 said:

Looks good - will enjoy following your progress. Do you work in Bone Daddies? 😅

Lol, it took me a while to get why you said that before I remembered what my username was. Nah dude, Ramen is just a pun on my real surname. Though it's a common one for people of my ethnic background so it'll be hard to guess where I work if you do manage to guess what it's a pun of

I do like me some Bone Daddies though.

1 hour ago, deitel130 said:

@LondonRamenThis looks like it's gonna be a great result. Its good the native hair seems pretty strong so should hopefully help with shockloss. Did you speak to Dr. Ferreira about what he felt about your native hair and whether he was ok working around them? 

Sorry, I didn't really ask about that!

Though while he was fairly concrete about saying he was aiming for 50 FU/cm2 in the hairline, for behind the hairline he gave me range of 40-50. I'm not sure if the range he gave is because it's not as important to have a super density behind the hairline (because when viewed side on the hair in front will add some extra 'false' visual density) or the range is to account for any potential hairloss of the natives from permanent shock loss. Who knows, as long as it looks good in the end I won't complain

6 hours ago, UnbaldEagle said:

So I had a video consultation with David Anderson from the Maitland Clinic, and it was very reassuring. He said they could add extra density to my hairline and transplant through the thin areas, while also reusing some of the odd multi grafts in the hairline by moving them behind. He was very professional and pleasant. However, they are fully booked until April.

He also said that this could be achieved with roughly 600-700 grafts, which seemed like a very low estimate. What do you guys think, could that be enough to make a cosmetic impact?

Seems about right to me. For most people the width of your hairline is about 15 cm. Keep in mind it takes around 50grafts/cm2 to achieve a native looking density. For 700 grafts thats an area of 14cm2. meaning he can get a dense looking hairline around 1cm deep with that.

However, you also have native hairs present. I can't comment on the density of that, but because of that he can implant less hairs per cm2 and therefore can make implantation deeper into your hairline with 700 grafts, maybe 2cm deep instead of 1cm. Maybe enough to cover your entire thinning area. Who knows. Hard to say and only the doctor can confirm after seeing your scalp in person and making measurements.

One thing you can try is take a clear plastic sleeve and place it on your scalp. While facing a mirror draw the region that you want work on with a marker pen. The plastic sleeve is flexible and can bend to touch your scalp as you mark so the lines you draw will be fairly accurate. You can then put the clear plastic sleeve on some grid paper and get an estimate of your thinning area size based on the markings you drew on it.

Edit: I just reread your first post on this thread and it's still a bit unclear to me, but 700 would be slightly on the lower end. Maybe more towards 1000. Though in your video consultation the Dr may have seen things we didn't in the pictures and saw fit to use a smaller amount.

My doctor said it was alright to rest on your donor area in his instructions so I'll quote what I told someone else (please correct me anybody else if I got it wrong)

it is okay to support your donor area when sleeping at night (my Dr gave me special protectors to not bloody my pillow/travel-pillow as there is some expected donor bleeding on the first night).

The neck pillow is to stop you sleeping on your recipient areas.

The crucial thing is to not rest on recipient area where hair was implanted as that could dislodge the grafts, but resting on the donor is fine. No need to do the personal endurance challenge some people do where they sit upright at 90 degrees to sleep.

I would say set up some pillows at like 30 degrees ish incline. Put the protector the doctor will hopefully give you on to your travel-pillow. Then stick the travel pillow on your neck with the protector inside it. Kick back and sleep. I slept like a log for 7-8 hours straight on the first night of my surgery. If you have some crown work down, maybe consider a steeper incline so it's less likely you lean on your crown.

Place an extra protector on your pillow just in case (i leaned back a bit unwittingly and left some blood spots on my pillow underneath my neck-pillow)

Edit: I should add, this is assuming you have an FUE procedure.

34 minutes ago, Rolandas said:

From what I've seen 0.8mm & 0.85mm punches are quite common. Some surgeons like Dr. Zarev are using even smaller like 0.65mm. I think maybe it's due to hair growth angles. If it's growing straight in the back, the hole overall would be smaller than sides for example where hair growth is more steep (at least for me it was very steep)

 

Fair point! It's a bit out of my experience so I can't comment further on it sadly!

5 minutes ago, Rolandas said:

I'm curious if Dr. Ferreira is doing something different in terms of extractions or it's just patient physiology. What I've noticed recently is everyone is healing in donor exceptionally fast. Your back side of donor looks incredible in just 1 day!

Hmm, hard to say. I'd say a bit of both. He clearly takes a lot of care such as when he switches between manual and motorized fue depending on what he feels is better for the situation.

Yours was quite clean too as you say, but your hair, similar to mine was around 50 microns so he can get away with smaller punches that perhaps promote donor healing better.

Day 1 Post Op Update

Already posting this one (I made the thread Day 1 Post Op too hence why the quick succession of posts) because I finally found the time to take some extra pics today.

Mild itching but you get two saline bottles. One of the assistants recommended I put one in the fridge and use the cold saline spray for when I feel itchy and it does help a bit.

But anyway, here's your pics!

Donor Area

Scalp

Pretty pleased with how it looks for day 1. Pretty clean!

36 minutes ago, Mycroft said:

I'll be interested to see how this goes. You've got a decent amount of native hair so as long as there are no issues with shock loss I think you have potential for a very nice result. I appreciate your breakdown of how the plan was mapped on the scalp.

Donor looks good. Any notable pain or discomfort so far?

 

Edit: I personally wouldn't drop the Minoxidil at this point. It's probably keeping your native hair thicker and healthier in appearance, and even those weaker hairs partially rejuvenated by Minoxidil can contribute to the fullness and density in your result if the doctor was implanting around them. If you drop it you run the risk of shedding and possible exacerbating your progression. I personally wouldn't want to risk it.

Oh for sure, I don't plan to drop it yet. I will wait until the transplant grows out before I decide that. I want to give the Drs hair transplant a fair a shot and to not contribute any potential bad result to changes in my routine.

It's more because it's difficult for me to comment on the efficacy of minox because I started it at the same time as finasteride. This experiment to determine whether minox is working for me will come at a much later time to not affect the transplant, rest assured. Similarly to my desire to switch to dutasteride full-time, I will hold off until the transplant grows out first.

Edit: No pain or discomfort so far! Surprisingly smooth sailing and I felt quite refreshed after my transplant and slept peacefully for 7-8 hours straight yesterday night after my transplant.

16 minutes ago, MachoVato said:

That donor management is perfect! Dr. F. made it easy for you to get a second procedure if you choose to do so.

I had similar hair loss to you, although I went more aggressive with the hairline (4200 grafts). Following this thread. I can't wait to see how it comes out!

 

Oooh yes, i'm similarly following yours because of how similar your required surgery is to mine. Best of luck with the growing!

Maybe in the future I will lower the hairline, but for now I am very happy.

4 minutes ago, UnbaldEagle said:

Thanks, LondonRamen, good to know Dr. Ferreira might be available in January and that he worked through your thinning hairline and temples. 

I couldn't find a thread showing your journey with Dr. Ferreira, I'd love to see some pics if you shared them anywhere.

Literally just made the thread haha. My surgery finished up yesterday and I had time while I recover now

Forgot to give a summary! overall very good. Felt like a celebrity as all attention was on me. Very extensive post-op care pack was given as well. I could have spent most of the post speaking about the food. So much choice in food. The grilled BBQ pork belly was bloody good!

I didn't really feel any pain or discomfort at all. Even with the needles for the anaesthesia going in. But I generally haven't suffered much pain from needles in the past such as for blood tests. At some point, rather embarassingly, I conked out and fell asleep

Hello! I know this forum has been hankering to see more results from Dr Bruno Ferreira so I thought I’d oblige.

I’m an interesting test bed as I have a diffuse thinning component but not super diffuse so care needs to be taken around my native hairs which is sure to be a test of the doctors skills.

About me:

Age: 28 years old at the time of surgery. Balding from early 20's. Hopped onto the finasteride and minox around 24 year olds and it pretty much halted. After much thought I've decided to take the plunge on a hair transplant, though admittedly I get by fine in life as I was. I even experimented being bald and looked good (if I may say so myself). Most people don't comment or notice my hair at all and I have reasonable success with women. This HT was just for my own personal confidence and having greater choice in hair styles.

Medication: I am a long time user of finasteride (almost 4 years) and recently around half a year ago began taking dutasteride twice a week Mon/Thu to help strengthen my hair and minimise shock loss during my procedure (this was my own initiative, not because the Dr asked me too). I am suffering no sides so considering switching to Dut full time but will wait for the transplant to mature first so I don't confuse things that could affect my assessment of the outcome. I usually use minox around once a day also before bed or just before I head to the gym (since I will shower after the gym and don't have to worry about residual grease afterwards). Tempted to go off minox, but again, I will wait until my transplant matures a bit before considering dropping it. I want to keep as many factors as constant as possible for now to assess the efficacy of the transplant.

The Surgery

The doctor classed me as a NW3 with a diffuse component. If you wanted to include the diffuse region as part of my classification he would give me a NW5V he said.

Unfortunately, I’m still waiting on the official photos of the day of my hair and pre and post-transplant look from the doctor so you’re going to have to make do with photos taken from my iPhone for now. One of the assistants obliged and took some quality shots with my phone under the stage lights too so hopefully it's not too bad. Will update once I have the full photos and report from the doctor!

My surgery experience pretty much echos the experience of @Rolandas. I had a two day surgery of 2882 grafts with the first day (~1500 grafts) focused on my hairline and the second day focusing on the thinning region just behind my forelock. In other words just a frontal-third restoration and a bit of my midscalp.

There was the option to tackle all my thinning areas including the crown, midscalp and hairline in one go. I was quoted 3500-4000 grafts for this and I received a similar quote of 3400 from Dr Bisanga when I asked him.

However, I was in two minds about on whether to commit so much grafts in one go knowing I am a difficult case and may want to bank some grafts for the future. Especially since south asians like myself seem to generally have a smaller donor supply which needs to be used sparingly. Also my crown doesn’t actually bother me that much (probably because I can’t see it and i'm quite tall )  I’m only concerned by the thinning in the frontal half and hairline.

However, upon seeing me in person the Doctor decided it would be better for me to do it in two as it was his opinion we would get a better results from smaller and more frequent surgeries by doing around two-thirds of the work now and a second later. After hearing my crown does not bother me it was decided to blend in the grafts to my native density in the back just in case I was satisfied enough with my first surgery that I didn’t want to come back for a second because I’m not bothered by the crown. It was good that he was not trying to force a design that would require me to come back for a second surgery for sure. Gives me some flexibility!

He also mentioned my donor density is good and I have around 8000 viable grafts which is much more than I expected. So I have plenty to play with as I enter my old age should my medication regime suddenly stop working (I hope it doesn’t).

Okay! I’ve rambled long enough, now the pictures!

Hair Before

Before the transplant (what I sent to the Doctor). Unfortunately the lighting is not very clear here but my hairline is very thin and the temples quite recessed. I should have taken some in outdoors light before the surgery. The Doctor has some good pre-surgery photos which he will pass on to me later and I will upload here down the line.

Wet Photo

Donor area

On The day

Took this snap on the day too but the lighting is not so clear, you will have to wait until the doctor sends me the official photos to see my hair properly, but I did also manage to snap this one photo from the screen that was on display during surgery

Shaved and with the areas to be transplanted marked!

Three regions can be seen here. The hairline region on the bottom where he will thicken it up and attack some of the temple recession. The second region just behing the forelock where I have native density already and will require less grafts. Finally there's a little box in the back which he will use to blend in the grafts a bit so I look normal just in case I am satisfied with this first surgery and choose not to come back for the second procedure on the crown and remaining midscalp.

You can see more clearly here the temple region he is going to fill in as well as the marked donor region faintly.

He really took his time doing this hairline and understanding my concerns and it took around 30mins in total. I've always had a large forehead and slightly recessed temples since I was young which I wanted to mantain because I quite like that feature of mine and wanted to be conservative with the hairline so I can grow in to it in my old age. He somehow knew where my original hairline used to be involving some weird trick where he asked me to raise my eyebrows lol, but he guessed very accurately so I'm not gonna question it. In the end he drew two hairlines one slightly more lower down in the temples and less conservative but I decided to go with the conservative approach in the end because for the most part I am happy with my hairline, just wanted density and the temples ever so slightly filled.

The Plan

2 days. Each day the extraction and implantation will happen in around 3/4 mini sessions where he will extract a bit and then implant a bit using the DHI method. Hairline region first day and then the behind the forelock area in the second day.

The aim was to have 50FU/cm2 in the hairline region and maybe slightly less around 40-50 ish when combined with my native density behind that.

Day 1 of Surgery

Total Grafts: 1469

Singles:315

Doubles:350

Triples:691

Quadruples:110

Quintuple!: 1

helluva lot of triples

My donor appears to be recovering super quick. In the morning session, he extracted from my nape and the central donor region. In the afternoon he was extracting just to the sides of the central donor region. You can see here the extraction holes from the morning session are already rapidly closing up and healing when compared to the fresh holes on the side! I think it's a testament to the doctors quality work and handling of the donor region, but the assistant also mentioned that I appear to be a crazy fast healer.

I had tough skin he said and at some point had to make a few pre-made incision slits near the hairline (i use to microneedle a year ago, maybe that's the cause?)

Day 2 of Surgery

Unfortunately forgot to take a picture of the graft count, but the ratio was higher aroudn 2.6 as opposed to 2.4, as he was extracting less singles. Still a lot of triples. He ha said if he were to blindly extract I would probably get an average of 2.5

Total grafts:1413

The assistant was very kind and took some shots using my phone under the stage lighting but the Dr's camera is better so I will post those when they arrive too

central region looks super healed and clean now (immediately post-op day 2). I just can't get over how clean it looks compared to some other jobs I see coming out of Turkey.

Extras

Some extra stats you may be interested in (more to come when Dr Ferreira sends his report)

Punch size: motorized punch. 0.85mm in back and 0.8mm around the sides of my donor region. He occasionally used a manual punch when it was convenient and easier for him. Use the appropriate tool for the appropriate situtation as they say.

Hair thickness: ~55 microns for me which he said was average. Seems to be on the finer end for people of my ethnicity though.

I will try to update on the following timescales (maybe more frequently), if I don’t, send me a reminder.

1 day, 1 week, 2 week, 1 month, 3 month, 6 month, 9 month, 12 months, 18months.

Apologies if the pictures are big, not sure how to make the size smaller on the post.

1 hour ago, UnbaldEagle said:

Thanks for the update, LondonRamen!

Good to know travelling wouldn't be an issue. 

How long did you wait to get to surgery with Dr. Ferreira? I heard his waiting list is really long, you have to book like 4-5 months in advance. 

Hey, I booked soon after my consult with him in June/July ish for November. I suggested the November date first as that was when worked for me and it was acceptable to him on the first try so we didn't need to change the dates around based on his waiting list. When I spoke to him yesterday he told me he's currently booked out with patients until Februrary so if you spoke to him now that would probably the earliest you would get. Maybe January too as I recall one patient was going to do it with him then but then rearranged so there might be space then again.

P.S. I just looked at your photo below of your thinning zone. Your frontal thinning is similar to mine, but mine is more recessed at the temples and Bruno happily worked on that region to restore the hairline for me. I can't comment on your crown thinning, though it looks quite thick to me and I imagine quite difficult to implant into. Certainly by my metric I wouldn't call it thinning in the crown, though you have long hair which could be disguising it well.

11 minutes ago, Melvin-Moderator said:

Great, yes his portfolio looks good thus far, but here we value the unbiased reviews from patients like yourself. Look forward to your review and happy growing 😎

Interestingly he is quite booked out despite covid, and you need to get in touch a few months in advance, so it could just be a higher occurence of patients who are keen to mantain their privacy. I am keen on my privacy too, so I will try to pick up some basic photoshop skills and figure out how to blur my face.

8 hours ago, Portugal25 said:

Totally understand.

Sadly we won’t see much on HRN because he’s affiliated with Dr. Lorenzo so he can’t promote his work and almost all of the patients from his own clinic don’t take the time to post at HRN or any other forum.

Keep your eyes peeled. I just finished day 1 of 2 of my surgery with BF

He said he splits his time 25/75 between Lorenzo's Clinic/His Porto clinic. He should be building a portfolio soon then I imagine. Patient results are also posted on his instagram occasionally.

On 11/9/2020 at 5:09 PM, MachoVato said:

All those clinics could do 2,000 grafts for under 5500 Eur. And all could correct and improve your hairline. I think your issue is travel and time. Portugal and Cyprus are closed, I believe. Turkey is open to medical tourism. The question is if any of those clinics can get you in soon enough.

 

Portugal is actually open as OP appears to be from the UK by way he uses £. I was able to get in fine just yesterday from the UK for my procedure with Bruno Ferreira. Most surgeons will also happily write you a doctors note so you can cross the borders.

Though depending on when OP chooses to have the surgery i.e. before/after the UK properly leaves the EU in January, he may have to do a covid-19 screen on arrival as currently UK citizens do not need to.

2 hours ago, Portugal25 said:

Espinho is another council so your taxi might be pulled over on the way and have to show your Doctor’s note. 
Also, don’t use taxi just download Uber and Bolt (cheaper).

Download Uber Eats app because  Uber Eats can deliver up to 01AM while restaurants need to close at 22.30h. 

If you are coming from the UK and have a Revolut card you dont need to bring a single euro as you can pay Uber/Bolt and everything else with Revolut and get a way better exchange rate.

Many thanks for this, I appreciate it. Best of luck with your consultation.

9 minutes ago, Portugal25 said:

I booked a consultation with Dr. Ferreira on the 11th of November at 16.30h.

I will be driving 3 hours from Lisbon and I just need Dr. BF note to be allowed to make this trip.

We have 120 councils on lockdown so people living in these "high risk" councils can only leave their respective council if they have one of many justifications like a Doctor note, work note, movie tickets, etc. 

The distance between councils is nothing which is why a movie ticket is enough to cross councils.

in these 120 high risk councils restaurants close at 22.30h (with 6 people max at each table) and shopping centers close at 22h. 

The police are making control checks in several council borders so trips across councils can be a pain. 

It´s not really a Lockdown 2.0 because the impact is very mild as we can all go about our daily lives as the goverment is mostly asking for common sense to reduce new cases.

Interesting, I note the Dr's clinic is in Espinho, which is not quite porto is it? Is that a distinct council from porto central? Should I anticipate any issues in booking a taxi to take me from Porto airport to my accomodation at espinho?  Though I imagine needing to go home after landing at an airport should be a good enough reason to cross council lines even if they are distinct (and I still have my medical forms from the Dr as further proof for my needing to cross borders).