Dr. Bruno Ferreira - 2nd Surgery. 2881 Grafts | 6540 Total. NW5a

[Rolandas]

I had my 2nd FUE Hair Transplant surgery done with Dr. Ferreira in Portugal on 03/06/2021 & 04/06/2021 (2 day surgery).

Since it's not my first post, I won't get into much detail about why I chose him and how he operates. You can find more information on my first post from 1st surgery.

On my first surgery I had done only frontal third, so remaining mid scalp and crown were still bare. This was of course the plan all along - 2 step approach.
2nd surgical goal - increase density in frontal 1/3, fill in mid scalp & crown and reinforce existing temple points. More info in here.

Here's my before & after 1st surgery shaven. 

Footage of recipient & donor area here.

(I do apologise for quality of pictures. I should receive pictures from Dr. Ferreira in upcoming weeks).

It wasn't a huge surgery, just 2881 grafts, but over 2 days. During my last surgery I had over 50% of popping due to my very elastic skin & excess bleeding, so Dr. Ferreira wanted to take it slow this time and make sure it's very well under control. This time, he said it was only about 5% as he was implanting the grafts in stages - about 500-600 grafts at a time and spreading implantations at a time.

First day we finished with 1231 grafts (3686 hairs & 2.99 ratio).

Dr. Ferreira said my donor has very minimal to no miniaturisation. He actually tried to find one under microscopic evaluation upon my request but couldn't see a clear example.

Day 1 finished. Main focus - reinforcing frontal 1/3 as well as mid scalp.

Day 2 same process. 1650 grafts (4562 hairs & 2.76 ratio).

Grant total - 2881 grafts (8248 hairs & 2.86 ratio).

These are approximate numbers - Frontal 1/3 - 700 grafts, Temple Peaks - 100 grafts each side, Mid scalpp & Crown - 1900-2000.

My overall thoughts and overview of the surgery in video format on my YouTube channel is here.

 

Dr. Ferreira estimated I've got about 2000 grafts in the donor available for next surgery should I need. This of course should be done carefully in order to preserve donor.
So far donor area looks pretty good. There's a lot of hairs in between extractions from both 1st & 2nd surgery. I did a small analyze with close-ups in here.

Overall I'm very happy with the way it's been done and the way it looks. So far following my post-op instructions and hoping for the best!

I'm posting a lot of updates on my YouTube Channel if someone would like to know & see more about my surgery and my recovery.

 

I will post here pictures as soon as Dr. Ferreira will send them over to me.

Edited June 7, 2021 by Rolandas

[Rolandas]

Oh, by the way. I've asked Dr. Ferreira as a joke during the surgery if he has seen 7 hair graft before, to which he replied "Oh yes, of course. As a matter of fact I just implanted few 6's & 7's into your scalp".

This was of course a surprise to me as he isn't documenting those. It's simply not that many and will take unecessary space on his screen during the surgery.

On my 2nd surgical day I've asked to take a picture for me of 6's or 7's hair graft should they find. Sadly Occipital area is the best of course, and this was done during the first day, but frankly they have found one 6 hair graft. Looks cool!

[asterix0]

great writeup @Rolandas and happy growing! 

How is your donor feeling, any discomfort? 

I thought your frontal third looked really good from your earlier videos, what made you want to strengthen it versus putting those grafts into your midscalp/crown? Unless Dr.Ferreira thought 2000 was good enough to give the illusion of full coverage in your midscalp/crown?

 

 

[Rolandas]

5 minutes ago, asterix0 said:

great writeup @Rolandas and happy growing! 

How is your donor feeling, any discomfort? 

I thought your frontal third looked really good from your earlier videos, what made you want to strengthen it versus putting those grafts into your midscalp/crown? Unless Dr.Ferreira thought 2000 was good enough to give the illusion of full coverage in your midscalp/crown?

 

 

Thanks. I'm trying to balance everything right now (recovery, filming & editing videos, answering emails & messages), so didn't really put that much effort into this write up

I have 0 pain since day 1. Never had any discomfort in any part of my scalp, so yeah.. Healing extremely well so far!

My crown closed a bit due to Finasteride (a lot of improvement from Month 6 to Month 23), so required less grafts than he originally thought.
My mid scalp gained quite a few hairs too, but these are very thin, miniaturised. He said they will still impact overall look, so he implanted around them.

I'm planning to start oral minoxidil, so this should help these hairs too. And overall, mid scalp doesn't require a lot of grafts/cm2 to create illusion of density, unlike hairline & crown.

I've got a gut feeling that I would like to have another 1000 spread all over, but think it's hair greed. Nontheless if everything will grow well and oral minoxidil will work without sides, then I'm sure it will be a huge turn around.

Edited June 7, 2021 by Rolandas

[asterix0]

Yes, I think that if the hairs are combed forward, actually the hairs from the crown area will add additional layering into the midscale when they are grown out, thus needing less grafts for coverage.

Why do you want to start oral vs 5% topical? Im guessing you are planning 5mg split into 2.5mg twice a day?

[asterix0]

A consultation with a very reputable surgeon recently said that he definitely recommends 5% minoxidil after surgery because it helps bring blood flow to the grafts and helps with yield/graft survivability. 

[Rolandas]

Will start from 1.25mg/day and see how it goes. I know what kind of results i can expect from topical, so I want to explore oral route.

[BLE123]

The recipient looks very natural even when shaved down but the donor scarring seems quite apparent, how do you see it Rolandas? I guess you're unlikely to ever have your hair that short again though so not really a concern.

[teeplant]

@RolandasI saw that the Dr suggested that you might have minor keloid scarring but this doesn't look the case to me. Hard to tell from the video? Keloid scar are usually raised. Do you feel any bumps?

[hairlossPA]

will be following

[Rolandas]

21 minutes ago, BLE123 said:

The recipient looks very natural even when shaved down but the donor scarring seems quite apparent, how do you see it Rolandas? I guess you're unlikely to ever have your hair that short again though so not really a concern.

Scar tissue is indeed very white. It seems like there's literally 0 pigment. Strange as it was much better at month 6-8 (after that I stopped looking at my donor).

Nonetheless I don't mind to limit myself with slightly longer hair on the sides and have great looking head of hair on top. No point of skin fade with horse shoe pattern haha

[Rolandas]

20 minutes ago, teeplant said:

@RolandasI saw that the Dr suggested that you might have minor keloid scarring but this doesn't look the case to me. Hard to tell from the video? Keloid scar are usually raised. Do you feel any bumps?

Indeed he said its "something like minor keloid". It's slightly raised. I can't tell you right now for sure as I'm trying not to touch my donor, but I haven't even thought about it before the surgery! Never came to my mind.

He gave me a good analogy with other scars on my body. They are all slightly raised (and I've got many), although not as white.

[teeplant]

@RolandasIn any case, you got an excellent and natural result from your first surgery, and wish you all the best on your second. Your videos are very frank and informative! Keep it up!

[BjornBorg]

Let's go. Following.

[hairlossPA]

6 hours ago, Rolandas said:

how does someone implant that 6 graft grouping? they're all at different heights. implanting it as a full grouping of 6 would mean 3 bulbs are a significant amount below the other 3 bulbs

[Rolandas]

19 minutes ago, hairlossPA said:

how does someone implant that 6 graft grouping? they're all at different heights. implanting it as a full grouping of 6 would mean 3 bulbs are a significant amount below the other 3 bulbs

That's an interesting question! I will see tomorrow Dr. Ferreira. Will ask him! (NERD GANG haha)

[Curious25]

I've been catching up on your videos over the last week, the content is great - I was really impressed with your final results from your first surgery and the way you were able to style your hair with the hair band, it worked really well.

No doubts this will leave you with a killer head of hair, so all the best, and keep up with the documentation!

[Rolandas]

24 minutes ago, Curious25 said:

I've been catching up on your videos over the last week, the content is great - I was really impressed with your final results from your first surgery and the way you were able to style your hair with the hair band, it worked really well.

No doubts this will leave you with a killer head of hair, so all the best, and keep up with the documentation!

Thank you kindly!

[RandoBrando517]

How much did you pay this time around? Did you get any discounts since you’re indirectly giving Dr. Ferreira a ton of free exposure. I didn’t know of him before seeing you here and YouTube 

[Rolandas]

8 minutes ago, RandoBrando517 said:

How much did you pay this time around? Did you get any discounts since you’re indirectly giving Dr. Ferreira a ton of free exposure. I didn’t know of him before seeing you here and YouTube 

I paid €5200 for the surgery itself. It was 2€/graft (at an old rate, 2€/graft after 4000 grafts). Dr. Ferreira indeed gave me 281 grafts for free too say thank you for exposure.

I didn't try to negotiate. I just said "give me the number and I'm transferring the money right now". At the end I wouldn't mind to pay full price of 3€/graft as he is charging right now for the first 4000 grafts. To me what matters are results.

[CosmoKramer]

Results came out great and this 2nd HT work looks real good, great planning!

Nice job on your videos as well man!

[shami26]

It looks good so far. I'm subscribed to your Youtube.

[Gatsby]

Well done Rolandas! I'm sure that this second surgery will follow the same path of your first surgery. That being the case then you will get great coverage and natural results. Do you know what size punch Dr Ferreira uses? Thanks for sharing!

[Britanium]

2nd Ht 🤩Woop Woop. We can look forward to some of your awesome videos and very detailed posts 👌 really hope this will give you as good as result as your first Ht. loved following that journey and your ever improving video skills 😉

[Rolandas]

1 hour ago, Gatsby said:

Well done Rolandas! I'm sure that this second surgery will follow the same path of your first surgery. That being the case then you will get great coverage and natural results. Do you know what size punch Dr Ferreira uses? Thanks for sharing!

Thanks Gatsby! Definitely hoping for good survival!

Dr. Ferreira was using 0.8mm & 0.85mm punch sizes on both first & second surgeries (both motorised & manual). He said he could really go lower than that for me, even though I have fine hair, my grafts are growing in kind of straight line as opposed to just in 1 bunches, so surface area is slightly wider than it could have been. He said technically its possibly but he doesn't want to compromise graft survival due to less supportive tissue.