Bisanga or Mwamba ?

[shiba1985]

22 hours 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 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.

 

 

No need to explain. Any reasonable and sane person would understand. 

[HappyMan2021]

15 minutes ago, shiba1985 said:

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."

have you even had 1 hair transplant? Even a consultation? You sure comment a lot on here for never haven gotten a hair transplant. 

All I ever see from you are out-of-the-blue and irrelevant comments. I don't recall anything from you about firsthand experience. 

I have never claimed to be an "expert" and I'm here for the same reasons everyone else is.

Your latest comments make it seem like you have been personally triggered. For the record I have zero interest in your own hair situation. 

I think I'm going to just block you my guy. I am here to peacefully share my own personal experiences as a patient, not to get into arguments or lower myself to petty name calling. Id rather only interact with constructive people on the forum. 

Best of luck with the SMP or whatever non-hair transplant solution you are considering. 

Edited February 1, 2023 by HappyMan2021

[Z--]

1 hour ago, HappyMan2021 said:

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. 

Gotcha — that’s helpful, thank you!  

[HappyMan2021]

8 minutes ago, Z-- said:

Gotcha — that’s helpful, thank you!  

Sure thing!

[gillenator]

1 hour ago, shiba1985 said:

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."

WOW!…after reading your post, I had to go back and read it again and wondering why you would take a cheap shot at HappyMan like this…totally uncalled for!

[gillenator]

1 hour ago, HappyMan2021 said:

have you even had 1 hair transplant? Even a consultation? You sure comment a lot on here for never haven gotten a hair transplant. 

All I ever see from you are out-of-the-blue and irrelevant comments. I don't recall anything from you about firsthand experience. 

I have never claimed to be an "expert" and I'm here for the same reasons everyone else is.

Your latest comments make it seem like you have been personally triggered. For the record I have zero interest in your own hair situation. 

I think I'm going to just block you my guy. I am here to peacefully share my own personal experiences as a patient, not to get into arguments or lower myself to petty name calling. Id rather only interact with constructive people on the forum. 

Best of luck with the SMP or whatever non-hair transplant solution you are considering. 

Well said my brother!

[coinflipdrifter]

Hey - I’m in the same camp here looking for a repair/fix. I’m looking to meet with Bisenga in person when he comes to Maryland - but can you keep us posted on the Mwamba consult and experience?

[gillenator]

Any reason why you are not also having a consultation with Dr. Mwamba?

[A_4_Archan]

On 2/1/2023 at 9:43 AM, gillenator said:

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.

Right..actually i believe that personal check up is good...bt as people are traveling frm so far thr shud be a balanced approach...after virtual consultation if a surgeon find out tht thr may be a chance of some issues with scalp or any othr thngs thn he shud ask patient that if you can travel for a personal consultation thn it wud be better and if u can't travel thn their cn be a chance that u will get rejected on the day of surgery ...so if the patient can afford to travel or if he is living nearby will go for a personal check up and if nt thn he wud b prepared for a rejection on the surgery day...

But yeh in ths scenario doctor's day wud be wasted as he wud have alloted tht day for the surgery to that particular patient..but thn doctor may use ths day for consultations and posting results on ths forum and replying to the queries here as they rarely get such full day opportunity like ths in their busy schedule ...😅

[Mike10]

 WIthout it 

On 2/1/2023 at 2:59 AM, HappyMan2021 said:

@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.

I agree with you that they do not like different views and that you are entitled to your own opinion on a public forum.  Although I have to agree with them on this, as an in person consultation is in the best interests of patient.

Edited February 2, 2023 by Mike10

[DavidFrancis]

Hi my friends ! 
I didn't get any feedback by email from Mwamba. 
I'm losing a lot of hair and I hope the medication will work. 
Is a precise evaluation of the donor area possible in video with Mwamba? 

[A_4_Archan]

2 hours ago, DavidFrancis said:

Hi my friends ! 
I didn't get any feedback by email from Mwamba. 
I'm losing a lot of hair and I hope the medication will work. 
Is a precise evaluation of the donor area possible in video with Mwamba? 

I dont think so...bt u can get some approximate idea ...and it can warry a bit when u go for a surgery....and what medication are u on? And if the hair fall is so vigorous thn u should consult a doctor first for your hairfall to settle down ..after tht u shud think of a surgery...

[DavidFrancis]

50 minutes ago, Archan said:

I dont think so...bt u can get some approximate idea ...and it can warry a bit when u go for a surgery....and what medication are u on? And if the hair fall is so vigorous thn u should consult a doctor first for your hairfall to settle down ..after tht u shud think of a surgery...

Okay thanks,
I have already seen a doctor who prescribed me oral minoxidil... in fact, apart from medication there is not much to do. I've been on finasteride 0,5mg and oral minoxidil for 1 month, I want to put the drop under the shedding, but I was also losing a lot before starting the treatment. 

[mrmane85]

8 hours ago, DavidFrancis said:

Okay thanks,
I have already seen a doctor who prescribed me oral minoxidil... in fact, apart from medication there is not much to do. I've been on finasteride 0,5mg and oral minoxidil for 1 month, I want to put the drop under the shedding, but I was also losing a lot before starting the treatment. 

The shedding is usually a good sign when you start medication like oral min and fin so hang in there and the hair that has shed will come back thicker and stronger 

[DavidFrancis]

16 hours ago, mrmane85 said:

The shedding is usually a good sign when you start medication like oral min and fin so hang in there and the hair that has shed will come back thicker and stronger 

I hope.. have you ever seen amazing regrowth with medications ? And do you know which vitamin is very good for hair ? 

[A_4_Archan]

2 hours ago, DavidFrancis said:

I hope.. have you ever seen amazing regrowth with medications ? And do you know which vitamin is very good for hair ? 

Yeh ofcourse ..dnt knw if anyone cn term it amazing bt i can say i got very good result and i have seen other people get good results too...

Actually thr are many vitamins which if a person has deficiency of cn contribute to hairfall and hair loss...and proper intake of them would help in reversing the situation...to name a few i would say biotin,zinc,iron..

[A_4_Archan]

On 2/7/2023 at 10:46 PM, DavidFrancis said:

Okay thanks,
I have already seen a doctor who prescribed me oral minoxidil... in fact, apart from medication there is not much to do. I've been on finasteride 0,5mg and oral minoxidil for 1 month, I want to put the drop under the shedding, but I was also losing a lot before starting the treatment. 

Oral finasteride and minoxidil will help you...be on it atleast for 6-8 months and thn see hows ur condition is and thn think of a surgery ...u cn consider prp therapy as well..tht will boost ur grafts and make them thicker and fuller..

[gillenator]

On 2/2/2023 at 2:49 AM, Mike10 said:

 WIthout it 

I agree with you that they do not like different views and that you are entitled to your own opinion on a public forum.  Although I have to agree with them on this, as an in person consultation is in the best interests of patient.

What’s in the patients’ best interest is not always possible but you make a good point.

[DavidFrancis]

I am at the end of my rope. 
I'm losing a lot of hair all over, more than 300 a day, and I have a huge diffusion coming. I wonder if it's still worth fighting this damn baldness, I've already wasted 2500 grafts in a lousy transplant, and I have some erection problems with the fina 0,5mg. I'm really losing hope

[A_4_Archan]

@DavidFrancis yeh looking sparse and i guess even ur donor area is nt looking fit frm ur pics...even donor is getting sparse so plz dnt take amy decision of a surgery at this stage untill u cn stop the hairloss ...u have just started the medication and it will take time to stabilise the hair fall...u cn even try prp sessions ...it works well in many cases ...and u cn consult a reputed local doctor as of nw to stabilise ur existing loss...

[DavidFrancis]

I’m really down.. 24 years old and i find myself with diffuse loss. I don’t even dare to go out anymore.
i’m going to make a consultation with a repair specialist to evaluate my donor area, but to staphilize it, apart from prescribing minoxidil or finasteride, the doctor won’t be able to do much. For PRP, it is too expensive for no guarantee of results..
On my previous picture, it is rather the vertex that is sparse, here is a picture of my donor area without flash

[DavidFrancis]

And with flash : 

[gillenator]

Based on your age it appears like an acute case of TE (Telogen Effluvium) so at this point you need to see a doctor who is knowledgeable and experienced in treating hair loss and the doctor needs to be able to perform a complete and thorough microscopic examination of your entire scalp and possibly lab work because some of the spots of loss may be unpatterned.

[DavidFrancis]

2 hours ago, gillenator said:

Based on your age it appears like an acute case of TE (Telogen Effluvium) so at this point you need to see a doctor who is knowledgeable and experienced in treating hair loss and the doctor needs to be able to perform a complete and thorough microscopic examination of your entire scalp and possibly lab work because some of the spots of loss may be unpatterned.

Thank you for your answer, 
I will surely see Bisanga, I will ask him. Telogen effluvium doesn't last more than a few months does it? My hair loss has been going on for 2 years. And in the case of telogen effluvium, is it possible to regrow hair with medication?  
Diffuse AGW can start at 24 years old too, right? 

[gillenator]

First things first…you will need an in-person physical examination, possibly some labs, and then a formal diagnosis before a treatment plan is proposed to you.