Norwood 4, 2100 grafts, FUE, Dr Lupanzula, Mar-20

[baalloss]

Hi all,

In the spirit of ‘paying it forward’ here’s my review of my recent transplant with Dr Lupanzula.

Summary

Norwood 4, Aged 55. Had full head of hair till around 50.

FUE procedure, 2111 grafts, 4444 hair, on surface area of roughly 50cm2.

(Another procedure to be done in a year, for the crown and back of the head.)

Graft details :

                             FU’s       Hair

1 Hair                  443        443

2 Hairs                1086     2162

3 Hairs                509        1527

4 Hairs                78          312

Total     FU’s       2111     4444

Background:

Mid 50’s, started losing hair around 8 years ago. I had been thinking of a transplant for 3 years as my hair have been shedding with increasing speed. Now at Norwood 4 I would say and knew that this year I would have to pull the trigger. Denial, fear of pain, and the negative emotions associated with anything to do with hair loss kept me from doing it.

Anyway, I did some research – I read these and other forums. Read lots of reviews. Where are the negatives ones? There seem to be very few of those – so I wondered how many of the reviews are actually genuine?

Had a face-to-face consult with two very well know doctors. Met Dr Lupanzula in Feb in London, and I liked what I heard. Asked further questions via his assistant Scott, who was, and continues to be, very responsive and informative, without being pushy or ‘sales-manny’. A week later I signed up. They had a slot in 3 weeks’ time, and I looked forward to anxiety and sleepless nights till then.

 

The Event

My pre-op consult was the same day as my operation, and this was fine with me. Day started at 6:30am. Photos takes, hairlines drawn, blood samples taken for the blood tests, hair shaved off. Dr Lupanzula did all of these himself.

Around 9:00am is when the main event started. Scalp anesthetised, and I lie on my front whilst the doc extracts the follicles from the donor. This lasted around 2.5 hrs. Then followed the incision stage where the doc made the openings for the extracted follicles to be transplanted and this was fairly quick, maybe an hour or just over.

The final stage was the placings, which was done by two technicians and lasted for around 2.5 -3 hours.

The whole process was finished by 5:30pm, and I then joined the doctor for a chat, Q-and-A and a well-deserved baguette.

My experience

Pain – this was the ONE thing which had prevented me from taking action for 3 years cos someone ones said to me “Oh, my brother-in-law had a transplant, and he said it’s really painful”. Well, I had the complete opposite experience - practically no pain at all. The only tiny bit was when the injections were used to numb the scalp, and on a scale of 0-10 where 0 is “No pain”, I would measure mine at 2. It’s like having an injection when a blood sample of taken from the arm – there is a little prick that lasts a few seconds.

I am a real whoos when it comes to pain, so if you are like me, and have been holding back, then let me reassure you – if you pick the right doctor/clinic, then the pain is minimal. In fact, numerous times, during the day I fell asleep – at one point, both the technicians were laughing as my snoring became so loud that it even woke me up.

That night I was expecting throbbing of the head, but nope, nothing. The most painful part is having to sleep at 45% angle at night – I liken it to being on a long-haul flight in an economy seat, ie. inconvenient and fidgety, but not painful.

The next day, I was given a 1000mg paracetamol to take, but I didn’t need to take it as there was literally no discomfort at all.

Doctor/Clinic/Staff

I’m trying to not make this sound like a sales pitch, but here goes :

Wonderful. All three. The doctor is really relaxed and chilled and that calmed my nerves. We even shared a few laughs while he was drilling around my head, and I tried to impress him with my 10 word knowledge of the Swahili language. The facilities are very modern and well-equipped. The technicians are friendly, and one invited me to look through the microscope while he was separating my follicles. During the 2.5 hours of the placings stage, I was free to pick my favourite Netflix shows to watch while the technicians quietly did their job.

Support

Pre-booking : All the comms are via Scott, the client liaison chappie. He’s very responsive and provided me all the info I needed. All the forms, payments etc were done online very efficiently, and within two days  of me saying ‘Yes’, we had everything finalised.

During the day : the doctor is very open to discussion, didn’t rush at all, and answered all the questions I had in a rational manner. The support staff too are very polite, respectful, and helpful. I was of course, the only person being operated on during that day, and this was important to me.

Post-op : I asked if I could come back the next day so someone could show me how to wash my hair, and of course, they were very happy to do so. In fact, I would say, whichever clinic you use, make sure you go back the next day, so they can clean you up properly, and show you good maintenance techniques. The staff even offered to video me having my hair washed for my personal use when I return home.

I will keep in contact with the doctor and have 3 and 6 monthly face-to-face consults when he visits London.

I feel great right now. Just want the ugly-duckling stage to pass quickly, and I look forward to seeing the results.

If you have any questions, feel free to ask.

 

 

 

 

 

 

 

 

[Melvin- Admin]

The work looks impeccable, very clean. I’ve always been impressed by Dr. Lupunzula, look forward to your updates.

[Scott Medikemos]

Thanks for the thorough testimonial. I look forward to your updates!

[baalloss]

It's 6 months now since my transplant, and I attach some photos. A few things to note :

- I normally dye my hair black, but haven't for a while so there is a different 'look' from now compared to the photos just before the operation.

- I was getting a little concerned by month 5 as I didn't see much growth, but Scott re-assured me that it will come.

- My hairline looks much better when I look horizontally in the mirror and the operation has made me look less ugly than before 🙂. Which is nice.

- The density is a little lacking right now, and I'm hoping that in the next few months it will improve.

- I use Rogaine foam twice a day and nothing else. (Maybe I should - anyone have any recommendations?)

The key learning for me is that everyone's hair and results are different and some patients will experience amazing looking transformations after just 5 months and seeing their reviews/photos can raise the expectations to un-realistic levels. 

In summary, whilst I am happy with the progress so far, I am expecting a lot more hair in my temples by the end of the year. And once the 12 months are over, I'll be able to give a rating out of 10 for the whole process. Till then, it's a case of not looking at myself in the mirror too often, and getting on with the life whilst the follicles do their magic in the background.

 

[Britanium]

I can see Improvement from where you started out from. This will only get better from this point onwards.

You have chosen a good Dr ! 

[Scott Medikemos]

Thanks for the update. Definite thickening and I'm happy with your progress to date. Diffuse cases with the grafts added around lots of already present native hair are notoriously slow in terms of noticing aesthetic change. Results often appear from nowhere suddenly.  Looking forward to seeing your next update.

[OliverAtom]

On 9/10/2020 at 3:10 PM, baalloss said:

It's 6 months now since my transplant, and I attach some photos. A few things to note :

- I normally dye my hair black, but haven't for a while so there is a different 'look' from now compared to the photos just before the operation.

- I was getting a little concerned by month 5 as I didn't see much growth, but Scott re-assured me that it will come.

- My hairline looks much better when I look horizontally in the mirror and the operation has made me look less ugly than before 🙂. Which is nice.

- The density is a little lacking right now, and I'm hoping that in the next few months it will improve.

- I use Rogaine foam twice a day and nothing else. (Maybe I should - anyone have any recommendations?)

The key learning for me is that everyone's hair and results are different and some patients will experience amazing looking transformations after just 5 months and seeing their reviews/photos can raise the expectations to un-realistic levels. 

In summary, whilst I am happy with the progress so far, I am expecting a lot more hair in my temples by the end of the year. And once the 12 months are over, I'll be able to give a rating out of 10 for the whole process. Till then, it's a case of not looking at myself in the mirror too often, and getting on with the life whilst the follicles do their magic in the background.

 

Hello baaloss,

First, thanks for sharing your experience.
I see a little change but it´s for sure you are having a slow growth... but do not worry, many are like this and after the 6 month until the 1 year post-op, boom, all those grafts get there...

Also, those photos and really good since you show the worst look... nobody will look at you from up there.

Be patient and wish u the best ; )

[baalloss]

Firstly, I need to clarify that what I express here is NOT a review of Dr Lupanzula or Scott - they have both been fine. I last spoke with Dr L on the day of the operation, and he was professional, pleasant and a gentleman. Scott has been my contact since and he has always been polite and very responsive.  This is a review of the results. Writing this update is an unpleasant experience - on the one hand I don't want to be seen as discrediting anyone (because that is not the intention), but on the other, I'm looking for help and assistance. I have been in denial about my transplant for a couple of months at least, and yesterday I came to an brutal realisation.

 

I attach my 9 month photos below. As you can see, things are not going according to plan. I'm understandably very disappointed and concerned. The very last photo is the Before/After - the left one one was taken by Dr L an hour before the op, and the right one was taken yesterday.

 

When I asked why my results are so poor, the official answer was that I need to wait for the full 12 months before an assessment can be made, and the doctor will only look at the photos at that point. That may be a fair point, but I find it difficult to believe that somehow the grafts will all suddenly spring to life in the next 3 months.

 

So, I come looking for feedback and advice pls from experienced people : 

 

1) How do I establish what's gone wrong? How can I work out the reason for this poor result? 

Could it be because of :

  a) my body chemistry or genetics (eg maybe low iron levels, low protein intake etc etc). I doubt if this matters, but I don't smoke, rarely drink and am physically fit.

  b) poor handling/usage of the grafts during the procedure.

  c) the planting wasn't done properly and the grafts failed to take hold.

2) What action can I take to remedy this situation? Who else can I talk to?

3) Has anyone else had such a poor result after 9 months (with any doctor) and then gone on to achieve reasonable density?

4) Is it possible for a doctor to tell, after examining my head, whether the implanted hair are just in the sleeping phase, or whether they are dead?

(Also, I would really like to reach out to others who have had failed transplants, so pls feel free to PM me.)

 

For ref, I started using Rogaine foam from 01-Apr at Dr L's recommendation, and then was advised to switch over to Dutasteride at the beginning of Oct, but I stopped it after a month and returned back to Rogaine due to side effects.

 

Guys, pls be brutally honest with me. I'm not looking for sympathy, nor for false hope. Neither am I looking to blame anyone. I'm looking to understand what's gone wrong. 

 

Much appreciated.

 

 

[Britanium]

@Egycould perhaps chime in here. 

[Melvin- Admin]

I do think it’s reasonable to give it till 12 months, it may improve. Now, will it improve to the point that you’ll be happy. I don’t know. As Dr. Bisanga, mentions, poor growth can happen for various reasons. The doctor should try and pinpoint the reason. If it is from surgical error. The doctor should rectify by providing a free surgical fix. If they cannot pinpoint anything.

A biopsy is definitely a must. The pattern does seem like it’s a possibility you have scarring alopecia. It doesn’t appear to be a normal horse shoe pattern, but this is just speculation. Wish you the best and were here to help, don’t hesitate to reach out to me for help.

[ITA]

I will not be able to say what went wrong with my transplant, until I have the result of the biopsy I did, unfortunately, bad luck haunts me, I still do not have the result because the trichologist who performed it got sick with Covid 19 and  he had to temporarily close his office.  It's not like he says @Melvin-Moderator or Doctor Lupanzula.  however, there is no need to wait 12 months to understand that something has gone wrong here.  I don't think it's the surgeon's fault, after all, Lupanzula is not the last of the transplant surgeons, indeed he is one of the best.  I would advise you to do a scalp biopsy too, to see if it is healthy or not, and in my opinion, it should be the surgeons who propose / perform it to the patient before doing the procedure, especially top surgeons like Lupanzula.

[Abi28]

In my own experience being a diffuse thinner is probably worst case when it comes to hair transplants, you will need more than 1 surgery most of the time.

[PizzaWolf]

@baalloss You state: "Norwood 4, Aged 55. Had full head of hair till around 50."

That's seems unusual for Androgenic Alopecia. I think it's also debatable that the Norwood scale is even applicable to you. Did Dr. Lupanzula have any input about your hair loss situation during the initial consult?

"For ref, I started using Rogaine foam from 01-Apr at Dr L's recommendation, and then was advised to switch over to Dutasteride at the beginning of Oct, but I stopped it after a month and returned back to Rogaine due to side effects."

Were you on Finasteride before the transplant?

[DenverBuff1989]

@baalloss sorry to hear about your failed HT. I can relate. My 1st HT was failed. Just like your hair is now, my hair looked "ok" to a casual observer, but was clearly a failure in terms of hair transplantation. All the transplant hair grew but there were definitely not enough grafts used. 2 repair jobs later and I am finally happy with my hair and able to put my hairloss war in the past. 

My failed HT literally was the most stressful thing in my life to deal with it. I went thru all 7 stages of grief, anger, denial, acceptance, etc. I was angry at myself - how stupid could I have been to go to a random no-name doc and not one of the highest rated ones. Mad at the doc, mad at the techs, was it really just bad luck or the result of negligence, etc. Embarrassed that I was now one of those "failed HT guys", and that my hair transplant was now a warning for others. 

Just like with the 7 stages of grief, the only way forward is acceptance, which it seems like you have done. Don't hold onto false hope that a miracle will happen and all the hair will grow in. Yes, of course a full HT takes 12 months to even 18 months to fully blossom, but by 9 months you absolutely know what the prognosis will be. 

The only way I could move forward from my 1st ht and really stop obsessing about it was research and start consulting and starting the process for my repair HT (unfortunately it took 2 of those to make everything good). 

A last piece of advice I have is beware of accepting a free repair job from the same operating surgeon, regardless of how tempting or convenient that may be. Who is to say the doctor won't make the same mistakes all over again? For my 2nd HT, I made the mistake of allowing the same surgeon to operate me again, and it was an improvement but gaps were still there. It wasn't until I went to a truly recognized doctor in the HT community that my hair finally looked great. IMO every doctor is very rigid in terms of the intricate processes of hair transplantation, they are very stubborn in their way of dpoing things. Even if the doctor is aware they are doing a repair case on one of their previous cases, they will still stick to their familiar way of doing things. For better or for worse, every doctor leaves their "signature" so to speak. 

[aaron1234]

Is there a reason you tried dutasteride but not fin? It appears that your lateral humps have receded since the HT.

[deitel130]

Have you spoke with a dermatologist? It's possible there is another underlying condition causing the hair loss. Even if you are offered another make-up procedure you should first get your scalp evaluated to rule out any issues. Keep us updated on how things go and really hope everything gets sorted out.

[ITA]

3 hours ago, deitel130 said:

Have you spoke with a dermatologist? It's possible there is another underlying condition causing the hair loss. Even if you are offered another make-up procedure you should first get your scalp evaluated to rule out any issues.

It is the first thing to do.

[baalloss]

Thank you all for your replies. They are really helping me to understand the situation better and helping me prepare for the next steps.

My response to the questions are below :

" Did Dr. Lupanzula have any input about your hair loss situation during the initial consult?"

I'm not sure I understand the question, but I had a physical consult with Dr L and Scott on London in Feb, and the doctor examined my head and we spent about 30 mins together. He proposed a hair line, gave me an idea of the number of grafts etc etc. He didn't think there was any problem with my scalp, or hair type etc.

"Were you on Finasteride before the transplant?"

Before the op, I was using a custom made topical solution of 6% minox+0.2%melatonin+0.2% fin (this had been recommended to be my a hair consultant doctor on Harley St, London)

15 hours ago, DenverBuff1989 said:

My failed HT literally was the most stressful thing in my life to deal with it. I went thru all 7 stages of grief, anger, denial, acceptance, etc.

Perfectly sums up how I'm feeling. You agonise for years watching your hair thin, you do the research, you read hundreds of reviews, and then you finally pluck up the courage to have the transplant done, and you feel ecstatic shortly afterward, knowing that you've taken positive action, and that the worst is over......only to realise months later, that it gets much worse. Without sounding like a girly whooz, the pain is similar to a breakup.

 

"Is there a reason you tried dutasteride but not fin? "

My hair were showing signs of poor growth at the 6-month mark, and Scott recommended that I move to dutasteride.

 

"Have you spoke with a dermatologist? It's possible there is another underlying condition causing the hair loss. Even if you are offered another make-up procedure you should first get your scalp evaluated to rule out any issues. "

No, not yet - I didn't know how to deal with this failure - Dr Lupanzula will not look at my situation till the end of the 12th month (in Mar '21), so I came here looking for advice and you guys have come up with great suggestions. And yes, a scalp biopsy would be on the list of things that would need to be done in Mar '21.

 

Much appreciated.

 

 

[teeplant]

I really find it shocking that the doctor will not look at your situation or provide any personal feedback until end of the 12th month. Most top doctors take the time to check up and evaluate progress at fixed intervals throughout the process and it really does not have to wait until month 12, particularly if at month 9 there is no evidence of new growth or any new grafts sprouting. Wishing you all the best @baalloss

[DenverBuff1989]

5 hours ago, teeplant said:

I really find it shocking that the doctor will not look at your situation or provide any personal feedback until end of the 12th month. 

@teeplant the cynical part of me says doctors know a dissatisfied patient 3 months post-op is much angrier than a patient at 12 months post-op. Doctors say "give it 10+ months till I can assess", in the hopes the patient's anger cools down or the patient just accepts the loss and finds a different doctor to deal with

[Scott Medikemos]

Hi Baalloss and thanks for everyone’s comments. First off, we appear to have got our wires crossed regarding the 12 month review. I’m sorry if I wasn’t clear what I meant. Dr Lupanzula does, of course, periodically review patients’ photographs every 3 months. What I meant was, the Dr would be unable to start any investigations to ascertain the reason for the result until at least the 12 month mark, because it isn’t a ‘result’ until that juncture.

The feedback to date is to wait until 12-14 months, as per your post-op instructions, when we will of course welcome the opportunity to assess your case and the way forward. Until such time, it is inaccurate to refer to this as a failed hair transplant. I think we need to be very clear about this. I look forward to speaking to you again. Best wishes, scott.

[PizzaWolf]

7 hours ago, baalloss said:

Thank you all for your replies. They are really helping me to understand the situation better and helping me prepare for the next steps.

My response to the questions are below :

" Did Dr. Lupanzula have any input about your hair loss situation during the initial consult?"

I'm not sure I understand the question, but I had a physical consult with Dr L and Scott on London in Feb, and the doctor examined my head and we spent about 30 mins together. He proposed a hair line, gave me an idea of the number of grafts etc etc. He didn't think there was any problem with my scalp, or hair type etc.

 

My question was pretty weak considering you asked for honest feedback, I was just trying to verify some things that sounded off to me.

Your hair loss doesn't look like standard MPB, and the age that it started for you (50 right?) is weird. The doctor giving you Dutasteride at the six month mark of your transplant sounds like he was panicking about your results, since, let's be real, if he thought your MPB was severe enough to require Dut that should have been prescribed before the transplant, not after.

As others have suggested, I don't think you have MPB, but some kind of scalp condition. IMO, you were rushed into a transplant by the doctor.

[Melvin- Admin]

6 hours ago, teeplant said:

I really find it shocking that the doctor will not look at your situation or provide any personal feedback until end of the 12th month. Most top doctors take the time to check up and evaluate progress at fixed intervals throughout the process and it really does not have to wait until month 12, particularly if at month 9 there is no evidence of new growth or any new grafts sprouting. Wishing you all the best @baalloss

The time frame is 12 months for a reason, there are cases or slow growth, and in some cases the hair grows well past 12 months. The timeframe of 12 months is there for a reason. Although, if the results don’t look as desired by 9 months it’s okay to reach out to the surgeon, to let them know what’s going on.

43 minutes ago, DenverBuff1989 said:

@teeplant the cynical part of me says doctors know a dissatisfied patient 3 months post-op is much angrier than a patient at 12 months post-op. Doctors say "give it 10+ months till I can assess", in the hopes the patient's anger cools down or the patient just accepts the loss and finds a different doctor to deal with

Well an angry patient at 3 months has no clue what their results will look like. It’s like hiring a contractor and complaining that your house looks like crap in the middle of a demo. Going around expecting to know your results at 3 months is ludicrous. It’s 12 months for a reason. Now, in your particular case, it was clear grafts were not placed in your hairline. That’s an issue that can be addressed right away. 

[mcr7777]

On 3/17/2020 at 3:54 PM, baalloss said:

Hi all,

In the spirit of ‘paying it forward’ here’s my review of my recent transplant with Dr Lupanzula.

Summary

Norwood 4, Aged 55. Had full head of hair till around 50.

FUE procedure, 2111 grafts, 4444 hair, on surface area of roughly 50cm2.

(Another procedure to be done in a year, for the crown and back of the head.)

Graft details :

                             FU’s       Hair

1 Hair                  443        443

2 Hairs                1086     2162

3 Hairs                509        1527

4 Hairs                78          312

Total     FU’s       2111     4444

Background:

Mid 50’s, started losing hair around 8 years ago. I had been thinking of a transplant for 3 years as my hair have been shedding with increasing speed. Now at Norwood 4 I would say and knew that this year I would have to pull the trigger. Denial, fear of pain, and the negative emotions associated with anything to do with hair loss kept me from doing it.

Anyway, I did some research – I read these and other forums. Read lots of reviews. Where are the negatives ones? There seem to be very few of those – so I wondered how many of the reviews are actually genuine?

Had a face-to-face consult with two very well know doctors. Met Dr Lupanzula in Feb in London, and I liked what I heard. Asked further questions via his assistant Scott, who was, and continues to be, very responsive and informative, without being pushy or ‘sales-manny’. A week later I signed up. They had a slot in 3 weeks’ time, and I looked forward to anxiety and sleepless nights till then.

 

The Event

My pre-op consult was the same day as my operation, and this was fine with me. Day started at 6:30am. Photos takes, hairlines drawn, blood samples taken for the blood tests, hair shaved off. Dr Lupanzula did all of these himself.

Around 9:00am is when the main event started. Scalp anesthetised, and I lie on my front whilst the doc extracts the follicles from the donor. This lasted around 2.5 hrs. Then followed the incision stage where the doc made the openings for the extracted follicles to be transplanted and this was fairly quick, maybe an hour or just over.

The final stage was the placings, which was done by two technicians and lasted for around 2.5 -3 hours.

The whole process was finished by 5:30pm, and I then joined the doctor for a chat, Q-and-A and a well-deserved baguette.

My experience

Pain – this was the ONE thing which had prevented me from taking action for 3 years cos someone ones said to me “Oh, my brother-in-law had a transplant, and he said it’s really painful”. Well, I had the complete opposite experience - practically no pain at all. The only tiny bit was when the injections were used to numb the scalp, and on a scale of 0-10 where 0 is “No pain”, I would measure mine at 2. It’s like having an injection when a blood sample of taken from the arm – there is a little prick that lasts a few seconds.

I am a real whoos when it comes to pain, so if you are like me, and have been holding back, then let me reassure you – if you pick the right doctor/clinic, then the pain is minimal. In fact, numerous times, during the day I fell asleep – at one point, both the technicians were laughing as my snoring became so loud that it even woke me up.

That night I was expecting throbbing of the head, but nope, nothing. The most painful part is having to sleep at 45% angle at night – I liken it to being on a long-haul flight in an economy seat, ie. inconvenient and fidgety, but not painful.

The next day, I was given a 1000mg paracetamol to take, but I didn’t need to take it as there was literally no discomfort at all.

Doctor/Clinic/Staff

I’m trying to not make this sound like a sales pitch, but here goes :

Wonderful. All three. The doctor is really relaxed and chilled and that calmed my nerves. We even shared a few laughs while he was drilling around my head, and I tried to impress him with my 10 word knowledge of the Swahili language. The facilities are very modern and well-equipped. The technicians are friendly, and one invited me to look through the microscope while he was separating my follicles. During the 2.5 hours of the placings stage, I was free to pick my favourite Netflix shows to watch while the technicians quietly did their job.

Support

Pre-booking : All the comms are via Scott, the client liaison chappie. He’s very responsive and provided me all the info I needed. All the forms, payments etc were done online very efficiently, and within two days  of me saying ‘Yes’, we had everything finalised.

During the day : the doctor is very open to discussion, didn’t rush at all, and answered all the questions I had in a rational manner. The support staff too are very polite, respectful, and helpful. I was of course, the only person being operated on during that day, and this was important to me.

Post-op : I asked if I could come back the next day so someone could show me how to wash my hair, and of course, they were very happy to do so. In fact, I would say, whichever clinic you use, make sure you go back the next day, so they can clean you up properly, and show you good maintenance techniques. The staff even offered to video me having my hair washed for my personal use when I return home.

I will keep in contact with the doctor and have 3 and 6 monthly face-to-face consults when he visits London.

I feel great right now. Just want the ugly-duckling stage to pass quickly, and I look forward to seeing the results.

If you have any questions, feel free to ask.

 

 

 

 

 

 

 

 

Definitely do a biopsy (don't have to wait - can do this now) - it will be worth it to rule out any scarring alopecia which generally causes bad growth (lichnen planopilaris, frontal fibrosing, etc)

Don't even think about a touch up without getting a biopsy and understanding what went wrong.  

 

[Huncholini]

Hey, do you have an update? Dr. Lupanzula is a surgeon I am considering.