Raphael84 - My Surgery - Dr. Bisanga BHR Clinic - 3466 Grafts - FUE 0 - 5 Months

[Raphael84]

In my own journey throughout the years and long before I was in my current role as patient advisor for Dr. Bisanga, I have spent many hours and found incredible value in this very forum. Being able to share frequent patient results from Dr. Bisanga is always a pleasure of mine and knowing that in doing so, it really adds to the essence of the community and can help to show what can be achieved.

With that being said, I am very happy to be able to present my own case and give back on a personal level.

In all honesty I did not intend to present my surgery photos until 12 months post op when I would have been nearer to my “final result”. This was because as many of you will know this was not my first surgery. I had previous strip surgery in 2012 (not with Dr. Bisanga) and was satisfied with my results at that time, however due to progressive hair loss, this meant that this surgery required "revisiting" the same area which was therefore not virgin scalp in the frontal half. Non virgin scalp means that quality of skin will be less due to making of previous recipient sites and subsequent scarring and this can have an impact on yield, and growth can oftentimes take longer to develop in repair surgery. I knew that I may have to be patient, but fortunately that has not been the case.

I had FUE surgery with Dr. Bisanga 5 months ago with the following objectives  -

*Rebuild my hairline and increase density through the frontal third
*Strengthen my temple points (as conservatively as possible)
*Reinforce my mid scalp and crown
*Place beard grafts into my previous strip scar (if possible)

This was a lot to ask in one surgery, especially considering my quality of candidacy.

In essence, any patient who is a candidate for hair restoration surgery does not have a “perfect” head of hair, but there are different levels to candidacy from excellent through to borderline and then obviously non candidate.
We often seen “hollywood” hairlines achieved on patients with focused loss and what would appear to be a great donor. That certainly isn’t my case and isn the case for many.

Challenges of surgery were -

*Larger pattern of loss/decline
*Retrograde alopecia (Dr. Bisanga explained that it is likely emphasised by my strip closure pulling my nape “higher”)
*Average/below donor density
*Below average hair groupings
*Fine hair
*Previous strip scarring

Surgery was always going to be challenging in terms of achieving the necessary graft numbers but I was well aware of this and understood that we may not have been able to have achieve all of my objectives. This really highlights how realistic expectations are key. As is my intention with all patients who I have the pleasure to communicate with, education is fundamental.

My surgery was scheduled over 2 days and I arrived in Brussels the days prior to my procedure for a thorough consultation using the state of the art equipment and software to allow Dr. Bisanga to assess the current status of my hair and scalp and discuss his approach.

Due to using oral minoxidil and finasteride, I was very pleased to hear that my donor was stable and without any signs of miniaturisation throughout. I discontinued meds several years back and lost quite a lot of ground at that time.

At 38 years of age, I wasn’t looking to lower my hairline at all despite it sitting high at over 8.5cm+ from the glabella. I really wanted to proceed as conservatively as possible in order to preserve as many grafts and achieve as much coverage as possible with an appropriate hairline as I age and inline with the shape of my face and considering my hair characteristics and donor specifics.

One concern that Dr. Bisanga did have was some potential scarring on my scalp.

Dr. Bisanga wanted to rule out any possible concerns such as scarring alopecia and decided to take a “punch” biopsy to remove a small tissue sample to be sent to the lab for testing. This then required a few stitches which were removed several days later. You can see the stitches in the post operative images and actually as this area did not receive any grafts to allow and encourage optimal healing, you can actually make out a weaker area in my recent photographs.

Fortunately my biopsy result came back without concern and without the presence of inflammation or scarring alopecia.

Surgery days went very smoothly as expected and after assisting many patients over the last years throughout their journey, it felt great to be taking my place in the chair. Dr. Bisanga explained that I had tough skin and I was burning through anaesthetic which meant the need for more numbing, but he reported easy harvesting despite my follicles sitting quite deep in my donor.

We didn’t want to push too heavily or aggressively on my donor as my hair is fine and we didn’t want to further expose my strip, and as with all of us, loss is progressive and being conscious of this it was agreed that we would harvest approximately 2400 from the scalp with further supplementation from my beard using it to great effect in placing into my mid scalp and crown. As expected, all of my beard grafts represented single hairs and due to this being my first beard session, it was decided not to push far beyond 1000 grafts to allow a good distribution in terms of extraction sites and ensure optimal healing.
With this being the approach, I was always going to fall slightly short in terms of placing grafts throughout my entire previous strip scar, and so therefore it was decided that we would commit to one side of the scar (approximately 260 - 300 grafts) which was still a bonus. Not the standard approach but in my case, it presented a great opportunity to be able to see yield throughout my scar tissue and at a later date, be able to return for further surgery, shave down and really understand and present what beard into strip scars can achieve by comparing both sides.

Healing was very straightforward. I am obviously well versed in our post op care but instructions are simple and all products are provided in the post operative kit and despite a few initial “uncomfortable nights” as expected, recovery was generally quite quick. In fact, I was working and responded to patients in the evening on my surgery days.

Being completely transparent, I was in no way expecting such early growth. Especially as despite a significant graft count, hair count with beard was lower and this was placed over a larger surface area, therefore I was/am extremely pleased to see density come in so quickly. Even now, improvement continues and I have several months to go.
I am absolutely thrilled and not having to think twice about your hair when you wake in the morning really does have an impact on your day to day life and not having to worry regarding product and styling etc is a game changer.

A big thank you to Dr. B and his team of amazing technicians and a shout out to all my colleagues at BHR who have shown their support. It is a special clinic and one that I am very proud to be part of.

On a personal level, I genuinely get great satisfaction from supporting patients on their journeys and am thrilled to see their response and how their confidence grows and impacts many facets of their lives.
I can honestly say that it has been a hugely positive experience and my results at this early stage speak for themselves and I couldn’t be happier.

Many other patients have taken similar steps in their own hair restoration surgery and I remember the first forum case that I read some 15+ years ago. It was overwhelming, daunting, interesting and very exciting to see that there is hope, and there will be individuals who are reading cases today for the first time. Such communities are integral in the journey of many patients, it certainly was mine and I felt it important to continue to pay it forward and support the community.

—

BHR Clinic

Dr. Christian BISANGA
Technique: FUE
Donor density: 70/70 FUs/cm2

Breakdown of grafts:-
2366 Scalp Grafts + 1100 Beard Grafts (Single hair)
1s - 1714
2s - 1341
3s - 411
Total Grafts :- 3466

Total Hairs :-5629

Average Follicular Unit (Scalp) = 1,91 hairs
Average Follicular Unit (Scalp + beard) :- 1.62 hairs

PRE SURGERY FRONT

 

TOP ELEVATION

PRE SURGERY RIGHT

PRE SURGERY LEFT

PRE SURGERY REAR

PLACING LEFT VIEW

PLACING RIGHT VIEW

PLACING WITH BIOPSY 

DONOR REAR

DONOR LEFT

DONOR BEARD

 ]

5 MONTHS POST SURGERY

LEFT 5 MONTHS 

RIGHT 5 MONTHS

TOP 5 MONTHS

REAR DONOR

COMPARISON 5 MONTHS

[SLA]

Wow, Ian- These results are absolutely outstanding and you did such a great job in explaining your journey and challenges. I am sure you are over the moon with delight!

Is there a reason you opted for FUE rather than going for a 2nd strip?

 

[Britanium]

Just stunning. And possibly the most detailed account of a transplant i have ever seen ! 
Thanks so much for the excellent write up. A enjoyable read/journey 👍🏼

[sl]

Ian this is a tremendous transformation even now and far still far from the final product and especially for 5 months. As a repair patient and going over a whole area again makes it even more incredible.

You have really come on week by week and I am always happy for all our patients who get such fast growth and adding to it that we work together brings a lot of pride and joy also.  I know how much this meant to you and already the changes it has afforded are immeasurable.

You are truly lovely person to work with and very passionate and knowledgeable but in the chair you were a patient and I am just so happy for you my friend and looking forwards to the updates!

 

 

Edited July 30, 2021 by sl

[Melvin- Admin]

Looks incredible Ian, it’s my understanding you had surgery over 10 years ago with Dr. Rahal, what did you look like before any surgery?

[Winston_Radical]

If this is after only 5 months, imagine what it will look like after 12! Beard looks untouched too.

[ITA]

Let me first say  that I consider Dr. Bisanga one of the best surgeons in the world of hair transplants, congratulations to you for the excellent writing, as well as the result that you have already obtained at only 5 months. @Raphael84 I want to ask you, did I read that Doctor Bisanga visited your scalp and did a biopsy as well, but he does it with all patients, or did he only do it with you because you are one of his consultants?

Edited July 30, 2021 by Egy

[Parasol]

Wow what a transformation! I’m very excited for you and appreciate everything you do for the forum and for your patients.

2 quick questions. What would you say would be a realistic goal percentage for graft survival in a non-virgin scalp when revisiting an area?

If you had had scarring alopecia, could the surgery have commenced as planned? If so, what would the challenges and expectations have been?

Again, thanks for all you do. I’m very excited for you. You look amazing at just 5 months.

Edited July 30, 2021 by Parasol

[Ajamilo]

Wow this is incredible for just 5 month. You are really awesome and helpful guy so I think everyone is happy now hehe

[A Fue Good Men]

Congrats Ian, looking fantastic.

[Raphael84]

Thank you for your interest and support guys.

23 hours ago, SLA said:

Wow, Ian- These results are absolutely outstanding and you did such a great job in explaining your journey and challenges. I am sure you are over the moon with delight!

Is there a reason you opted for FUE rather than going for a 2nd strip?

 

I didn't really consider a second strip and based on my scalp laxity and the fact that the closure had pulled and exacerbated the appearance of retrograde and also caused some changes if angles to surrounding follicles, a further FUT  would only "intensify" this.

22 hours ago, Egy said:

I want to ask you, did I read that Doctor Bisanga visited your scalp and did a biopsy as well, but he does it with all patients, or did he only do it with you because you are one of his consultants?

Not at all. The intention was never to have a biopsy. This actually added an extra "concern" at the time and resulted in having to skirt around the area of the biopsy when placing so was more of an inconvenience. 
Dr. Bisanga wanted to rule out scarring/cicatricial alopecia due to some scarring that he could see under magnification. Scarring alopecia is where the hair follicle is targeted in a destructive inflammatory process which essentially kills the hair follicle. 

21 hours ago, Parasol said:

2 quick questions. What would you say would be a realistic goal percentage for graft survival in a non-virgin scalp when revisiting an area?

If you had had scarring alopecia, could the surgery have commenced as planned? If so, what would the challenges and expectations have been?

Again, thanks for all you do. I’m very excited for you. You look amazing at just 5 months.

In terms of graft survival in non virgin cases, this is very case specific. Dr. Bisanga is able to achieve very successful yield in many of his repair patients, but the physiology of the skin is different than it was before any surgery and therefore it can and does respond differently. Obviously there are many "levels" to repair surgery and potentially compromised skin and scarring and so the extent of the damage to the skin can be relative to what may be expected in terms of yield.

Generally if scarring alopecia is present then the patient would be referred to a specialist dermatologist for further investigation and to see if treatment may be able to help or be effective. The concern with scarring alopecia is that it is not curable and surgery itself can trigger the condition further, so this must be well understood by the patient and knowing that it could occur again at any time. Oftentimes due to when weighing up the risk/reward ratio, most individuals with such a type of hair loss would not be good candidates for surgery.

22 hours ago, Melvin- Moderator said:

Looks incredible Ian, it’s my understanding you had surgery over 10 years ago with Dr. Rahal, what did you look like before any surgery?

Thanks so much Melvin. When I arrive at the 12 month stage, I intend to put together a more detailed presentation of my personal journey from pre any HT. 

Edited July 31, 2021 by Raphael84

[Moe N]

This is remarkable! Reading through your post, I am amazed at the thorough and meticulous approach that Dr. Bisanga took to rule out any potential concerns before conducting the surgery. A top-notch result from a world-class surgeon! Thanks for sharing 😊🤟

[aaron1234]

@Raphael84 If this was a 12 month result we'd all be congratulating you - at just 5 months it is simply stellar!  Great detailed write-up (I learned a few things from it) and happy to see someone who gives so much to the community enjoy a fantastic result.  Bravo Dr. Bisanga and congrats! 👏

[Raphael84]

UPDATE AT 6.5 MONTHS!!!

I wanted to thank each of you for your above comments and support and provide an update as I have now surpassed the 6 month post surgery stage.

I have been fortunate enough to have seen further improvement over the last month or so and the quality and feel of my hair continues to improve. My hair feels as though it has real structure and body to it and is in all honesty this is the best my hair has been since my teenage years.

In terms of day to day life, there is no styling to conceal or styling to improve the illusion of density any more. Now it is genuinely styling to preference and the freedom that this allows is a great feeling.

Again, if this was my final result I would be ecstatic, but with several months to go I do look forward to see how things will continue to mature.

 

[Britanium]

Absolutely stunning 🤩 jeez that’s already a full on result ! How much better can it get ? Can’t wait to find out 😉

[Curious25]

Amazing  !! 

[sl]

Yes,  I echo, amazing and so natural....really has come on from last month also...You can hear the density as you touch it..Very happy for you mate and you knew you were in good hands and to top it off this was a repair! 

[SLA]

WOW!

[Moe N]

On 9/4/2021 at 8:50 AM, Raphael84 said:

UPDATE AT 6.5 MONTHS!!!

I wanted to thank each of you for your above comments and support and provide an update as I have now surpassed the 6 month post surgery stage.

I have been fortunate enough to have seen further improvement over the last month or so and the quality and feel of my hair continues to improve. My hair feels as though it has real structure and body to it and is in all honesty this is the best my hair has been since my teenage years.

In terms of day to day life, there is no styling to conceal or styling to improve the illusion of density any more. Now it is genuinely styling to preference and the freedom that this allows is a great feeling.

Again, if this was my final result I would be ecstatic, but with several months to go I do look forward to see how things will continue to mature.

 

Thanks for sharing your amazing progress. Also great to see you at the instalive with Dr. Bisanga 😃🤟

[aKaWonderKid]

Does anyone know what bisangas waiting time is

[Gatsby]

What an excellent write up Ian. At 5 months you have achieved an incredibly impressive and natural result already. Lots of more happy days of growth even still!! Thanks for sharing!

[Raphael84]

5 hours ago, Moe N said:

Thanks for sharing your amazing progress. Also great to see you at the instalive with Dr. Bisanga 😃🤟

Thank you @Moe N
 

1 hour ago, aKaWonderKid said:

Does anyone know what bisangas waiting time is

@aKaWonderKid
By all means send me a dm or email and we can discuss your case with Dr. Bisanga and provide specifics and potential dates. Currently scheduling is completing its final dates in 2021 with more availability beginning in the second half of January 2022.

14 minutes ago, Gatsby said:

What an excellent write up Ian. At 5 months you have achieved an incredibly impressive and natural result already. Lots of more happy days of growth even still!! Thanks for sharing!

Appreciate your support and kind words @Gatsby. Thank you.

[Raphael84]

It has been a few months since my last update, and so I am thrilled to be able to present my current situation at 10 months post surgery.

As you may know from my previous updates, I was very fortunate to experience great early growth with density being achieved in those first 6 months which was much more than I expected. 

The last several months have allowed my hair to mature and settle further and it is great to be able to play around with lengths and styles and simply have more confidence day to day in all situations.

You honestly can't underestimate the impact that such a transformation has and your new hair quickly becomes the norm. That is not to say that you forget your starting point or your journey, but as the process was so seamless and after the initial healing you are quickly back to your pre op status, the evolution is just very natural. 

As per my initial post detailing the challenges that my case presented including average/below donor density, below average hair groupings and fine hair, this just adds to the magnitude of what has been achieved. My donor looks and feel as it did pre surgery and I am very happy to be heading into my 40s with the head of hair that I currently have.

With medication the status of my hair is stable and long may that continue, but in summary at 10 months post surgery, results have surpassed my expectations and I couldn't be more happy. 

A big thank you to Dr. Bisanga and the BHR team.

 

 

 

[sl]

 

Great improvement Ian and really natural looking..you have certainly got an enviable head of hair now!

 

[Gatsby]

Wow Ian. You would have no idea that you have had surgery and the incredible natural result is testament to that! Thanks for sharing and incredibly happy for you!