Repair work, does 3000 grafts sounds resonable, what do you guys think?

[Rickard_c]

Hi everyone!

Been reading on this great forum for about a year now, thank you for everything guys. I never commented anything though, mainly since I dont consider myself enough educated on the subject.

However, I'm now planning to do my own repair hair transplant. I will probably go with Dr Bruno Ferreira, and I'm planning to post my journey here. Figured it might be desirable since there aren't that many Ferreira-journeys on the forum.

Anyhow, really quick backstory: I've had two generally bad hair transplant (2016 and 2018), made by no-name cheap clinics (very stupid of me, but what's done is done...). It doesn't look terrible, but definitely not good either. My biggest problem is my hairline which looks unnatural, mainly because of the see through, angulation, hair follicle type and the lack of temple points (not much is actually good about it..).

I'm aware that my situation is quite complexed, but I've spoken to several of the best clinics in Europe (via email, whats app and phone) about my situation (I'm living in Europe and planning to do the procedure in Europe). A few stated that they dont want to take on the challenge, a few needed to see me in person before making a statement regarding if anything can be done and a few said something most likely can be done but exactly what can only be determined after seeing me in person.

I also got a few in depth answers though, and Bruno Ferreira was one of them. Bruno was also one of the surgeons I was hoping for most beforehand. I there for have decided I most likely will to go with him.

The plan is to partly remake the hairline, by removing some hair (a couple of hundreds grafts) and transplant new hair in the area where they've been removed. I will also like to make the hairline more dense and rebuild the temple peaks. Bruno says it will be done with at least 2 procedures, maybe 3, and we will be using a couple of hundred beard grafts (Bruno was the only one suggesting also using beard grafts). He also says that the procedure will be a bit of improvisation and that it’s hard to give an estimate on how many grafts who will be needed, but he says he like to get close to 3000 or more (between, re-implanted grafts, beard and scalp hair).

My initial thought was that 3000 grafts sounded abit much. The other surgeons stated that around 1000-2000 probably would be enough, for example. I guess its not a bad thing that Bruno thinks 3000 is needed though, it just shows that he is very thorough. There is a pretty big price difference though, so I'm just wondering what you guys think? Do you think 3000 grafts sounds resonable?

/Rickard

[Britanium]

Dr B Ferreira seems a very good fit for you. Based on what I can see then 3000 grafts is more than enough though. Maybe he will be able to achieve a more natural hairline and certainly get better density in 2 procedures at the most. Your right the work is poor and it’s definitely going to take a skilled Dr and a good plan to get back on track. Look forward to seeing you post your result. We do need more Dr Ferreira cases. Thanks for the detailed back story ! 🙏

Edited August 23, 2021 by JohnAC71

[JayLDD]

I personally don't see how this requires 3000 grafts and have seen plenty of repair cases which are one and done. Fair enough to suggest that there is more uncertainty with a repair but stating that there is "minimum 2-3" procedures doesn't sound necessary to me. 

Depends on your donor, but imo I also wouldn't assume you'd need to remove any grafts to begin with, even a slight lowering of the hairline to place single hairs at the front wouldn't take the graft number up to 3000.  Maybe just at the corners where the frontal hairline meets the sides which currently is quite unnatural.  Depends very much on the donor but the mention of beard hair and a few hundred sounds more like a tactic to charge more than it does a necessity for your case. 

Would also forget temple points entirely for now, yours currently don't look that bad and certainly not unnatural with reference to the current hairlines height. Temple points are by far the hardest area to achieve naturalness in and its possible you might only end up with further problems to correct. 

I've seen cases of patients in a worse position than you are currently through 1500-2000 grafts in a single procedure looking almost perfect.  Not that I think he isn't a competent surgeon, but I'd want a much broader variety of consults to make a decision off before I came to the conclusion that this was the optimal approach. In my opinion the repair is a 1 procedure job (if the procedure goes smoothly and with some luck on your side) and the temple points are a consideration for a future procedure beyond that because the reality is that currently they're not a huge problem. 

[A Fue Good Men]

I agree with most on here. I think 3000 is too much for your case. I would consult with a few more doctors and get their opinion. Good luck

[MachoVato]

There are many threads on here of repair work. Look at Bisanga and Mwamba in Belgium. Or De Freitas in Spain.

Start here...

https://www.hairrestorationnetwork.com/search/?q=repair&quick=1&type=forums_topic&search_in=titles

 

[Rickard_c]

Thanks for your respons guys. I'll attach a picture on my donor area. As you can see its partly over harvested, whereas the lower part isn't even touched.

Dr Ferreira seems like a very good and careful surgeon. However I was also thinking that 3000 grafts sounded pretty much. I wanted to confirm that it wasnt only me who made that conclusion. 

I did mentioned in my consultation request though that if there was any grafts left in my donor area, I'd be happy to also make the crown more dense (as you can see on picture below its thinning on crown as well). I now noticed that Bruno actually wrote this in his very long and thoroughly consultation response: "We could, for example, remove the worse grafts from the hairline and implant them in the midscalp or frontal third, extract from the donor in the areas that have the most density to help even it out and consider using beard hair to further improve the density in the midscalp. We will also need to rebuild those temple peaks."

I suppose maybe the extra grafts Bruno thinks will be needed is because he's the only one of the surgeons Ive spoken to who considering filling the crown?

Anyhow, I'll ask Dr Ferreira about where he thinks the grats will go.

I consulted with the Bisanga-team who said that they needed to see me in person before making any statement, but that they problably would be able to make it look much better.

HLC stated that they didnt recommend to remove already transplanted hair. Then they concluded that they could get about 1000-1400 from my donor area. They recommended to use those grafts to make the hair line more dense. 

I also spoke to Dr. Lupanzula who said about 1000 grafts, with out temple points, by lowering the hair line a couple of m.m. or removing and re-transplanting grafts (would result in about the same amount of grafts), plus around 300 for temple points (not sure if its 300 per side, or 300 in total, but I think 600 in total).

Mwamba said that about 1300-1900 grafts would be needed. His plan was to lowering the hair line on both sides, make the middle more dense and rebuild temple points. 

I didnt get any answer from Dr Feriduni-team even though I emailed them a couple of times. Just got the answer "we're working on it". Sended in my consultation request about 10 months ago now.

HDC-clinic didnt think it was worth the risk of making it look worse, they therefore adviced me not to do anything at all.

Dr Keser didnt want to do anything either.

Didnt speak to De Freitas, but he is abit pricier as I understand? I heard waiting time for surgery is very long too? Might be wrong though? Does anybody know?

Regarding lowering the hair line, I would very much like to avoid that. In fact, I think the hair line is to low as it is now already, way lower than what it was before I started to lose hair, I hardly recognise myself... In fact, my plan is rather to raise the hair line a little, by removing a couple hundred grafts (I know it will leave smal scars, but I'm ok with that).

Regarding the temple points I would like to rebuild those mainly because the outer layer consists of very light blonde baby hair. My hair line used to consist of the same type of blonde baby hair which made the face look very natural and balanced. Now, whith the transplanted darker hair and prominent har line mixed with the not so prominent temple points, it looks kinda strange, specially from in front, my forehead looks much wider than before (se picture below). I will however take your advice into consideration, thank you. I could just do the temple point in the future, after all. On the other hand, I would really much like if this could be my last hair transplant.

The reason for doing 2 procedures is for trying to avoid not being overly aggressive which would only cause more scarring. The first one will consist of remove the worse grafts from the hairline and implant them in the midscalp or frontal third. Then the skin needs to heal whereas the second procedure will be the construction of hairline etc. The 3rd one might not be neccecary. Its just a "back up" to do eventual smal adjustment/fill-ins.

[JayLDD]

2 hours ago, Rickard_c said:

Thanks for your respons guys. I'll attach a picture on my donor area. As you can see its partly over harvested, whereas the lower part isn't even touched.

Dr Ferreira seems like a very good and careful surgeon. However I was also thinking that 3000 grafts sounded pretty much. I wanted to confirm that it wasnt only me who made that conclusion. 

I did mentioned in my consultation request though that if there was any grafts left in my donor area, I'd be happy to also make the crown more dense (as you can see on picture below its thinning on crown as well). I now noticed that Bruno actually wrote this in his very long and thoroughly consultation response: "We could, for example, remove the worse grafts from the hairline and implant them in the midscalp or frontal third, extract from the donor in the areas that have the most density to help even it out and consider using beard hair to further improve the density in the midscalp. We will also need to rebuild those temple peaks."

I suppose maybe the extra grafts Bruno thinks will be needed is because he's the only one of the surgeons Ive spoken to who considering filling the crown?

Anyhow, I'll ask Dr Ferreira about where he thinks the grats will go.

I consulted with the Bisanga-team who said that they needed to see me in person before making any statement, but that they problably would be able to make it look much better.

HLC stated that they didnt recommend to remove already transplanted hair. Then they concluded that they could get about 1000-1400 from my donor area. They recommended to use those grafts to make the hair line more dense. 

I also spoke to Dr. Lupanzula who said about 1000 grafts, with out temple points, by lowering the hair line a couple of m.m. or removing and re-transplanting grafts (would result in about the same amount of grafts), plus around 300 for temple points (not sure if its 300 per side, or 300 in total, but I think 600 in total).

Mwamba said that about 1300-1900 grafts would be needed. His plan was to lowering the hair line on both sides, make the middle more dense and rebuild temple points. 

I didnt get any answer from Dr Feriduni-team even though I emailed them a couple of times. Just got the answer "we're working on it". Sended in my consultation request about 10 months ago now.

HDC-clinic didnt think it was worth the risk of making it look worse, they therefore adviced me not to do anything at all.

Dr Keser didnt want to do anything either.

Didnt speak to De Freitas, but he is abit pricier as I understand? I heard waiting time for surgery is very long too? Might be wrong though? Does anybody know?

Regarding lowering the hair line, I would very much like to avoid that. In fact, I think the hair line is to low as it is now already, way lower than what it was before I started to lose hair, I hardly recognise myself... In fact, my plan is rather to raise the hair line a little, by removing a couple hundred grafts (I know it will leave smal scars, but I'm ok with that).

Regarding the temple points I would like to rebuild those mainly because the outer layer consists of very light blonde baby hair. My hair line used to consist of the same type of blonde baby hair which made the face look very natural and balanced. Now, whith the transplanted darker hair and prominent har line mixed with the not so prominent temple points, it looks kinda strange, specially from in front, my forehead looks much wider than before (se picture below). I will however take your advice into consideration, thank you. I could just do the temple point in the future, after all. On the other hand, I would really much like if this could be my last hair transplant.

The reason for doing 2 procedures is for trying to avoid not being overly aggressive which would only cause more scarring. The first one will consist of remove the worse grafts from the hairline and implant them in the midscalp or frontal third. Then the skin needs to heal whereas the second procedure will be the construction of hairline etc. The 3rd one might not be neccecary. Its just a "back up" to do eventual smal adjustment/fill-ins.

From what I'm aware Freitas is a similar price to the average of other options mentioned. Repairs might be a different story however. Also I think his waiting list is lengthier than average.

When I say lowering the hairline I don't mean in the sense of explicitly attempting to do this or anything significant, but rather placing a layer of singles at the front rather than extracting multigrafts. I would absolutely recommend against removing hair or raising the hairline. I've looked at at endless foreheads and your hairline already appears very high, not in an unnatural way but noticeably so. Removing grafts is a recipe for potentially killing donor hairs and lowering total yield and ending up with permanent scarring at the front of your head. The best case of action is placing singles in front of any doubles and poorly angled grafts in the hairline here, with overall density increases. 

"We will also need to rebuild those temple peaks."

Also from the Ferreira response I dislike this. You absolutely don't have the rebuild the temple peaks, especially when your hairline is quite high. The lower the hairline the more forward the temple points to appear natural, in your case you currently have a highish hairline and non-recessed but small temple peaks. This is totally natural. Will agree that the corners (not the point itself) do look quite unnatural currently from the contrast in transplanted/native hair and its possible that 50-100 grafts might be better off removed here. But would tread cautiously.

Reading the other referenced consults I feel quite confident that the approach offered in your original post is overly convoluted and the graft numbers don't make sense. Would also suggest that your crown should be left alone imo and you should tread very carefully when it comes to temple points. Even high-tier surgeons cannot work magic in this regard, the difference between donor hair and temple point hair often goes beyond what a surgeon is able to work with to create a natural appearance without very large graft numbers to cover the entire area rather than just extending the point as most do. 

Majority of clinics you mentioned are of a high standard, personally I'd consider those like Bisanga that are interested in making judgement in person and being cautious or those that have explicitly recommended a slight lowering of the hairline with density increases and no extraction of transplanted grafts.  In terms of hairline aesthetics I feel Freitas is among the best in the world but I haven't seen his repair cases. 

As a side note, your current result is quite bad but its probably borderline passable for the average person looking at it. 

Edited August 23, 2021 by JayLDD

[deeznuts]

Well I'm booked for Dr. De Freitas for mid-May. I think they mentioned that the earliest surgery date with Dr. De Freitas now was sometime in August next year and I think it was also mentioned that the consultation is also a couple months. So imo, if you were to try to reserve a date with Dr. De Freitas, it would be sometime in late 2022 or early 2023. 

3000 does seem like a lot though. Though hairline density usually requires a ton of grafts because that's where the grafts make the most impact yet you're also forced to use a lot of singles due to the fact that the hairline tends to comprise of mostly singles. I've heard that lowering the hairline by a centimeter is 1k grafts by itself to give you an idea.

Also, you look diffuse NW5/6 so maybe 3k grafts might be kinda questionable. 

Edited August 23, 2021 by deeznuts

[Britanium]

De Freitas is €3.50 for the first 1000 grafts and then €2.50 thereafter. However it’s going to be more than that for a repair case I would imagine. His waiting list is pretty long as @deeznutsmentioned and i have not seen many repair results from him.

Dr Bisanga would be a good choice, and I can totally understand why they would actually want to see you in person. The clinics/Drs your looking at is a pretty good list to be fair. 

[ITA]

@Rickard_c I want to tell you mine, not about the choice of surgeon you will choose ( although, you are here for this reason) , because among the help of the most experienced members of this forum, and the names you mentioned (which are of a high level) you will surely find the right doctor or clinic for you.  Often, you come to forums like HRN, after making bad decisions (it happened to me too, like you twice), I often say, but not always, to seek help or a word of comfort, and here are members who are always available to advise, help and cheer up.  The fact that you did not want to name the clinics of your two transplants, is not helpful to those members, who instead (fortunately) are here and who can still avoid doing the same bullshit (but also two), that we did me, you and many others.  This is what I feel like telling you.

[Rickard_c]

@Egy, thank you for your concerne as well as the uplifting words, and thank you everybody for taking time to response, I really appreciate it.

The first clinic I went to was called Nordic Hair Clinic. Took like 3 minutes for the consulant to "construct" the hair line (he was not even a surgeon or technician, he was just a guy who spoke swedish and the same language as the the ones who made the transplant (think it was Turkish)). Suppose that should've scared me, but oh well... The second one I did in Turkey, via a company in my country (Sweden). Kinda shady... So stupid of me again... The name of the Swedish company is Lifetime clinic. This (beauty surgeries vs the customer's right and the surgeons permissions etc) has been a very big thing in Sweden last year, new legislations has entered into force, and more is most likely to come. Hopefully bad clinics like this will be closed down, sparing people from the hassle. 

However, Im not feeling particaly unwell because of my earlier operations, I kinda made my peace with it. After all its not that terrible (even though its not good at all) and it actually looks better than it did before the hair transplants. On top of that I havent spended alot of money on it so far, and as I understand its totaly managable to make it look more natural. 

In the end I just want to make the hair look more "as me" again (if you know what I mean). Today my hair also requires alot of maintance since I need to keep it very short in neck, else it looks very weird since its very uneaven because of the partly overharvesting. Thats something I also would like to be "free" from.

Regarding the possition of the hairline, mine has always been high, today its about 2-2,5 cm lower than it originaly was. I thought mine now was considered low? My forehead now isnt 1/3 of my face's lenght for example, its a couple of centimeters less. I suppose thats not the only meassurement you usually use though, but do you really think it's still high?

However, nowadays I trim and pluck almost 1 cm in middle of hariline everyday. I think it looks better when doing it. I know I'll get scars if I remove grats, but my plan is to use laser after. The scars wont dissapear entireley, but I prefer having scars if I can get a natural looking hairline.

I had more or less already decieded to go with Ferreira, with the procedure described in my first post. Im kinda getting second thoughts though (which is good, I really dont want to do anything to hastly again). 

I will email Ferriera asking if he could provide me with some photos etc on repair works he have done (cant find any here). I will also ask De Freitas for queue lenghts for consultation and operation as well as price (doesnt say much on his homepage).

I would love to hear more people's thoughts though. Do you think I should skip removing grafts and going for refine existing hairline instead? Whats your thought on temple points?

I'll attach pictures taken today. The left one is approximately how Im imagining the finished result (as stated above about 1 cm of the hairline is plucked/trimmed in middle, and the temple points and corners are filled with a brown pencil). The middle picture the actual hairline is marked with black. The right picture is with out temple points and corner, with actualy hairline marked with black. I'll also attach pictures on how Im imagining temple points will look like in profile.

[Melvin- Admin]

On 8/22/2021 at 4:42 PM, JayLDD said:

I personally don't see how this requires 3000 grafts and have seen plenty of repair cases which are one and done. Fair enough to suggest that there is more uncertainty with a repair but stating that there is "minimum 2-3" procedures doesn't sound necessary to me. 

Depends on your donor, but imo I also wouldn't assume you'd need to remove any grafts to begin with, even a slight lowering of the hairline to place single hairs at the front wouldn't take the graft number up to 3000.  Maybe just at the corners where the frontal hairline meets the sides which currently is quite unnatural.  Depends very much on the donor but the mention of beard hair and a few hundred sounds more like a tactic to charge more than it does a necessity for your case. 

Would also forget temple points entirely for now, yours currently don't look that bad and certainly not unnatural with reference to the current hairlines height. Temple points are by far the hardest area to achieve naturalness in and its possible you might only end up with further problems to correct. 

I've seen cases of patients in a worse position than you are currently through 1500-2000 grafts in a single procedure looking almost perfect.  Not that I think he isn't a competent surgeon, but I'd want a much broader variety of consults to make a decision off before I came to the conclusion that this was the optimal approach. In my opinion the repair is a 1 procedure job (if the procedure goes smoothly and with some luck on your side) and the temple points are a consideration for a future procedure beyond that because the reality is that currently they're not a huge problem. 

I agree with JayLDD 3,000 grafts seems excessive. I do believe broadening your pool of surgeons would be beneficial. I do believe Dr. BF is good, but definitely get more than one opinion. Talk to Dr. Bisanga and Dr. Feriduni, if you’re in the UK definitely reach out to Dr. Reddy.

[Min12]

How long did it take for Bruno Ferreira to get back to you for your consultation? He usually takes ages.

 

Also 3000 grafts looks like way too much, Rolandas another Bruno Ferreira patient only had 3500 done to his frontal 3rd and he barely had any hair there. Whereas you have had is the area.

From looking a tons of before and after s over the years it looks like 2000-2400 grafts should be the sweet spot for what your wanting of course however different surgeons will have different estimates.

[Rickard_c]

Thanks alot guys for your replies. I have been in contact with a couple of surgeons - Dr Ferreira, Bisanga, Ferudini, Mwamba, Keser, Lapanzula, HLC and HDC (see my second post what they said). 

 

As mentioned in earlier post Dr Bisanga needed to see me in person before making a statement. I sended one more email, asking if it could be done online again, but got rejected. I will consider going to Belgium.

 

I sended my consultation request to Dr Ferudini about 10 months ago. Have had some contact with them after that, in februari, asking how things were going. Havent heard anything from them since then, untill today. I emailed them earlier and got a reply only a couple of hours later. Was promised a Skype-konsultation, they were going to get back to me next week. Really hope so, I really like Ferudini's work.
 

 

Furthermore, I did ask Dr Ferreira what he would have done to make my hair look more natural/better, with out taking my kinda distinct requirement in mind - if he still would go with removing some grafts, rebuilding temple peaks etc.

 

@Min12 I sended my consultation request to Dr Ferreira in beginning of october 2020. I contacted him again in end of februari 2021 after still not hearing anything. I then got an answer from his patient manager saying he was very busy. She recommended the "fast lane", meaning you pay 50 euro to get an reply within a week (I think it was). So I did that, and about 2 days later I got a very thoroughly reply.

[WhiteyUK]

12 minutes ago, Rickard_c said:

Thanks alot guys for your replies. I have been in contact with a couple of surgeons - Dr Ferreira, Bisanga, Ferudini, Mwamba, Keser, Lapanzula, HLC and HDC (see my second post what they said). 

 

As mentioned in earlier post Dr Bisanga needed to see me in person before making a statement. I sended one more email, asking if it could be done online again, but got rejected. I will consider going to Belgium.

 

I sended my consultation request to Dr Ferudini about 10 months ago. Have had some contact with them after that, in februari, asking how things were going. Havent heard anything from them since then, untill today. I emailed them earlier and got a reply only a couple of hours later. Was promised a Skype-konsultation, they were going to get back to me next week. Really hope so, I really like Ferudini's work.
 

 

Furthermore, I did ask Dr Ferreira what he would have done to make my hair look more natural/better, with out taking my kinda distinct requirement in mind - if he still would go with removing some grafts, rebuilding temple peaks etc.

 

@Min12 I sended my consultation request to Dr Ferreira in beginning of october 2020. I contacted him again in end of februari 2021 after still not hearing anything. I then got an answer from his patient manager saying he was very busy. She recommended the "fast lane", meaning you pay 50 euro to get an reply within a week (I think it was). So I did that, and about 2 days later I got a very thoroughly reply.

You mean to say clinics charging you 50 euros just to get a reply...  So they ignore you for months then recommend you pay to be fast tracked. 
Easy money and wrong in my opinion, every enquiry should be dealt with correctly and not used as an extra cash cow.