Bisanga or Custodio

[JulianRoss]

Hello everybody,

It is my first post. First of all I’d like to thank you very much for your work here. It is an invaluable guidance on a topic that is really important for many, and I’ve been following you for years.

I've been considering FUE for many years now and I’ve narrowed the search to 2 surgeons who seem to have good skills and availability: bisanga+kostis and Espinosa Custodio. I’ve consulted with Custodio in person and with BHRs team in Malaga.

My concerns on Bisanga are that he does not use DHI. Also he does not extract the follicles, he does just the incisions, therefore most of the procedure is not done by him but Kostis and the technicians. Plus I need to travel to Belgium.

My concerns with Custodio are that I really do not have much assurance of his quality as he’s not quite as known nor I know anyone who knows him.

Who do you think is the safest bet?

I’m 38, I want to rebuild my hairline and both have estimated 2000-2500 FUs. 
Note: there’s not much difference in cost: 3 vs 3,5 per FU

Thank you so much for your help. 🙏🙏🙏🙏

Edited June 15 by JulianRoss
Add cost difference

[baddecisions]

Bisanga, all day long.

[BaldReaper]

If cost is not a factor I think the question is rhetorical

Edited June 15 by BaldReaper

[FUEtile]

DHI is all hype

[mr_peanutbutter]

what didnt you like about bhrs in malaga?

 

in spain you have also other options

 

check out this

 

 

[Berba11]

4 hours ago, JulianRoss said:

My concerns on Bisanga are that he does not use DHI.

Can you explain why this concerns you?

[JulianRoss]

1 hour ago, Berba11 said:

Can you explain why this concerns you?

The technique seems messier and more difficult to perform correctly without damaging the graft or recipient area, and it seems that relies much more on the skill of the technicians. 
What’s better, a great surgeon but less involved, or a very good surgeon handling everything?

 

[JulianRoss]

2 hours ago, mr_peanutbutter said:

what didnt you like about bhrs in malaga?

 

in spain you have also other options

 

check out this

 

 

Thank you for the list of alternatives! I’ve consulted with some of those surgeons.

The problem for me in Spain is often availability and waiting lists. None of those would be available within 2024 and I find very difficult to commit to a date more than 6 months in advance. 
 

I do not consider Malaga as I don’t perceive the same level of assurance and recommendation for those surgeons nor I know anyway who knows them.

Thank you very much for your reply

[BaldGuy]

6 hours ago, JulianRoss said:

Hello everybody,

It is my first post. First of all I’d like to thank you very much for your work here. It is an invaluable guidance on a topic that is really important for many, and I’ve been following you for years.

I've been considering FUE for many years now and I’ve narrowed the search to 2 surgeons who seem to have good skills and availability: bisanga+kostis and Espinosa Custodio. I’ve consulted with Custodio in person and with BHRs team in Malaga.

My concerns on Bisanga are that he does not use DHI. Also he does not extract the follicles, he does just the incisions, therefore most of the procedure is not done by him but Kostis and the technicians. Plus I need to travel to Belgium.

My concerns with Custodio are that I really do not have much assurance of his quality as he’s not quite as known nor I know anyone who knows him.

Who do you think is the safest bet?

I’m 38, I want to rebuild my hairline and both have estimated 2000-2500 FUs. 
Note: there’s not much difference in cost: 3 vs 3,5 per FU

Thank you so much for your help. 🙏🙏🙏🙏

Like you said Bisanga does only a small part of the procedure which is incisions...extraction and implantation is done by techs and dr kostis who is an assistant doctor. Therefore i would select espinosa custodio or other spanish/portugese doctor who uses DHI method and does bigger part of the hair transplant by himself.

Edited June 15 by BaldGuy

[Berba11]

36 minutes ago, JulianRoss said:

The technique seems messier and more difficult to perform correctly without damaging the graft or recipient area, and it seems that relies much more on the skill of the technicians. 
What’s better, a great surgeon but less involved, or a very good surgeon handling everything?

 

I'm a bit confused. You said you were concerned that he does not use DHI, and then went on to explain some reasons that you perceived DHI to be inferior (messy, more difficult etc). If you don't like DHI and he doesn't use DHI, I'm unsure what the problem is... Unless you mistyped?

[JulianRoss]

15 minutes ago, Berba11 said:

I'm a bit confused. You said you were concerned that he does not use DHI, and then went on to explain some reasons that you perceived DHI to be inferior (messy, more difficult etc). If you don't like DHI and he doesn't use DHI, I'm unsure what the problem is... Unless you mistyped?

Hi!

Maybe I am mistaken. My concern is that Bisanga does not use implanter but the techs use forceps to place the grafts after the doctor has made the incisions.
 

I’m no expert, that’s why I ask for your expertise, but seems to me that it would be preferable to have the surgeon implant the grafts himself and also that the implanter seems like less risk of damaging the grafts or the scalp.

If someone has some insight on this it would greatly appreciated.

My guess is that not using the implanter allows the surgeon to do the incisions without spending as much time as placing the grafts himself, but I don’t know if that has a noticeable impact on the quality of the transplant.

Edited June 15 by JulianRoss

[Berba11]

3 minutes ago, JulianRoss said:

Hi!

Maybe I am mistaken. My concern is that Bisanga does not use implanter but the techs use forceps to place the grafts after the doctor has made the incisions.
 

I’m no expert, that’s why I ask for your expertise, but seems to me that it would be preferable to have the surgeon implant the grafts himself and also that the implanter seems like less risk of damaging the grafts or the scalp.

If someone has some insight on this it would greatly appreciated.

My guess is that not using the implanter allows the surgeon to do the incisions without spending as much time as placing the grafts himself, but I don’t know if that has a noticeable impact on the quality of the transplant.

Most of the top clinics in the world use either forceps or implanters and most of the implantation is done by technicians in either case. The top clinics have techs who have been handling grafts for many years so it's unlikely to be an issue at a top clinic (and Bisanga's practice is top notch of course).

It's your call and it's not my place to tell you where to go, but I don't think this is something you have to worry about when it comes to the elite clinics. Obviously you want the surgeon's oversight during the parts of the procedure that are being delegated to technicians. Unfortunately we do see a lot of cases when even at good clinics, the surgeon goes AWOL during large parts of the surgery, so that is something to be mindful of.

[laverita]

Dr.B staff use KEEP implanters often and have a videos on this. I would prefer pre-made sites as he does as opposed to DHI cutting the sites WHILE you place. Does the other doctor do all the placing himself or techs? Sites are not easy to cut and give the depth, direction, density etc for the follicle to be placed into so not a small part of the result. 

Essentially results speak for themselves and Dr.B has as said recently more patient posted cases on this forum than most clinics so I don't think after 20 years in the game there is a problem him not doing DHI or techs placing when all of his results are him or Dr.K cutting sites and then the team placing.

A DHI problem can be techs placing and they all placing at different angles and as they see fit and and this is avoided with a bonafide doctor cutting sites for techs to place into. I myself prefer the consistency of a doctor alone cutting and not whoever happens to hold the implanter pen.  As said the other doctor may do all this process himself and I would say that is far better than techs doing it but I don't see the advantage of DHI compared to pre-made sites with clear field of vision and an elite doctor cutting them. 

You will need to decide as you are the patient as to what you want but I think many don't understand fully in some cases the implications of DHI. 

[BaldGuy]

DHI method has the advantage that the doctor implants by himself the grafts in the recipient area and also its less risky than pre made slits in which method grafts may be damaged during implantation by techs, since doctors do not supervise them in the most time. Also DHI method produces less bleeding in the recipient area than pre made slits, thus ensuring less shock loss to the surrounding hairs.

All spanish and portugese elite doctors use DHI method and they implant the grafts by themselves without techs. Thats very important to have the dctor implant the grafts to your scalp. For examples doctors like Freitas, Lorenzo, Couto, ximena vila, Hans Heinicke, Ferreira, Pinto, Espinosa Custodio use DHI method and they implant the grafts into the recipient area without having techs doing it for them.

Edited June 15 by BaldGuy

[laverita]

Pre-made sites the doctor can also place if he wishes so, that is not a DHI benefit as such...Large Strip cases are placed or have been traditionally also with forceps and even with 5k plus in good hands you will not bleed excessively, so with even smaller FUE sessions and with good hands and protocol for coming off alcohol etc it is not an issue and more so for an elite doctor who used small blades, 20, 21 gauge etc for sites.

Shock loss is not usually about bleeding but more the opposite, the lack of blood by anesthetics is more common and leads to vasoconstriction and shock and also if there is transection. So personally I don't buy into the above reasons and less so if techs are well trained. 

A downside of DHI is that yes, it really does need to be the doctor as in essence this is piercing the skin and making sites simultaneously, whereas with other methods the doctor makes the sites and the techs place. Most cases on this site I guess are not DHI. 

[laverita]

  Here is a DHI result just posted...what's your thoughts on this @BaldGuy @JulianRoss. I think the question really is not the implanter but the hands performing is so important. Some DHI may turn out really well but the outcome really is far more complex than just if they use an implanter or pre-made sites etc. 

[JulianRoss]

4 hours ago, laverita said:

  Here is a DHI result just posted...what's your thoughts on this @BaldGuy @JulianRoss. I think the question really is not the implanter but the hands performing is so important. Some DHI may turn out really well but the outcome really is far more complex than just if they use an implanter or pre-made sites etc. 

wow, this looks like my hairline right now 😂.

absolutely agree. That’s why my concern is that Bisanga does not perform most of the procedure himself. Though I agree that he should vouch for the quality of his team so hopefully the result should be top tier either way.

[laverita]

Well none of BHR results for last 20 years were solely him, so all of them are with his team. If you want him alone then I guess you could book it at a price but really I don't think it is necessary or has even any advantage. He has a lot of patient posted cases and none to my knowledge were only him. If you want only a doctor only then best research and have cons with a clinic that is doctor only if that is a true worry or DHI only if that also is important for you.  You may find the costs are higher though or go to those who offer within your budget 100 percent doctor surgery. It is important to have peace in your decision and if doctor only then Mel or others here may be able to advise also some. 

 

All the best in whatever you do!

 

[Al - Moderator]

Implanter pens are faster because you don’t make an incision and then later put the graft in. It’s all done at once. It’s also usually cleaner because of the same reason. However the results still depend on the skill of the person performing the transplant. You can angle the hair wrong, not go deep enough, damage the graft while putting it into the implanted pen, etc. So don’t choose a clinic based on what insertion technique they are using. Choose one based on actual results over a period of time.