Bisanga or Mwamba ?

[DavidFrancis]

Hello forum, 
I have just registered, and I regret not having found this forum earlier! 
I am 24 years old, and I had a bad transplant of 2500 FUE a year ago. I would like to repair it. 
I'm hesitating between Bisanga and Mwamba, could someone advise me? I would like to extract 200-300 misdirected grafts, and have a very natural hairline-middle with 1500 FUE.  (I haven't seen many cases where Bisanga extracts a lot of misdirected plugs)
The price is also important for me, and I don't know about these two doctors. 
Thank you in advance

 

Edited January 31, 2023 by DavidFrancis

[Rafael Manelli]

Both are highly regarded for repairs. I’ve heard Mwamba is slightly less expensive, but you may as well inquire to both. If you’re looking at Belgium you could also consider Feriduni and Lupanzula.

Personally I’d trust any of the above. Good luck with your repair!

[A_4_Archan]

@DavidFrancis both are great surgeons ...if you going for that budget thn you can consider dr munib ahmad ...dr couto...feriduni...zarev...

[vanilia]

I was also considering Bisanga for my second OP, but he wanted that i come first to brussels to check how good my donor was since i already had one and if i am a good candidate...so this would be two time travelling and months between checking and operation.

[HappyMan2021]

47 minutes ago, vanilia said:

I was also considering Bisanga for my second OP, but he wanted that i come first to brussels to check how good my donor was since i already had one and if i am a good candidate...so this would be two time travelling and months between checking and operation.

its quite ridiculous isn't it?

It may be fine for OP - I think he lives in France - so not a terrible trip to Belgium just for a consult. But for anyone not near Brussels it kind of makes Bisanga seem out of touch to demand patients go to Brussels just for a consult. "Sure, let me just clear my schedule and hop in my private jet and head over to Brussels for a 30 min consult." But seriously, it demands that a patient pay thousands and thousands of dollars, take time off work, etc solely for a preliminary consult. 

Not only that, but it needlessly adds months and months to your hair transplant journey. Because instead of simply booking your surgery, you are booking for a consult, and only after that can you book for surgery. 

Even when Bisanga is in the US and occasionally has consults in Maryland, going say from the West Coast to Maryland just for a 30 min consult just to validate everything you the patient alrady know, that is a bit much to take too. 

I will say - to be fair - Dr. Cooley in the US has this draconian policy in place as well, and my criticism of it is equal to Bisanga doing it.

Edited January 31, 2023 by HappyMan2021

[Raphael84]

I post a response here as BHR Clinic and Dr. Bisanga are being discussed somewhat unfairly in terms of the requirement of consultation being "ridiculous".

We will all have our own perspectives which is understandable, but if I was in a position to invite any individual to come and attend a full day of consultation where the doctor will meet numerous individuals throughout the day I would very much like to do so. Of course I cant with patient confidentiality, but you would be extremely surprised to find that several individuals with apparently good heads of hair presenting lesser Norwood patterns and what would appear to be solid donors, to actually present an unstable environment in terms of their donor when assessed under magnification and the risk of yield and growth would be high.

I ask if you may have had the opportunity to assess donor areas under magnification and become intimately knowledgeable of them? I would suggest probably not, and there lies the lack of understanding.

Just these last weeks at the clinic, two patients who did not appear to present any problems in terms of candidacy from photos, showed some suspicions within their scalp and potential inflammation that looked liked LPP (scarring alopecia). In both cases upon biopsy with their own sourced dermatologists, scarring alopecia was confirmed and a years treatment has now begun for both patients. LPP can not be cured and even with treatment if becomes inactive, surgery itself can trigger the condition and cause further and extensive loss. 
What would have been the case if both of these individuals had proceeded with surgery based on their photos and achieved little to no yield and actually lost more hair due to surgery being performed? That would have been terrible and a "ridiculous" and unethical decision.
Consultations are not just about hair. They are about the integrity and the environment of the scalp, which in most cases, can not be seen to any degree in photos.

These consultations can honestly bring you close to tears. Being a patient myself and knowing how hair loss impacted me as a young man and the extents I went in terms of holding down 3 jobs and saving every penny to be able to finance my first procedure, to see men attend consultation and the pain of loss is written all over their faces. They are overcome with emotion, especially those who have had previous surgery and may be unsatisfied. Many patients due to loss have struggled with anxiety and/or depression, this is common and so the idea of proposing surgery to patients without any empirical data to support the fact that they may or may not be a candidate, and to propose surgery and encourage that hope to then potentially find that they may not be candidates for surgery or may be borderline at best and the objectives that they discussed and desired may not be within reach, can be very negatively impactful to individuals. Having committed to surgery, invested both emotionally and financially to their perceived outcome and result, only to find that this is not the reality of their case and situation.

We have never encouraged a patient from outside of Europe to travel to Brussels for consultation so to suggest the "private jet" and "demanding" theory is distasteful. I also understand the geography of the US and that Maryland consultations are not convenient or feasible for all, but obviously the doctor is not able to travel to each state and all locations.

Again, we will all have our own perspectives and whilst other clinics will book purely on photos, I very much hope that come the time of surgery that those who have concerns with the requirement for in person consultation do not then find themselves in a position where candidacy is declined after such extensive travel and expense, or exponentially worse, the clinic proceed with surgery on a patient who really is not a viable candidate and therefore concerns will present themselves either in the short or long term.

This forum presents many surgeons for your consideration. If you have concerns with one surgeons approach, then you can simply disregard him from your consideration. That is absolutely fine and actually encouraged. But to then publicly and on many occasions and threads, take issue with the fact that he is ethical is also "ridiculous".

For those that may be new to the discussion, please find a previous post linked further explaining and discussing this very point.

I genuinely wish that everybody was a great candidate for surgery but naivety and ignorance is not in anybodies best interests.

I wish everybody the best in their onward paths.

 

Edited February 1, 2023 by Raphael84

[Viney]

17 minutes ago, Raphael84 said:

I post a response here as BHR Clinic and Dr. Bisanga are being discussed somewhat unfairly in terms of the requirement of consultation being "ridiculous".

We will all have our own perspectives which is understandable, but if I was in a position to invite any individual to come and attend a full day of consultation where the doctor will meet numerous individuals throughout the day I would very much like to do so. Of course I cant with patient confidentiality, but you will be extremely surprised to find that several individuals with apparently good heads of hair presenting lesser Norwood patterns and what would appear to be solid donors, to actually present an unstable environment in terms of their donor when assessed under magnification and the risk of yield and growth would be high.

I ask if you may have had the opportunity to assess donor areas under magnification and become intimately knowledgeable of them? I would suggest probably not, and there lies the lack of understanding.

Just these last weeks at the clinic, two patients who did not appear to present any problems in terms of candidacy from photos, showed some suspicions within their scalp and potential inflammation that looked liked LPP (scarring alopecia). In both cases upon biopsy with their own sourced dermatologists, scarring alopecia was confirmed and a years treatment has now begun for both patients. LPP can not be cured and even with treatment if becomes inactive, surgery itself can trigger the condition and cause further and extensive loss. 
What would have been the case if both of these individuals had proceeded with surgery based on their photos and achieved little to no yield and actually lost more hair due to surgery being performed? That would have been "ridiculous".

These consultations can honestly bring you close to tears. Being a patient myself and knowing how hair loss impacted me as a young man and the extents I went in terms of holding down 3 jobs and saving every penny to be able to finance my first procedure, to see men attend consultation and the pain of loss is written all over their faces. They are overcome with emotion, especially those who have had previous surgery and may be unsatisfied. Many patients due to loss have struggled with anxiety and/or depression, this is common and so the idea of proposing surgery to patients without any empirical data to support the fact that they may or may not be a candidate, and to propose surgery and encourage that hope to then potentially find that they may not be candidates for surgery or may be borderline at best and the objectives that they discussed and desired may not be within reach, can be very negatively impactful to individuals. Having committed to surgery, invested both emotionally and financially to their perceived outcome and result, only to find that this is not the reality of their case and situation.

We have never encouraged a patient from outside of Europe to travel to Brussels for consultation so to suggest the "private jet" and "demanding" theory is distasteful. I also understand the geography of the US and that Maryland consultations are not convenient or feasible for all, but obviously the doctor is not able to travel to each state and all locations.

Again, we will all have our own perspectives and whilst other clinics will book purely on photos, I very much hope that come the time of surgery that those who have concerns with the requirement for in person consultation do not then find themselves in a position where candidacy is declined after such extensive travel and expense, or exponentially worse, the clinic proceed with surgery on a patient who really is not a viable candidate and therefore concerns will present themselves either in the short or long term.

This forum presents many surgeons for your consideration. If you have concerns with one surgeons approach, then you can simply disregard him from your consideration. That is absolutely fine and actually encouraged. But to then publicly and on many occasions and threads, take issue with the fact that he is ethical is also "ridiculous".

For those that may be new to the discussion, please find a previous post linked further explaining and discussing this very point.
https://www.hairrestorationnetwork.com/topic/62648-why-the-need-for-in-person-consultation/

I genuinely wished that everybody was a great candidate for surgery but naivety and ignorance is not in anybodies best interests.

I wish everybody the best in their onward paths.

 

I'm happy to chime in and say I am one of these people. I thought my donor appeared better (based on pictures) than it actually was under a microscope. What appeared to be an average donor was actually below average. The only reason I had it examined under microscope was because BHR Clinic required it. This has been extremely useful information for me in deciding what medication I need to take and if and how I should go about proceeding with a hair transplant.

Having the detailed examination is honestly one of the best decisions I've ever made, because the medication I was prescribed following the examination is giving me results better than I could have ever anticipated or expected, even exceeding what I thought was actually possible (I'm collating some information on this which I will send to you within the next few weeks Ian 😉).

Edited February 1, 2023 by Viney

[Dillpickle123]

19 minutes ago, Viney said:

I'm happy to chime in and say I am one of these people. I thought my donor appeared better (based on pictures) than it actually was under a microscope. What appeared to be an average donor was actually below average. The only reason I had it examined under microscope was because BHR Clinic required it. This has been extremely useful information for me in deciding what medication I need to take and if and how I should go about proceeding with a hair transplant.

Having the detailed examination is honestly one of the best decisions I've ever made, because the medication I was prescribed following the examination is giving me results better than I could have ever anticipated or expected, even exceeding what I thought was actually possible (I'm collating some information on this which I will send to you within the next few weeks Ian 😉).

So you had LPP? 

[Viney]

53 minutes ago, Dillpickle123 said:

So you had LPP? 

No, I didnt.

I simply have (or had... 🤨?) a below average donor which would not have been known if I hadn't had an in person examination of my hair.

Say if I booked a hair transplant with a surgeon overseas based purely on my pictures, once I got there on the day of surgery only then we may have realised my donor is not as good as it appears in the pictures. This could have meant less grafts available for the surgery on the day, meaning a huge change in plans and expectations, or worse cancellation/refusal to do surgery due to the risk of operating on someone with a below average/higher risk donor. These last minute changes and surprises on the day of surgery is the last thing you need with such a significant procedure, especially while in a foreign country.

Edited February 1, 2023 by Viney

[HappyMan2021]

@Raphael84 I seemed to have touched a nerve, I am sorry. I just thought I was allowed to express my opinion on this forum, its not 'select your doctor, and stay completely silent on all the others'.

If anything, take my opinion as a compliment that Bisanga is one of the most skilled repair surgeons in the world. If I didn't think he was skilled I wouldn't care what his consultation policies are.

Edited February 1, 2023 by HappyMan2021

[gillenator]

Wait a minute here, there are too many  generalizations being implied here when there should be some clarifications made…please let me state that yes the ideal protocol is to physically examine each and every patient “prior” to any surgery being considered…however, we all know that many of the top surgeons are located across the globe which presents the challenges being discussed.

But let’s put things in perspective…for many years it has been rather commonplace for the patient to meet the doctor via a virtual consultation, email multiple photos and if agreeable,   surgery is scheduled contingent on physical examination on the morning of surgery and should there be any issues that would disqualify the patient, the procedure is cancelled…Why was this commonplace for the traveling patient?…because disqualification was rare and currently there are other technologies such as using high powered scopes, FaceTime, during the initial virtual consultation that greatly helps to minimize any surprises…if this was commonplace, there would be lots of complaints being voiced in these online communities.

Now obviously this approach does not apply to repair cases or individuals with unique or acute attributes but candidates with virgin scalps or a second procedure rarely run into problems on the day of surgery if the initial virtual consultation is thorough…in all the years that I worked inside the clinics, this was not an issue… in fact if there was a problem, it almost always was an issue of doing less grafts than initially scheduled…however if this approach is an issue, there are other skilled surgeons to choose from and as I already stated, the more complex repair cases would be exempted.

[gillenator]

I should have also mentioned that I believe Dr. Mwamba attained his M.D. license in the USA and he legally can practice both in the USA and Belgium…however I don’t think Dr. Bisanga attained an M.D. here and is limited to practice in Belgium…his wife however is a licensed physician in the USA and works in Maryland and they also live in  Maryland.

[DavidFrancis]

Thank you for your advice, 
I have already seen Lupanzula, very nice clinic and staff, but he did not offer me graft extraction. Only a densification with 2000 grafts.
In terms of skills, I know that Bisanga and Mwamba are the best in repair. But are they under 5 euros per graft? And above all, I would not want to do 2 or 3 repair procedures, it is quite difficult as an experience

[Jackdaniels]

I would prefer mwamba. Mwamba spends more time with every patient explaining everything and also during the surgery he seems to take very good care of each patient participating and supervising every single step of the procedure.

Also mwamba is less expensive than dr bisanga…

[HappyMan2021]

1 hour ago, DavidFrancis said:

And above all, I would not want to do 2 or 3 repair procedures, it is quite difficult as an experience

 

1 hour ago, Jackdaniels said:

Also mwamba is less expensive than dr bisanga…

Mwamba has different prices for virgin scalps vs repairs. No clue how much Bisanga charges but for Mwamba repairs its basically $4k per half day $8k for full day of repairs. And this may be a multiple day procedure. It likely will be, as Mwamba likes to take his time. So Mwamba is certainly not a cheap doctor in terms of repairs.

Also keep in mind the 21% VAT tax.

1 hour ago, DavidFrancis said:

I would not want to do 2 or 3 repair procedures, it is quite difficult as an experience

the complication with extracting bad angles is, during 1 round of surgery, if 2 badly angled grafts are very close to each other, only 1 can be extracted during that round. Extracting both would lead to two small holes that connect each other to form one large hole, scarring, bad stuff, etc. 

So extracting bad angles often involves multiple procedures. If your bad angles are really spaced apart you may be in luck, you would have to ask Bisanga and Mwamba if you consult with them. 

 

You live in France correct? Since Bisanga and Mwamba are so close by to you, I would consider them both somewhat equally. Also keep in mind the repair cost of Mwamba and they may be relatively equal pricing.

There is also Feriduni in Belgium. He doesnt have as much publicity/marketing as the above doctors but from what I have observed, he is equally as skilled at repairs as the above doctors. He just kind of flies under the radar. 

Cooley in the US is renowned as well, but probably more inconvenient for you due to geography. 

If you want even more options, pretty much every "elite" doctor is competent and experienced with repairs. Unfortunately with the state of the industry, so many hairmills, and so many people getting botched, there are so many repair patients out there that even doctors who do not market themselves specifically as "repair" specialists still have loads of experience doing repair surgeries.

Ex. H&W and Konior don't really tout or market themselves as repair doctors, but are nonetheless still extremely experienced in repairs and likely could do just or almost just as good of a job as the true "repair doctors"

Edited February 1, 2023 by HappyMan2021

[HappyMan2021]

1 hour ago, DavidFrancis said:

I have already seen Lupanzula, very nice clinic and staff, but he did not offer me graft extraction. Only a densification with 2000 grafts.

I'm not familiar with Lupanzula, is he known as a repair surgeon? Why didn't he offer graft extraction, did he think none of your grafts are actually misangled?

[Z--]

15 minutes ago, HappyMan2021 said:

 

Mwamba has different prices for virgin scalps vs repairs. No clue how much Bisanga charges but for Mwamba repairs its basically $4k per half day $8k for full day of repairs. And this may be a multiple day procedure. It likely will be, as Mwamba likes to take his time. So Mwamba is certainly not a cheap doctor in terms of repairs.

Also keep in mind the 21% VAT tax.

 

Does Mwamba charge a day rate now? I always thought it was by number of graft count (with it being double for a repair).

[DavidFrancis]

I also thought it was with the number of grafts. 
Lupanzula noticed that the grafts were misaligned, but he thought it was easier to densify the whole thing. In reality, it's really convenient for me to densify only, but it's a gamble to take, is the mass of new hair going to succeed in camouflaging. As for Feriduni, I'm afraid it's very expensive.

[HappyMan2021]

14 minutes ago, Z-- said:

Does Mwamba charge a day rate now? I always thought it was by number of graft count (with it being double for a repair).

I can only speak for myself, but the 2x I have seen Mwamba for repairs, it was a flat rate of $4k for half day and $8k for a full day. And of course its likely going to be a multi-day procedure. 

Even with straightforward virgin scalps with 2k or less graft count, Mwamba seems to prefer making those a 2-day procedure. I mention this because I doubt any repair with him would just be a 1-day affair, since even his 'normal cases' are 2 days or more. 

[HappyMan2021]

6 minutes ago, DavidFrancis said:

As for Feriduni, I'm afraid it's very expensive.

how much was Feriduni?

I would consider Feriduni, Bisanga, and Mwamba to be more or less equal. They are all extremely well-regarded repair surgeons. Its just a strange coincidence they all happen to be Belgian. 

Edited February 1, 2023 by HappyMan2021

[Jackdaniels]

52 minutes ago, HappyMan2021 said:

 

Mwamba has different prices for virgin scalps vs repairs. No clue how much Bisanga charges but for Mwamba repairs its basically $4k per half day $8k for full day of repairs. And this may be a multiple day procedure. It likely will be, as Mwamba likes to take his time. So Mwamba is certainly not a cheap doctor in terms of repairs.

Also keep in mind the 21% VAT tax.

the complication with extracting bad angles is, during 1 round of surgery, if 2 badly angled grafts are very close to each other, only 1 can be extracted during that round. Extracting both would lead to two small holes that connect each other to form one large hole, scarring, bad stuff, etc. 

So extracting bad angles often involves multiple procedures. If your bad angles are really spaced apart you may be in luck, you would have to ask Bisanga and Mwamba if you consult with them. 

 

You live in France correct? Since Bisanga and Mwamba are so close by to you, I would consider them both somewhat equally. Also keep in mind the repair cost of Mwamba and they may be relatively equal pricing.

There is also Feriduni in Belgium. He doesnt have as much publicity/marketing as the above doctors but from what I have observed, he is equally as skilled at repairs as the above doctors. He just kind of flies under the radar. 

Cooley in the US is renowned as well, but probably more inconvenient for you due to geography. 

If you want even more options, pretty much every "elite" doctor is competent and experienced with repairs. Unfortunately with the state of the industry, so many hairmills, and so many people getting botched, there are so many repair patients out there that even doctors who do not market themselves specifically as "repair" specialists still have loads of experience doing repair surgeries.

Ex. H&W and Konior don't really tout or market themselves as repair doctors, but are nonetheless still extremely experienced in repairs and likely could do just or almost just as good of a job as the true "repair doctors"

A surgery should be charged depending on the number of grafts even if it is repair or not.

So I don’t agree with the fact that mwmaba charges more for repairs since if they dedicate a day for a normal procedure the same applies for a repair procedure. The same techs would be used in both procedures, and the same surgery stuff…The money the get for a normal procedure is already high enough, so no reason for extra charges.  

I think It’s a marketing trick for clinics to use the word “repair” to ask for more money from clients and increase their profits. 

Edited February 1, 2023 by Jackdaniels

[HappyMan2021]

5 minutes ago, Jackdaniels said:

A surgery should be charged depending on the number of grafts even if it is repair or not.

So I don’t agree with the fact that mwmaba charges more for repairs since if they dedicate a day for a normal procedure the same applies for a repair procedure. The same techs would be used in both procedures, and the same surgery stuff…The money the get for a normal procedure is already high enough, so no reason for extra charges.  

I think It’s a marketing trick for clinics to use the word “repair” to ask for more money from clients and increase their profits. 

Perhaps Mwamba charges more for repairs because they require a lot more surgical planning, skill/expertise, and are more time-consuming. 

5 minutes ago, Jackdaniels said:

same surgery stuff

Extracting and reimplanting badly angled grafts requires a lot more skill and is alot different than straightforward implantation on a virgin scalp. 

Edited February 1, 2023 by HappyMan2021

[HappyMan2021]

6 minutes ago, Jackdaniels said:

I think It’s a marketing trick for clinics to use the word “repair” to ask for more money from clients and increase their profits. 

While I agree that many patients and clinics alike are too liberal in their use of repair (someone who had sub-par density in a 1st round and just needs a 2nd pass density fill-in is not a repair IMO even though they may describe themselves as a repair), there are many legitimate repair patients. 

How can you say someone with hundreds of badly angled grafts, a junevile hairline, or an overharvested donor is not a 'repair'? I'm not sure what other word you would use. You cannot simply implant more grafts in many of these scenarios and call it a day - they require repair techniques. 

[Jackdaniels]

12 minutes ago, HappyMan2021 said:

Perhaps Mwamba charges more for repairs because they require a lot more surgical planning, skill/expertise, and are more time-consuming. 

Extracting and reimplanting badly angled grafts requires a lot more skill and is alot different than straightforward implantation on a virgin scalp. 

Both procedures repairs and normal ones need the same surgical planning, skill expertise and they are time cosnuming (the normal ones would be more time consuming, since in them they extract and implant more grafts). The extra thing with repairs is to just remove some handrend (?) grafts from hairline. Do u think that would be time consuming?? i dont think so. 

If a surgeon dedicates a day for a normal procedure, then he would dedicate a day also for a repair procedure. So in both cases he spends a day and the same techs and surgical stuff would be used. So no extra expenses for the clinic and no extra time for the repair.

Edited February 1, 2023 by Jackdaniels

[shiba1985]

I feel like happyman2021, for being a non surgeon or a non medical person, sure has a lot to say about how a surgeon should go about evaluating his patient. Apparently hanging out on the forum, and having a few hair surgeries makes one an "expert."

I think it is completely fair for a surgeon to ask for an inperson consultation. These same patients that bitch about this (pre op in person consult), will be the same ones that bitch post operatively if their surgery doesn't produce the results. 

 

"Good surgeons know how to operate, better ones when to operate, and the best when not to operate."

Edited February 1, 2023 by shiba1985