donor area miniaturizing advice

[aKaWonderKid]

Hi,

I recently went to see Dr Bisanga in London thanks to Ian for being amazing and linking me up with him.

Here is the email back which got sent a day after london so the turn around was amazing

 

Here is a summary of your consultation -

 

Hair Character - Straight

Hair Thickness - Fine

Donor Density  -  60/60

Miniaturisation in donor - 37% Auricular / 28% Mastoid

Dermoscopy - Dry scalp (flakes) / folliculitis 

——

 

Consultation Summary and Recommendations

 

The following has been determined from your consultation -

• Young individual 
• Diffuse thinning throughout the recipient area from front to back 

• Very high levels of miniaturisation in the donor area, especially behind the ears. (please see attached images)
• Folliculitis in the donor area that may be responsible for miniaturisation 

• Higher than average levels of miniaturisation present in both the recipient and donor areas which presents concern regarding candidacy of surgery and makes any potential surgery hazardous. When miniaturisation (decline in quality of hair in the process of loss) is present, this can have an effect in success of any transplant effecting yield and growth and also the longevity of the result. At most we would prefer this to be in the 10 - 15% range. As areas of your donor presents much higher than this amount, candidacy is not able to be approved at current Stephen.
• https://www.youtube.com/watch?v=95dQGwpM3Ck&t=40s

• When miniaturisation is present in the recipient due to diffuse loss, this can present a higher risk of shock loss of native hair that may be too weak to return post shedding.

• To maintain and preserve current hair, and in an attempt to stabilise and reduce levels of miniaturisation in both recipient and donor areas, further / changes to medication must be considered.

• Dr. Bisanga recommends to begin oral minoxidil 5mg daily (please see attached study in regard to efficacy and safety). 
• Dr. Bisanga has a colleague, (he then told me an email address to email and they will hit me up with oral minoxidil)

• See a dermatologist to assess and provide a course of treatment for your folliculitis 

• Consider PRP treatment with mesotherapy + dutasteride

• Dr. Bisanga explains that surgery at current is not in your best interests Stephen. Growth and yield will be impacted due to folliculitis and levels of miniaturisation and longevity of any transplanted hair would be compromised.
  Serious regimen and commitment to medication is essential in your case.

 

——

 

I am going ahead with PRP on Tuesday and Dr said because my age (27) i only need one PRP every 6 months. I am still using Nizorail to calm my eczema down at the bottom of my donor area.

I did move to Oral minoxil but my hair has been shedding for roughly 3 weeks now and this doesn't seem to be going away. I am aware shedding is good at the start but when I was taking regaine (foam) it didnt shed for this long so im a bit concerned.

I have been taking oral fina and minoxil every day and also been chucking in Dutasteride every tuesday and friday alongside the 2 others.

 

Does anyone know what else I can do to help

 

[MAIZE1694]

Can we see pics of your donor? Curious what high levels on miniaturization would look like.

[JoeMan]

PRP is questionable at best. If you have money to burn then go for it as it can't hurt. But it's usually very expensive and results are not well studied. 

Can you please share a picture of your donor area?

[Eugenix Hair Sciences]

Please do share some pictures of your scalp. It would be interesting to see the miniaturization in the donor area also.

[aKaWonderKid]

Hi all

 

@Eugenix Hair Sciences

@MAIZE1694

@JoeMan

Here is a video 6 months ago- 

 

 

Here is a video from today - https://youtube.com/shorts/O8Y_r-z-DBM?feature=share

Edited March 27, 2022 by aKaWonderKid

[aKaWonderKid]

Also would like to say It is diffused to im losing hair everywhere on top but it seems to be going more on my left hand side by the temples. Its also very itchy

Is tbis sides to oral minoxidil?

 

Edited March 27, 2022 by aKaWonderKid

[Ryan Daniel]

Excellent donor area, very promising to achieve a good result with it because it has a mixture of thick coarse brown hair and also soft thin hairs for that hairline!

Good luck for your journey. Dr Bisanga is a qualified doctor 

[MAIZE1694]

Hmm the donor looks ok to me. The nape looks thinner perhaps its your haircut? A "thinner" nape, maybe slight retrograde seems normal and most clinics will still operate. 

Bisanga, a world class dr., seems to be particularly more selective than most.

Whats your plan going forward @aKaWonderKid?

[aKaWonderKid]

8 minutes ago, MAIZE1694 said:

Hmm the donor looks ok to me. The nape looks thinner perhaps its your haircut? A "thinner" nape, maybe slight retrograde seems normal and most clinics will still operate. 

Bisanga, a world class dr., seems to be particularly more selective than most.

Whats your plan going forward @aKaWonderKid?

Hi

 

No idea on plans going forward. I think I will maybe go to mwamba or Spain like freitas and have a face to face.

It won't be my haircut as to be honest I havent had it cut in a while. 

 

I have PRP Tuesday, im not too fussed about growing more. If I could just keep what I have now then I'd be happy.

 

Thanks for everyone's replies

[aKaWonderKid]

How long does shedding last for when you change medication gang?

[Eugenix Hair Sciences]

15 hours ago, aKaWonderKid said:

How long does shedding last for when you change medication gang?

Usually 1 to 2 months are normal for rhe shedding to last when changing medications.

[Raphael84]

Thanks @aKaWonderKid

It is great that you have posted your consultation summary. You often hear Dr. Bisanga speaking about the importance of in person consultation and being able to provide honest feedback based on empirical data that he is able to attain which is completely objective, as opposed to the often cited subjective donor evaluation of "4/5" or "good/strong donor".

A big factor in being able to achieve consistently excellent results is based on thorough assessment and evaluation pre surgery and whilst the patient at times may feel frustrated by such a summary detailing that candidacy is not currently recommended, the frustration of less than optimal yield post surgery or concern with longevity of any result is far more impactful.

I wish you the best moving forward and with a positive response to medication such as oral minoxidil having a positive impact on your donor area, you may find yourself in a more favourable position in 12+ months.

[aKaWonderKid]

On 3/29/2022 at 11:16 PM, Raphael84 said:

Thanks @aKaWonderKid

It is great that you have posted your consultation summary. You often hear Dr. Bisanga speaking about the importance of in person consultation and being able to provide honest feedback based on empirical data that he is able to attain which is completely objective, as opposed to the often cited subjective donor evaluation of "4/5" or "good/strong donor".

A big factor in being able to achieve consistently excellent results is based on thorough assessment and evaluation pre surgery and whilst the patient at times may feel frustrated by such a summary detailing that candidacy is not currently recommended, the frustration of less than optimal yield post surgery or concern with longevity of any result is far more impactful.

I wish you the best moving forward and with a positive response to medication such as oral minoxidil having a positive impact on your donor area, you may find yourself in a more favourable position in 12+ months.

Hi mate

 

And thats exactly why dr bisanga is one of the best in the world. He tells you the truth, doesn't matter if you like it or not! Its the truth.

 

So I said before I'm oj oral minoxidil and oral finasteride daily. Is it worth me chucking in dutasteride daily too so I'm taking 3 of them?

Also I've seen some on here say they take vitamin tablets, what ones are the best?

Also I've seej someone say help hair whey protein. 

[aKaWonderKid]

Can I take finasteride and dutasteride together? Will this help more?

[SD1984]

Maybe it's just me but that donor looks fine, and I've seen an endless amount of photos of HT's / donors over the years and have seen plenty that have looked worse. Maybe this doc is just very conservative/selective? Sure maybe the hairs aren't as thick as tree trunks but I don't see any reason a HT of a few thousands grafts can't make a nice impact. 

Edited April 4, 2022 by SD1984

[aKaWonderKid]

I think its because its still minituraizing maybe?

Whilst I still have hair I can use toppik if I go on nights out so its not too bad. I'm just trying to prep for when it all goes  which looks inevitable 

[SD1984]

I just saw your other thread with the frontal photos. Yes that is pretty aggressive hair loss for only 27. Medication would be the first course of action but I still think a HT for the frontal third to reframe your face wouldn't be a bad idea. I'm not sure about your temples/sides but it looks like a wide frontal third to cover so you may be looking at a large number of grafts.

[aKaWonderKid]

Whats the thought of finasteridr and dutasteride together daily

[Viney]

Hey OP.

You're not alone and your situation is quite similar to mine. I've just switched from fin to dut and added sublingual minoxidil to my regime.

I think I'm going to take the safe long game and see how my existing hairs and donor reacts to the meds. After 12 months I'll reasses my hair transplant candidacy.

To me it's too important of a decision to get wrong both visually and financially. I think it's best try and be patient before pulling the trigger.

It's good to see you're trying to do the right thing and following advice.

[hairman22]

no real point going to bisanga unless you have a very good donor and on meds.

He just constantly looks at the wores case scenario very time.

I get it hair my thin out alot over time.

But better to have good hair while you are young & if it thins out later in life while at least you had a good run.

Everyone knows hair transplant will thin out at least a bit after 5-10 years.

 

[asterix0]

On 4/11/2022 at 8:19 AM, hairman22 said:

no real point going to bisanga unless you have a very good donor and on meds.

He just constantly looks at the wores case scenario very time.

I get it hair my thin out alot over time.

But better to have good hair while you are young & if it thins out later in life while at least you had a good run.

Everyone knows hair transplant will thin out at least a bit after 5-10 years.

 

Why will the hair transplant thin out after 5-10 years?

[LaserCaps]

If you are experiencing a dermatological issue in the donor, it can transfer to the recipient area during a transplant procedure.  The doctor or a dermatologist can put you on some steroidal creams/shampoos to help you.  If active, continue medical therapy until resolved.  

Transplanted hair can thin if the hair is thinning in the area where it came from originally.  Get everything under control before moving forward.

[Raphael84]

Great discussion and conversation here.

Not at all based on your case or comments @aKaWonderKid but in response to other ideas posts, not all of us are great or even good candidates for surgery and I am the perfect example of this (by all means check out my own result thread), and for some of us whose donor is below average and for those who may have specific challenges, perhaps being a borderline candidate and being able to achieve an overall improvement will suffice in regard to our expectations and objectives.

For others, this will not be the case and despite more extensive loss and below average donor for example and therefore potentially a borderline candidate, expectations are  not appropriate and desires are an aggressively low and straight hairline that their "situation and status" is simply not able to support.

I was fortunate able to achieve an incredible result despite being a repair case, having below average density, strip scar, retrograde alopecia and having fine hair. The positive that I had was that I had a regimen of medication in place and had no concerns of miniaturisation.

Dr. Bisanga takes on some of the most challenging cases and most extensive patterns of loss. This can be seen throughout the last 15 years of his career. One thing he doesn't do is proceed with surgery on patients who are not candidates and this is for their best interests. This is a question of ethics.

 

[RTC]

When was Dr Bisanga in London? I wish the Belgian doctors visited London more frequently

[aKaWonderKid]

5 hours ago, Aslitarcan sucks said:

When was Dr Bisanga in London? I wish the Belgian doctors visited London more frequently

Contact Ian mate. I think someone is back in May but not 100%