Dr. Bisanga - Repair Stage I (Removal)

[FormerFutureKrillin]

Hi all!

As promised, I am back to document the next steps in my HT journey with Dr. Bisanga. This thread is for what I am calling “Stage I” covering the removal of grafts, the first session of which was yesterday. Stage II will be a repair surgery rebuilding the hairline/temple points/frontal third, similar to the strategy for a couple other posters on this forum.

The goal of this surgery was to remove as many grafts as possible in the frontal line and high temple areas within the first half centimeter, with particular emphasis on chunky multi-grafts or misangled grafts. Dr. Bisanga was able to remove 306 grafts during this session. I may need an additional removal session(s) depending on how things are looking. All removed grafts were reimplanted in the strip scar.

Surgery itself was uneventful and was completed over the course of a 3-4 hours. No real pain during the procedure and any time I started to feel anything the team was very good about responding with more anesthetic. 

As many users have pointed out, the pre/post (and during) surgery care, communication and attentiveness of the BHR team is world class and really does help reduce the anxiety of the entire process.

I hope this thread and my eventual repair can be helpful reference points to others in this situation or considering this situation or more generally for those researching. However, I would really like to keep this thread focused on this surgery (and the go-forward repair), not on the previous surgery - I have a separate thread for my original surgery.

Photos below:

 

 

 

This side is harder to see (my hair is falling over half of the scar), but the implantation area was similar to the other side.

 

[Melvin- Admin]

Thanks for the amazing write-up. Im following this thread closely. Dr. Bisanga is certainly one of the best. 

[BaldReaper]

Good luck, you are in really good hands

[Needhelpwithscar]

Does it leave scarring when you remove grafts from hairline ?  

[Berba11]

1 hour ago, Needhelpwithscar said:

Does it leave scarring when you remove grafts from hairline ?  

Depends. The forehead tends to heal a bit differently to the donor area, and usually if the extractions are precise and there aren't too many extractions too close together, they often heal without any visible scarring.

Extracting these grafts can be complex if the directions of the implanted grafts are all over the place, because the surgeon is having to guess the angle needed to punch graft to graft. Also some people just mark up and scar more easily than others, so some patient to patient variation is expected. The best hairline removal work seems to leave very little to no visible scarring at all though. Hopefully that's the case for the OP!

[baddecisions]

Really happy to see you are in your repair adventure now. You have chosen the best.

All the best!

[chrisu]

Hey thanks for posting your updates. Curious why are you taking the implants out and putting them back in the original strip scar area? For your second procedure do you plant to go with FUT or FUE?

[TrainingDay]

good luck!

[FormerFutureKrillin]

13 hours ago, Berba11 said:

Depends. The forehead tends to heal a bit differently to the donor area, and usually if the extractions are precise and there aren't too many extractions too close together, they often heal without any visible scarring.

Extracting these grafts can be complex if the directions of the implanted grafts are all over the place, because the surgeon is having to guess the angle needed to punch graft to graft. Also some people just mark up and scar more easily than others, so some patient to patient variation is expected. The best hairline removal work seems to leave very little to no visible scarring at all though. Hopefully that's the case for the OP!

Exactly this. In my case, the only additional complication is that it was evident prior to the removal session that I would likely need laser resurfacing and/or professional microneedling due to ridging/cobblestoning and generally some fairly large areas of scarring on one side of my hairline. I am still crossing my fingers that once this heals up, it may not be all that noticeable - nevertheless, the goal here was certainly to minimize any further visible scarring.

[FormerFutureKrillin]

3 hours ago, chrisu said:

Hey thanks for posting your updates. Curious why are you taking the implants out and putting them back in the original strip scar area? For your second procedure do you plant to go with FUT or FUE?

Future surgery will be FUE - I am very, very, VERY lucky to have good donor density. This is an extremely fortunate break, as I think it’s fair to say the vast majority of repair patients also have depleted donor adding to the complication of the repair. My donor density means we’ll likely be able to do some temple point work in the repair surgery. 

Given how wide my scar ended up from one strip (could easily end up wider or stretch from more strips) and my personal recovery process generally, I wanted to avoid another FUT surgery unless my donor would not permit. I wanted the removed grafts placed in the strip scar because it meant less shaving for the surgery and also I would like to be able to go slightly lower on the buzzer. As you see, 306 grafts is not enough to fill the full scar. I may throw some more into it in the full surgery to help conceal it more.

[chrisu]

7 hours ago, FormerFutureKrillin said:

Future surgery will be FUE - I am very, very, VERY lucky to have good donor density. This is an extremely fortunate break, as I think it’s fair to say the vast majority of repair patients also have depleted donor adding to the complication of the repair. My donor density means we’ll likely be able to do some temple point work in the repair surgery. 

Given how wide my scar ended up from one strip (could easily end up wider or stretch from more strips) and my personal recovery process generally, I wanted to avoid another FUT surgery unless my donor would not permit. I wanted the removed grafts placed in the strip scar because it meant less shaving for the surgery and also I would like to be able to go slightly lower on the buzzer. As you see, 306 grafts is not enough to fill the full scar. I may throw some more into it in the full surgery to help conceal it more.

Thanks, what influenced your decision to go with another surgeon this time? Did Bloxham say anything about your results and doing another surgery with him?

[chrisu]

following up, OP can you message me. In similar situation as you and considering FUE

Thanks

[Bellingham]

@FormerFutureKrillin thank you for sharing your repair journey. It’s threads like these that gives hope for people like us that are considering a repair in the future. I’m praying everything goes well for you! 

[FormerFutureKrillin]

On 2/21/2024 at 12:57 PM, chrisu said:

Thanks, what influenced your decision to go with another surgeon this time? Did Bloxham say anything about your results and doing another surgery with him?

14 hours ago, chrisu said:

following up, OP can you message me. In similar situation as you and considering FUE

Thanks

The bottom line is that Dr. Bisanga's assessment and strategy resonated with me and I trust him completely given my in person consultation, his previous results and his experience in repairs of this type. My feelings on my previous procedure, my concerns about a future surgery and a summary of my last interaction with Dr. Bloxham (and my feelings on that interaction) are well documented in my previous thread.

Sorry if that feels like deflection, but I really don't want this thread to devolve into drama or mulling on the previous surgery. If you have specific questions feel free to PM me.

As for FUE vs. FUT, that is just my personal choice having gone through the FUT recovery. At the time of my first surgery, I thought FUT was right for me given I was young in HT terms, had fairly progressed hair loss (nearly total loss in frontal third, crown starting to thin at young age) and one grandfather who was NW 7. However, being unable to lift weights/stay out of the gym took a large toll on my mental and physical health. I avoided weightlifting for nearly 5-6 months (longer than Dr. Bloxham's restriction of 10 days), and my scar still stretched / is very wide. I really did not want to go through that again if I could avoid it. I also felt another FUT carried a high risk of leaving the scar even wider. 

[chrisu]

@FormerFutureKrillin thanks for the info. Can you send me a blank message? I tried DMing you but it says i am not allowed

 

 

[RazersEdge]

I’ve been lurking this forum for about a year now and I felt obligated to finally post. I wanted to give you some hope OP. I too had an FUT about 18 months ago that I wasn’t satisfied with. I also had a rather wide scar.

I went to Konior for a 2 step repair. He removed maybe a couple hundred unsightly grafts in temples and hair line and placed them into the strip scar. Not only did I not have any evidence of scarring from the extractions, I also had really great growing in the strip scar. In fact it looked like every one of the grafts placed into my FUT scar survived because the camouflage is so much better.  My strip scar wasn’t as long as yours but it was about as wide and I managed to get solid coverage. 

I had my 2nd step operation with Konior about a month ago and we placed another couple hundred into my strip scar. If they survive as well as my first go around then I reckon I’ll be able to cut my hair pretty sure (2-3 guard). 

I’ll be following your case OP. Good luck. 

[RTC]

On 2/20/2024 at 4:10 PM, FormerFutureKrillin said:

Hi all!

As promised, I am back to document the next steps in my HT journey with Dr. Bisanga. This thread is for what I am calling “Stage I” covering the removal of grafts, the first session of which was yesterday. Stage II will be a repair surgery rebuilding the hairline/temple points/frontal third, similar to the strategy for a couple other posters on this forum.

The goal of this surgery was to remove as many grafts as possible in the frontal line and high temple areas within the first half centimeter, with particular emphasis on chunky multi-grafts or misangled grafts. Dr. Bisanga was able to remove 306 grafts during this session. I may need an additional removal session(s) depending on how things are looking. All removed grafts were reimplanted in the strip scar.

Surgery itself was uneventful and was completed over the course of a 3-4 hours. No real pain during the procedure and any time I started to feel anything the team was very good about responding with more anesthetic. 

As many users have pointed out, the pre/post (and during) surgery care, communication and attentiveness of the BHR team is world class and really does help reduce the anxiety of the entire process.

I hope this thread and my eventual repair can be helpful reference points to others in this situation or considering this situation or more generally for those researching. However, I would really like to keep this thread focused on this surgery (and the go-forward repair), not on the previous surgery - I have a separate thread for my original surgery.

Photos below:

 

 

 

This side is harder to see (my hair is falling over half of the scar), but the implantation area was similar to the other side.

 

Love it. Can you show a photo of the skin now?

Edited February 24 by RTC

[Lenzman]

6 hours ago, RTC said:

Love it. Can you show a photo of the skin now?

Ye id like to see this also. Please share some photos 

[FormerFutureKrillin]

Sure - I’m now at Day 5. The redness is already fading and some remaining hairs are sprouting back through. I’ll try to get a pic of the scar grafts soon, for now it is a bit tricky as I have very long hair and don’t want to rip the grafts out or damage them manipulating my hair too much.

[FormerFutureKrillin]

11 hours ago, RazersEdge said:

I’ve been lurking this forum for about a year now and I felt obligated to finally post. I wanted to give you some hope OP. I too had an FUT about 18 months ago that I wasn’t satisfied with. I also had a rather wide scar.

I went to Konior for a 2 step repair. He removed maybe a couple hundred unsightly grafts in temples and hair line and placed them into the strip scar. Not only did I not have any evidence of scarring from the extractions, I also had really great growing in the strip scar. In fact it looked like every one of the grafts placed into my FUT scar survived because the camouflage is so much better.  My strip scar wasn’t as long as yours but it was about as wide and I managed to get solid coverage. 

I had my 2nd step operation with Konior about a month ago and we placed another couple hundred into my strip scar. If they survive as well as my first go around then I reckon I’ll be able to cut my hair pretty sure (2-3 guard). 

I’ll be following your case OP. Good luck. 

Thanks for the post and encouragement. I am sorry that you had to be in a similar situation, it certainly was not easy for me to make the decision to go down this path and I’m sure it was the same with you. Hope everything with the 2nd step goes well, and I’m sure it will given you went to Dr. Konior.

[FormerFutureKrillin]

Today is Day 7 - here are some photos:

Scar left side:

Scar right side:

[FormerFutureKrillin]

Here are some photos from Day 11 - scabs are gone from the implanted grafts. Redness is fading gradually from the area of removal.

 

For anyone curious of the cosmetic effect of the removal of 306 grafts on my frontal line, I’ve posted some photos with my hair down below. IMO, no one other than me (or perhaps some people on this forum) would notice a cosmetic difference at this stage. This makes me feel very validated in my decision and my overall feelings about the prior surgery, and is a bit crazy to think about how so many grafts were essentially not accomplishing much cosmetically.

 

[Berba11]

Things are healing up nicely. How long do you have to wait before your second round of punch outs? Obviously you'll need to have the ones that have started to poke through punched out as well.

You're dead right about how removing these grafts hasn't had any negative cosmetic impact on the overall appearance. I've made the point before on this forum that simply having enough of a hairline to frame the face is 1000x more important that having a low or aggressive hairline. Often less is more and I think that can be very true with HT's.

[FormerFutureKrillin]

1 hour ago, Berba11 said:

Things are healing up nicely. How long do you have to wait before your second round of punch outs? Obviously you'll need to have the ones that have started to poke through punched out as well.

You're dead right about how removing these grafts hasn't had any negative cosmetic impact on the overall appearance. I've made the point before on this forum that simply having enough of a hairline to frame the face is 1000x more important that having a low or aggressive hairline. Often less is more and I think that can be very true with HT's.

Haven’t put anything on the books yet for next steps, but I’ve heard usually between 8-12 weeks is the minimum spacing for removal sessions. I’m guessing there could be some variance in my case given I already had a lot of scarring on one side of hairline prior to the punches, but we will see. Assuming I need another round of punchouts (would agree that it seems probable, and was definitely prepared for that), I’d prefer to get it done as soon as I can feasibly get it done.

[FormerFutureKrillin]

Here are some photos at 1 month post removal. Redness continues to fade and some hairs are growing back (I think there are less grafts still there than it looks in the photos).

Some of the ridging/cobblestoning/skin damage from my previous surgery is definitely more evident in certain light conditions - as Dr. Bisanga wisely noted I am in agreement I will probably need some laser resurfacing and/or professional micro needling sessions to help with that, although in normal to bright light the bumpiness is harder to see.

Front

 

Scar: