Dr. Kostis & Bisanga High Norwood

[SY7]

Dear members,

I have planned an operation head and body grafts next year with Dr. Kostis at BHR Belgium. I am a bit worried now since Dr Kostis and Bisanga here in the forum are not famous for higher Norwoods? I am a Norwood 6, taking oral Minoxidil but donor not perfect. The plan is to cover the frontal part and maybe add some MHP. What do you guys think? Should it be ok since they are good doctors? 

[mr_peanutbutter]

they show a few high norwood cases on their youtube page, one guy from norway and one from malta

 

and dr. kostis is kinda a high norwood case himself…

[hairman22]

Bisanga can't get that many grafts from the donor area. Its why he is conservative about taking on patients not on meds or not an excellent donor.

His punches look too big. He gets brillant growth though

Edited December 21, 2023 by hairman22

[SY7]

16 minutes ago, mr_peanutbutter said:

they show a few high norwood cases on their youtube page, one guy from norway and one from malta

 

and dr. kostis is kinda a high norwood case himself…

Yeah looks good with him. Thanks for the response.

[SY7]

29 minutes ago, hairman22 said:

Bisanga can't get that many grafts from the donor area. Its why he is conservative about taking on patients not on meds or not an excellent donor.

His punches look too big. He gets brillant growth though

Why are some doctors able to get more grafts from the donor than others? 

[Gramatik]

2 hours ago, SY7 said:

Dear members,

I have planned an operation head and body grafts next year with Dr. Kostis at BHR Belgium. I am a bit worried now since Dr Kostis and Bisanga here in the forum are not famous for higher Norwoods? I am a Norwood 6, taking oral Minoxidil but donor not perfect. The plan is to cover the frontal part and maybe add some MHP. What do you guys think? Should it be ok since they are good doctors? 

Can you show us the area they suggested you to implant and with how many grafts ? Also upload us some panoramic photos of your situation..

[Raphael84]

Hi @SY7

Thanks for posting and sharing your concerns.

In terms of your personal case, Im not sure who your advisor may be or if you have met with the doctor for consultation and data such as donor density and potential graft availability have been provided, but Im sure you would find value in discussing this with them based on any data that has been measured and attained.

As with any patient regardless of Norwood status, donor availability will be very unique to them based on the surface area of viable, density throughout areas of the donor and the calibre of the hair. Then depending on their follicular make up and how many single, double, 3s and 4 hair follicles they may have, will also dictate what can be "safely" extracted. 

If a patient has more coarse hair, higher density and predominantly 3s and 4s within their donor area, then extracting a higher percentage of grafts from within each cm2 would be more viable as the total hair count (not graft count) within each cm2 would still allow the donor to appear untouched. 

Alternatively if a patient may have finer hair, with a lesser density and predominantly singles and double hair follicles with few larger groupings, then a lesser percentage of grafts within each cm2 can be extracted in order to maintain an appropriate hair count to maintain the integrity of the donor area.

This is without even considering potential future loss, miniaturisation and any requirements for potential future surgeries.

In terms of punch sizes, Dr. Bisanga will generally use a 0.75 - 0.8mm punch on patients with caucasian hair and average hair calibre. If a patient has afro wiry hair with naturally tight curls, then the punch size would be slightly larger to ensure complete encapsulation.

The comments regarding Dr. Bisanga using large punch sizes is completely unfounded and as BHR patients represent amongst the most posed on this forum, both patient and clinic posted, then this can be verified by taking a look at countless examples.

The reality today is that a very small percentage of patients share their case or give permission to the clinic to do so.
 

This means that only a very small window is seen in relation to the work that a clinic does. On this very forum, most users won’t normally share their case.

Most clinics will attest to this, especially those that do not offer incentives to patients to share just as BHR don’t.

The idea that Dr. Bisanga only accepts patients with excellent donors is completely false and the very fact that BHR perform more repair surgery than most clinics reinforces this.

I share the following image of a patient, post surgery taken at the clinic and smaller punches than this whilst avoiding transection is not possible and the reality is if a patient is not willing to have this size of punch, then FUE is probably not the right option for them.

 

The cases that were detailed above I believe were referring to the following first 2 cases.

Also in response to only accepting candidates who have excellent donors, please take a look at the condition of the second example and the aggressive nature of retrograde alopecia, whilst also considering the dropping in the lower crown and scarring within his donor. 

I also share other examples of larger patterns of loss with non optimal donors.

 

 

Edited December 21, 2023 by Raphael84

[laverita]

Most cases from any clinic will not post, more so with the advent of copy and paste to social media and re-mixing etc, they are less keen to. Also I think higher NW scales will need to budget and by default will orient to clinics that can offer a price per graft more in-line with their overall budget and will look at 2 Euros or so a graft, so that means most of Europe is not going to be an option but south America and India etc are more viable when we are talking 10k grafts or more, so I would expect more cases there as a general rule if not an exclusive one.

[SY7]

2 hours ago, Raphael84 said:

Hi @SY7

Thanks for posting and sharing your concerns.

In terms of your personal case, Im not sure who your advisor may be or if you have met with the doctor for consultation and data such as donor density and potential graft availability have been provided, but Im sure you would find value in discussing this with them based on any data that has been measured and attained.

As with any patient regardless of Norwood status, donor availability will be very unique to them based on the surface area of viable, density throughout areas of the donor and the calibre of the hair. Then depending on their follicular make up and how many single, double, 3s and 4 hair follicles they may have, will also dictate what can be "safely" extracted. 

If a patient has more coarse hair, higher density and predominantly 3s and 4s within their donor area, then extracting a higher percentage of grafts from within each cm2 would be more viable as the total hair count (not graft count) within each cm2 would still allow the donor to appear untouched. 

Alternatively if a patient may have finer hair, with a lesser density and predominantly singles and double hair follicles with few larger groupings, then a lesser percentage of grafts within each cm2 can be extracted in order to maintain an appropriate hair count to maintain the integrity of the donor area.

This is without even considering potential future loss, miniaturisation and any requirements for potential future surgeries.

In terms of punch sizes, Dr. Bisanga will generally use a 0.75 - 0.8mm punch on patients with caucasian hair and average hair calibre. If a patient has afro wiry hair with naturally tight curls, then the punch size would be slightly larger to ensure complete encapsulation.

The comments regarding Dr. Bisanga using large punch sizes is completely unfounded and as BHR patients represent amongst the most posed on this forum, both patient and clinic posted, then this can be verified by taking a look at countless examples.

The reality today is that a very small percentage of patients share their case or give permission to the clinic to do so.
 

This means that only a very small window is seen in relation to the work that a clinic does. On this very forum, most users won’t normally share their case.

Most clinics will attest to this, especially those that do not offer incentives to patients to share just as BHR don’t.

The idea that Dr. Bisanga only accepts patients with excellent donors is completely false and the very fact that BHR perform more repair surgery than most clinics reinforces this.

I share the following image of a patient, post surgery taken at the clinic and smaller punches than this whilst avoiding transection is not possible and the reality is if a patient is not willing to have this size of punch, then FUE is probably not the right option for them.

 

The cases that were detailed above I believe were referring to the following first 2 cases.

Also in response to only accepting candidates who have excellent donors, please take a look at the condition of the second example and the aggressive nature of retrograde alopecia, whilst also considering the dropping in the lower crown and scarring within his donor. 

I also share other examples of larger patterns of loss with non optimal donors.

 

 

Thanks Rafael!! For the elaborate explanation!

[SY7]

1 hour ago, laverita said:

Most cases from any clinic will not post, more so with the advent of copy and paste to social media and re-mixing etc, they are less keen to. Also I think higher NW scales will need to budget and by default will orient to clinics that can offer a price per graft more in-line with their overall budget and will look at 2 Euros or so a graft, so that means most of Europe is not going to be an option but south America and India etc are more viable when we are talking 10k grafts or more, so I would expect more cases there as a general rule if not an exclusive one.

Ah ok, I think I understand but you mean the “cheaper” clinics just do more grafts in general or are in tule better at doing it too?

[laverita]

I can't talk for all but I think many will not consider clinic X because let's be real, money is a limiting factor, so by default they cannot pay over a certain budget and by essence will be funnelled to options within their budget and then research among them. This is just logical, you won't factor in what is beyond your budget for hair or for buying a house or car etc. So probably a reason why a lot of higher Norwoods go to certain countries and great if they get good results. You are talking a lot of grafts and serious money so it is not a factor that can be ignored. This is why so many fly internationally also from the UK or USA for surgery as the costs are generally higher there and it is mentioned in posts. 

[SY7]

1 hour ago, laverita said:

I can't talk for all but I think many will not consider clinic X because let's be real, money is a limiting factor, so by default they cannot pay over a certain budget and by essence will be funnelled to options within their budget and then research among them. This is just logical, you won't factor in what is beyond your budget for hair or for buying a house or car etc. So probably a reason why a lot of higher Norwoods go to certain countries and great if they get good results. You are talking a lot of grafts and serious money so it is not a factor that can be ignored. This is why so many fly internationally also from the UK or USA for surgery as the costs are generally higher there and it is mentioned in posts. 

Yeah, I agree. The thing is what makes me curious is how certain elite doctors are known for higher Norwoods. It is not that they magically “create” grafts. Do they have a higher survival rate or they just take more risk? Something like that?

[SY7]

3 hours ago, laverita said:

Most cases from any clinic will not post, more so with the advent of copy and paste to social media and re-mixing etc, they are less keen to. Also I think higher NW scales will need to budget and by default will orient to clinics that can offer a price per graft more in-line with their overall budget and will look at 2 Euros or so a graft, so that means most of Europe is not going to be an option but south America and India etc are more viable when we are talking 10k grafts or more, so I would expect more cases there as a general rule if not an exclusive 

54 minutes ago, SY7 said:

Yeah, I agree. The thing is what makes me curious is how certain elite doctors are known for higher Norwoods. It is not that they magically “create” grafts. Do they have a higher survival rate or they just take more risk? Something like that?

 

[SY7]

54 minutes ago, SY7 said:

Yeah, I agree. The thing is what makes me curious is how certain elite doctors are known for higher Norwoods. It is not that they magically “create” grafts. Do they have a higher survival rate or they just take more risk? Something like that?

With that I mean do the “high Norwood” doctors take more risk in general or do the punch with higher surival rate or something? Btw thanks for the answers guys, I am always a bit of a hesitant person with decisions etc.

[BackFromTheBrink]

When you say high Norwood doctors, I think or 4 surgeries - Hattigen, Zarev, Pittella and Eugenix. 

They all have different approaches. Hattigen are FUT and FUE combo, Eugenix are body hair and scalp and often over multiple sessions.

I'd say the other two are different.

Zarev is the outlier since he appears to carry out more donor analysis, uses .45 punches, uses the whole donor for a homogenous look, and unique extraction methods for very high survival rates.

I'm not sure about methods, but Pittella also achieves high graft counts in single sessions.

How many grafts do you need for full coverage? 

I'd say your choice is sound, and there have been superb results on high NWs by your doctor on this forum in 2023.

I think there are better (I'd have chosen Zarev if money and time were not a factor as I believe he's unique and his results are unrivaled), but you have selected a top surgeon.

[SY7]

2 hours ago, BackFromTheBrink said:

When you say high Norwood doctors, I think or 4 surgeries - Hattigen, Zarev, Pittella and Eugenix. 

They all have different approaches. Hattigen are FUT and FUE combo, Eugenix are body hair and scalp and often over multiple sessions.

I'd say the other two are different.

Zarev is the outlier since he appears to carry out more donor analysis, uses .45 punches, uses the whole donor for a homogenous look, and unique extraction methods for very high survival rates.

I'm not sure about methods, but Pittella also achieves high graft counts in single sessions.

How many grafts do you need for full coverage? 

I'd say your choice is sound, and there have been superb results on high NWs by your doctor on this forum in 2023.

I think there are better (I'd have chosen Zarev if money and time were not a factor as I believe he's unique and his results are unrivaled), but you have selected a top surgeon.

Thanks for the feedback! That relaxed me a bit more. The first session would be 2700 head grafts and 500-1000 bht. My aim is the front/mid with mhp later. I saw Zarev prices and I cannot afford that. I have the Kostis with Bisanga assisting him package. Thank you for the explanation! Apreciate it very much.

[A_4_Archan]

@SY7

If you are a high norwood case than you can consider fut+fue combo and hattingen is a good option if your budget is under 5 euros.

If you are reluctant to go with fue only than zarev is ofcourse a no brainer bt you have stated earlier that you can't afford him so the next best bet can be dr pittela who is under 5 euros....

And if your budget is around 2.5 euros than even hdc is worth considering 

[SY7]

6 minutes ago, A_4_Archan said:

@SY7

If you are a high norwood case than you can consider fut+fue combo and hattingen is a good option if your budget is under 5 euros.

If you are reluctant to go with fue only than zarev is ofcourse a no brainer bt you have stated earlier that you can't afford him so the next best bet can be dr pittela who is under 5 euros....

And if your budget is around 2.5 euros than even hdc is worth considering 

Thanks for the response! I have booked with Kostis next year but was indeed considering HDC as well. Do prefer to stay a little closer to home (Netherlands). The thing was that I was reading on the forum and that some people said BHR was more for hairlines and others maybe more for high Norwoods? Thanks for the response though!!! Apreciate it a lot

[A_4_Archan]

2 minutes ago, SY7 said:

Thanks for the response! I have booked with Kostis next year but was indeed considering HDC as well. Do prefer to stay a little closer to home (Netherlands). The thing was that I was reading on the forum and that some people said BHR was more for hairlines and others maybe more for high Norwoods? Thanks for the response though!!! Apreciate it a lot

Congratulations..you have chosen a great ethical and experienced doctor...ofcourse hairlines of bisanga is pretty good and he is experienced enough to handle high nw cases as well ....so you will be under safe hands...best of luck..

[SY7]

5 minutes ago, A_4_Archan said:

Congratulations..you have chosen a great ethical and experienced doctor...ofcourse hairlines of bisanga is pretty good and he is experienced enough to handle high nw cases as well ....so you will be under safe hands...best of luck..

Thanks!!!!!