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Raphael84 - My Surgery - Dr. Bisanga BHR Clinic - 3466 Grafts - FUE 0 - 5 Months

Raphael84

Raphael84

Valued member
In my own journey throughout the years and long before I was in my current role as patient advisor for Dr. Bisanga, I have spent many hours and found incredible value from hair loss forums. Being able to share frequent patient results from Dr. Bisanga is always a pleasure of mine and knowing that in doing so, it really adds to the essence of the community and can help to show what can be achieved.

With that being said, I am very happy to be able to present my own case and give back on a personal level.

In all honesty I did not intend to present my surgery photos until 12 months post op when I would have been nearer to my “final result”. This was because as many of you will know this was not my first surgery. I had previous strip surgery in 2012 (not with Dr. Bisanga) and was satisfied with my results at that time, however due to progressive hair loss, this meant that this surgery required "revisiting" the same area which was therefore not virgin scalp in the frontal half. Non virgin scalp means that quality of skin will be less due to making of previous recipient sites and subsequent scarring and this can have an impact on yield, and growth can oftentimes take longer to develop in repair surgery. I knew that I may have to be patient, but fortunately that has not been the case.

I had FUE surgery with Dr. Bisanga 5 months ago with the following objectives -

*Rebuild my hairline and increase density through the frontal third
*Strengthen my temple points (as conservatively as possible)
*Reinforce my mid scalp and crown
*Place beard grafts into my previous strip scar (if possible)

This was a lot to ask in one surgery, especially considering my quality of candidacy.

In essence, any patient who is a candidate for hair restoration surgery does not have a “perfect” head of hair, but there are different levels to candidacy from excellent through to borderline and then obviously non candidate.
We often see “hollywood” hairlines achieved on patients with focused loss and what would appear to be a great donor. That certainly isn’t my case and isn`t the case for many.

Challenges of surgery were -

*Larger pattern of loss/decline
*Retrograde alopecia (Dr. Bisanga explained that it is likely emphasised by my strip closure pulling my nape “higher”)
*Average/below donor density
*Below average hair groupings
*Fine hair
*Previous strip scarring

Surgery was always going to be challenging in terms of achieving the necessary graft numbers but I was well aware of this and understood that we may not have been able to have achieve all of my objectives. This really highlights how realistic expectations are key. As is my intention with all patients who I have the pleasure to communicate with, education is fundamental.

My surgery was scheduled over 2 days and I arrived in Brussels the day prior to my procedure for a thorough consultation using the state of the art equipment and software to allow Dr. Bisanga to assess the current status of my hair and scalp and discuss his approach.

Due to using oral minoxidil and finasteride, I was very pleased to hear that my donor was stable and without any signs of miniaturisation throughout. I discontinued meds several years back and lost quite a lot of ground at that time.

At 38 years of age, I wasn’t looking to lower my hairline at all despite it sitting high at over 8.5cm+ from the glabella. I really wanted to proceed as conservatively as possible in order to preserve as many grafts and achieve as much coverage as possible with an appropriate hairline as I age and inline with the shape of my face and considering my hair characteristics and donor specifics.

One concern that Dr. Bisanga did have was some potential scarring on my scalp.

Dr. Bisanga wanted to rule out any possible concerns such as scarring alopecia and decided to take a “punch” biopsy to remove a small tissue sample to be sent to the lab for testing. This then required a few stitches which were removed several days later. You can see the stitches in the post operative images and actually as this area did not receive any grafts to allow and encourage optimal healing, you can actually make out a weaker area in my recent photographs.

Fortunately my biopsy result came back without concern and without the presence of inflammation or scarring alopecia.

Surgery days went very smoothly as expected and after assisting many patients over the last years throughout their journey, it felt great to be taking my place in the chair. Dr. Bisanga explained that I had tough skin and I was burning through anaesthetic which meant the need for more numbing, but he reported easy harvesting despite my follicles sitting quite deep in my donor.

We didn’t want to push too heavily or aggressively on my donor as my hair is fine and we didn’t want to further expose my strip, and as with all of us, loss is progressive and being conscious of this it was agreed that we would harvest approximately 2400 from the scalp with further supplementation from my beard using it to great effect in placing into my mid scalp and crown. As expected, all of my beard grafts represented single hairs and due to this being my first beard session, it was decided not to push far beyond 1000 grafts to allow a good distribution in terms of extraction sites and ensure optimal healing.

With this being the approach, I was always going to fall slightly short in terms of placing grafts throughout my entire previous strip scar, and so therefore it was decided that we would commit to one side of the scar (approximately 260 - 300 grafts) which was still a bonus. Not the standard approach but in my case, it presented a great opportunity to be able to see yield throughout my scar tissue and at a later date, be able to return for further surgery, shave down and really understand and present what beard into strip scars can achieve by comparing both sides.

Healing was very straightforward. I am obviously well versed in our post op care but instructions are simple and all products are provided in the post operative kit and despite a few initial “uncomfortable nights” as expected, recovery was generally quite quick. In fact, I was working and responded to patients in the evening on my surgery days.

Being completely transparent, I was in no way expecting such early growth. Especially as despite a significant graft count, hair count with beard was lower and this was placed over a larger surface area, therefore I was/am extremely pleased to see density come in so quickly. Even now, improvement continues and I have several months to go.

I am absolutely thrilled and not having to think twice about your hair when you wake in the morning really does have an impact on your day to day life and not having to worry regarding product and styling etc is a game changer.

A big thank you to Dr. B and his team of amazing technicians and a shout out to all my colleagues at BHR who have shown their support. It is a special clinic and one that I am very proud to be part of.

On a personal level, I genuinely get great satisfaction from supporting patients on their journeys and am thrilled to see their response and how their confidence grows and impacts many facets of their lives.
I can honestly say that it has been a hugely positive experience and my results at this early stage speak for themselves and I couldn’t be happier.

Many other patients have taken similar steps in their own hair restoration surgery and I remember the first forum case that I read some 15+ years ago. It was overwhelming, daunting, interesting and very exciting to see that there is hope, and there will be individuals who are reading cases today for the first time. Such communities are integral in the journey of many patients, it certainly was mine and I felt it important to continue to pay it forward and support the community.



BHR Clinic

Dr. Christian BISANGA
Technique: FUE
Donor density: 70/70 FUs/cm2

Breakdown of grafts:-
2366 Scalp Grafts + 1100 Beard Grafts (Single hair)
1s - 1714
2s - 1341
3s - 411
Total Grafts :- 3466

Total Hairs :-5629

Average Follicular Unit (Scalp) = 1,91 hairs
Average Follicular Unit (Scalp + beard) :- 1.62 hairs


PRE SURGERY FRONT

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TOP ELEVATION

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PRE SURGERY RIGHT

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PRE SURGERY LEFT

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PRE SURGERY REAR

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PLACING LEFT VIEW

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PLACING RIGHT VIEW

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PLACING WITH BIOPSY

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DONOR REAR

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DONOR LEFT

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DONOR BEARD

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5 MONTHS POST SURGERY

LEFT 5 MONTHS


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RIGHT 5 MONTHS

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TOP 5 MONTHS

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REAR DONOR

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COMPARISON 5 MONTHS

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Kevboy

Kevboy

Valued member
Brilliant write up mate, it was an enjoyable read. One of my biggest concerns when contemplating hair restoration surgery was a less than desirable result. Was your result from the first transplant a disappointment or was it a big improvement but lacked density?
This surgery with Dr Bisanga has made a massive difference. I’d be happy as it stands, never mind waiting the full 12 months.
What swayed you to Fue as opposed to another strip?
 
sl

sl

BHR Clinic Patient Advisor
Ian this is a tremendous transformation even now and far still far from the final product and especially for 5 months. As a repair patient and going over a whole area again makes it even more incredible.

You have really come on week by week and I am always happy for all our patients who get such fast growth and adding to it that we work together brings a lot of pride and joy also. I know how much this meant to you and already the changes it has afforded are immeasurable.

You are truly lovely person to work with and very passionate and knowledgeable but in the chair you were a patient and I am just so happy for you my friend and looking forwards to the updates!
 
Bigmac

Bigmac

Administrator
Staff member
Brilliant write up mate, it was an enjoyable read. One of my biggest concerns when contemplating hair restoration surgery was a less than desirable result. Was your result from the first transplant a disappointment or was it a big improvement but lacked density?
This surgery with Dr Bisanga has made a massive difference. I’d be happy as it stands, never mind waiting the full 12 months.
What swayed you to Fue as opposed to another strip?


Hi Kevboy. Ian mentioned he was happy with the first HT but progressive hair loss meant he needed another one. Stay off the booze!
 
Bigmac

Bigmac

Administrator
Staff member
Hi Ian.
It`s great to read about your Ht with Dr Bisanga. It’s written well and very thorough with excellent picture documentation. At 5 months you’re having a super transformation with early growth. The hairline already looks very natural. The donor extractions look very neat and distributed in a good pattern. Placing the grafts in one half of the scar will show how effective beard hair can be in scar tissue when you hit 12 months and do a comparison.
After your first hair transplant did you stop the meds which resulted in further loss of native hair?
It’s an interesting point about your hair appearing thinner above the nape and Dr Bisanga saying it’s probably due to the stretching of the skin after your FUT surgery.
With regards to the biopsy that was performed. Was the scarring actual scar tissue or an area of inflamation that still had hair? I’m pleased it came back negative.
I see you’re taking Finasteride and Oral Minoxidil. How long have you been on the Minoxidil and did you have any issues at all?
Thanks for sharing your journey and giving something back. I’m looking forward to seeing the end result.
All the best.
Bm.
 
bullitnut

bullitnut

4 awesome repairs with SMG
This looks incredible, even if this was 12 months I'm pretty sure 99 percent of people would be happy with your current situation so come 12 months its gonna blow everyone away.

Please update us I can't wait to see this.
 
Raphael84

Raphael84

Valued member
Thank you for interest and support guys, it is much appreciated.

In response to any questions -

Was your result from the first transplant a disappointment or was it a big improvement but lacked density?
My initial surgery achieved good growth albeit at a lesser density than Dr. Bisanga placed, but due to discontinuing medication for a time to start a family, I certainly lost ground resulting in lesser density.

What swayed you to Fue as opposed to another strip?
I didn't really consider a second strip and based on my scalp laxity and the fact that the closure had pulled and exacerbated the appearance of retrograde and also caused some changes if angles to surrounding follicles, a further FUT would only have of "intensified" this.

Do you have any pics of what your beard looked like immediately after?
There is one photo in the original post showing beard extractions immediately post surgery. Im not sure if you may not have seen that one.

Was the scarring actual scar tissue or an area of inflamation that still had hair?
It was not scar tissue and did not clearly have any inflammation. After focused consultation under magnification, it was a concern that Dr. Bisanga wanted to rule out.

How long have you been on the Minoxidil and did you have any issues at all?
Oral minoxidil around two years now. No issues at all.

Did you see early results with your FUT surgery?
Not to the extent of this surgery.

Thanks again for your support
 
D

djkillab

member
Thank you for interest and support guys, it is much appreciated.

In response to any questions -

Was your result from the first transplant a disappointment or was it a big improvement but lacked density?
My initial surgery achieved good growth albeit at a lesser density than Dr. Bisanga placed, but due to discontinuing medication for a time to start a family, I certainly lost ground resulting in lesser density.

What swayed you to Fue as opposed to another strip?
I didn't really consider a second strip and based on my scalp laxity and the fact that the closure had pulled and exacerbated the appearance of retrograde and also caused some changes if angles to surrounding follicles, a further FUT would only have of "intensified" this.

Do you have any pics of what your beard looked like immediately after?
There is one photo in the original post showing beard extractions immediately post surgery. Im not sure if you may not have seen that one.

Was the scarring actual scar tissue or an area of inflamation that still had hair?
It was not scar tissue and did not clearly have any inflammation. After focused consultation under magnification, it was a concern that Dr. Bisanga wanted to rule out.

How long have you been on the Minoxidil and did you have any issues at all?
Oral minoxidil around two years now. No issues at all.

Did you see early results with your FUT surgery?
Not to the extent of this surgery.

Thanks again for your support
Ah sorry, i thought the beard picture was the back of your head! I wish I didn't have a ginger beard else that could be an option for me
 
Raphael84

Raphael84

Valued member
Thanks for your question @Techno1

As Dr. Bisanga did not perform my previous surgery, he isn't able to know how aspects of surgery were and how grafts were handled etc, but in all honesty the body is a complicated and ever-changing system and even with the same surgeon, I have seen return patients have differing growth timelines from one procedure to another so it is very hard to provide a definitive explanation as to why.

In my particular case, what is most impressive is that my frontal third was non virgin scalp and to achieve such a result at this early stage in terms of growth and yield is really something.
 
Kevboy

Kevboy

Valued member
It’s amazing how some people get these great results early on. It’s like some sort on miracle grow. If I end up getting one I think Bhr will be top of my list
 
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Techno1

member
In my particular case, what is most impressive is that my frontal third was non virgin scalp and to achieve such a result at this early stage in terms of growth and yield is really something.

Thanks for the thorough response.
I do have another query that may need the doc to answer when he has time.
On many occasions I have read that transplanting in an area that has already been transplanted is more challenging with scar tissue being the main factor.
When a graft is placed in the area during any subsequent surgery it will be placed in
virgin scalp that previously had a native hair follicle. Scar tissue would only be available if the original transplanted graft failed, thus leaving a blank space with an incision scar. Other than that, is it the damage previous surgeries have done to the subcutaneous tissue?
 
Raphael84

Raphael84

Valued member
Untouched or virgin scalp offers the natural physiological response of non compromised tissue.
When cutting skin, the bodies natural healing response is scar tissue as you have said, but scar tissue is generally avascular meaning the surrounding area to the original recipient site may have compromised blood supply and so depending on the quality of the previous surgery and in many repair cases quality of initial surgery was sub optimal, extent of potential scarring and "damage" to the skin can cause a different physiological response and therefore this can influence potential yield and growth.
Some repair patients may have cobblestoning, tenting or other such concerns to the skin which present a different situation and surface to virgin scalps and all of the above present unique challenges to surgery.
 
Bigmac

Bigmac

Administrator
Staff member
Hi Ian. Has there been any noticeable change since last month?
 
Raphael84

Raphael84

Valued member
Thanks for your interest Bigmac. Things continue to improve and I will provide an update over the next weeks and continue to do so as I reach the 12 month stage.
 
Bigmac

Bigmac

Administrator
Staff member
Sounds good.
I’ll look forward to the next update.
 
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Raphael84

Raphael84

Valued member
UPDATE AT 6.5 MONTHS!!!

I wanted to thank each of you for your above comments and support and provide an update as I have now surpassed the 6 month post surgery stage.

I have been fortunate enough to have seen further improvement over the last month or so and the quality and feel of my hair continues to improve. My hair feels as though it has real structure and body to it and is in all honesty this is the best my hair has been since my teenage years.

In terms of day to day life, there is no styling to conceal or styling to improve the illusion of density any more. Now it is genuinely styling to preference and the freedom that this allows is a great feeling.

Again, if this was my final result I would be ecstatic, but with several months to go I do look forward to see how things will continue to mature.

 
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