Why the Need for In-Person Consultation?

[Raphael84]

With the growth and popularity/demand of hair restoration surgery today, all clinics will receive enquiries and interest from all over the world.
Whilst it is great that we as patients now have many options to consider, it is also important to understand that when assessing individuals based on pictures and/or video, there is only a certain amount of accuracy that can be known. 

With the ever increasing demand of surgery and also as the boundaries have been pushed and what can now be achieved with hair restoration surgery being more impressive and dynamic than ever, individuals with all extents of hair loss are searching for viable options and as they conduct their search and perform their due diligence, they contact several clinics.

As we know, not all hair restoration surgery is performed to the same quality and all clinics will have their own approaches and thoroughness in terms of consultation and attaining empirical data etc.

With that being said, some patients based on their photos may require a thorough in-person consultation with the doctor under magnification so that data can be attained such as donor density, hair groupings, hair calibre and texture, potential levels of miniaturisation, an understanding of hair status and stability and potential progressive loss.

Whilst this may seem like a considerable inconvenience based on location and the need to travel etc. it is important to understand that not all individuals are good or even acceptable candidates for surgery and an in person consultation is always in the best interests of the patient.

With the state of the art FotoFinder technology that we utilise in the clinic, consultation is able to be much more thorough and also allows an assessment of any skin irregularities. This is even more important for repair patients or those with "non virgin" scalp as it can highlight any pitting, ridging, tenting, cobblestoning etc and oftentimes the patient may not even be aware of this.

In the case of BHR and my own experience, several individuals ask why Dr. Bisanga has requested an in person consultation when clinic "x" have not. Whilst I can not speak for another clinic and their protocols and assessment, I wanted to share with you correspondence that I sent to a very nice individual, who requires consultation as we were discussing this exact point. I will copy below the explanation to add further consideration whilst editing/removing any personal details -

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I do understand your frustrations.

To better explain the necessity of consultation for patients that present a specific pattern of loss, many believe that FUE is simply FUE. Removing hair from the donor and placing in the recipient. The reality is that there is much more to consider and to understand before being able to accurately recommend surgery for an individual.

Just this week, a 38 year old male visited the clinic for consultation. From his photos, he essentially had a full head of hair with favourable hair calibre, very slight temple recession which was arguable if a transplant was even necessary. The individual had been committed to medication for the past 7 years.

Upon inspection and assessment under magnification, it could be seen that his donor presented 30% miniaturisation on average, with other areas actually showing higher than this.

This was not at all expected and could not have been known from photos or videos and without magnification.

If surgery had been scheduled on this patient as it may have been with other clinics, then yield and growth would have been questionable and also the longevity of any growth as his donor was in decline. This would not have been the right decision for the patient.

I explain this story just because it was this week, but this is more common than you would imagine.

As a patient myself, I can completely empathise with the desire for surgery but also the anxiety of travelling for surgery, surgery day/s and then the need for patience post surgery. Fortunately in my case, growth was excellent and early, but if growth is not as expected, the further anxiety and disappointment would have been very complicated and difficult to manage.

Not all individuals are good candidates for hair transplant surgery. One very important factor (of which there are several) as to why Dr. Bisanga is able to achieve consistently excellent results is due to thorough assessment and ensuring that an individual is an acceptable candidate to proceed with surgery.

It is due to such consistently excellent results that you are considering Dr. Bisanga for surgery, and so therefore it is important that such protocols are followed.

Every day we receive individuals for consultation who are essentially a repair surgery. Not all of these individuals are repair due to visiting low quality cheap clinics and in many cases, this is because they were not good candidates to begin with and surgery may not have been the best option for them.

Any decision to request consultation with an individual is always for the patients' best interest. It is not a business or financial decision, but a medical decision to better inform both the patient and the doctor and allow a more accurate understanding of current status and candidacy.

However inconvenient it is to need a consultation prior to surgery, when travelling such long distances, I can assure you that the inconvenience of arriving to the clinic and having paid for surgery, paid for travel and hotels, arranged time off work etc to find that you may not be a candidate would be a far worse and more stressful situation. One which the clinic will try to avoid at all costs/measures.

Any such requirement for consultation is genuinely always in the patient´s best interests.

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Below is a video explaining the importance and process of a thorough hair restoration consultation.

 

Edited February 4, 2022 by Raphael84

[Melvin- Admin]

Excellent video, it very important to see physicians in person for assessment. The donor, hair loss can’t be properly assessed until you see the doctor in person.

[NARMAK]

52 minutes ago, Melvin- Moderator said:

Excellent video, it very important to see physicians in person for assessment. The donor, hair loss can’t be properly assessed until you see the doctor in person.

I think through assessments are very important too but it's amazing how often it's overlooked. 

 

Edited February 4, 2022 by Melvin- Moderator
Deleted emoji

[Melvin- Admin]

5 minutes ago, NARMAK said:

I think through assessments are very important too but it's amazing how often it's overlooked. 

 

Yea people don’t put enough importance on something very vital.

[NARMAK]

16 minutes ago, Melvin- Moderator said:

Yea people don’t put enough importance on something very vital.

Thanks for the emoji delete champ

I think not enough clinics show off using the equipment to check for miniturisation (sic?) and that's probably a key part of good hair transplant practice. 

[HappyMan2021]

@Raphael84 I am in the US and interested in a repair with Dr. Bisanga. 

I get the importance of the in-person consult, but realistically its very difficult for me to fly internationally just for a consult.  

I am wondering if Dr. Bisanga physically must do all in-person consults himself?

For example, would it be possible for Dr. Cooley or another American doctor to do my in-person consult, and have that consultation report be submitted to Dr. Bisanga, in lieu of flying out to Belgium?

 

[Raphael84]

I understand the challenges in place and travelling for consultation may not be easy or even feasible for some depending on location and their situation.

Hair restoration and its approach is not an exact science and as such is subjective. As said above, all doctors and clinics will have their own protocols and preferred approach and as we see on this very forum, approaches and design can differ quite dramatically which is one of the main motivations for individuals to have interest and preferences for one doctor over another.

Dr. Bisanga and every other doctor would all proceed with surgery with their own artistic vision. We see this not only in hairline design, but also in donor extraction management. This also applies to what they may perceive as limitations, "safe" donor area and graft availability etc.

Each doctor will have their own "markers" and their own "specifics" that they may assess and measure to determine candidacy. There is no industry standard or set protocols / "check list" for this and that applies even more so for repair patients.

Repair patients and their hair situation and status are all very unique depending on their history and previous surgery and repair in general can present very delicate challenges. It is down to thorough and ethical practices that Dr. Bisanga would require to assess repair patients in-person himself to be able to understand the patient´s case and based on those findings, have an in-depth conversation personally with the patient explaining any and all concerns and challenges.

If candidacy is possible, this then allows the patient to have been thoroughly informed of any limitations and allows Dr. Bisanga to honestly and transparently explain what he feels may be achievable. It allows Dr. Bisanga to explain that growth can not be guaranteed for example which is the case and protocol in repair surgery and to ensure that the patient has realistic expectations and understands the potential limitations in place. This is a very important part of the process to avoid disappointment or confusion at a later stage when surgery may have already have taken place.

Each doctor will not only conduct their consultation and assessment uniquely, they will also explain their summary uniquely and make unique recommendations and this therefore explains why consultations with different doctors presents different experiences and is another reason why patients will make their final decision on their preferred physician. They get a feel for the doctor´s personality and if they are a good fit.

The clinic appreciate the potential challenges with travel and this is why Dr. Bisanga offers international consultations, to be as accessible as possible to individuals who present interest in surgery with him. Dr. Bisanga offers consultation in the US each year, just as he does in the UK and many other locations. He is one of the most travelled doctors and performs consultation himself as opposed to non medical staff or non doctor. 

Any such requirement for in-person consultation is always a medical decision made in the best long term interests of the patient as opposed to a business or financial motivation.

If the industry standard were to be more thorough in assessment and requirement of in-person consultation when necessary, the amount of repair surgery or poor results would be much less as a result. As an industry we must improve to protect patients and make decisions based on their well-being.

Edited February 4, 2022 by Raphael84

[HappyMan2021]

thanks @Raphael84 I appreciate and understand the in-depth response

[New_Barnet_Please]

Such an awesome write up and explanation - integrity is everything! 

[Raphael84]

Great new bitesize to further detail and reinforce this exact subject -

 

[Rahal Hair Transplant]

Raphael,

Thanks for sharing and I couldn’t agree more.  Photos and videos sent by prospective patients can tell surgeons and clinics a lot about their current hair loss and situation but nothing beats an in person consultation.  The bottom line is, the surgeon can see a whole lot in person that photos and videos just don’t show.

I also understand that it’s simply not feasible for some prospective patients to fly out strictly for a consultation. But that’s why the ultimate determination of whether or not a prospective patient is a candidate is determined during the in person consultation on the day of the procedure prior to actual surgery.

In rare cases, some individuals who have traveled to under surgery are told on the day of the procedure that they are not candidates for hair transplantation and are ultimately sent home.  As discouraging and upsetting us can be for both patients and surgeons, ethical surgeons will always do what is in the best interest of the patient and sometimes that means not operating.

Best wishes,

Rahal Hair Transplant

Edited April 11, 2022 by Rahal Hair Transplant

[Grouse]

Great discussion. 

 

How have others managed in-person consults for overseas doctors? Would hate to show up and be rejected for poor donor, but also can't really afford to visit a country 2x either.

 

@Melvin- Moderator @Gatsby @Zoomster - think you all went to Eugenix for example, and had many grafts done. How did you all manage the need for an in-person consultation before booking a procedure?

[Gatsby]

I kept in touch via WhatsApp/skype with Dr Pradeep regularly for a couple of years before my surgery. I also sent a lot of videos and pics. But you raise an excellent point. Upon arrival Dr Pradeep felt that both my scalp and beard donor were weaker than he had envisaged. However he was still confident that I would get the result that I wanted and achieve my goals. I was fully prepared to actually cancel the surgery if on arrival Eugenix believed that they couldn't help me reach my goals. I had spoken with them about this prior to leaving for India. This is something that you must keep in mind. An in person consultation is really the only way to receive an accurate assessment. If you arrive at an overseas clinic are you prepared to cancel if they tell you that your crown cannot be filled in, etc? It's imperative that you discuss this with the clinic prior to flying. There is no point going ahead with surgery if it is not what you had planned for just because you made the trip to get there. I would rather lose the cost of the flight and deposit (if I had to) than be left with a transplant that I never wanted in the first place. Communication is key!

[anotherbaldguy]

3 hours ago, Grouse said:

Great discussion. 

 

How have others managed in-person consults for overseas doctors? Would hate to show up and be rejected for poor donor, but also can't really afford to visit a country 2x either.

 

@Melvin- Moderator @Gatsby @Zoomster - think you all went to Eugenix for example, and had many grafts done. How did you all manage the need for an in-person consultation before booking a procedure?

For my consult with Hattingen Dr Muresanu suggested I buy a usb microscope from amazon so he could look at my donor. It was incredible instructive, only costs around $30, and given how important it is I genuinely have no idea why other clinics aren't doing the same. 

[Grouse]

10 hours ago, anotherbaldguy said:

For my consult with Hattingen Dr Muresanu suggested I buy a usb microscope from amazon so he could look at my donor. It was incredible instructive, only costs around $30, and given how important it is I genuinely have no idea why other clinics aren't doing the same. 

Awesome! I will reach out to them, I haven't heard of this before. Wish more docs would do this - sounds extremely helpful.

[Raphael84]

Some clinics recommend purchasing a USB microscope to be able to present magnified images. This can present a more realistic and detailed hair status than standard photos and we have use this with specific patients and cases in the past and it is great that some clinics in the industry are taking that extra step/precaution.

Of course even with magnified images, there are still question marks regarding data in terms of measurements of the donor area, surface area of "safe" donor zone, ruling out any skin issues/concerns,  potentially compromised skin if a repair patient perhaps with tenting, pitting, ridging, evaluating scalp laxity, miniaturisation throughout the scalp etc.

It is a difficult balance and as a patient myself, I completely empathise with the challenges of travelling for consultation only. It is not convenient for most and not cost effective. However we do need to be conscious of the fact that hair restoration is a medical procedure and neither the industry nor any clinic has a 100% success rate (and never will) and none of us as patients want to be "that patient" where "things did not work out as planned". Being thorough and having an in person consultation prior to confirming surgery can go a long way in terms of due diligence and making an informed decision on provided recommendations based on accurate data.

This is great and valuable discussion and what the community is all about.

[anotherbaldguy]

2 hours ago, Raphael84 said:

Of course even with magnified images, there are still question marks regarding data in terms of measurements of the donor area, surface area of "safe" donor zone, ruling out any skin issues/concerns,  potentially compromised skin if a repair patient perhaps with tenting, pitting, ridging, evaluating scalp laxity, miniaturisation throughout the scalp etc.

I ended up cutting a 1cm square hole out of a piece of paper and shaved the same area into various regions across my donor area, taking photos at at the occipital parietal and temporal regions. Donor surface area can also be easily measured or estimated by the patient.

In terms of repair patients then id agree with you things like tenting pitting and ridging ideally should be assessed in person, although again these are easy enough to diagnose even without a microscope. Both Dr Wong and Dr Muresanu were able to accurately estimate my scalp laxity based on videos (if anything they underestimated it).

 

The issue of course is always candidacy - specifically as it relates to donor miniaturisation -  which from my conversations with other clinics they seemed to think my approach was good enough.