Dr Bruno Ferreira - 2882 grafts - Diffuse Thinner

[LondonRamen]

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.

Edited November 26, 2020 by LondonRamen
changed content to be more accurate

[LondonRamen]

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

Edited November 19, 2020 by LondonRamen

[UnbaldEagle]

I love the hairline design. Also looks like very clean and professional work. Happy growing!

[Rolandas]

Glad to see hairline wasn't lower too much as you could expect from shit Turkish places. Very appropriate design which will work long term + enough available grafts for the future.

My donor in the mid area healee extremely quickly too. On my second day of surgery when I came in they immediately noticed that my donor scars are closed down in central area.

Looking forward for your updates!

Edited November 19, 2020 by Rolandas

[MachoVato]

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!

 

[LondonRamen]

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.

Edited November 19, 2020 by LondonRamen

[Mycroft]

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.

Edited November 19, 2020 by Mycroft

[LondonRamen]

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.

Edited November 19, 2020 by LondonRamen

[LondonRamen]

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!

[Rolandas]

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!

[LondonRamen]

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.

 

 

Edited November 19, 2020 by LondonRamen

[Rolandas]

24 minutes ago, LondonRamen said:

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.

 

 

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)

 

[LondonRamen]

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!

[Mycroft]

From what I understand he has a relatively low daily graft count per day. If I remember your thread correctly @Rolandasyou had around 3,500 but spread over two days. If a small punch size is being used and total punches per day is kept low, possibly this leads to a faster healing time because the total scalp trauma at one time is kept to a minimum.

 

[Rolandas]

1 minute ago, Mycroft said:

From what I understand he has a relatively low daily graft count per day. If I remember your thread correctly @Rolandasyou had around 3,500 but spread over two days. If a small punch size is being used and total punches per day is kept low, possibly this leads to a faster healing time because the total scalp trauma at one time is kept to a minimum.

 

This can be it! Makes absolute sense. Punch size is pretty standard, but less trauma per day, thus body can recover easier and faster. Didn't come to my mind

[Melvin- Admin]

@LondonRamen

Thank you for sharing your review, this is gonna be exciting in 6 months 👍🏼
 

@Mycroft

In my experience, my first procedure I had 0.8mm punch and a total of 1,800 grafts carried over two days. The healing was about the same. Unfortunately, the results were not that good. But I do think allowing an extra day or two does help with the scabbing. 

[Rolandas]

1 hour ago, Melvin-Moderator said:

@LondonRamen

Thank you for sharing your review, this is gonna be exciting in 6 months 👍🏼
 

@Mycroft

In my experience, my first procedure I had 0.8mm punch and a total of 1,800 grafts carried over two days. The healing was about the same. Unfortunately, the results were not that good. But I do think allowing an extra day or two does help with the scabbing. 

Interesting...

Do you think Melvin it's due to patient healing ability, or there's something more to it thats happening during the surgery? I'm just genuinely curious.

[deitel130]

@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? 

[Nounours]

Looks fantastic! Dr Ferreira gave me a similar classification of hair loss and I've got a HT booked with him next year so I will be keenly following your progress. Happy growing!

[Melvin- Admin]

46 minutes ago, Rolandas said:

Interesting...

Do you think Melvin it's due to patient healing ability, or there's something more to it thats happening during the surgery? I'm just genuinely curious.

We all heal differently, I healed relatively quick in all of my procedures, my scars were similar as well. The benefit of doing a procedure in two days, as opposed to one is to allow the scabs to heal, which would make it look better in pictures. 

[LondonRamen]

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

Edited November 19, 2020 by LondonRamen

[Curious25]

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

[LondonRamen]

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.

Edited November 20, 2020 by LondonRamen

[LondonRamen]

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

[Melvin- Admin]

Looking good man 👏🏼