Eugenix 3514 grafts (720 on the temples) May 2022 Dr Priyadarshini Das

[Gatsby]

On 2/9/2023 at 7:17 AM, GeneralNorwood said:

On 2/9/2023 at 3:02 AM, Rafael Manelli said:

You might end up nw7 

But it can be after 20 years so i don't care. 

Trust me you will! 😉 But you have strong factors in your favour @GeneralNorwood. You hair to skin color is a great match. You can tolerate the big gun dutasteride. You have beard grafts you can use to augment if required, etc. I think your result is an excellent one and there are no two people alike that have to abide by the one rule when it comes to hair transplants. If you look at my case I'm a Norwood 7. I have a large head and a very large bald area, especially in terms of my crown. The way you style your hair plays a big part in the illusion of hair density and finally their is the psychology. Many people will be saying similar things about my results when they grow in. But psychologically, no longer having an ugly hairline scar thanks to surgery today, makes me feel a winner and in many ways trumps the thought of hair loss for me. It's definitely different strokes for different blokes when it come to hair restoration. That's a big reason why for some people surgery has been life changing while for others it is the worst decision they have ever made. I've been around long enough to have experienced both ends of that spectrum. All the best! 👌

[GeneralNorwood]

5 hours ago, Judelaw said:

I’m sorry to hear the bad news but you have to respect Bisanga for giving it to you straight with a plan of action. What led your surgeon to place so many grafts in the temple points?

I asked for temple restoration. That was the project that we made together. 

5 hours ago, ZeeMan said:

Ultimately, it all depends on how you feel about your hair? Are you satisfied/happy etc? People will always talk, but you are wise enough to ignore the nay-sayers!!

I am not satisfied. The worst thing is lateral humps, because it looks very unnatural from the side that i have dense front and then it's bald spot on the side. 

5 hours ago, Z-- said:

Honestly, I thought your hair looked fantastic, until I saw the Bisanga photos, which makes the situation a bit more nuanced. Think Eugenix got you great growth, but if it's true that you only have 3,200 hairs remaining and that large of an area to cover, there are going to have to be some sacrifices (e.g. a bald spot left in the crown or weaker coverage on the lateral humps). Was this made clear to you before the surgery? Did you insist on the aggressive hairline?

That said, if you're happy with a strong hairline and weaker midscalp/crown, then the surgery was a success. I'd seriously consider going to a more conservative doctor to maximize your yield and one who plans for future loss. Bisanga is, of course, a great option. Others to reach out include Dr. Munib Ahmad and Konior. I've seen great repair cases from all of them.

How are you feeling about the result?

The aggresive hairline was first draft of dr Das and i agreed to this. I asked for some grafts on the crown, but what i got was only 350. Lateral humps was neglected, we didn't talk about it, i didn't see at the moment that this requires a lot of grafts to look good with HT on the front. 

I am not happy with strong hairline and weaker midscalp/lateral humps. The final result is not good. 

 

3 hours ago, hairman22 said:

 

I think Bisanga was a bit harsh. Although i think the front is too dense,

Actually a less dense hairline & frontal third would save more grafts & you could have equal density through the top of the scalp.

It is probably too low as well considering you are a NW7 in the future,

@GeneralNorwood I would not rush the next surgery.

I think Zarev or Pitella are your best shot & receiving a great result,

They will be able to get more from your scalp donor than 3000

Bisanga told me that safe zone is 4 cm. You multiply it by 26 cm and you have 104cm2 donor area. The donor area is 65 grafts/cm2. So if you take 31 grafts from each cm2, you take 3200 grafts total. Donor area will be then 65-31 grafts = 34 grafts/cm2. Anyway, what can do dr Zarev and Pitella? Take more grafts from safezone and donor will look sparse or avoid the safe zone. 

42 minutes ago, Rafael Manelli said:

Has he seen Brad Pitt? It looks natural to me.

If you’re worried about running out of grafts, you could go with the option of doubling down on the frontal third with the second transplant for higher density, and use non surgical solutions for the mid scalp and crown (concealers, smp or prosthesis, all three of which work best on the mid scalp and crown.)

Concealer doesnt work for midscalp and lateral humps, because there is huge difference in density and everything behind frontal third loos flat. Furthermore, frontal hair are curly and miniaturised hair in the midscalp aren't. 

What is prosthesis? Fake hair? 

[Rafael Manelli]

Zarev and Pitella are known for doing huge cases, but I don’t believe they’re doing anything magic. Just good skill and taking more grafts, depleting the donor and going outside the safe zone.

Prosthesis as in a partial hairpiece or hair system. It would look great, but it’s not for everyone. Takes a certain mentality and many men can’t get over the mental block around it, which is understandable.

I understand your skepticism of concealers, and you are partially correct. They work for opacity and color, but they do not work for volume very much. Fibres can add thickness to the hair shaft and make thin hairs more “massive” in a sense,  but because they’re not actually part of the hair, they weigh it down without adding structural support, essentially adding more weight to already thin, miniaturised hairs. Transplanting more may be the best option for adding volume, and you could potentially use concealers for opacity if and as needed.

[Rawkerboi]

Hi, 

What Eugenix has to say? 

Did you share your concerns with them? 

[GeneralNorwood]

5 minutes ago, Rawkerboi said:

Hi, 

What Eugenix has to say? 

Did you share your concerns with them? 

Dr Das proposed 1000 grafts for midscalp and 1500 for the crown. 

[Rafael Manelli]

7 hours ago, GeneralNorwood said:

Dr Das proposed 1000 grafts for midscalp and 1500 for the crown. 

Does Eugenix agree with Bisanga's estimate of how many grafts you have left in the bank? 

[GeneralNorwood]

1 hour ago, Rafael Manelli said:

Does Eugenix agree with Bisanga's estimate of how many grafts you have left in the bank? 

Dr Das said that i have between 2800-3000 left in donor

[Rafael Manelli]

If you manage to hold on to natives with dutasteride that might be enough 

[GeneralNorwood]

49 minutes ago, Rafael Manelli said:

If you manage to hold on to natives with dutasteride that might be enough 

I think that this pictures better show that Bisanga is right. The more I think about it, the more convinced I become that this HT plan was dumb.

 

 

 

[GeneralNorwood]

1 hour ago, Rafael Manelli said:

If you manage to hold on to natives with dutasteride that might be enough 

 

I think that this areas that i marked in red rectangle are looking the most ugly and it should be number 1 priority for HT. 

I don't know if i want you use all ~3000 grafts in next procedure. Maybe better idea is to use 2000 and leave some in the bank. Another think is considering FUT technique, but is it profitable when i already had FUE and now there is only 65 grafts/cm2 in donor? 

[Rafael Manelli]

This triangle, in my view, is the top priority for naturalness, and will only take a few hundred grafts. It is strange that Dr Das didn't anticipate needing to fill it in, and that she gave you such an aggressive hairline considering what Bisanga has revealed. Perhaps you should ask her about that.

Regardless, what's done is done. You can only move forward. You may have regrets, which are reasonable, but on the plus side you got a natural looking result with high yield, invisible scarring (as far as I can tell) and they have not depleted your donor or harvested in a strange pattern. 

And you're handling the strongest meds available. 

You went to a highly regarded clinic and put your trust in an expert's judgment. You can't beat yourself up about that. 

As for the big red rectangle you just posted, thay could eat up 1000 grafts per side. It would make a big difference though.

And as for FUT, if you're going to do FUT yothe conventional wisdom is to strip out and then do FUE. Starting with FUE and then doing strip is not the best idea because FUE will harvest some hairs from the strip area, thus making any strips you get less profitable. However, those hairs aren't wasted. They've been used for FUE. So it shouldn't be too big a deal. 

Strip candidacy depends on scalp laxity. 

Not many European surgeons are known for FUT these days. Bisanga and Lupanzula do it on occasion. Drs Muresanu do it regularly. Dr Ball in the UK does it.

It's a wise choice if you want to eke out every graft you can. 

I think you should consider it. 

[Berba11]

If you can push your donor to around 3,500 grafts (only slightly over the Dr Das & Bisanga’s estimates) and get 1,500 from your beard then I’d imagine 5,000 grafts would probably see you through the midscalp, lateral humps & crown - maybe some compromise on crown density but you’ll probably be fine. 
 

Dr Bisanga’s argument that the work is too aggressive may have merit, but I don’t agree with him about the temple points, for example. Yours look very natural. You may have benefitted from the hairline being 1 or 2cm’s higher up by the temple points really add to the aesthetic.  

[GeneralNorwood]

21 minutes ago, Rafael Manelli said:

This triangle, in my view, is the top priority for naturalness, and will only take a few hundred grafts. It is strange that Dr Das didn't anticipate needing to fill it in, and that she gave you such an aggressive hairline considering what Bisanga has revealed. Perhaps you should ask her about that.

 

 

It was all there, just look at the picture. She didn't take time to think about the plan and for me everything was happening fast and i didn't think it through too. They are doing multiple surgeries, consultations etc during the day and this is the final outcome of this approach. 

 

 

22 minutes ago, Rafael Manelli said:

 

You went to a highly regarded clinic and put your trust in an expert's judgment. You can't beat yourself up about that. 

As for the big red rectangle you just posted, thay could eat up 1000 grafts per side. It would make a big difference though.

And as for FUT, if you're going to do FUT yothe conventional wisdom is to strip out and then do FUE. Starting with FUE and then doing strip is not the best idea because FUE will harvest some hairs from the strip area, thus making any strips you get less profitable. However, those hairs aren't wasted. They've been used for FUE. So it shouldn't be too big a deal. 

Strip candidacy depends on scalp laxity. 

Not many European surgeons are known for FUT these days. Bisanga and Lupanzula do it on occasion. Drs Muresanu do it regularly. Dr Ball in the UK does it.

It's a wise choice if you want to eke out every graft you can. 

I think you should consider it. 

 

Yes, i went to highly regarded clinic and unfortunetly received one of the worst results in the hairrestorationnetwork. 

 

I will definetly consider FUT, because what can i do... Area to cover is huge. Dr Bisanga said that miniaturised hair doesn't matter, they are thin, light colored, so we need good density anyway. 

 

[Rafael Manelli]

Personally I wouldn't go to anyone who won't spend more than 5 minutes on the design. That's reckless and inconsiderate, for a surgery that will last a lifetime. Honestly, I would expect at least half an hour guaranteed for design and planning alone. A consultation can reasonably last an hour or two. 

Approx 6000 grafts, with your hair type, was never going to be enough to cover the whole nw7 area with good density and that aggressive hairline. So you were always reliant on the meds and it was always a risk. I'm surprised Dr Das was so rushed, by the sound of it.

I don't consider it anywhere near the worst result I've seen. If it helps, I've seen far, far worse. Miles worse. I don't say this to deny your perspective but to give you a new one and for reassurance. It's not that bad. Just reckless and rushed by the sound of it in the planning phase. 

But, at the end of the day it's your head so it's your opinion that matters and it reflects badly on Eugenix that you're unsatisfied. 

[Rafael Manelli]

The miniaturised hair definitely does matter, but only as long as it lasts.  If you don't believe me, try shaving it all off and see if you look any different. 

For Dr Bisanga to say the miniaturised hair doesn't matter is for him to say it doesn't matter if you take meds so you may as well get off the dutasteride, which is obviously a bad idea, and he would tell you it's a bad idea. 

It does matter, but it's insufficient. You would still need a good density of grafts, just not AS much as you'd need if you were slick bald on top. I'm sure Dr Bisanga would agree with this. 

[Rafael Manelli]

On 12/2/2022 at 1:14 PM, GeneralNorwood said:

it could'v forseen that sides wouldnt keep up with the powerfull transplant on the front, especially left side. 

However at the day of procedure i didn't see this possibility

I went back and noticed you said this. That you didn't foresee the possibility that you'd need grafts on that triangle on the side, especially the left. 

But really, whether you noticed it or not, Dr Das should have noticed it.

[aaalan]

How about the possibility of BHT? Leveraging beard hair?

Not to dismiss your concerns but i agree with @Rafael Manelli on this is not the worst. Keep up the confidence/ plan ahead and dont let this consultation and critic play on your head too much. 

Edited March 21, 2023 by aaalan

[Rafael Manelli]

@aaalan Dr Bisanga told him his beard was unsuitable as donor.

Perhaps Eugenics would feel differently.

[aaalan]

51 minutes ago, Rafael Manelli said:

@aaalan Dr Bisanga told him his beard was unsuitable as donor.

Perhaps Eugenics would feel differently.

Yes but thats the thing… as much as these clinics are well reputed/ respected- theres always going to be an element of critic/ compare that we (consumers/ payers) will need to accept.  They are indeed competing for top dollars. To your point Eugenix may have thought differently.

As suggested earlier, a consultation with Eugenix on next step/ forward looking plan may not be a bad idea.

[Berba11]

1 hour ago, Rafael Manelli said:

@aaalan Dr Bisanga told him his beard was unsuitable as donor.

Perhaps Eugenics would feel differently.

I know of cases outside of this forum where Bisanga has rejected people or suggested their donor resources aren’t good enough, so it seems his criteria for what he would take on is quite stringent. 
 

Equally we know that more than one surgeon had turned away the likes of Zoomster, Gatsby and others and look at them now…

[Rafael Manelli]

@Berba11 I think his beard looks suitable in the photos he's provided. The color and texture are not too different that they couldn't blend in. But I have not taken a close eye to it like Dr Christian Bisanga.

My concern with transplanting the midscalp and crown would actually be the possibility of killing off some of the miniaturised natives. They appear dense and shrunken, which can make them vulnerable to shockloss.

It's going to require some strategising.

Edit: and yes, Dr Bisanga is renowned for his conservative approach. He does not beat around the bush. He's a straight shooter and rarely oversteps the mark. 

 

Edited March 21, 2023 by Rafael Manelli

[Melvin- Admin]

4 hours ago, GeneralNorwood said:

I think that this pictures better show that Bisanga is right. The more I think about it, the more convinced I become that this HT plan was dumb.

 

 

 

Well, different doctors have different philosophies, I have nothing but the utmost respect for Dr. Bisanga. That said, I think you still have plenty of donor left. I was in a similar situation before my last HT.

Can your situation be improved with another surgery? In my opinion, absolutely. Now, will you ever have a full head of hair with no weak spots? Probably not. That’s being realistic.

[Zoomster]

Please take some hope from this @GeneralNorwood..there’s 5,400 beard grafts in there some where within my midscalp / crown…..if Eugenix deem your beard suitable then as was mentioned earlier a 3k scalp 2 K beard procedure should put an end to your concerns …most of my last crown procedure hasn’t fully borne fruit yet either ..i understand your frustration though ..I’d be feeling the same way .

Ive a feeling you’re going to be ok at the end of all this so hang in there .

 

 

[Rafael Manelli]

1 hour ago, Melvin- Moderator said:

Well, different doctors have different philosophies, I have nothing but the utmost respect for Dr. Bisanga. That said, I think you still have plenty of donor left. I was in a similar situation before my last HT.

Can your situation be improved with another surgery? In my opinion, absolutely. Now, will you ever have a full head of hair with no weak spots? Probably not. That’s being realistic.

 How much of your native hair have you been able to save with finasteride? How much do you have left on top?

 

[mister_25]

After reading your thread I do have to agree with Dr Bisanga's assessment. 3200 Grafts isn't enough to get you a full head of hair regarding your midscalp and crown but I still feel like 3200 grafts would make you look somewhat normal with just vertex thinning if executed properly and carefully. I feel like the planning here is most definitely working against you but its not unsalvageable and you can at least get to a point that looks natural and not artificial.

Did Dr Bisanga mention how many grafts you could get outside of the safe zone?