Bittersweet feelings after Bisanga Consult

[SeanT1]

1 minute ago, Savemyhairline said:

Think I need to take a few days, let the disappointment settle then decide. I do find it interesting that Hasson was willing to book me without an in-person consult based on my photos. I am booked for June with a fully refundable deposit with him as of now. I definitely don’t want to make a permanent mistake here though, of course.

Same situation happened with me also at elithair.  It was just an analysis based on photos, booked for a procedure then on the day the doctor checked my donor area quality before doing the surgery the same day.
(Which was so so, a bit below average)

[Savemyhairline]

11 minutes ago, SeanToman said:

Same situation happened with me also at elithair.  It was just an analysis based on photos, booked for a procedure then on the day the doctor checked my donor area quality before doing the surgery the same day.
(Which was so so, a bit below average)

Bisanga said mine was above average, which is good to know. Seems like most people do that tbh. Idk if I want to fly out to get another in-person consultation from someone reputable and ethical, have to think on my next move I guess.

[HairRun]

I think some doctors take the mental health of the patient into account when accepting a case. I feel that in same cases the patient has an itch that won't be satisfied until the have a procedure. I saw a post where a 20 year old was accepted as a case with a highly regarded doctor on here, and that doctor told that patient the risks. Many people on here implored the patient to reconsider. I'm curious why the Dr accepted the case but I bet it may have been for the patient's mental health. 

 

I'm not in your situation so I haven't vetted surgeons this way, but from my limited research I would do an in person consult with Shapiro, Konior, maybe Carmen and Cooley if I were to go with a North America based doctor. But if I were in Europe, I would leave it up to Dr Bisanga and chill 

Edited August 28, 2022 by HairRun

[HairEnthusiast101]

Do you when any photos shaved to a buzz? You say your diffuse and I can see some areas but there is also some density patches too so wondered what it would look like shorter

[Gatsby]

15 hours ago, Savemyhairline said:

So I finally had my in-person consultation with Dr. Bisanga. He told me it would be a mistake to get a hair transplants for me. I’m 26 y/o diffuse thinner, but really the most intense thinning is in my temples. He said I haven’t actually lost any hair, it has all just been thinned out on top. He did say my donor density was good at 75.  I’m on fin and foam minoxidil. He recommended I switch to oral minoxidil. Kevin Mann’s videos have made me apprehensive in taking oral minoxidil, though Bisanga really was saying it could reverse the loss I have. I’m going to look into it more.

 

i wish I could just at least get a small procedure to fill in my temples which undoubtedly have the most thinning, but he really felt it would be a mistake and do more harm than good. H&W and Rahal were willing to schedule a HT appointment, I’m wondering if they would’ve changed their minds after I flew out to them and they saw me in person, or they’d just have a different opinion. Do you think it’s worth getting another opinion in person from someone reputable? I consider Bisanga to be amongst the best of the best so maybe I should just take his opinion and hold off. 

If Dr Bisanga told you that you’re not a candidate then as much as you may feel unhappy he is doing you a huge favour. Any hair mill will tell you what you want to hear. Oral minoxidil is not something new but has been used for hair loss for over ten ten years as far as I’m aware of. For some reason it seems to the flavor of the month as a topic recently. You’ve just saved a lot of money but more importantly a lot of life long scars. All the best! 

[StillAlive]

Agree with Bisanga and the consensus. Your hair is quite thick and seems to be responding well to meds. Any procedure at this point is not worth the risk of shock loss to the existing hair. You need to re-evaluate in about 10 years or so. 

[Savemyhairline]

7 hours ago, JoDimaggio22 said:

Do you when any photos shaved to a buzz? You say your diffuse and I can see some areas but there is also some density patches too so wondered what it would look like shorter

Nah not recently. The pics I posted were the shortest I’ve cut it in a while. Thankfully I can hide it somewhat easily just by combing my hair the right way, just would be nice to not have to worry about wind, super bright sunlight, oily hair, etc. also my hairline, or at least my temples are just super high and thin so I was hoping to get them addressed. But hey, I think my hair now is about the same as it was when I was 21, so I can definitely live with it as long as the meds prevent it from getting worse for a long long time. 

[Chickennuggets95]

I agree that dipping pass into mid-crown is a bad idea, but doing work on your temple region seems totally normal standard for the HT industry? I don’t see why he wouldn’t be open to reconstructing your temples, perhaps get a 2nd opinion from another expert

[Hairy Henderson]

I wasn’t a diffuse, but, Lost a majority of my frontal third by 25.

 Got on meds, 2k grafts by Hasson and it was the best decision of my life!

I am only now looking for a second pass because at 42 I am single again otherwise it was totally sufficient up until now.

 

I think Bisanga is excellent however a tad conservative so definitely seek some other opinions

[Savemyhairline]

1 hour ago, Calihome1 said:

I wasn’t a diffuse, but, Lost a majority of my frontal third by 25.

 Got on meds, 2k grafts by Hasson and it was the best decision of my life!

I am only now looking for a second pass because at 42 I am single again otherwise it was totally sufficient up until now.

 

I think Bisanga is excellent however a tad conservative so definitely seek some other opinions

I’d like to get a consult from him in person but flying to Vancouver for a consult seems excessive. I can’t afford Konior but I was considering getting his opinion in-person, not sure its worthwhile since I think he charges like $500 just for a consult and like I said I can’t pay for him to do it so makes less sense.

 

 

[general-etwan]

Yes, you’re not a good transplant candidate…Not because you’ve lost too much but because you haven’t lost nearly enough. Most people wouldn’t even notice your hair loss in public. Take finasteride and use minoxidil if you want. I’m personally not a fan of minoxidil though because I am convinced it ages the face more quickly when applied to the top of the scalp. 

[Savemyhairline]

3 hours ago, general-etwan said:

Yes, you’re not a good transplant candidate…Not because you’ve lost too much but because you haven’t lost nearly enough. Most people wouldn’t even notice your hair loss in public. Take finasteride and use minoxidil if you want. I’m personally not a fan of minoxidil though because I am convinced it ages the face more quickly when applied to the top of the scalp. 

The pics might make it look better than it really is, I feel like when my hair is parted the wrong way in the wrong lighting it can look pretty bad. I tried to use bright bathroom lighting but as we all know different lighting can make your hair look better or worse. I am pretty worried about oral minoxidil, A lot of doctors say the risk profile is very minimal but haircafe is kind of freaking me out with it. I would never want to risk my cardiovascular health, literally your most important organ, over hair. Need to do more thinking/researching on it I guess.

[general-etwan]

7 minutes ago, Savemyhairline said:

The pics might make it look better than it really is, I feel like when my hair is parted the wrong way in the wrong lighting it can look pretty bad. I tried to use bright bathroom lighting but as we all know different lighting can make your hair look better or worse. I am pretty worried about oral minoxidil, A lot of doctors say the risk profile is very minimal but haircafe is kind of freaking me out with it. I would never want to risk my cardiovascular health, literally your most important organ, over hair. Need to do more thinking/researching on it I guess.

I’d talk to some other doctors and get some more opinions. I’m sure there’s someone who can do some good work with your case…give it time and discussion. 👍

[shiba1985]

Dr Bisanga is experienced so definitely take his advice. 

but also keep in mind sometimes when a doctor is busy he doesn’t want to work on more difficult cases that require a lot more time but won’t be worth it in terms of value. 
 

so for eg. If he can do 2 cases in one day easily but if he put your case and that day he can only do 1 case cause you are challenging but he is charging per graft he will “lose” money. If his schedule is booked it’s easier for him to say don’t bother. 
 

get some more advice from other  reputable docs. I think u could have a good restoration if ur expectations are realistic. 

 

[Vann]

6 minutes ago, shiba1985 said:

Dr Bisanga is experienced so definitely take his advice. 

but also keep in mind sometimes when a doctor is busy he doesn’t want to work on more difficult cases that require a lot more time but won’t be worth it in terms of value. 
 

so for eg. If he can do 2 cases in one day easily but if he put your case and that day he can only do 1 case cause you are challenging but he is charging per graft he will “lose” money. If his schedule is booked it’s easier for him to say don’t bother. 
 

get some more advice from other  reputable docs. I think u could have a good restoration if ur expectations are realistic. 

 

I agree with this.

there are other cases where I have seen him do with similar scalps as yours. Once you shave your head down it doesn’t mean that you’ll have the same issues faced with… but if you had an in person consultation I’m sure he tested for that. 
 

definitely reach out to other surgeons and see what they say and maybe include what bisanga said and see if the surgeon can work around it. 
 

look at other cases similar to yours and see the results. Of course you can always wait and see what happens but it’s up to you how you want to proceed. No matter what option you take surgical or not, nothing is guaranteed.

[Savemyhairline]

I also feel like I’ve seen guys in a similar situation and they’ve had their hair restored well if I’m being completely honest. For my temples, he said, I haven’t lost hair and they’re all just miniaturized/baby hairs. To me it’s like, the hairs may as well not even be there they are so thin, here is a pic he took:

 

 

again, I feel like the guys who have gotten good transplants and were completely bald here and further back even, would beg to differ. I don’t think I need a 6000 graft mega session here but just a nice 2000-3000 grafts for the frontal third would be nice.

 

i am consulting with Hasson again, showing him some more pics as well as what Bisanga said, and asking his opinion. I think I’m done with any meds beyond topical minoxidil and oral finasteride. Literally would rather be bald than have potential heart issues with oral minoxidil. I was willing to risk my libido with fin which thankfully is just fine after well over a year. I am not willing to risk the most important organ in the human body, even if it is a “small” risk.

[SoSoz]

21 hours ago, Calihome1 said:

I wasn’t a diffuse, but, Lost a majority of my frontal third by 25.

 Got on meds, 2k grafts by Hasson and it was the best decision of my life!

I am only now looking for a second pass because at 42 I am single again otherwise it was totally sufficient up until now.

 

I think Bisanga is excellent however a tad conservative so definitely seek some other opinions

How often do u take 0.5mg finasteride?

[HappyMan2021]

Doctors can and do reject patients for any reason they feel like. This is an elective for profit surgery. 

Maybe Bisanga technically could have worked on you if he really wanted to. But maybe for whatever reason he just didnt want to.

He and all the other elite doctors have lines out the door so they can be very VERY choosy if they want to. 

[Raphael84]

@Savemyhairline

Thank you for attending consultation with Dr. Bisanga. You and I have been in communication both prior and post consultation and reviewing our initial summary from pictorial assessment, the concerns that were detailed and therefore presented the requirement for consultation, essentially were reinforced at consultation.

This thread has presented some very positive and constructive discussion and different opinions and points of view. As we all know, elite doctors may have difference in opinion of what may be in the best interests of a patient just as each doctor would present their own artistic interpretation of an optimal hairline design.

All any doctor can do, is use their experience of which Dr. Bisanga has 20+ years of, and make recommendations to the patient as they see in the best interests of the patient. 

We see at the clinic, week in and week out, individuals who may have opted for surgery at a younger age at other clinics, who find themselves in a very different position at the age of 30 or 35 in terms of how their hair loss has progressed and are now in a regrettable and challenging position.

26 years of age in the right candidate is generally fine, in a lesser candidate, this can present significant "risks" in the future and this is the key point here. It is very patient specific. Either way, 26 years in the larger scheme of adult life is in the early stages.

The objective of any restoration with any reputable clinic has to be the long term. Providing a restoration that allows the patient to grow into and that will continue to present a natural appearance over the long term. 

For any patient around 25 years of age that may have began to experience loss at 18 for example, this represents a timeframe of 7 years. 
This timeframe represents less than 1/5 of the timeframe between 25 and 60 years and so when a patient in their mid twenties present some concerning other factors and propensity for a larger pattern of loss, then these must be given serious consideration.

Restoring temples or hairline currently, with diffuse and likely progressive loss to evolve, may leave any patient in a compromised position with an unnatural appearance/pattern of loss based on transplanted hair becoming disconnected to native hair. When there are clear signs of decline from hairline to crown, then not rushing into surgery and seeing how the next 12+ months may evolve will always be a sensible consideration for any patient.

Undoubtedly other physicians will proceed with your case and so therefore you will always have options available to you. Our advice would be to not rush into anything, take some time to digest your consultation and your conversation with the doctor and then take the next steps as you see appropriate.

The idea of turning down patients for more simpler cases is not an approach that Dr. Bisanga has ever taken and for anybody who has been in this community or following the industry for any period of time will be aware of this. Dr. Bisanga is often mentioned on this very forum as a recommendation to consider in complicated repair cases. This is due to his reputation in doing so and repair cases would be far more challenging than restoring the frontal area of a diffuse thinner.

This is the controversial side of the hair restoration community. We as a community are always fighting for more ethical practices and protocols and imploring clinics and doctors to put patients over profits and quite rightly campaigning for unethical surgeons and clinics to take accountability for their actions and for the lives that they impact in such negative ways.

This thread and consultation whilst clearly very frustrating for you @Savemyhairline, and understandably so is an example of where a recommendation has been made on ethical and medical grounds as the doctor sees in the best interest of the patient. One may or may not agree with the recommendation and that is each of our prerogatives, but clearly the intentions of the doctor are on solid ground and there are few doctors in the field that have the experience both in terms of years as an elite doctor and also in terms of patients and range of cases that he has seen and been involved in.

As the community are offering their interpretations and advice based on the photos provided, @Savemyhairlineit may be worthwhile to share the further photos that were taken and shared from consultation as I would suggest that they do present a further reality and potentially more scalp than earlier photos that were shared and may therefore present amended feedback.

We wish you the best in however you may decide to proceed and have presented recommendations as we see in your very best interests.

We can also remain in contact privately and if you do have any further questions, then as always, dont hesitate.

[Savemyhairline]

37 minutes ago, Raphael84 said:

@Savemyhairline

Thank you for attending consultation with Dr. Bisanga. You and I have been in communication both prior and post consultation and reviewing our initial summary from pictorial assessment, the concerns that were detailed and therefore presented the requirement for consultation, essentially were reinforced at consultation.

This thread has presented some very positive and constructive discussion and different opinions and points of view. As we all know, elite doctors may have difference in opinion of what may be in the best interests of a patient just as each doctor would present their own artistic interpretation of an optimal hairline design.

All any doctor can do, is use their experience of which Dr. Bisanga has 20+ years of, and make recommendations to the patient as they see in the best interests of the patient. 

We see at the clinic, week in and week out, individuals who may have opted for surgery at a younger age at other clinics, who find themselves in a very different position at the age of 30 or 35 in terms of how their hair loss has progressed and are now in a regrettable and challenging position.

26 years of age in the right candidate is generally fine, in a lesser candidate, this can present significant "risks" in the future and this is the key point here. It is very patient specific. Either way, 26 years in the larger scheme of adult life is in the early stages.

The objective of any restoration with any reputable clinic has to be the long term. Providing a restoration that allows the patient to grow into and that will continue to present a natural appearance over the long term. 

For any patient around 25 years of age that may have began to experience loss at 18 for example, this represents a timeframe of 7 years. 
This timeframe represents less than 1/5 of the timeframe between 25 and 60 years and so when a patient in their mid twenties present some concerning other factors and propensity for a larger pattern of loss, then these must be given serious consideration.

Restoring temples or hairline currently, with diffuse and likely progressive loss to evolve, may leave any patient in a compromised position with an unnatural appearance/pattern of loss based on transplanted hair becoming disconnected to native hair. When there are clear signs of decline from hairline to crown, then not rushing into surgery and seeing how the next 12+ months may evolve will always be a sensible consideration for any patient.

Undoubtedly other physicians will proceed with your case and so therefore you will always have options available to you. Our advice would be to not rush into anything, take some time to digest your consultation and your conversation with the doctor and then take the next steps as you see appropriate.

The idea of turning down patients for more simpler cases is not an approach that Dr. Bisanga has ever taken and for anybody who has been in this community or following the industry for any period of time will be aware of this. Dr. Bisanga is often mentioned on this very forum as a recommendation to consider in complicated repair cases. This is due to his reputation in doing so and repair cases would be far more challenging than restoring the frontal area of a diffuse thinner.

This is the controversial side of the hair restoration community. We as a community are always fighting for more ethical practices and protocols and imploring clinics and doctors to put patients over profits and quite rightly campaigning for unethical surgeons and clinics to take accountability for their actions and for the lives that they impact in such negative ways.

This thread and consultation whilst clearly very frustrating for you @Savemyhairline, and understandably so is an example of where a recommendation has been made on ethical and medical grounds as the doctor sees in the best interest of the patient. One may or may not agree with the recommendation and that is each of our prerogatives, but clearly the intentions of the doctor are on solid ground and there are few doctors in the field that have the experience both in terms of years as an elite doctor and also in terms of patients and range of cases that he has seen and been involved in.

As the community are offering their interpretations and advice based on the photos provided, @Savemyhairlineit may be worthwhile to share the further photos that were taken and shared from consultation as I would suggest that they do present a further reality and potentially more scalp than earlier photos that were shared and may therefore present amended feedback.

We wish you the best in however you may decide to proceed and have presented recommendations as we see in your very best interests.

We can also remain in contact privately and if you do have any further questions, then as always, dont hesitate.

I certainly did not personally believe that Dr. Bisanga made any recommendations based on level of difficulty. I respect his opinion and hold it to a very high regard. I did send all the pictures he took to another elite surgeon just to get a second opinion. That of course is nothing personal as I like to get multiple opinions on anything. I am still not 100% convinced on the oral minoxidil but that is okay. I am thinking that it may be best to just continue what I am doing and then reassess in 3-4 years when I’m 30. 
 

thank you,

[Tybwl5]

On 8/29/2022 at 5:49 PM, Savemyhairline said:

I certainly did not personally believe that Dr. Bisanga made any recommendations based on level of difficulty. I respect his opinion and hold it to a very high regard. I did send all the pictures he took to another elite surgeon just to get a second opinion. That of course is nothing personal as I like to get multiple opinions on anything. I am still not 100% convinced on the oral minoxidil but that is okay. I am thinking that it may be best to just continue what I am doing and then reassess in 3-4 years when I’m 30. 
 

thank you,

May I ask who the other elite doctor is?

[Savemyhairline]

5 minutes ago, Tybwl5 said:

May I ask who the other elite doctor is?

Hasson. If he says it’s a bad idea, after showing him additional pictures that Bisanga took, then I will 100% drop the idea of getting one. He rejected me the first time a year ago due to my diffuse thinning and I wasn’t on meds back then, which made sense. 

[Savemyhairline]

So, H&W got back to me. Hasson said he feels I might not be an ideal candidate, but Wong believes he can safely transplant between the existing hair and get around 2000 grafts for the frontal third. According to the advisor, Wong specifically has developed techniques that allow him to navigate around the existing hairs more effectively than other doctors. Here’s another pic Bisanga took, kind of wish my hair was shorter but oh well:

 

 

what do you think? Worth potentially going to Wong instead? I feel like I’ve seen a lot more of Hasson’s work here, though I know both are highly regarded. My top two choices don’t think I’m a great candidate which is making me lean towards holding off, though I am intrigued by Dr. Wong’s thoughts.

[HairRun]

6 hours ago, Savemyhairline said:

So, H&W got back to me. Hasson said he feels I might not be an ideal candidate, but Wong believes he can safely transplant between the existing hair and get around 2000 grafts for the frontal third. According to the advisor, Wong specifically has developed techniques that allow him to navigate around the existing hairs more effectively than other doctors. Here’s another pic Bisanga took, kind of wish my hair was shorter but oh well:

 

 

what do you think? Worth potentially going to Wong instead? I feel like I’ve seen a lot more of Hasson’s work here, though I know both are highly regarded. My top two choices don’t think I’m a great candidate which is making me lean towards holding off, though I am intrigued by Dr. Wong’s thoughts.

It's an interesting situation. I personally wouldn't do it unless I was 100% and with Dr Wong's being regarded as he is, I would be 80%, but not 100%. You had two more opinions, one for, one against. 

I would do one more consult with Shapiro, Konior, and or Cooley, in person preferably. I believe consults with Shapiro and Cooley's patient advisor are free, but you need to take a direct look at the Dr themselves, so you probably need to pay for a consult. Konior has no patient advisor, over a year ago his consult was 500, it might be more expensive now, but absolutely worth it considering your situation. Paying money to have more certainty and less anxiety going into your procedure is absolutely worth it to me. 

 

 

[BurnieBurns]

13 hours ago, Savemyhairline said:

So, H&W got back to me. Hasson said he feels I might not be an ideal candidate, but Wong believes he can safely transplant between the existing hair and get around 2000 grafts for the frontal third. According to the advisor, Wong specifically has developed techniques that allow him to navigate around the existing hairs more effectively than other doctors. Here’s another pic Bisanga took, kind of wish my hair was shorter but oh well:

 

 

what do you think? Worth potentially going to Wong instead? I feel like I’ve seen a lot more of Hasson’s work here, though I know both are highly regarded. My top two choices don’t think I’m a great candidate which is making me lean towards holding off, though I am intrigued by Dr. Wong’s thoughts.

I'm also a diffuse thinner with slightly less thinning with yourself and I'm booked for Dr Wong. Feel free to message me if you'd like me to let you know how it goes.

Even the elite doctors have different 'philosophies'. E.g. some doctor wouldn't want to risk losing even half miniaturised hairs while others would agree that they're so find they may as well not be there.