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Sorry gentle_man, for the late reply. I had trouble to get access to the new forum.

You made the right step to post pics and contact the forum board.

This is actually all I wanted to say:  You need to share information (pictures, not your real name) to get help. I did not (!) want to imply that this is a good result or you are a fake.

Seeing your result, this is obviously dissapointing respecting the amount of grafts taken. Your donor looks already spars, especially below the strip; slightly better above.

The offer from Feriduni (to take over all travel costs) is fair, but you should still try to get a second opinion from another recommended clinic. If, and this is a big IF, you have a bullet left, it is definitely you last. Also, in case a biopsy can/would lead to the result that you are not a candidate for a hairtransplant, this biopsy should have been taken before (!) the last FUE after already two FUT with poor growth performed. This would be on the clinic. Only error from your side: You should not have waited 3 years to ask for help.

Best of luck and keep us updated.

 

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4 hours ago, Payam said:

What about BHT combined with FUE for recipient and SMP in the donor?


 

BHT is unpredictable and not always close enough in terms of texture to natural scalp hair to work naturally. Certainly wouldn't opt for it in this guys case where he has very little on top to begin with, highly exposed BH could look disastrous and isn't worth the risk. 

If he's had this much surgery and without even remotely successful results through both FUE and FUT with a top surgeon, I'd be inclined to think the issue might be physiological. Perhaps the lifespan of his grafts outside the body is well below average. A biopsy is highly unlikely to give any conclusive insight either.

Considering that his donor is the size of a typical NW7 due to the clear retrograde alopecia unless it was completely free and didn't impact his working life etc. it's hard to suggest surgery is the right option for him at this point. Honestly I think his best option would be a full SMP approach, at least he has some hair in the frontal area mixed in to better aid the illusion.

Edited by JeanLDD

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19 hours ago, Gasthoerer said:

 Sorry gentle_man, for the late reply. I had trouble to get access to the new forum.

You made the right step to post pics and contact the forum board.

This is actually all I wanted to say:  You need to share information (pictures, not your real name) to get help. I did not (!) want to imply that this is a good result or you are a fake.

Seeing your result, this is obviously dissapointing respecting the amount of grafts taken. Your donor looks already spars, especially below the strip; slightly better above.

The offer from Feriduni (to take over all travel costs) is fair, but you should still try to get a second opinion from another recommended clinic. If, and this is a big IF, you have a bullet left, it is definitely you last. Also, in case a biopsy can/would lead to the result that you are not a candidate for a hairtransplant, this biopsy should have been taken before (!) the last FUE after already two FUT with poor growth performed. This would be on the clinic. Only error from your side: You should not have waited 3 years to ask for help.

Best of luck and keep us updated.

 

Thank you Gasthoerer I really appreciate your reply.

Exactly like what you have mentioned above I hope I still have one more chance as I really need it . That's why I mailed H&W and they told me that they can handle it and make it better in the frontal area but unfortunately I had some issues to get visit visa so, I am trying again for the best possible alternative.

I waited for three years because I was unable financially to have any HT at that time. 

Edited by gentel_man83

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19 hours ago, JeanLDD said:


 

BHT is unpredictable and not always close enough in terms of texture to natural scalp hair to work naturally. Certainly wouldn't opt for it in this guys case where he has very little on top to begin with, highly exposed BH could look disastrous and isn't worth the risk. 

If he's had this much surgery and without even remotely successful results through both FUE and FUT with a top surgeon, I'd be inclined to think the issue might be physiological. Perhaps the lifespan of his grafts outside the body is well below average. A biopsy is highly unlikely to give any conclusive insight either.

Considering that his donor is the size of a typical NW7 due to the clear retrograde alopecia unless it was completely free and didn't impact his working life etc. it's hard to suggest surgery is the right option for him at this point. Honestly I think his best option would be a full SMP approach, at least he has some hair in the frontal area mixed in to better aid the illusion.

What do you think about Dr. Sanusi Umar results they are really impressive. I don't think about SMP at all as it looks like escape from the trouble not to find a solution. 

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1 hour ago, gentel_man83 said:

That's why I mailed H&W and they told me that they can handle it and make it better in the frontal area but unfortunately I had some issues to get visit visa so, I am trying again for the best possible alternative.

H&W advertised to have consultations in Munich if I remember correctly. Maybe you can combine it with your Feriduni trip.

If you are in Hasselt (Feriduni) you should at least visit Devroye, Bisanga, Mwamba, ... they are all close by (<2 h trip).

The problem I see is, you already had FUT, even the best FUE (and also FUT) will at least put similiar stress on the grafts. Why should the result be better? You need to find out what happend or maybe do a very small test case (<<100 FU) with a different method that Feriduni.

Best of luck.

P.S. You should really think about SMP too, even though it is hard to swallow after what you have behind you.

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21 minutes ago, Gasthoerer said:

H&W advertised to have consultations in Munich if I remember correctly. Maybe you can combine it with your Feriduni trip.

If you are in Hasselt (Feriduni) you should at least visit Devroye, Bisanga, Mwamba, ... they are all close by (<2 h trip).

The problem I see is, you already had FUT, even the best FUE (and also FUT) will at least put similiar stress on the grafts. Why should the result be better? You need to find out what happend or maybe do a very small test case (<<100 FU) with a different method that Feriduni.

Best of luck.

P.S. You should really think about SMP too, even though it is hard to swallow after what you have behind you.

If it is like the one in the UK though, then it is just a local agent who sends your pictures and some advice to H&W and then they give you their verdict via email. This is not the same as being personally examined by a doctor so I am not so sure how worth it this would be.

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Why was the title edited? I believe it said "Bad FUT Result - Dr. Feriduni."

This is a terrible result and I hope that the patient receives a full refund. 


I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

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Delancey,

The topic title was modified at the  ops request. He originally wanted to change it to something completely different which didn’t make sense so I just suggested that if he wanted to change it to just remove the word “bad”.  Since she agreed, I changed it. 

 Whether or not the result is good or bad  is of no consequence. A lot of people post positive results without saying “good“. People who read the topic will draw their own conclusions. 

Bill

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Delancey,

A lot of members are Very quick to suggest full refunds win I don’t think most people understand that for refunds are not typical. I’m not saying it doesn’t or won’t happen in this case, but,  most hair transplant surgeons go over the risks of surgery before hand and even if they don’t go over it personally, there is a piece of paper that goes over all of it and even discusses the process of surgery and explains that they agreed to take upon the risks themselves. Now, I do firmly believe that a good quality surgeon like Dr. Feriduni  should stand behind his patients and do something for him, but providing a full refund is in very typical. Typically, what we recommend is for the patient to work with her doctor and try to undergo a free procedure  to replace the grafts that did not grow or  resolve whatever concern there is. Frankly,  a full refund, although it sounds good  doesn’t really resolve any problems. If anything, they have their money back but now they’re in a worse off position then when they started. So, it’s actually better to undergo another surgery in order to  resolve the issue. After all, he’s already selected an outstanding surgeon and it’s possible that his case has extenuating circumstances. 

I would like to hear how the surgeon intends to resolve this issue but I also need to get verification that he has permission to post and share his side of the story. 

Bill

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4 hours ago, Bill - Managing Publisher said:

Delancey,

A lot of members are Very quick to suggest full refunds win I don’t think most people understand that for refunds are not typical. I’m not saying it doesn’t or won’t happen in this case, but,  most hair transplant surgeons go over the risks of surgery before hand and even if they don’t go over it personally, there is a piece of paper that goes over all of it and even discusses the process of surgery and explains that they agreed to take upon the risks themselves. Now, I do firmly believe that a good quality surgeon like Dr. Feriduni  should stand behind his patients and do something for him, but providing a full refund is in very typical. Typically, what we recommend is for the patient to work with her doctor and try to undergo a free procedure  to replace the grafts that did not grow or  resolve whatever concern there is. Frankly,  a full refund, although it sounds good  doesn’t really resolve any problems. If anything, they have their money back but now they’re in a worse off position then when they started. So, it’s actually better to undergo another surgery in order to  resolve the issue. After all, he’s already selected an outstanding surgeon and it’s possible that his case has extenuating circumstances. 

I would like to hear how the surgeon intends to resolve this issue but I also need to get verification that he has permission to post and share his side of the story. 

Bill

He said earlier in the thread he had given his permission and even posted email exchanges with the clinic

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On 6.7.2018 at 3:38 PM, TrixGlendevon said:

If it is like the one in the UK though, then it is just a local agent who sends your pictures and some advice to H&W and then they give you their verdict via email. This is not the same as being personally examined by a doctor so I am not so sure how worth it this would be.

Ok, if this is the case, I would not recommend this. A special case like this needs a personal consultation with the surgeon. But I still recommend to visit the other belgium clinics.

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2 hours ago, Gasthoerer said:

Ok, if this is the case, I would not recommend this. A special case like this needs a personal consultation with the surgeon. But I still recommend to visit the other belgium clinics.

I agree. Heading there next month for 3 consultations. Four if Dr Mwamba ever gets back to me.

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Well done. I visited Bisanga, Lupanzula und Feriduni myself (https://www.hairrestorationnetwork.com/topic/50323-options-for-diffuse-thinning/).

It is always good to have a second or third opinion, especially for critical cases. In the end it is about asthetics.

 

 

 

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1 hour ago, Gasthoerer said:

Well done. I visited Bisanga, Lupanzula und Feriduni myself (https://www.hairrestorationnetwork.com/topic/50323-options-for-diffuse-thinning/).

It is always good to have a second or third opinion, especially for critical cases. In the end it is about asthetics.

 

 

 

I am visitng Dr Lupanzula in London. The three in Belgium are Drs Bisanga, Deroye and Feriduni. As I said, this will include Mwamba too if his clinic ever gets back to me. My issue is that I do not want to take meds but my expectations are also much lower than others on this forum. I am at the crossroads though where I either need to pull the trigger or just shave it so next month will be decisive. Pretty nervous. 

Good thread. Hadn't seen it before. How did you find out your scar potential type?

Edited by TrixGlendevon

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23 hours ago, Bill - Managing Publisher said:

Delancey,

A lot of members are Very quick to suggest full refunds win I don’t think most people understand that for refunds are not typical. I’m not saying it doesn’t or won’t happen in this case, but,  most hair transplant surgeons go over the risks of surgery before hand and even if they don’t go over it personally, there is a piece of paper that goes over all of it and even discusses the process of surgery and explains that they agreed to take upon the risks themselves. Now, I do firmly believe that a good quality surgeon like Dr. Feriduni  should stand behind his patients and do something for him, but providing a full refund is in very typical. Typically, what we recommend is for the patient to work with her doctor and try to undergo a free procedure  to replace the grafts that did not grow or  resolve whatever concern there is. Frankly,  a full refund, although it sounds good  doesn’t really resolve any problems. If anything, they have their money back but now they’re in a worse off position then when they started. So, it’s actually better to undergo another surgery in order to  resolve the issue. After all, he’s already selected an outstanding surgeon and it’s possible that his case has extenuating circumstances. 

I would like to hear how the surgeon intends to resolve this issue but I also need to get verification that he has permission to post and share his side of the story. 

Bill

Dear Bill,

I informed earlier that I told the doctor there will be no issue at all to post his explanations (I already posted them here) as long as no private details will be revealed. I agree that, there was a piece of paper talking about the risks but I am not sure if a bad result could be classified as a risk? a good quality doctor should care about all possible factors and take all required measures to ensure a satisfactory result before the surgery.

As you said Bill, full refund will not solve the problem at all and I believe Dr. Feriduni will stand behind his patients.

Unfortunately, I didn't read a lot of positive replies here as some of them where destructive, some were annoying and some just want to blame the doctor for the result even thought it could happen to any one.

I believe in this forum when I selected my surgeon and I still have the faith that I will get the support to get out of this ****.

As I posted earlier, I started to think about BHT as a possible solution but I am not sure about the hair nature and the growth. 

 

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Gentleman,

If you already gave @Dr. Bijan Feriduni Permission to reply to this topic than hopefully he will reply with more information.  Has he made you any kind of offer to resolve your concerns?

Thanks  for your continued faith in this community to help you even in the midst of difficult circumstances. I appreciate how you keep a level head and recognize that your doctor is still top-notch bought that you were situation just didn’t work out the way it should. But you do of course, still need to focus on resolution when she’s on her since understandable and expected.  

Please keep us posted.

Bill

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image.thumb.png.4a187325754c601d4d775a5e4883ff32.pngimage.thumb.png.4a187325754c601d4d775a5e4883ff32.pngFirst of all, I would like to mention that I feel very sad about the patient’s situation. 

At my clinic and towards our patients, we always do our utmost from the preoperative planning/consultation onwards until the day of surgery. We also appreciate to stay in touch for any specific questions concerning the aftercare and monthly updates.
 

Here’s a brief summary from the initial contact until the follow-up after his 2nd  surgery:

- Online consultation (July 2012) – pictures hair situation patient
*attached picture Results1-jpg

Since I hadn’t met the patient in person, I wasn’t able to perform any measurements concerning his donor density and scalp flexibility. Therefore, the initial treatment plan, after inspecting the pictures of his online request, (pic 5 & 6) was either a FUE 3000 – 3500 FU or FUT with 3500 - 4000 FU. I also advised him to consider the extraction of the previous transplanted FU’s on his right temporal area (pic 2), as in my opinion, the hairline design (ex-domo) was too low.

 

- Preoperative consultation (1st surgery - October 2012, Hasselt, Belgium)
Anamnesis:
29-year-old patient who suffers from hair loss since 2004 and underwent a FUT operation in 2008 ( ex-domo). At the current age of 29, the patient believed his hair loss was relatively stable and he didn’t use any medication such as Finasteride or Minoxidil.

Family anamnesis:
Hair loss father: all zones
Hair loss mother: /
Hair loss brother: 1, 3
Hair loss grandfather on mother’s side: /
Hair loss grandfather on father’s side : 5, 5v, 6
Hair loss uncle on mother’s side: unknown
Hair loss uncle on father’s side: unknown

- The genetic hair loss is inherited from the male side of his family
- According to the patient, approx. 1000 - 1500 FU were transplanted for the reconstruction of his hairline and temporal recessions during his previous surgery in 2008.
 

Diagnosis:
Hair loss pattern classification: MPB Type NW III – IV, vertex, Class T
Donor area: good skin condition and optimal scalp laxity occipital and parietal area
Hair structure: slightly wavy
Measured density occipital: 76 FU/cm² of which 25 % – 30 % were singles FU
Miniaturization occipital: 10 %
Hair density: 158 hairs/cm²

Linear scar in the lower occipital and parietal area with a length of approx. 14 cm and a variating width of 3 to 8 mm.
Recipient area: multiple incorrectly placed FU’s (incorrect angulation and direction) in his right + left temporal recession

Advised treatment plan after personal examination: 

  1. FUT in order to reconstruct frontal third (zone 2, 3 and the transition towards zone 4) in a medium density
  2. Extraction of several incorrectly placed FU from previous surgery out of his right temporal recession

 

- OR-Report October 2012 – 1st surgery (Dr. B. Feriduni)

Breakdown:
1684 Singles (!)
1965 Doubles/Triples 
Total: 3649 FU

Aftercare:
Postoperative aftercare performed at my clinic between 1 and 14 days postoperative without any complications
*attached picture Result2-a.jpg

Evaluation after 11 months postoperative:
As it wasn’t possible - due to the high percentage of single FU’s - to achieve the necessary HGI during the 1st operation, we agreed on performing a touch-up surgery (April 2015) through FUE with the strategy to “cherry-pick” the double and triple FU in order to obtain a higher HGI (Hair per Graft Index).

 

- OR-Report April 2015 - 2nd surgery touch-up FUE  (Dr. B. Feriduni)

Breakdown:
FUE in cherry-picking technique with a total amount of 1299 FU (HGI: 2.3 Hairs/FU) to increase the density in the central core and bridge  (zone 3 and 4).

Internal rating of surgery quality (1 = very bad; 10 = excellent):
Extraction: 8/10
Implantation: 8/10
Graft quality: 7/10

Aftercare:
Apart from a slight seroma wound on the 1st and 2nd day postoperative, no further inconspicuous findings were visible. 



After the 2nd procedure, I haven’t heard back from my patient until the 18th day postoperative when he sent some pictures which showed a normal healing situation. And as I didn’t receive any further updates I presumed that the result turned out fine because most patients tend to forget to keep us posted as the growth continues to mature. 

>> So why did we get this result?
In general, following points are important for a good result:                

  1. The operation (long term strategy, meticulous preoperative planning)
  2. The healing process during the first 14 days postoperative
  3. Patient related factors like the PGI (Personal Growing Index), general diseases, smoking or other non-MPB related reasons
  4. BUPA (Bald Unpatterned Alopecia with a high degree of miniaturization in the donor area)

 

I’ve sent a personal message to the concerned patient to invite him for a check-up at my clinic. I will examine the result and have a closer look at his donor area to exclude BUPA (recently revealed), other patient-related factors and to discuss possible further medical therapy, surgical as well as non-surgical options such as Tricopigmentation in order to help him correct the unexpected result.

Dr. B. Feriduni

 

 

 

Resuls1-.jpg

 

Result2-a.jpg

Edited by L0ke

L0ke - Representative for Dr. Feriduni

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L0ke,

Just to make sure: The pics shown are all before and after 2nd surgery (FUT). FUE was performed afterwards, but not shown in this post, right?

Overall I have to say, that the plan looked good (FUT cause there was already a scar, design of hairline, concentration on front and bridge,...). Work looks clean as well.

But the result is not there. What is hard to tell from the pictures: Is there (only) bad growth or is the recipient hair also miniaturized? In the last pic of Feriduni/L0ke it appears that also hair diameter is reduced. But there was an earlier pic by gentle_man where it looked ok and "just" missing density.

2nd point which is not clear yet to me: From Feriduni's presentation it appears that FUT was "more succesfull" than the FUE. From the impression of gentle_man (the pics he gave) it appears the FUE was (relatively) better. Would be great to see one post/presentation from start (before 2nd surgery) to end of the journey (after +6 month after 3rd surgery).

I wish the patient strength and all the best.

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That's right.
And as we already mentioned, we haven't received any updates from our patient as from the 18th day postop until now.


L0ke - Representative for Dr. Feriduni

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I posted the most recent photos here so how do you say you did receive any update until now?! 

 

Edited by gentel_man83

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On 7/11/2018 at 12:56 AM, Gasthoerer said:

L0ke,

Just to make sure: The pics shown are all before and after 2nd surgery (FUT). FUE was performed afterwards, but not shown in this post, right?

Overall I have to say, that the plan looked good (FUT cause there was already a scar, design of hairline, concentration on front and bridge,...). Work looks clean as well.

But the result is not there. What is hard to tell from the pictures: Is there (only) bad growth or is the recipient hair also miniaturized? In the last pic of Feriduni/L0ke it appears that also hair diameter is reduced. But there was an earlier pic by gentle_man where it looked ok and "just" missing density.

2nd point which is not clear yet to me: From Feriduni's presentation it appears that FUT was "more succesfull" than the FUE. From the impression of gentle_man (the pics he gave) it appears the FUE was (relatively) better. Would be great to see one post/presentation from start (before 2nd surgery) to end of the journey (after +6 month after 3rd surgery).

I wish the patient strength and all the best.

As you said the FUT result in som how was more successful but the FUE didn’t show any improvement laterally. Check the previous posted photos and you can see it easily.

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On 7/10/2018 at 11:36 PM, L0ke said:

image.thumb.png.4a187325754c601d4d775a5e4883ff32.pngimage.thumb.png.4a187325754c601d4d775a5e4883ff32.pngFirst of all, I would like to mention that I feel very sad about the patient’s situation. 

At my clinic and towards our patients, we always do our utmost from the preoperative planning/consultation onwards until the day of surgery. We also appreciate to stay in touch for any specific questions concerning the aftercare and monthly updates.
 

Here’s a brief summary from the initial contact until the follow-up after his 2nd  surgery:

- Online consultation (July 2012) – pictures hair situation patient
*attached picture Results1-jpg

Since I hadn’t met the patient in person, I wasn’t able to perform any measurements concerning his donor density and scalp flexibility. Therefore, the initial treatment plan, after inspecting the pictures of his online request, (pic 5 & 6) was either a FUE 3000 – 3500 FU or FUT with 3500 - 4000 FU. I also advised him to consider the extraction of the previous transplanted FU’s on his right temporal area (pic 2), as in my opinion, the hairline design (ex-domo) was too low.

 

- Preoperative consultation (1st surgery - October 2012, Hasselt, Belgium)
Anamnesis:
29-year-old patient who suffers from hair loss since 2004 and underwent a FUT operation in 2008 ( ex-domo). At the current age of 29, the patient believed his hair loss was relatively stable and he didn’t use any medication such as Finasteride or Minoxidil.

Family anamnesis:
Hair loss father: all zones
Hair loss mother: /
Hair loss brother: 1, 3
Hair loss grandfather on mother’s side: /
Hair loss grandfather on father’s side : 5, 5v, 6
Hair loss uncle on mother’s side: unknown
Hair loss uncle on father’s side: unknown

- The genetic hair loss is inherited from the male side of his family
- According to the patient, approx. 1000 - 1500 FU were transplanted for the reconstruction of his hairline and temporal recessions during his previous surgery in 2008.
 

Diagnosis:
Hair loss pattern classification: MPB Type NW III – IV, vertex, Class T
Donor area: good skin condition and optimal scalp laxity occipital and parietal area
Hair structure: slightly wavy
Measured density occipital: 76 FU/cm² of which 25 % – 30 % were singles FU
Miniaturization occipital: 10 %
Hair density: 158 hairs/cm²

Linear scar in the lower occipital and parietal area with a length of approx. 14 cm and a variating width of 3 to 8 mm.
Recipient area: multiple incorrectly placed FU’s (incorrect angulation and direction) in his right + left temporal recession

Advised treatment plan after personal examination: 

  1. FUT in order to reconstruct frontal third (zone 2, 3 and the transition towards zone 4) in a medium density
  2. Extraction of several incorrectly placed FU from previous surgery out of his right temporal recession

 

- OR-Report October 2012 – 1st surgery (Dr. B. Feriduni)

Breakdown:
1684 Singles (!)
1965 Doubles/Triples 
Total: 3649 FU

Aftercare:
Postoperative aftercare performed at my clinic between 1 and 14 days postoperative without any complications
*attached picture Result2-a.jpg

Evaluation after 11 months postoperative:
As it wasn’t possible - due to the high percentage of single FU’s - to achieve the necessary HGI during the 1st operation, we agreed on performing a touch-up surgery (April 2015) through FUE with the strategy to “cherry-pick” the double and triple FU in order to obtain a higher HGI (Hair per Graft Index).

 

- OR-Report April 2015 - 2nd surgery touch-up FUE  (Dr. B. Feriduni)

Breakdown:
FUE in cherry-picking technique with a total amount of 1299 FU (HGI: 2.3 Hairs/FU) to increase the density in the central core and bridge  (zone 3 and 4).

Internal rating of surgery quality (1 = very bad; 10 = excellent):
Extraction: 8/10
Implantation: 8/10
Graft quality: 7/10

Aftercare:
Apart from a slight seroma wound on the 1st and 2nd day postoperative, no further inconspicuous findings were visible. 



After the 2nd procedure, I haven’t heard back from my patient until the 18th day postoperative when he sent some pictures which showed a normal healing situation. And as I didn’t receive any further updates I presumed that the result turned out fine because most patients tend to forget to keep us posted as the growth continues to mature. 

>> So why did we get this result?
In general, following points are important for a good result:                

  1. The operation (long term strategy, meticulous preoperative planning)
  2. The healing process during the first 14 days postoperative
  3. Patient related factors like the PGI (Personal Growing Index), general diseases, smoking or other non-MPB related reasons
  4. BUPA (Bald Unpatterned Alopecia with a high degree of miniaturization in the donor area)

 

I’ve sent a personal message to the concerned patient to invite him for a check-up at my clinic. I will examine the result and have a closer look at his donor area to exclude BUPA (recently revealed), other patient-related factors and to discuss possible further medical therapy, surgical as well as non-surgical options such as Tricopigmentation in order to help him correct the unexpected result.

Dr. B. Feriduni

 

 

 

Resuls1-.jpg

 

Result2-a.jpg

Bill, 

this is the doctor’s reply here. I hope you can comment on it as I can’t find any technical explanation of the bad result here!

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