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Danny1671

Two very different consultations. Help needed!

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Hi everyone.  I’m after some advice....

I have finally had consultations with the two surgeons I have narrowed down to after years of research. Dr Edward Ball of the Maitland clinic and Dr Bisanga. Both doctors have said that I am an excellent candidate for fue surgery, however the plans for my surgery in terms of graft numbers and hairline design are very different.  

I am a apparently a Norwood 3v diffused pattern and it’s fairly obvious where I will eventually go bald.  

Dr Ball measured a donor density of 80 and 70 fu, and total donor capacity of 6000 grafts. He drew a very conservative hairline and advised against really touching the crown. Graft proposal was 1800-2000.

After seeing Dr Bisanga today in London, he measured my donor density at 80 and 90 fu with total donor capacity of 8000 grafts. The hairline he drew was still fairly high but much less receded in the temples compared to Dr Ball  if that makes sense. The proposed graft numbers were 4000 and he said he would cover the crown (although not full density) in one hit.

When I asked Dr Bisanga if that was a wise option considering my balding future pattern he said I didn’t need to worry as I am 37 not 25, I have high sides and above average donor density.

So now I’m confused!

Obviously I would love to get almost full coverage and stop drowning myself in consealer so hearing Dr Bisanga’s plan was music to my ears......but is it too good to be true? 🤔

Also FYI I started Propecia 7 weeks ago, use regaine once a day, Nizoral sometimes and biotin. No effects from Propecia yet good or bad. I also asked both Doctors to plan for me assuming I don’t take Propecia in case I need to stop.

As well as this, do you think I should be considering other surgeons? Maybe I’ve missed some!

Thanks all, your opinions and advice are most welcome.

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I would have guessed you were a higher norwood than a 3v, probably closer to a Norwood 5v diffuse thinner tbh - that is at least based on the status of your crown - but again that's just my take on it. You do have high sides and a forelock which is good so hopefully the medications can help retain your native hairs. 

In terms of your dilemma between choosing the surgeons, I was admittedly in the same situation; I consulted 17 clinics before my last procedure so I know how easy it is to get confused by different advice and the differing approaches. If I were you I'd look at the individual work of the surgeons you are interested in, particularly Norwood cases similar to your own and see what results they got. Ask the surgeons to provide you some if you can't find them online yourself. 

That was smart to ask both Doctors to plan for you assuming you can't tolerate the side effects of propecia

In terms of getting full coverage, given your level of balding I'd probably take a two-step "conservative" approach to things, with your 1st surgery concentrating on your hairline and midscalp regions, then if that all went well I'd concentrate on the crown and make any adjustments you wanted on the hairline. That way in that time period you could also find out how well you tolerated propecia and see how your donor responded to surgery. But that would only by my approach - there are world class clinics like HnW that can give you full coverage in one sitting.

In terms of thinking about other surgeons everyone has their favourites, there is no "best" surgeon (although a few always top most people's list), but there is more accurately the best surgeon for your situation. I would assume you are in the UK or Europe based on your choices, so the only other piece of advice one can give is not let geography dictate your choices. 

Hopefully someone else more well versed in these matters can provide better advice than my own. Whatever your choose to do I wish you luck sir! :)

 

 

Edited by transplantedphil

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Funny coincidence I also saw Dr Bisanga yesterday in London lol

Just a suggestion, the analysis of where you are in terms of donor density etc doesn’t sound that different between the two. Just a different vision of where you could be - sounds like you have a strong donor so 1800 doesn’t sound much, possibly a bit conservative? 

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If it was just out of them two, I think I would go with Bisanga. Both good surgeons, but when I was looking, I found most uk surgeons to be a lot more conservative in the number of grafts used, and hair line designs.Dr Ball’s quote was about 1800, well on your level of loss that wouldn’t give you any density! And a very conservative hairline. Dr bisanga’s quote of 4000 is more realistic.however even at that number  I think you would possibly need another transplant for full density in the crown.

Best of luck whoever you choose 

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@Danny1671

How are you?

I hope all is well. 

Deciding on your physician is never an easy choice, it is very personal and if most individuals did their due diligence as you are, then there would be far more happy patients, and less need for repair work. So well done for that, you have the right approach and should continue to do so.

Donor density will offer an average donor density in various areas of your donor region. Not every squared centimetre will offer you the same amount of follicles, therefore an average or one particular cm2 could be provided, potentially explaining different values.

Some of the comments above have made good points. I would imagine that a 2 step approach from Dr Ball would ultimately equate to a similar graft count recommended from Dr Bisanga. So in that respect, it would depend on how you personally felt more comfortable addressing your personal journey. 

Most patients, especially with a more advanced amount of loss, are normally not fortunate enough to have a one and done approach. You may have one procedure to address your hairline and frontal third, maybe graft a little into the mid scalp, and after so many years of having no hair or styling options, be absolutely content with this and feel no motivation to even consider addressing your crown loss. Alternatively, you may have a larger session, and whilst achieved a great result and solid coverage and a great transformation, still desire "touching up" a few areas.

Again, the journey is very personal. Expectations whilst essential that they are realistic, also vary extremely, I as an individual who experienced excessive loss at a young age, never desired a low/aggressive hairline or an overly dense result. I was elated to simply have a hairline and frame my face.

One thing is for sure, both Dr Ball and Dr Bisanga are both excellent surgeons. You would be in the very best of hands with either, and there are few if any more ethical and patient orientated than these individuals. 

Wishing you the best of luck moving forward. Keep researching and asking questions.


Patient Advisor for Bisanga Cole Hair Transplant Clinic - Athens, Greece

Consult: https://bchairtransplant.com/online-consultation/ - bc2@bchairtransplant.com -  WhatsApp - + 34 642 37 03 83

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

My Hair Loss Website - Hair Transplant with Dr. Rahal

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A couple of suggestions and the reasoning behind it.....

The crown takes TONS of grafts due to the whirl.  Thus if you draw a dot on a piece of paper....draw a cross intersecting the point....turn the paper a touch in either direction and draw another cross intersecting the point once again......Every time you draw...it;s another procedure. You could actually use your entire donor.

Hair in the middle and hair in the front grow forward and because of the shingling effect, these two areas typically will look fuller because of it.  

Thus, my suggestion is to consider adding density to  the most prominent area.  Start in the front and go back until you run out of grafts...concentrating on the front and top.  The doctor can actually work on the horizontal plane and leaving the crown "round" so that, if your pattern expands, the crown will still look normal.  Hopefully, by working in this fashion, your crown will end up being a lot smaller.

It seems you have a lot of miniaturized hairs....and your pattern seems to be progressing.  I would highly encourage you to get on a medical regimen to help with retention of the native hair.  Second, talk to the doctor about doing PRP at the time of the procedure.  This can help bring the results sooner but, more importantly, help reverse the miniaturization.  

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13 hours ago, transplantedphil said:

I would have guessed you were a higher norwood than a 3v, probably closer to a Norwood 5v diffuse thinner tbh - that is at least based on the status of your crown - but again that's just my take on it. You do have high sides and a forelock which is good so hopefully the medications can help retain your native hairs. 

In terms of your dilemma between choosing the surgeons, I was admittedly in the same situation; I consulted 17 clinics before my last procedure so I know how easy it is to get confused by different advice and the differing approaches. If I were you I'd look at the individual work of the surgeons you are interested in, particularly Norwood cases similar to your own and see what results they got. Ask the surgeons to provide you some if you can't find them online yourself. 

That was smart to ask both Doctors to plan for you assuming you can't tolerate the side effects of propecia

In terms of getting full coverage, given your level of balding I'd probably take a two-step "conservative" approach to things, with your 1st surgery concentrating on your hairline and midscalp regions, then if that all went well I'd concentrate on the crown and make any adjustments you wanted on the hairline. That way in that time period you could also find out how well you tolerated propecia and see how your donor responded to surgery. But that would only by my approach - there are world class clinics like HnW that can give you full coverage in one sitting.

In terms of thinking about other surgeons everyone has their favourites, there is no "best" surgeon (although a few always top most people's list), but there is more accurately the best surgeon for your situation. I would assume you are in the UK or Europe based on your choices, so the only other piece of advice one can give is not let geography dictate your choices. 

Hopefully someone else more well versed in these matters can provide better advice than my own. Whatever your choose to do I wish you luck sir! :)

Thanks transplantedphil that’s good advice.  As it happens I have asked about similar Norwood cases to my own and have received a few from BHR clinic. One example I was sent was a almost slick Norwood 5 and the final result was amazing( after 2 sessions).  The Maitland clinic said they’d prefer not to send me such examples as each person is unique and I might set myself unrealistic expectations. I get that in a way but it may have helped with my decision making!

cheers for your thoughts

 

 

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Cheers for the input guys it really is useful stuff.  I’m edging towards Bisanga out of the two, simply because the results seem generally very good to me, I can achieve more coverage in one procedure over 2 days at the same price as the Maitland Clinic.  I know cost shouldn’t be a factor but it kind of is really.

largechris we probably passed in the hotel lobby ha!

Slightly off topic but one more surgeon I am suddenly considering is Dr Rahal. Does anybody have any experience with him surgically?  Any idea of cost per graft and his general planning?  His work like Bisanga and Ball looks very very good.  Worth a look I wonder? 🤔

 

 

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10 hours ago, Danny1671 said:

Cheers for the input guys it really is useful stuff.  I’m edging towards Bisanga out of the two, simply because the results seem generally very good to me, I can achieve more coverage in one procedure over 2 days at the same price as the Maitland Clinic.  I know cost shouldn’t be a factor but it kind of is really.

largechris we probably passed in the hotel lobby ha!

Slightly off topic but one more surgeon I am suddenly considering is Dr Rahal. Does anybody have any experience with him surgically?  Any idea of cost per graft and his general planning?  His work like Bisanga and Ball looks very very good.  Worth a look I wonder? 🤔

 

 

I think Bisanga opened a clinic in Greece as well, so as you mentioned cost is a factor I'd probably look into any price differences between the Belgium and Greek clinics. Only issue with that (besides travel) is I would want to know the level of experience of all the techs and their degree of involvement in the surgery (extractions/implanting etc). Generally speaking though I do find Bisanga's work impressive. 

Regarding Rahal it might be easier to check out his patient listed results and message a few of them individually. Most guys here are supportive and more than happy to share their experiences.

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I actually had a procedure booked in Athens when I learned on here about the new clinic.  After speaking with Raphael84 ⬆️ who is a fantastic rep for Bisanga, I learned that the techs and newer doctors actually were planning to do more of the work than I’d have liked so therefore started looking into BHR Brussels. That way I know I’d get that little more from Dr Bisanga himself.  I’m sure I would have gotten a great result in Athens but it’s just personal peace of mind.

 

Ill enquire more about Rahal as actually it’s quite cheap to fly to Canada.  Still very close to booking with Bisanga in Brussels and I’m kind of exited to have hair a can style again! 😀

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I agree that you are more of a Norwood class 5v, not a 3.  If it were me, I would concentrate on the frontal third and make sure that area was to my satisfaction...second, transitioning into the mid-scalp with a lower grafted density level.

37 is still young and although most of the hair in your crown is gone, it can open up further in circumference.

Crowns can demand up to 60% of one's donor availability so in keeping that in mind, you can always go much lighter in grafted density and consider a quality SMP session to combat the light reflection off of your crown.


Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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Thanks Gillenator, that’s definitely some food for thought.  I’m hoping that Propecia will stop further loss but don’t want to totally rely on it in case I have to stop for any reason.  SMP isn’t something I’ve really looked into, I kind of assumed it was for the guys who want the look of a shaved head.  Is it a common thing to get smp along side a hair transplant?  Can you recommend a place to get information and pictures?

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On 9/2/2019 at 1:38 AM, Danny1671 said:

I actually had a procedure booked in Athens when I learned on here about the new clinic.  After speaking with Raphael84 ⬆️ who is a fantastic rep for Bisanga, I learned that the techs and newer doctors actually were planning to do more of the work than I’d have liked so therefore started looking into BHR Brussels. That way I know I’d get that little more from Dr Bisanga himself.  I’m sure I would have gotten a great result in Athens but it’s just personal peace of mind.

 

Ill enquire more about Rahal as actually it’s quite cheap to fly to Canada.  Still very close to booking with Bisanga in Brussels and I’m kind of exited to have hair a can style again! 😀

Could you kindly elaborate more on the involvement of the doctors/techs at the Greek location vs the Belgian location? Very curious 

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@jj51702

In Athens the technical team/nurses do just as they do in most other established clinics. That being extracting the pre punched grafts and placing them in the pre made incision sites. A very important part of the procedure undoubtedly, but they will never be asked to perform other parts of the procedure.

BisangaCole`s objectives are to offer quality surgery at competitive pricing. To be able to offer individuals that are financially/budget restricted another viable option rather than just technician led/pop up clinics in countries such as Turkey. The intention being that BisangaCole is clinic that has the patient as their priority and being a clinic that you can trust.

Considering this, various pricing options that will allow BisangaCole to be accessible to price conscious patients are available. 

Dr Bisanga and Dr John C have led every surgery in Athens. Led meaning that they have consulted, planned and prepared the approach, and performed punching and the making of incision sites. With some patients, they have been assisted by two fellow Doctors. Dr Kyparissou and Dr Venetsanos. These local Doctors have been working and training with Drs Bisanga and John C and have assisted them in punching grafts and in the making of incision sites. Assisting meaning generally less, never more than 50%.

Dr Bisanga and Dr John C are available and more than happy to perform all punching and all incisions as was the case with yesterdays patient. But this will be at a higher price point.

Hopefully that clears a few things up.

Thanks


Patient Advisor for Bisanga Cole Hair Transplant Clinic - Athens, Greece

Consult: https://bchairtransplant.com/online-consultation/ - bc2@bchairtransplant.com -  WhatsApp - + 34 642 37 03 83

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

My Hair Loss Website - Hair Transplant with Dr. Rahal

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26 minutes ago, Raphael84 said:

@jj51702

In Athens the technical team/nurses do just as they do in most other established clinics. That being extracting the pre punched grafts and placing them in the pre made incision sites. A very important part of the procedure undoubtedly, but they will never be asked to perform other parts of the procedure.

BisangaCole`s objectives are to offer quality surgery at competitive pricing. To be able to offer individuals that are financially/budget restricted another viable option rather than just technician led/pop up clinics in countries such as Turkey. The intention being that BisangaCole is clinic that has the patient as their priority and being a clinic that you can trust.

Considering this, various pricing options that will allow BisangaCole to be accessible to price conscious patients are available. 

Dr Bisanga and Dr John C have led every surgery in Athens. Led meaning that they have consulted, planned and prepared the approach, and performed punching and the making of incision sites. With some patients, they have been assisted by two fellow Doctors. Dr Kyparissou and Dr Venetsanos. These local Doctors have been working and training with Drs Bisanga and John C and have assisted them in punching grafts and in the making of incision sites. Assisting meaning generally less, never more than 50%.

Dr Bisanga and Dr John C are available and more than happy to perform all punching and all incisions as was the case with yesterdays patient. But this will be at a higher price point.

Hopefully that clears a few things up.

Thanks

Thanks for the clarification!

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