Dr. Chris Bisanga: Hair Transplant Questions

Dr. Teresa Meyer: Hair Transplant Article in Spanish Journal of Dermatology

2011-08-29T07:01:00.000-07:00

Dr Teresa Meyer has written and had published an Article on Hair Transplantation for the Spanish Journal of Dermatology. Dr Meyer has been working with BHR Clinic and alongside Dr. Bisanga for over 2 years and will be performing hair transplantation in her native Spain from 2012.

https://ws001.juntadeandalucia.es/bvsspa/sciencedirect/science/article/pii/S0001731011003383

Dr. Teresa Meyer. BHR Clinic. For more details please email medical@bhrclinic.com

Hair Line Repair Strip/FUT Hair Transplant with BHR Clinic

2011-08-14T05:29:00.000-07:00

Before & After. BHR Clinic Hair Transplant Repair

BEFORE BHR WITH 2 PREVIOUS POOR HAIR TRANSPLANTS

AFTER BHR CLINIC HAIR TRANSPLANT REPAIR

For more information you can visit www.bhrclinic.com or email medical@bhrclinic.com

FUE Results: Follicular Unit Extraction Hair Transplant Patient Results

2011-08-13T17:13:00.000-07:00

3034 FUE Frontal Third & Hair Line Reconstruction

Before & After BHR Clinic Hair Transplant

Before & Post Operation 3034 FUE Grafts

Grown Out Result

if you would like to know more please visit www.bhrclinic.com or email medical@bhrclinic.com

How Many Hairs In An FUE Graft, Explains Dr. Bisanga of BHR Clinic

2011-04-26T13:20:00.001-07:00

What is important here is what the definition of a graft is, some doctors deal in grafts, other follicular units and others hairs, so there can be a wide range of answers, and for that matter hair numbers; and hair numbers fundamentally make a result.

A follicular unit can be made up of 1-4 hairs normally and they grow in little bunches and normally this is considered a "graft" when removed from the scalp with the FUE punch and then placed back into the head in the same state. With FUE much relies on the size of the punch tool, obviously the larger the diameter of the punch the more chance there is of taking more hairs in a graft, for example you may take an intact follicular (for example a 4 hair FU) unit but also an adjacent unit in full or partially, (for example another 2 hairs from a 4 hair FU), so in total that punch has taken 6 hairs in one graft. This could potentially mean less punches but the trauma to the scalp can be much higher, potential for more visible scarring, transection of follicular units and trauma to the surrounding hair causing miniaturisation.

In it's purest forum FUE is about taking a single intact follicular unit, be it 1,2,3 or 4 hairs within the unit, and not overlapping to take more hairs per graft; this can be quicker to perform but is not always in the best interests of donor management and can leave a very uneven pattern of growth in the donor making it harder to go back into and harvest more at a later date. Also it could mean you end up paying more for less hair than your donor could have given if the follicular units were taken individually, especially if you are paying per graft and the average number of hairs drops below the average number you have in your donor.

Hair Transplants in Europe: BHR Clinic Trichophytic Closure for Strip/FUT

2011-03-04T10:51:00.000-08:00

Trichophytic Closure has been used for some years now to close the donor on Strip hair transplants, unlike the traditional closure method Trichophytic can allow hair to regrow through the scar line. A small lip is cut on one edge before closure, when the two edges are sutured the sides come together neatly. When performed correctly follicles on the closure line will start to regrow hair again, through the scar and will camouflage what is typically a straight linear scar.

It is important to understand the scar is still there, but less visible because the line is broken up with hair, typically this technique will allow a person to wear their hair shorter than the old closure technique, but it is not likely that the person will be able to shave their hair without the scar being noticeable. When a scar forms the scar tissue is slightly different in appearance to virgin skin and there is a subtle change in the direction the hair grows through the scar and sometimes slightly around the scar line.

It is possible to see here, shaved donor after 4000 grafts,

BHR Clinic Strip/FUT Closure, Shaved After 4000 Grafts

An issue that may affect a small number of people, dependent on hair characteristics is during the early months of scar healing and hair starting to grow there may be slight inflammation on the suture line, this can be due to the hairs growing through the line and irritating the skin tissue slightly. This is not common but can occur and is only short term if it does occur. Also using Trichophytic to repair an old scar from a previous strip operation is not always possible as the closure relies on hair being on the closure line, obviously if an old scar is large it may not be possible to close with hair on the line and it cannot be assumed a scar revision will benefit from this closure method.

For more information about BHR Clinic or an online free, no obligation assessment please mail medical@bhrclinic.com

Healing After A Hair Transplant

2011-02-10T15:47:00.000-08:00

Healing is an important factor when deciding when to undergo a hair transplant, work issues, friend/family and just getting out and about without feeling totally conscious of how you look. Healing can be subjective to many factors, the size of the wound, the amount of wounds, natural skin characteristics, wound repair and post-operative wound care to name a few important aspects. The healing process can vary around the scalp, from scalp donor to traditional recipient, to scar tissue to body/beard areas. The healing process may take different durations on different body areas on the same person even when the very same protocol is used, similarly, the healing may differ in different people depending on their skin types.

A study report in 1975 by Dr. Fitzpatrick helped to classify variants in skin healing and developed a classification system for skins; the classification is also useful in body hair transplant to predict the course that the healing will follow; a brief outline below of Dr. Fitzpatrick’s classification:

Fitzpatrick skin types and their description-
Skin type 1- Extremely fair skin (always burns on excessive exposure to sunlight but never tans).
Skin type 2- Fair skin (always burns and sometimes tans).
Skin type 3- Medium skin (sometimes burns, always tans on sun exposure).
Skin type 4- Olive skin (Rarely burns, but always tans).
Skin type 5- Moderately pigmented Brown skin (never burns, but always tans).
Skin type 6- Markedly pigmented black skin (never burns but always tans).

An outline of the healing process for Skin type 1, 2 and 3 as an example during the healing phase,

Redness (erythema) that gradually diminishes to spots, white scarring. Depending on the various factors enumerated above, the complete healing may take from 4 to 18 months. Rarely 24 months. The more melanocytes (pigment producing cells), then greater the chance of transient hyperpigmentation in the healing phase. Those with the skin types 3 and 4 (and maybe 2), may follow any of the above 2 patterns of healing.

Under considered conditions this reference gives an idea of the healing process involved and what the skin goes through over the days and weeks before it is truly healed; obviously it does not take into consideration changes in the repair process and how it may elongate areas of healing.

The healing goes through a number of processes, visible and within the skin, both are important to the overall healing and the visible cosmetic effects. It is important to adhere to protocols for the best healing possible and there are also aspects you can personally do to aid the healing, dietary intake, smoking habits for example.

Stages of Wound Healing

Wounds usually affect the outer most skin layer known as the epidermis. Wound healing would be slow or fast, depending upon the cause and size of the wound and also upon your physical fitness, for instance, elevated blood sugar levels can slow down wound healing process. Wound healing process involves mainly four wound healing stages.

The Inflammatory Phase
The inflammatory phase begins with the injury itself as the wound starts bleeding in the first phase and the formation of clots at the site of the wound. Certain chemical substances produced by the body, are released right into the wound site for the healing process to begin. If inflammation continues it will normally mean healing has been impaired in some way in the early stages, leading to continued formation of cells but also the body wanting to build a clot at the site of the wound. Vasodilation is responsible for the erythema, edema, and heat observed after tissue injury. Vasodilation is an important means by which the wound can be exposed to increased blood flow, accompanied by the necessary inflammatory cells and factors that fight infection

The Proliferative Phase
During the proliferative phase, formation of cell latticework or matrix accumulation occurs, the “new skin cells” and new blood vessels are formed on the matrix formation. These newly formed blood vessels, known as capillaries, provide nutrients and oxygen to the rebuilding cells. Thus, new cells grow.

The Remodelling Phase
The remodelling phase begins some days after the injury. It can be seen that collagen is better organised by this time. Now, the tissues are strengthened by collagen. As the blood vessels become less dense, the wound loses its pink colour. As the injured area becomes strong, the wound heals up to 70% of the original skin.

Epithelialisation
Epithelialisation involves the laying down of epithelial cells for the formation of new skin. Among the four stages of wound healing, this is the last stage, during which the skin forms a protective barrier between the body and its outer environment. This barrier protects the wound from bacterial infection and excessive loss of water.

Wound contraction begins almost concurrently with collagen fusion. Contraction, easier defined as the closing of the wound edges that effectively seals the closure, is generally up to around 15 days after the wound is formed. Loose tissues contract more than tissues with poor laxity, and square wounds tend to contract more than circular wounds. Contraction results in a decrease in wound size, the appearance and long term visibility and overall quality of the wound healing. With a hair transplant we have wounds in the recipient and donor sites, and both can react differently and have different healing times.

The open wound slits of the recipient are “packed” with the graft soon after being made, the healing process between the skin tissues is relatively fast with the formation of the capillary vessels and the contraction of the wound. The area remains red for some time, some maybe a few weeks whereas others maybe months, can be dependent on the number and proximity to each other of the wounds and healing characteristics. Recipient sites in less conventional areas, impaired skin, old scars or in areas of pitting or ridging may behave differently and healing may take longer or be impaired, if previous scarring is so bad that healing never fully concluded it is advisable to not re-enter the areas again. The recipient is generally going to have many multiple wounds and infection is greater, so cleaning regularly and allowing the crust that appears to remove is vital, not to pick at the crust but allow to hydrate and dehydrate the crust will aid the natural healing.

The donor area, conventionally the back and sides of the scalp, and harvested using either the Strip or FUE techniques; each will have different healing characteristics. The removal of the Strip, position, length, width, depth of incision will all effect, too deep an incision for example can lead to increased fibrosis collection under the skin, resulting in possibly a wider scar or a raised scar area. It is important that during the first weeks of healing the area is kept clean and washed regularly, the suture type is removed as suggested by your doctor. Not cleaning the area can leave bacteria and unable to remove the suture, causing the skin to react against the suture and impair healing. Due to the linear nature and position stretching is also a consideration and it is prudent before doing any type of physical work that may put pressure on the area to fully allow the wound to relax and the skin return to normality. This may mean a few months in some cases but it has to be considered a small price to pay for minimal cosmetic scarring as well as leaving the donor in better condition for future procedures.

FUE donor healing is sometimes thought or considered to be faster and better than Strip but still holds many complications, and can still leave a visible sign of scarring in some cases. Multiple open wounds create their own problem for the body to heal all consistently becomes harder the more wounds that are made.

Body hair is becoming a more common use with FUE, this area can involve area of the body more commonly used to constant attention such as close shaving and touch and more susceptible to infection due to added trauma or abrasiveness. Due to this greater care has to be taken in the earlier days of healing but it does not mean slower healing will occur under normal post-operative circumstances.

Due to the BH areas, chest, legs, beard etc. there is more chance of abrasion and trauma during the healing process. During healing the skin may appear relatively normal, not be sensitive to the touch for example, but outward forces. Shaving for example, a remnant of hair is left in the hair follicle. As this starts to grow out of the follicle, it may immediately curve round into the surrounding skin, because there is nothing to keep it straight. Besides the healing of the skin still in a progressive state the ingrowing hair irritates the skin and can cause a reaction. The next abrasive action the area is caught again, worsening the inflammation and perhaps allowing an infection to occur. This can occur when the skin externally and internally has not gone through the stages of healing and still requires time to correctly form the protective barrier, or new skin on the surface and healing is complete. The problem being the more trauma caused during week one and two of healing can exacerbate the entire healing process from weeks to months, dependent on conditions, skin characteristics etc.

As said contraction healing can take around 15 days, before this although the wounds are small the skin is still susceptible to a prolonged healing pattern, and it is not as simple as starting again and expecting the sequence of healing to refresh, the pattern of healing has been interrupted and now takes on a different regime of healing.

Although FUE wounds are individually small does not detract that each is a separate wound and has to go through the same processes of healing. Due to the wound being smaller it can be thought either less care needs to be taken or healing is faster, this is not the case and an interruption or impairment in the healing process can cause healing to be slowed down as the wounds have not had time to properly repair and heal.

How to improve wound healing, it can be as simple or as complicated, from simply allowing the wound to naturally regenerate the natural properties required to improving areas of your diet and life. What is important is good healing time is respected and not tried to be rushed. Choose your moment for a hair transplant when you can allow for healing to take the natural course, not always easy but important as the final result is never today or even tomorrow but the rest of your life.

Scar Repairs: Hair Transplant FUE Technique... Does It Work?

2010-12-13T14:15:00.001-08:00

Placing grafts into scar tissue is a delicate and precise hair transplant procedure. Scar tissue makes the regrowth of hair much harder to achieve as the skin tissue is impaired and the cardio vascular system is also impaired. BHR Clinic deal with many repair cases and specialise in FUE, Follicular Unit Extraction. The technique requires the use of a punch, normally 0.75mm in diameter surrounding the hair shafts and extracting the graft, due to the micro surgical nature of the procedure it takes a great deal of expertise to perform.
Here we have a case, an previous strip scar that had stretched and also caused tram lines due to the closure technique used. 498 grafts were added into the scar to help camouflage the area, and we have pre op, post op placement and 12 months regrowth.

: Pre BHR Strip Scar

: Post Op FUE Into Scar by BHR Clinic

: 12 Months Post Op FUE Scar Revision Growth

Do I Have A Hair Transplant and Am I Ready For A Hair Transplant?

2010-11-22T11:31:00.000-08:00

Is a hair transplant suitable for everyone, why are some people more suited than others, and why are some not suitable at all?

The critical problem technically is the donor resources in relation to the surface area to cover short and long term projection; if you like supply and demand. The donor supply coupled with the extent of hair loss the candidate is suffering from at the time but also what the potential for hair loss could be in the future must be equated as best as possible.

Obviously this is harder to determine in the early stages of hair loss so any design must be in keeping with the limitations of the donor supply and thinking of the future. Some candidates, a few very lucky people have “home run” donor supply, meaning they can treat almost any degree of hair loss, but these candidates should not be seen as average or even very good but the exception to the rule.

But besides the technicalities of a hair transplant there is another side to being a better candidate.

Making someone a good hair transplant candidate can be their expectations and goals, short and long term, also the candidates understanding of how a hair transplant works, pros and cons. Hair loss is an emotive issue that touches men of all ages, there is no real boundary, having a hair transplant can also create varying emotions. It is common to go through different emotions during the entire process, choosing your doctor, then deciding to commit, waiting for the big day, wishing now you had decided it would come tomorrow.

Then the big day, normal emotions when having a medical procedure, as well as watching everything that goes on during the day, is everything going well, is the doc in a good mood, is everyone paying attention and working well. This is your big day and obviously you are rightly concerned everything is going well. Then the post op, what many call the initial “ugly duckling stage” as the HT is healing, waiting for the redness to go, hoping you are the one that the hair doesn’t fall out at the end of the 1st month, invariably it will. Getting over the hair falling out is then the next stage....................will it grow back?

We want to be positive but sometimes we find ourselves becoming so worried about getting the result we want we start to over analyse. We look for every hair that grows and every hair that doesn’t, we compare to other people's cases and compare time lines. They are dates along the way like milestones, the first month, 3 months mark, 6 months and so on, until the person is happy with his result. For most of us happiness probably does not come until around the 12 months mark. Some people go through this easier than others, and it can be hard, what has to be understood is we are all different and if we grow faster, slower, mature at different speeds it really doesn’t matter until a realistic time line has passed, and in hair transplantation it can be around 12 months or so for most of us. Obviously as time goes by and you do not feel you are at the stage you should be you ask yourself questions. Did everything go well on the day, what if a mistake was made, and sometimes crazy notions come into our heads that in normal life you would dismiss, but at the time they are real.

A hair transplant is a tough decision to take, some are not right to go ahead, be it age, hair loss stage, goals and expectations. An important aspect is that a hair transplant should be a good thing, something for whatever reason improves how you feel, getting there may not be an easy journey but I am sure going to any quality clinic you will have their backing and full support,

We recommend when possible to have a one to one consultation with a few doctors to assess your situation and gain multiple opinions. If possible also talk to previous patients from these doctors and see their results in person. You will gain an idea how the doctor approaches his surgery and if he is along the same lines as you in terms of results and what is achievable. Becoming hair educated is vital to being a happy hair transplant patient in the long term, especially as it is an emotional issue and sometimes our heart can rule our head when making decisions such as this.

BEARD HAIR TO BEARD SCAR REVISION VIA FUE HAIR TRANSPLANT TECHNIQUE

2010-10-27T06:32:00.000-07:00

Scar Repair on the beard using beard hair extracted via FUE, Follicular Unit Extraction Technique

PRE OP SCAR

: Pre Op Beard Scar

POST OP PLACEMENT AND EXTRACTION 150 FUE GRAFTS

: 150 FUE Beard to Beard EXTRACTION AND PLACEMENT

ONLY 5 MONTHS POST OP HEALING AND GROWTH

: 5 Months Post Op Beard to Beard FUE

: 5 Months Post Op Beard to Beard FUE

FOR MORE INFORMATION ON FUE, FOLLICULAR UNIT EXTRACTION AND HAIR TRANSPLANT REPAIRS PLEASE EMAIL BHR CLINIC ON MEDICAL@BHRCLINIC.COM

Choosing Your Hair Transplant Doctor

2010-10-22T12:18:00.000-07:00

Researching Before Deciding

One of our International patients recently started a thread on a hair transplant forum to discuss how clinics and some forums approach hair transplants. For the person researching it can be very difficult to get through to what is real. Our patient’s basic point was how hard it can be picking through the real, the marketing and the shills.

There are important aspects when researching and choosing the right doctor for you, and also deciding if a hair transplant is right for you in the first place. The forums can help, see the doctors before and after cases and also read the experiences of patients and other posters’ comments. This can help in many ways, everyone has their own opinion, some based on their experience and some based on what others tell them, so get through the marketing and hype and then decide on maybe three, four doctors who you like or would be interested to hear from them.

When possible have a personal consultation with multiple doctors, this can help have your donor density examined, the quality of your hair, have your hair line designed if needed, all the technical aspects. But another aspect you will find when you visit a clinic is do you like the doctor’s attitude and manner, does he come across as honest and open or closed and just interested in booking you for surgery. This can give you a good indication whether you trust the doctor, like the clinic and would use them. If you cannot personally visit the clinic then have a on line consultation, this can answer many questions, how efficient they are at answering your questions, how much information they offer you, and ensure it is the opinion of the doctor and not an agent, it is the doctor who has the responsibility and will perform your operation and the person who ultimately you will turn to for advise and help if required.

A hair transplant is elective surgery, so you should feel free to ask questions of the doctor and see how they answer. The more questions you can ask the better informed you will become and you will also see how open the clinic is. Important questions to see whether you agree with the doctor’s ethics and approach to a hair transplant. You need to then compare the approaches from different doctors and decide who you feel has the correct approach for you, who has your best interests and who can deliver the result you want.

Another important consideration to deciding on your doctor is past patients, talk to them by email or telephone if possible and even better meet them in person, there is nothing better than meeting a past patient and see a hair transplant in reality. Here are a few questions you should ask the doctor, please feel free to make comments and add to the questions, it will help newbies to become better educated.

Why did you begin doing hair transplants? (Although there is no right or wrong answer to this question, the response should offer some insight into the doctor’s motivation and personality.)

How long did you train with other doctors before you began performing the procedures?

What is the doctor’s assessment of your current situation and what does the doctor advise for you, the best technique for you to use and why, the number of grafts he intends to use and why, how many grafts you have remaining in your donor for future loss, should you take hair loss medications, for example.

Does the doctor perform both FUE and FUT and what are his thoughts on both techniques

Does the clinic ever turn away hair transplant candidates and if yes the reason why, if the answer is no be careful.

Do you think everyone is a good hair transplant candidate; if the answer is yes, again be careful.

Is it possible to meet with some of past patients with similar hair loss to mine, and who have grown out results?

BHR Clinic Launch New Website

2010-10-07T05:40:00.001-07:00

We are please to announce the improvement in our website, we hope you find it easy to navigate and find the information you are looking for. There are clear sections explaining a hair transplant, the techniques, costs, pros and cons to having a hair transplant. The site will be available in English, Spanish, French, German and later Swedish and Polish.

www.bhrclinic.com

Hair Transplant FUE Hair Line Repair. A Patient's Experience: Stingray

2010-09-25T12:52:00.002-07:00

"Hey guys

This is my first post on Hair Loss Experience but some of you may know me from a few of the other forums.

I thought I would start a new thread as I am scheduled for a FUE session with Dr Bisanga on 19th December. ........................

You can see my pics attached and although they look pretty bad the reality is that when my hair is grown out and with a bit of concealer (see last pic) I can pretty much get away with it. However, I would really like to get to a position where I didn't have to wear concealer and I could not have that constant hair worry. You know that feeling when you tense up when a girl playfully runs her hands through your hair?

My plan is to have approximately 1000 FUE grafts into the transplanted area to create the hairline..................I realise that 1000 FUE is probably a bit less than I need but I think it is enough to make a significant cosmetic difference and it will allow me to assess the results without using too much more of my donor hair. Once this procedure has grown in I will reassess where I am. I haven't ruled out going down the strip route at some point later on.

I spent a long time deciding on the doctor that I wanted to go to. I think since I have begun my hair transplant decision I have consulted with 6 docs in person and several more via the internet. I have emailed dozens of patients and even have a facebook friend out of it. For this 2nd procedure I eventually narrowed it down to either Dr Bisanga or Dr Ron Shapiro. I have had a lot of contact with Phil from Dr Bisanga's office and Jason from Dr Shapiro's office. Both have been fantastic and I would feel completely confident with either Dr. The choice eventually came down to one of scheduling and the fact that, living in London, Brussels is cheaper and more convenient to get to and from.

Well, I have to say I am nervous and excited. I am not looking forward to the actual procedure but I am hopeful that it will be worth it in the end. I will keep everyone updated on the progress of my 2nd round in the chair and am happy to answer any questions that people have.

Best wishes,

Stingray"

UPDATE AT SIX MONTHS

"Hey guys

I'm at 6 months today. I am very happy with my progress and have booked my second pass with Dr Bisanga for the spring next year.

Pics are below. I have died the gray and there is a bit of wax in my hair but nothing else. You can see that the area which was implanted is looking really strong. The area behind is a bit thin but will be sorted next year.

I am really pleased to be able to leave the house without concealer for the first time in years.

Feel free to make any comments or questions.

All the best,

SR"

BEFORE BHR AND SIX MONTHS POST OP FUE HAIR LINE REPAIR

PRE BHR FUE HAIR LINE REPAIR

PRE BHR FUE HAIR LINE REPAIR

6 MONTHS POST OP HAIR LINE REPAIR WITH BHR

6 MONTHS POST OP FUE HAIR LINE REPAIR WITH BHR

6 MONTHS POST OP FUE HAIR LINE REPAIR WITH BHR

You can read more of Stingray's comments and feelings and those of other hair loss sufferers on
hairlossexperiences open forum and HairlossHelp Open Forum

For more information on BHR, the FUE Technique or Repair Hair Transplant Surgery please contact medical@bhrclinic.com

Hair Transplant FUE Hair Line Repair. A Patient's Experience: Stingray

2010-09-25T12:52:00.000-07:00

UPDATE AT SIX MONTHS

BEFORE BHR AND SIX MONTHS POST OP FUE HAIR LINE REPAIR

PRE BHR FUE HAIR LINE REPAIR

PRE BHR FUE HAIR LINE REPAIR

6 MONTHS POST OP HAIR LINE REPAIR WITH BHR

6 MONTHS POST OP FUE HAIR LINE REPAIR WITH BHR

6 MONTHS POST OP FUE HAIR LINE REPAIR WITH BHR

You can read more of Stingray's comments and feelings and those of other hair loss sufferers on
hairlossexperiences open forum and HairlossHelp Open Forum

For more information on BHR, the FUE Technique or Repair Hair Transplant Surgery please contact medical@bhrclinic.com

FUE, Follicular Unit Extraction in Europe. Can You Shave, Density & Scarring

2010-09-23T14:58:00.000-07:00

Follicular Unit Extraction, FUE, a hair transplant technique using a micro surgical punch to remove individual follicular units/hair groups. The benefit is no linear scar like the Strip technique and when performed to the highest standard can leave no visible signs hair has been removed even with short, shaved hair. Dense packing the grafts also enables again even with short hair is possible allowing a natural looking density to blend with the surrounding native hair. Below is an example of example of FUE, 2144 grafts over 2 procedures and a fully grown out result.

PRE OPERATIONS DESIGN

AFTER 2144 FUE GROWN OUT RESULT, SHAVED HIGH DENSITY HAIR LINE AND PRISTINE DONOR

FOR MORE INFORMATION OF FUE, FOLLICULAR UNIT EXTRACTION EMAIL MEDICAL@BHRCLINIC.COM

Hair Transplant Patient Testimonials

2010-08-29T07:07:00.000-07:00

It is always important to research before undergoing a hair transplant, the two different techniques FUE and FUT can both give excellent results when used correctly and on the right candidate. Talking to different doctors, have a personal consultation if possible will give you an insight into their plans and how they work, and if you are happy with what you hear.

A big help can be to read other people's experiences and see them in person; many people are happy to talk about their experience as they know how difficult and hard it can be to make the correct decision. Seeing a hair transplant in person can help a great deal, how natural the hair line is placed and the quality of their donor area after the extractions.

It is possible to read a very small selection of patient comments about their results and experiences with BHR Clinic, simply click on the various links below to read, English, Polish and Spanish speaking patients.

http://www.hairtransplantadvice.org/miscellaneous-patient-quotes-t264.html

http://www.hairtransplantadvice.org/patient-testimonials-f32.html

http://www.hairtransplantadvice.org/wypowiedzi-pacjentow-f41.html

http://www.hairtransplantadvice.org/testimonios-de-pacientes-f45.html

Is A Hair Transplant Suitable for Female Hair Loss?

2010-08-16T13:06:00.000-07:00

Female hair loss or thinning is maybe more common than realised, women begin to have hair loss as they get older, possibly medical conditions, stress, chemical damage to name a few reasons, so hair loss is not just a concern for men. In the age of cosmetic surgery you could ask why few women do not opt for a hair transplant as a solution, or is it because many females do not meet the criteria for a hair transplant.

Women typically have different hair characteristics to men as well as style of hair loss. For men, their baldness is classed as MPB, or male pattern baldness, affecting the top of the scalp whereas the sides and back are immune from this loss. The donor hair around the sides and back can be partially moved to the top, recipient area, where it will continue to have the same characteristics as before and not suffer from MPB. The cause of the loss is chemical known as DHT, created when a naturally occurring enzyme in the body comes together and combines with testosterone.

: Before After Comparison 1698 FUT BHR Clinic

The female pattern for hair loss is measured on what is known as the Ludwig Scale; typically the thinning hair is diffused over the head and not merely at the top like it is with men. This can affect the entire scalp and not simply the top as in MPB, thus can create a problem if there is no stable hair zone to use as a donor. The pattern of loss as said is more diffused but also classically suffering from miniaturisation around the thinning area. Because of the patterning of miniaturisation or loss this can make many fewer woman hair transplant candidates compared to men.

Due to the nature of this hair loss it is important for a personal consultation and correct assessment to be made, measurements of the typical donor area for density and signs of miniaturisation. Then the extent of the thinning is to be assessed against the suitable donor supply and calculate not only that this thinning can be successfully treated but for potential future loss.

For a full and detailed assessment of your situation if you have not done please email your pictures and details of your hair loss history to either info@bhrclinic.com or your Patient Advisor.

How Short Can I Cut My Hair With FUT/Strip Hair Transplant Technique?

2010-08-06T07:56:00.000-07:00

The Strip Technique also known as Follicular Unit Transplant "FUT" has been the standard for hair transplantation for some years now. Helps both men and women suffering from male or female pattern baldness and it is still a great method of extraction in the correct hands, practised and used on thousands of patients around world wide. Strip has many advantages to the patient and only the real downside to this technique is the linear scar that remains in the donor area as to remove the hair a cut along the scalp has to be made and then sutures, the length depends on the density of hair in the area, the laxity of the scalp and then how many grafts are required for that procedure.

Questions such as "What are the chances of the scar widening and becoming more visible" and "How long or short do I have to keep my hair?"

Trichophytic Closure. BHR Clinic Standard

When performed to a good standard the width of this scar is very minimal, the patient has their own responsibility to follow the post operation instructions for wound healing to minimise the chance of stretch back also. With the advent of the Trichophytic Closure, a technique used to close when suturing hair now will grow back through the line making it even harder to detect and allow for shorter hair cuts.

The hair characteristics of the person can also have a part to play in how short hair can be kept, curly hair, straight, coarse or fine, and even the colour can all add to camouflaging the area, but it could be s aid that any hair length under 1/4” or #2 buzz clip may make the scar more apparent.

FUT Linear Tricho. Scar After 4000 Grafts Extracted

More recently the FUE technique has evolved, this is the extraction of each follicular unit one by one, so no linear scar, this is now available to minimise the scarring from Strip as hair can be placed along and around the linear scar to diffuse the look and camouflage even further. The scar is obviously still there but much harder to find and will allow the person to keep even shorter hair with the comfort and security the line cannot be seen. FUE has also opened the door to Body Hair being used and with experienced FUE hands BH can produce a high yield and become an alternative to having to use valuable scalp hair.

For a full and detailed assessment of your situation if you have not done please email your pictures and details of your hair loss history to either info@bhrclinic.com or a BHR Patient Advisor.

Hair Transplant Techniques FUE or FUT in Europe

2010-08-01T02:50:00.000-07:00

As a hair transplant relies on the movement of hair the donor supply was be able to sustain the need for hair over the area the candidate wishes to cover, this is not always possible and it is important the candidate discusses at length with doctors and becomes "Hair Educated" as to the pros and cons of this surgical procedure. In the past and even sometimes today patients who were not suitable candidates for hair transplant surgery have undergone the procedure and regretted the decision. The amount of research that is now available with the internet should be able to provide the knowledge required to make the correct decision. Sometimes that decision maybe to not have a hair transplant, but if so it is for the correct reasons and the person's long term happiness; a "HT" is not a miracle sure, and to date there is not one, as the HT relies of the remaining hair sometimes the decision is to either have no HT or refine your goals to accomodate what is actually possible and will look natural.
Dr. Christian Bisanga, Medical Director of BHR Clinic in Brussels has devoted much of his medical career to hair transplant and one of the first to perform consistently the technique known as FUE. He has developed the FUE technique now to the highest level, has presented talks to International Hair Restoration Societies, trained other doctors to his exacting standards and is considered by many of his peers and patients alike to be at the forefront of the FUE technology worldwide, attracting patients from around the globe.
There will always be debate over the techniques, either patient to patient or clinic to clinic. They both have pros and cons and it is a hard question to really give defining answers to, so maybe better settle on a simple get out, it depends on what you need and what your donor can afford, of course with long term planning always in mind; so assuming both are performed to a high standard.

FUE or Follicular Unit Extraction is obviously more welcome for smaller procedures if only because it will not leave a linear scar so still allows the person to keep their hair shorter than strip could and even shaved. FUE becomes harder to advise the larger the session, either because of potential limits to harvesting so many grafts individually in one session or the impact it may have on the safe donor area again removing so many individual FU from a surface area that does not change and still leave the donor looking natural and not thin.

Strip is obviously great for larger sessions and high NW cases when maybe FUE cannot safely reach the numbers in one session or even multiple sessions, and Strip can give the person much greater coverage quicker. OK, it leaves a linear scar but then no one said HT is all good and there will never be any visible signs of surgery, and most guys can accept this for the trade off of much more hair. Strip with Trichophytic Closure has the benefit over FUE that the area the hair is taken from is actually removed so the donor density is not as such effected, yes the laxity will alter slightly but not to the point more cannot be taken in the future. Because the area of extraction is concentrated generally more grafts can be taken in one session compared to FUE.
It may also be possible to utilise FUE and even leave a band of virgin scalp in the donor for later use of Strip if the hair loss progressed and required a larger procedure. This is possible with smaller FUE procedures and maybe worth doing with average density donor as it gives an uncorrupted Strip zone with original density.

This all comes down to planning from the first op and you and the doc being on the same page, obviously a personal consultation is had before, or at least very good educational dialogue between clinic and you to thrash out the possibilities prior to the day, and then on proper assessment the choices and reasons are already known and understood. Always remember, talk to previous patients and see their results in person if you can, this will tell you much about the doctor's work and how he thinks.

FUE, Follicular Unit Extraction, Setting Standards in Europe

2010-07-29T13:52:00.000-07:00

Dr. Chris Bisanga of BHR Clinic in Brussels, Belgium is a leading hair restoration surgeon and probably best known for his skills when practising the highly demanding FUE, or Follicular Unit Extraction Technique, especially with Body Hair and Beard Hair. This has widened the scope for many hair transplant candidates, previous patients and repair cases. With his unique Manual Punch Technique and protocols Dr. Bisanga has made this area of Hair Transplant is devotion to offering candidates in Europe and afar the highest standards possible.

Follicular Unit Extraction is for obvious reasons becoming more and more popular with hair transplant candidates in Europe, it’s minimally invasion action sets it apart from the more traditional FUT technique, not leaving a linear scar and when performed to the highest standards candidates are able to shave their hair with no obviously visible signs a hair has been removed. FUE also allows for hair transplant repair, allowing patients with previous poor hair transplants to continue their quest for normality and opens avenue previously not available, for example removing old grafts and the use of BH in the repair process.

Dr. Bisanga of BHR Clinic is one of the world’s renown leading hair restoration surgeons, and especially for his skills with the FUE Technique, combined with his artistic hair line designs makes him a very popular choice amongst hair loss sufferers in Europe and worldwide. He knowledge of FUE stretches back for ten years and he has written papers and articles to his peers and patients with his findings and developments in this demanding technique. One aspect that is setting Dr. Bisanga apart from others is his absolute belief that FUE can only be performed to the highest standards when using a manual punch; this enables a clear and tactile feeling between the punch and the graft when extracting, being able to feel the depth, direction and angle of the graft.

His great knowledge and devotion to FUE has moved him more and more to develop a viable Body and now Beard hair protocol, this has been practised for some years but with varied success and some glaring errors, two being very low yield and visible scarring. Dr. Bisanga has been performing BH for over five years now and has always had a reputation for caution and small procedures, preferring to test first before committing himself or the patient to a larger procedure. Even today he is not an advocate for large procedures and would prefer to keep the numbers below 2000 grafts per procedure, believing with his protocols in place and his Manual Punch Technique this creates the best growth atmosphere and healing to attain the best result for the patient. He now feels with the right candidate that it is possibly to safely perform a BH procedure without needing a small patch test, this is at his discretion and not to be considered every case is suitable. Beard hair especially he feels has opened the door for patients to gain a new resource to harvest, although he is very mindful of the dangers of scarring in such a visible area of the body.

FUE relies much on the technique of the doctor performing the extraction, Manual Punch is slower but more accurate with a lower transection rate and potentially much lower visible scarring. The size or diameter of the punch is also crucial not just to cause no visible scarring but also to be able to remove an intact follicular unit with all the peripheral glands and nerves required for it to grow in the new area. A great problem when performing FUE is the position of the recipient area in terms of the angle the doctor allows the punch to enter the skin. This is crucial to the long term success of the result, donor and recipient and is something that some doctors can learn, some have a gift and others do not pick it up to the level required to keep transection to the minimum.

If you are interested in learning more about Dr. Bisanga and his advanced hair transplantation methods, please contact the BHR Clinic in Brussels, Belgium for a free assessment of your case, with no obligation and total confidentiality.

Can Beard Hair via FUE Be A Viable Edition to Hair Transplantation

2010-07-27T00:36:00.000-07:00

Beard hair has become a viable source of hair harvesting, assuming the beard has the correct characteristics, it can be used to blend with traditional scalp hair and this obviously extends the donor resources for the patient, allowing more hair and more long term coverage to be achieved. Beard hair has opened another avenue especially for repair cases when the traditional scalp donor has been depleted. There are limitations to beard hair and it is important to discuss with an experienced FUE doctor, with body and beard hair experience before just assuming it is a viable option for you.

Here we have a scalp FUE example, the patient has grey hair which in itself makes FUE much more demanding to perform; the patient had 2 previous poor operations, Strip and 2mm punch with little growth and leaving scarring in the recipient and donor. Due to his good hair characteristics it was possible to spread the grafts over a larger surface area and still maintain a good cosmetic result. The beard hair was deliberately placed in an area behind the hair line to be able to monitor the growth, which even at only 5 months post operation is very obviously good.

: Before & 5 Months Post Op FUE with Dr. Chris Bisanga

The Beard as seen is removed using the FUE technique, a micro punch with manual extraction removes each follicular unit, it is important to not over harvest an area so the beard area remains looking untouched. Here it is possible to see the extraction and healing of the beard 5 months post extraction with no signs of hair removal.

Overall it is important to appreciate this is only 5 months post op result at present, there will be more regrowth from the hair transplant to come over the coming months and more maturity of the hair. It is considered that around 12 months is the benchmark to wait for a hair transplant to fully mature, in some cases this can be a little longer, repair cases for example when the skin in the recipient area has scarring, ridging from the previous surgery; in these cases it may take 5-6 more months for the hair to regrow and mature.

7914 Grafts , 2 x Operations Hybrid FUT and FUE Combination

2010-07-23T09:03:00.000-07:00

: 7914 Grafts Dr. Chris Bisanga, BHR Clinic

Under the correct circumstances and with a well thought out pattern of extraction, and obviously assuming the patient has the donor capacity even large hair loss stages can be very successfully treated.
The patient of Dr. Christian Bisanga above came to him after a previous unsuccessful small FUT procedure; his initial goal was to place a natural hair line and cover as much of his scalp as possible in one procedure. He was well aware that total coverage was never going to be achieved in one procedure and the focus was to be the hair line, frontal third and as far back as possible. The initial procedure used the FUT procedure, or the Strip method as it is commonly known. This incorporates the Tricophytic Closure technique to reduce the appearance of the strip scar.
The end result of the first procedure was 4151 grafts and a natural hair line and coverage.

: 12Months Post Op 4151 FUT Dr. Chris Bisanga

Twelve Months later a second procedure was carried out, this time a mix of FUT and FUE, the removal of each follicular unit one by one. By combining the two techniques allowed for the greater number of grafts to be harvested from the patients donor area. The strip was smaller than before due to the laxity changes in the skin after the previous surgeries but the FUE allowed the donor surface to be wider, the final graft count being 3763 grafts, 2568 FUT and 1195 FUE, so with Dr.Bisanga now a total 7914 Grafts.

Not Sure What Hair Transplant Technique To Use? FUE and Strip Surgery

2010-07-20T14:25:00.000-07:00

Is it best to have strip surgery first, then fue to maximise the donor harvesting of grafts, or vice versa ? .............................. A question that when one starts to research is not far on the list to decide and debate.
There will always be debate over the techniques, either patient to patient or clinic to clinic. They both have pros and cons and it is a hard question to really give defining answers to, so maybe better settle on a simple get out, it depends on what you need and what your donor can afford, of course with long term planning always in mind; so assuming both are performed to a high standard.

FUE or Follicular Unit Extraction is obviously more welcome for smaller procedures if only because it will not leave a linear scar so still allows the person to keep their hair shorter than strip could and even shaved. FUE becomes harder to advise the larger the session, either because of potential limits to harvesting so many grafts individually in one session or the impact it may have on the safe donor area again removing so many individual FU from a surface area that does not change and still leave the donor looking natural and not thin.

Strip is obviously great for larger sessions and high NW cases when maybe FUE cannot safely reach the numbers in one session or even multiple sessions, and Strip can give the person much greater coverage quicker. OK, it leaves a linear scar but then no one said HT is all good and there will never be any visible signs of surgery, and most guys can accept this for the trade off of much more hair. Strip with Trichophytic Closure has the benefit over FUE that the area the hair is taken from is actually removed so the donor density is not as such effected, yes the laxity will alter slightly but not to the point more cannot be taken in the future. Because the area of extraction is concentrated generally more grafts can be taken in one session compared to FUE.

Stephenl, one time patient of BHR and now a Senior Patient Advisor opted for FUE, and was a NW5/6 but had a much higher than average donor and even still is relying on BH to finish his crown. Stephen decided on FUE because he wanted to be able to shave still, something he couldn't have done with Strip. But if he didn't care about shaving he could have completed his restoration a few years ago, with less ops, rather than multiple smaller FUE;s; one big Strip to start with probably giving him the same as 3 FUE sessions did. So, it is all about what you have in your donor, what your goals and intentions are and the future, both are good techniques and used well and can combine well also.
So, Whats the average donor supply of a person in the nw3-5 range?
Obviously the average donor is going to change dependent on the person's genre and hair characteristics, but we base an average density around the 75 follicular units per cm2 mark, 80 and above being good and 60 being poor and potentially not a candidate. Then there is the approx amount of hairs per FU, skin laxity to address also.

To max the number of grafts on most candidates it is best to go Strip first if the pattern of hair loss is high and a lot of grafts are needed. With good healing of the suture another Strip could then be taken, smaller than the first and then FUE at the same time or later, probably still leaving room for another smaller op or two with good planning and harvesting of the grafts.

If the density is very high then FUE can be used and continued to be used and still get a meaningful amount from a Strip later, so if the hair loss pattern is still relatively minimal and FUE is preferred under the circumstances then do smaller FUE sessions as long as the harvesting pattern is well thought out, this will minimise the density loss to the donor and enable a decent Strip if the pattern of loss increases dramatically in the future.

Over harvesting with either technique can be a problem, the skin laxity changes with every strip so the position of the suture is important, taking it in a safe area where even with aggressive hair loss it will not be visible, but also with FUE; over harvesting will thin the donor and leave it see through, and this could expose the suture line area or leave an unbalanced appearance of density around the donor if not harvested correctly.
So, How many Strip surgeries can I have, 2,3 more?
It's not really as simple as that because you have to look at the hair groupings, the laxity of the skin, there are many variables to think about. You have to question where each strip will be removed from, the length and width, would it be possible to remove the strips from different areas of the scalp or would it mean englobing each one, thus effecting the laxity more. Every time a linear cut is made, and dependent on the technique used by the doctor is it going to impair the skin healing and laxity, so this will have a knock on effect for future procedures, especially as the Strip safe zone is relatively limited in size, that is unless you start taking the strip from different angles and positions.

Multiple strips is obviously possibly but the amount that can be taken per strip over time is harder to assess. Also there is the question why do relatively small strips that will leave a linear scar when FUE is probably more suitable if around 2000 grafts is required, especially if the example has average to good density.

It may also be possible to utilise FUE and even leave a band of virgin scalp in the donor for later use of Strip if the hair loss progressed and required a larger procedure. This is possible with smaller FUE procedures and maybe worth doing with average density donor as it gives an uncorrupted Strip zone with original density.

This all comes down to planning from the first op and you and the doc being on the same page, obviously a personal consultation is had before, or at least very good educational dialogue between clinic and you to thrash out the possibilities prior to the day, and then on proper assessment the choices and reasons are already known and understood. Always remember, talk to previous patients and see their results in person if you can, this will tell you much about the doctor's work and how he thinks.

2556 FUT 7 Months Post Op with BHR Clinic's Dr. Chris Bisanga

2010-07-14T05:56:00.000-07:00

2556 FUT 0-7 Months Post OP

FUE Hair Transplant: Mega sessions or Quality over Quantity with Dr. Bisanga

2010-07-12T15:14:00.000-07:00

FUE, Follicular Unit Extraction, is the removal of individual follicular units (FU) one by one from the donor area, an FU is a natural group of hairs growing from our scalp, normally between 1 to 4 hairs per FU and different areas of the scalp will have a greater % of number hairs than others, the sides more single and 2 hair units and the back a greater number of 3 and 4 hair units.

It is important to ensure an educated extraction pattern when removing the units, to evenly distribute the extraction across the entire donor safe zone so to maintain the integrity and average density across the donor rather than excessively thin areas of the donor. To do this requires an ironically educated uneducated pattern of extraction, not to carte blanche remove FU in a pre meditated pattern but to actually calculate the pattern of extraction to follow the scalp make up of FU positions, a little like a chess player would think 5 moves in advance. This will take more time as the pattern of extraction may have to change so slows down the extraction, but will preserve the integrity of the donor area.

Manual punch extraction; in a world of speed and the perception speed is better or an improvement FUE can buck this conception. Performing FUE is akin to multiple mini single operations in one larger procedure, every extraction is a minor procedure in itself as every punch has the ability to either successfully extract an intact FU or negatively transect or kill the FU. It is easy to measure the success of the extraction by how many FU are removed intact against the number transacted. Manual punch extraction enables the doctor to be able to “feel” the punch surround the FU under the scalp surface, changes in direction and depth that cannot be felt with mechanical devices for example. This does require more time but it acutely more accurate and will reduce transection greatly when there is a good understanding of FU positioning and skin “play”.

The scalp is not a flat surface, changes in hair direction can occur either through the natural characteristics of the person and dependent on the area of the scalp being treated. Movement and re-positioning is required for almost every extraction performed rather than keeping one position for entire area; again these slight changes in angle and direction are calculated on the individuals’ characteristics and cannot be pre ordained to cover an entire area.

There is then a simple factor of fatigue to consider, doctor and patient; the patient is required to lie still for a good period of time, if anyone has ever tried it is much harder than you may think. Any movement, arm, leg will have a ripple effect over the body to the scalp and when extracting with a punch as small as 0.75mm in diameter, the slightest variant can mean missing the FU. The concentration of the doctor is paramount to treat each extraction as individual and over time it is reasonable to expect each extraction to take slightly longer than the last.

Dr. Bisanga has been involved with the FUE technique for almost 10 years, over time he has developed, adapted and improved his technique, writing many articles to educate his findings. He initially found himself comfortable with performing around 500 FUE grafts per day, this later rose to around 1000 and now in perfect conditions this can rise to over 1500 grafts per day on one patient. But he warns not to set out with needing to reach specific number before starting the procedure, but allow the procedure to happen within his protocols, so if 1200 are safely extracted rather than 1500 the number is less important against the survival of the FU and maintaining the integrity of the donor. Some procedures are easier than others and allow for faster extraction but it can never be to the detriment of the result.

It is Dr. Bisanga’s belief that FUE should remain a manual extraction technique, that it requires a great deal more skill opposed to the FUT /Strip technique and should not be compared in that way, the number of grafts able to be extracted in a day. Dr Bisanga believes that FUE is more than a viable hair transplant technique but has restrictions due to the micro nature of the individual removal of each FU and with this comes a responsibility to respect these conditions to achieve the best results possible, even if this does not always meet our desire for speed.

Hindsight is always a beautiful thing, if you asked a hair transplant patient who’d undergone 2500 FUE in one day, 50% transection of the removed grafts, so actually over 3500 punches made, a severely depleted donor and poor yield if they could turn the clock back and remove less over a longer period and have better growth and better donor the answer would always be obviously, of course.

Dr. Bisanga is the Medical Director of BHR Clinic and works from Brussels , Belgium and a member of the International Hair Society, ISHRS

Dr. Chris Bisanga: Graft Care Performing Hair Transplantation

2010-07-11T14:53:00.001-07:00

Once the “graft” has been extracted from the scalp donor the graft either has to be dissected into the individual follicular units with FUT or checked and cleaned if necessary with FUE. Skin tissue is delicate and requires great care when handling to not damage or traumatise the tissue, also the size of the tissue makes it difficult with the human eye to ensure the greatest accuracy and care is taken. To ensure this care is taken stereo-microscopes are utilised and this enables the surgical team to maintain the integrity of each follicular unit when either dissecting from the main tissue into the individual units or being checked and cleaned.

Under magnification it is possible to accurately ensure any directional changes of the hair in the tissue, sometimes the hair colour, especially grey or light blonde can make the depth and direction of the hair difficult to establish and without magnification the chance of transection or killing the graft is more likely. Therefore it is considered vital to generate a hair follicle that contains all the essential anatomic structures necessary for maximum survival and growth, therefore stereo magnification must always used.

A carefully dissected graft, trimmed of excess epidermis and fat has the flexibility to be inserted into the tiny opening made and placed at an angle almost flush with the skin. The recipient sites are made in close proximity to each other, the angle and direction decided dependent on the site position as well as the size of the site dependent on the number of hairs in place in the graft. When the grafts are placed the angles can be so acute that the base of one follicle lies under the shaft of the next; this close proximity placement must also be undertaken with magnification to ensure correct direct, depth and graft care, not to place the graft too deep or crush the bulb with the forceps whilst handling. The trimmed grafts have very little volume other than the functional follicle so they are perfect for dense packing but are delicate and easily traumatised.

Dr. Christian Bisanga has been a recognised leader in Hair Transplant worldwide and a member of the International Hair Restoration Society, ISHRS. He is the Medical Director of BHR Clinic and practices out of Brussels, Belgium.

Who Will Do My FUE Hair Transplant Procedure?

2010-07-10T11:06:00.000-07:00

Hair Transplant has become an effective way to treat hair loss, and now can provide the right candidate with the most natural results possibly.

A Hair Transplant procedure is relatively simple in surgical terms – hair from the donor will be extracted using the latest surgical tools and honed knowledge and then placed into the recipient area.
When one starts to research it will be obvious there are many Hair Transplant companies offering their services, and it is important during research that you keep a broad view and get as many professional opinions as possible, as well as meeting and seeing a hair transplant patient in reality. When choosing BHR Clinic for your hair transplant you are choosing much more than just a surgical procedure, you make a life style decision.

BHR’s clinic employ the FUT Trichophytic Closure technique and the Follicular Unit Extraction or "FUE" technique, both to the highest medical standards, but that is not always enough for the discerning hair transplant candidate, they want more. BHR bring their innate skills and empathy to the person, their knowledge and understanding meaning they can connect with the person with a greater understanding about what this can mean to them and how a hair transplant can really improve their life; but at the same time have a knowledge base and able to educate the person so short and long term they understand the pros and cons to undergoing the procedure and what results can realistically be achieved. These combined with our patient care and always being available, during the initial weeks and months where some find very hard, to the longer term with help and advice, you never need to feel you are alone or have no one to discuss your questions with.

Although performing both recognised hair transplant techniques to the highest standards BHR and the Medical Director, Dr. Christian Bisanga, are probably best known for the work in Follicular Unit Extraction, the FUE technique. FUE is technically the hardest hair transplant technique with every follicular unit being removed one by one, making the procedure longer to perform, and technically more demanding to perform for the doctor. Dr. Bisanga has developed his FUE technique over the last 10 years and considered by his peers and patients to be one of the world experts at this demanding technique, with patients travelling from all round the globe for his expertise in FUE.

Does the FUE transplant process have any disadvantage? Yes, it does – a disadvantage from a cosmetic and post op aspect is the fact your donor area needs to be shaved for the hair groups to be removed; healing is fast and within as little as 10 days it is difficult to see any type of surgical procedure has been performed. Does it have advantages over other techniques, yes it does; especially for smaller procedures FUE can leave no obvious signs a hair transplant has ever been performed, and allows the person to even shave their hair without having the conventional linear scar. Smaller procedures, repair procedures and for those with excellent hair characteristics even larger hair loss stages can be treated with FUE.

Although FUE is becoming widely available and employed by many doctors it is important to research results, technique used, harvesting protocols, previous patients treated to gain the knowledge required to ensure you are making the correct decision for you.

Body & Beard Hair, Turning the Corner in Hair Transplants?

2010-07-07T13:30:00.000-07:00

Body Hair is being asked to be used by more and more by HT candidates, especially those with greater hair loss and repair patients.

BH potentially opens up the donor supply and this can be of a real benefit to repair patients whose scalp donor is limited or used already and potentially those with a high Norwood scale hair loss looking to achieve better coverage than their scalp donor can give. The extraction of BH is by the FUE technique, Follicular Unit Extraction, the direction and angles of the BH can be very different to that of the scalp and this is an important factor in the survival and long term yield. Direction is especially difficult on the beard hair as the angles can change with almost every extraction so a very good and experienced understanding is required. Scarring can also be a large issue, especially on very visible areas of the body like chest and beard/face, so the extraction tool size and technique is vital not to leave visible signs or scarring.
Different areas of the beard make extraction harder and easier, the laxity of the skin and bone structure in some areas will cause potentially high transection when trying to punch. So, to take the entire beard although possible you have to ask at what cost. Dr. Bisanga generally will do a smaller beard session initially, make sure healing is good then increase the size of the session. Even so, space has to be left between each punch to “design” a natural looking beard still and not just leave patches of thick and thin hair, and different people, skin types heal better than others, some for example are more prone to keloid formation.

Although BH is being used it needs to be understood it is not a miracle and is very different to traditional scalp hair in many ways. BH for example when used and the person is on DHT blockers can affect the growth in actually an opposite way to scalp donor hair. When using DHT blockers some men find their body hair quality and quantity decreases as the lack of DHT to body hair reduces the quality of the regrowth. It is not advisable to undergo a BH procedure if you are either on DHT blockers and suffer from this change or if you will potentially use DHT blockers in the future.
BH also displays different growth characteristics compared to scalp hair, the growth and dormant phases can be different, hair growth length, calibre of the hair, colour sometimes and the average amount of hairs per follicular unit is lower than scalp, with most BH growing in 1 and 2 hair units. The yield from BH is also considered to be generally lower than scalp hair although in recent grown out results we have found, especially beard hair to give 90% plus yield. But due to this factor of generally lower yield a smaller session should be carried out first to assess the not just the growth but the “look” of the BH growth.

It has also been noticed that Beard hair transplant starts to take on the characteristics of the scalp hair in the area of placement. Beard hair is generally thicker than most scalp hair and when initially placed can appear coarse and thicker than any surrounding scalp hair. It has been noted on cases that over time, around 12 months the beard hair regrowth began to soften in calibre blending much easier with surrounding scalp hair, native and or transplanted.

Although BH can help some people it has to be understood it is not for everyone, it has many limitations to the usage and should be blended into the areas with scalp hair. Smaller session seem to be the optimum way to go, healing is better, trauma to the skin and surrounding hairs minimised and yield improved; obviously this takes longer to gain the desired result, but as the result is the goal it must be prudent to go slower if required to achieve the best result possible, in the recipient and donor areas.

Am I A Good Hair Transplant Candidate? with Dr. Chris Bisanga

2010-07-06T10:48:00.000-07:00

Advances have been made in hair loss medications, research is providing hope for many if not all hair loss sufferers that a "miracle cure" maybe around the corner, but until either of these become main stream and viable options it really leaves a hair transplant to provide growing hair in areas that have lost in the past. So, is a hair transplant suitable for everyone, why are some people more suited than others, and why are not suitable at all?

The critical problem is the donor resource, the hair has to come from somewhere upon your body and wherever we take the hair from is going to be a finite supply, running out at some point, this area is called the donor site. The most common donor site used by all reputable doctors initially is going to be the scalp, around the sides and back of the head, the areas commonly immune from Male Pattern Baldness, the common hair loss condition in men.

This hair can be "moved" to traditionally the top of the scalp (recipient area) to cover the areas that over the years the hair has receded, BUT, if the donor hair is not healthy and weak or in small supply we face a problem, this can make a person not a suitable candidate or provide limitations to performing one or multiple hair transplants. The donor supply coupled with the extent of hair loss the candidate is suffering from at the time but also what the potential for hair loss could be in the future must be equated as best as possible. Obviously this is harder to determine in the early stages of hair loss, say so any design must be in keeping with the limitations of the donor supply and thinking of the future. Some candidates, a few very lucky people have "home run" donor supply, meaning they can treat almost any degree of hair loss, but these candidates should not be seen as average or even very good but the exception to the rule.
Another important aspect in making someone a good hair transplant candidate can be their expectations and goals, short and long term; hair loss is an emotive issue the touches men of all ages, there is no real boundary with some men who want hair, regardless of age almost. The temptation is always wanting to return to a stage before hair loss was obvious but as suggested this is not feasible due to donor limitations for most. The candidate must first have a good understanding and education as to the pros and cons of a hair transplant, understand their own head of hair and appreciate that some times their expectations may have to be diluted a little to what is realistically achievable. This is an important aspect of making a happy hair transplant patient, one who understand the procedure will ultimately be happier and have no regrets with the final result. Those who do not understand can find themselves being unhappy long term because their initial goals cannot be met and either they did not listen to the education they were given or did not receive the information in the first place.

A relatively new avenue is becoming more viable for some candidates, and this allows doctors to use donor hair from alternative parts of the body. Upper body hair hair, even beard hair has been used with success in combining with scalp hair to provide the candidate with a new resource to open the donor wider. This technique, Body Hair FUE is technically and medically hard to perform, and has many draw backs so it is again vital that the candidate understands fully before trying this option. Assuming it can be used it should only be used as a last resort, for hair transplant repair cases or when the scalp donor is exhausted; the BH hair is very different from scalp hair for one and can look and grow very differently.

Dr. Chris Bisanga recommends when possible to have a one to one consultation with a few doctors to assess your situation and gain multiple opinions. If possible also talk to previous patients from these doctors and see their results in person. You will gain an idea how the doctor approaches his surgery and if he is along the same lines as you in terms of results and what is achievable. Becoming hair educated is vital to being a happy hair transplant patient in the long term, especially as it is an emotional issue and sometimes our heart can rule our head when making decisions such as this. So, ensure before making the decision all your questions have been answered to your satisfaction, that you and your chosen doctor have reached a mutual understanding about the results that are possible, now and for the future.

Hair Transplantation History and Today with Dr. Chris Bisanga

2010-07-05T05:44:00.000-07:00

A Hair transplant is a minor surgical procedure that takes hair from the back and sides of the head (the donor area) and moves it to the area of hair loss, normally the top, or known as the recipient. The back and sides of the head on a balding scalp have hair loss repellent and this hair will continue to grow throughout the life of most men. Considered to be behind the advent of hair transplantation is a Dr. Okuda of Japan, he first described the use of transplanted hair to repair scarred eyelashes and eyebrows and later a Dr. Norman Orentreich published the first widely read report on hair transplantation surgery in 1959.

As a hair transplant relies on the movement of hair the donor supply was be able to sustain the need for hair over the area the candidate wishes to cover, this is not always possible and it is important the candidate discusses at length with doctors and becomes "Hair Educated" as to the pros and cons of this surgical procedure. In the past and even sometimes today patients who were not suitable candidates for hair transplant surgery have undergone the procedure and regretted the decision. The amount of research that is now available with the internet should be able to provide the knowledge required to make the correct decision. Sometimes that decision maybe to not have a hair transplant, but if so it is for the correct reasons and the person's long term happiness; a "HT" is not a miracle sure, and to date there is not one, as the HT relies of the remaining hair sometimes the decision is to either have no HT or refine your goals to accomodate what is actually possible and will look natural. From the early days hair transplant has moved on a great deal, more recently in the last ten years the "FUE" or Follicular Unit Extraction technique has become available.

Dr. Christian Bisanga, Medical Director of BHR Clinic in Brussels has devoted much of his medical career to hair transplant and one of the first to perform consistently the technique known as FUE. He has developed the FUE technique now to the highest level, has presented talks to International Hair Restoration Societies, trained other doctors to his exacting standards and is considered by many of his peers and patients alike to be at the forefront of the FUE technology worldwide, attracting patients from around the globe.

“FUE is the individual removal of follicular units, or simply put the removal of naturally growing small groups of hairs from what we term as the donor site of the person, the back and sides of the scalp. The procedure is so refined that most of the time I will utilise a punch tool no larger than 0.75mm in diameter to harvest the grafts” says Dr. Christian Bisanga.

Dr. Christian Bisanga have specialised in the FUE or “Follicular Unit Extraction” for almost 10 years, and has developed his own harvesting protocol “Educated Harvesting” so leaving no obvious signs a hair transplant has been performed allowing the person to keep your hair short and even shaved. He has a dedicated Medical Team that assists him to produce the most natural results possible, even at the closest inspection.

“FUE has revolutionised hair surgery, when performed to the highest standards there can be no visibly obvious scarring so no signs a hair transplant has taken place. This means, especially smaller hair line procedures, even eyebrow procedures can be performed with the minimum of fuss and change for the patient. I am thrilled to be able to develop this technique and move hair transplant procedures to a new level of excellence”

Dr. Bisanga says, “Proof is always in results and satisfied patients, independent hair loss forums such as www.hairlossexperiences.com can be a great source of information for those wanting to get a balanced, open and honest view of what a hair transplant involves, and I will always recommend the person does as much research as possible. “

Traction Alopecia discussed by Dr. Chris Bisanga

2010-05-28T08:48:00.001-07:00

Recently I have been approached more and more with people suffering traction alopecia. This can be a disturbing form of hair loss as it does not follow the usual patterning and many people are still not aware of the damage that can be caused and also that in some instances cannot be reversed.

Traction alopecia is a form of hair loss caused by a pulling force being applied to the hair shaft against the scalp. This commonly results from the sufferer frequently wearing their hair in a particularly tight style like a ponytail, braid, or dreadlocks, also there is another form related to this alopecia known a Trichotillamania, when the person themselves constantly tangles and pulls their hair into tight curls causing the same symptoms. The constant pulling and twisting against the skin causes the follicle to slowly weaken and the regrowth quality of the hair decreases until finally in severe cases can cause baldness in the localised area.
Traction alopecia is the technical name for tension hair loss—simply, localised hair loss caused normally by self induced styling creating damage to the hairs' roots from constantly pulling hair too tight in the same direction. Traction alopecia occurs gradually, dependent on your hair characteristics some may suffer more than others, and is merely a cosmetic issue as hair around the points of pressure begins to thin but it does not spread to others areas of the scalp that have not been subjected to the same pressures. Severer forms of traction alopecia can cause permanent localised hair loss. The condition is not a disease, and has no medical symptoms.

Preventing Traction Alopecia
The easiest way to prevent traction alopecia is simply to vary your hair style and not putting as much pressure on the hair root. Wearing hair in a tight style for a single day is unlikely to cause the condition but constant application of the pressure will in almost every individual over time exacerbate the condition. Varying tight and looser, softer hairstyles will help to prevent thinning hair, as will varying the pressure and direction in which the hair is coaxed. It is prudent to leave the hair loose for sometimes and in severe cases do nothing to the hair in terms of pressure for a year to allow the hair and skin to relax. It is possible in some cases for the hair root to repair to a degree but this must be taken as a warning and no further traction applied to the scalp.
There is no real treatment to encourage the hair to regrow stronger again although some have tried minoxidil 2% and other stimulants, as well as natural oils such as vitamin E oil to help the scalp if there is any tension. Time can be the best healer, and although difficult to leave it will be the only way to judge whether an improvement can be made to the damaged hair.

A hair transplant is not always a credible solution, it really depends on the severity of the traction alopecia and the surface area it has covered, and it must be checked that the same has not occurred in the "donor safe zone". Dependent on hair type, sometime with very curly hair a low density can be placed and when the hair grown longer give enough appearance of thickness to hide the area well. But this only is viable if the person is not going to go down the same road again and start creating the same tension and pressure on the new hair.

“Regaining my hair was one of the best decisions I’ve ever made.....Thank You BHR Clinic"

2010-05-11T17:06:00.000-07:00

“Regaining my hair was one of the best decisions I’ve ever made............. Thank You BHR Clinic"

Daniel Andrea, International Musician & Spanish TV Personality

BEFORE

AFTER 2600 GRAFTS WITH BHR CLINIC BRUSSELS, BELGIUM

Can Body Hair Really Be A Viable Donor Supply? discusses Dr. Chris Bisanga

2010-05-08T06:16:00.000-07:00

With hair restoration techniques improving with top doctors pushing research and development, surgeons are thinking to challenge the conventional donor area and look to widen the extraction zone to the body. BH or body hair has been used for some time with mixed results and should be approached with caution even now, but Dr. Christian Bisanga has found the richest supply in terms of sustainable quality of yield has been the upper chest and beard hair. Speculation can be it is closer to the traditional scalp donor so retains more characteristics, stronger follicular units with better calibre hair and more multiple hair units possibly.

BH potentially opens up the donor supply and this can be of a real benefit to repair patients whose scalp donor is very limited and potentially those with a high Norwood scale hair loss looking to achieve better coverage than their scalp donor can give. One of the challenges is the extraction technique to use, FUE, Follicular Unit Extraction, the use of a small micro surgical punch is implemented to extract each follicular group, the direction and angles of the BH can be very different to that of the scalp and this is an important factor in the survival and long term yield. Direction is especially difficult on the beard hair as the angles can change with almost every extraction so a very good and experienced understanding is required. Dr. Bisanga recommends that BH extraction is not undertaken unless a high degree of understanding is known from the doctor about much simpler scalp FUE. Scarring can be a large issue, especially on potential naked and very visible areas of the body like chest and beard/face, so the extraction tool size and technique is vital not to leave visible signs or scarring.

There are a number of interesting points to BH, DHT blockers can effect the growth in actually an opposite way to scalp donor hair. When using DHT blockers some men find their body hair quality and quantity decreases as the lack of DHT to body hair reduces the quality of the regrowth. It is not advisable to undergo a BH procedure if you are either on DHT blockers and suffer from this change or if you will potentially use DHT blockers in the future.

Another interesting case Dr. Christian Bisanga has noticed that long term growth, especially beard hair transplant starts to take on the characteristics of the scalp hair in the area of placement. Beard hair is generally thicker than most scalp hair and when initially placed can appear coarse and thicker than any surrounding scalp hair. It has been noted on cases that over time, around 12 months the beard hair regrowth began to soften in calibre blending much easier with surrounding scalp hair , native and or transplanted.

Dr. Bisanga has always had a cautious approach to BH over the last 5 years, and in his opinion rightly so as many procedures seem to fail in their objective, especially when using large amount of graft numbers per procedure. He is now quietly optimistic though about the future of BH for the patient and is happy to utilise BH more and more into his procedures. He remains cautious with his approach and has the patient well being always as priority. He is keeping the size of the procedures small to monitor potential scarring, also to spread the extraction over a wider area to allow for better cosmetic healing and in the recipient nor dense packing to encourage the best possible yield. Of course the downside is smaller procedures more are required, but the positive is the hair regrows with no obviously visible extraction scars and long term little wastage of valuable donor supply.

With hair restoration techniques improving with top doctors pushing research and development, surgeons are thinking to challenge the conventional donor area and look to widen the extraction zone to the body. BH or body hair has been used for some time with mixed results and should be approached with caution even now, but Dr. Christian Bisanga has found the richest supply in terms of sustainable quality of yield has been the upper chest and beard hair. Speculation can be it is closer to the traditional scalp donor so retains more characteristics, stronger follicular units with better calibre hair and more multiple hair units possibly. BH potentially opens up the donor supply and this can be of a real benefit to repair patients whose scalp donor is very limited and potentially those with a high Norwood scale hair loss looking to achieve better coverage than their scalp donor can give.

One of the challenges is the extraction technique to use, FUE, Follicular Unit Extraction, the use of a small micro surgical punch is implemented to extract each follicular group, the direction and angles of the BH can be very different to that of the scalp and this is an important factor in the survival and long term yield. Direction is especially difficult on the beard hair as the angles can change with almost every extraction so a very good and experienced understanding is required. Dr. Bisanga recommends that BH extraction is not undertaken unless a high degree of understanding is known from the doctor about much simpler scalp FUE. Scarring can be a large issue, especially on potential naked and very visible areas of the body like chest and beard/face, so the extraction tool size and technique is vital not to leave visible signs or scarring.

There are a number of interesting points to BH, DHT blockers can effect the growth in actually an opposite way to scalp donor hair. When using DHT blockers some men find their body hair quality and quantity decreases as the lack of DHT to body hair reduces the quality of the regrowth. It is not advisable to undergo a BH procedure if you are either on DHT blockers and suffer from this change or if you will potentially use DHT blockers in the future.

Another interesting case Dr. Christian Bisanga has noticed that long term growth, especially beard hair transplant starts to take on the characteristics of the scalp hair in the area of placement. Beard hair is generally thicker than most scalp hair and when initially placed can appear coarse and thicker than any surrounding scalp hair. It has been noted on cases that over time, around 12 months the beard hair regrowth began to soften in calibre blending much easier with surrounding scalp hair , native and or transplanted.

Dr. Bisanga has always had a cautious approach to BH over the last 5 years, and in his opinion rightly so as many procedures seem to fail in their objective, especially when using large amount of graft numbers per procedure. He is now quietly optimistic though about the future of BH for the patient and is happy to utilise BH more and more into his procedures. He remains cautious with his approach and has the patient well being always as priority. He is keeping the size of the procedures small to monitor potential scarring, also to spread the extraction over a wider area to allow for better cosmetic healing and in the recipient nor dense packing to encourage the best possible yield. Of course the downside is smaller procedures more are required, but the positive is the hair regrows with no obviously visible extraction scars and long term little wastage of valuable donor supply.

Is FUE Hair Transplantation Technique Viable

2010-05-06T12:15:00.000-07:00

Follicular Unit Extraction (FUE) hair transplantation is becoming more popular in the last few years for balding men as it offers the opportunity to not have the traditional linear scar that comes with follicular unit transplantation (FUT). While we personal believe and stand by the qualities of the FUE procedure in surgical hair restoration it is important that the facts are known about this hair transplant technique and that claims falsely selling as a “scarless” procedure or replacing FUT need to be addressed.

To see ISHRS member Dr. Christian Bisanga's approach and explanations on video regarding FUE and its place in surgical hair restoration, watch the videos below or visit “Dr. Christian Bisanga's site for education on Follicular Unit Extraction (FUE)”.

We have written many papers on FUE and how it can go wrong and the pitfalls to the technique as it is demanding and open to errors being so intensive, but this time we will concentrate on the benefits FUE can give rather than the negatives when performed poorly; first we will say that before making any decisions on FUE or the doctor who is performing it research the doctor as much as possible. Speak and see ex patients that have had FUE, check the donor for scarring, the placement for naturalness and assess the yield against what you are told was placed.

FUE has been around longer than most would think, Dr. Chris Bisanga's first documented case is over 7 years ago now, but most when asked would probably agree FUE has only been practised in the main for about 5 years, except the odd case. FUE should no longer be considered a "new" technique but it is, why?

Is it because a conspiracy by FUT Clinics to down play FUE as a credible technique, that it has fundamental flaws that cannot be over come, could it be that it appears very easy to perform and appealing to the public so many doctors jump on the technique without correct training or proper understanding, causing sub par results and giving the technique a bad name. There is probably a degree of truth to both.

FUE has given the man in the street an alternative option to the FUT technique, it has allowed the correct candidate for FUE to be able to have a hair transplant with sometimes no obviously visible signs a surgical procedure has been performed, even allowing for someone to shave their hair if they wish. It has taken away the need for small procedures to need Strip thus no linear scar, it has allowed harvesting out side the traditional "safe" zone for FUT, thus opening the donor to more grafts. It has allowed another option for repair patients who maybe have no more FUT in the bank, and has allowed more recently for the harvesting from the body and beard, again extending the harvest area and giving some more options and opportunities to achieve their goals or repair their situation.

Dr. Bisanga feels that FUE is more than a credibly technique in the right hands, he is under no illusions how difficult it is to perform having practised the technique for almost 10 years, and over that time has built a formidable gallery of documented cases. FUE as a technique is not flawed, yes it is vastly more complicated and intense to perform than FUT but it can stand as a valued technique for hair restoration.

Get to the Facts about Hair Transplantation Techniques

2010-05-05T10:26:00.000-07:00

Over the past years, more so the last decade there have been some major advances in hair transplantation techniques. This has now allowed more and more men and women the option to restore thinning or balding areas with a permanently solution that looks natural, is your own hair.

The phrase, "caveat emptor" or "buyer beware" has a true ring in many commercial transactions and a hair transplant is no different, a hair transplant is not right for everyone and a great deal of research is required, talking to ex patients, a variety of doctors to build your own opinion and take educated opinion from others before making any decisions. As a hair transplant doctor and been devoted to his field for the past 10 years Dr. Christian Bisanga is well aware of this;

"there’s also a lot of misconceptions about what hair transplantation can achieve, and it is important the potential candidate research thoroughly and diversely to ensure they become well informed, I make it my commitment to be open with all patients, even sometimes when it is not what they wish to hear, but for their greater long term happiness." .

The two established hair transplant techniques are FUT or “strip harvesting” and FUE or Follicular Unit Extraction. Both when performed well are viable and high quality techniques that achieve high yields for the patient. They are both very different harvesting techniques and each has their pros and cons, so it is important to ensure that the one you choose or are advised is the best suitable for you and your hair loss stage at the time, but also with future loss in mind.

Each technique relies on the fact that we keep a band of hair around the sides and back of our head that is genetically pre programmed to continue to grow throughout our life; that said this does not prevent older age or health from effecting this area too. Whilst we keep this hair it is possible to remove some and replenish the area on the top of our head we have thinned or lost hair, and because the hair follicle is pre programmed it will over time continue to grow, fall and regrow as if it was never moved.

This area we remove hair, the donor, is a finite resource and at some stage will not be able to safely offer any more donor hair. It is important to "manage" the donor in an educated and sensible fashion so long term if required the maximum number of hairs can be removed, be it with either or maybe both techniques. It is obviously very tempting as a younger man to restore an adolescent hair line and think just of the next few years, but of hair loss progresses with age you may find yourself with a low hair line and not enough donor to be able to "balance" the look and coverage this gives over the rest of your head; a situation called "front loading". Only those with exceptional donors and a history of minor hair loss in the family should consider this, otherwise a more sensible approach is to air on the side of caution and design a hair line slightly conservative with the view to gain more coverage further back in the future if required.

Dr. Bisanga writes;

"I believe it is important to take each case on it's own merits, I have designed strong hair lines for the correct candidate and also the opposite very mature hair lines when required. It is important to listen to the patient's desires and goals, then assess them against the limitations of their donor before making any decision on what is possible and discussing more with the patient."

It is not uncommon that doctor and patient will initially have a different approach to a hair transplant design, most men will obviously want the maximum hair possible, whereas other are fine with a conservative approach, the "less is more." When researching it is good to find a doctor who has similar thoughts to your own, approach, style of design, willingness to educate and be open to questions and answer directly. This is elective surgery so you have a choice, and there are many out there, so make sure the hair transplant doctor you choose as much as possible fits the criteria you have in your mind, ask questions of the doctor and do not be "fobbed off" with half answers to important questions, it is your head.

When considering a hair transplant, ensure you have the facts. A good hair transplant doctor will plan with your long term well-being in mind based on your personal situation, he will listen to you and either agree or question your ideas and give you solid reasons why he feels it it is not in your best interests. He will not offer you just what he can do, for example if he offers just the one technique and the other is suitable he will tell you, or if he feels your goals are not achievable he will tell you.

Christian Bisanga MD, practising in Brussels, Belgium has a devotion to hair transplantation surgery solely dedicating the past 10 years to developing, researching and improving hair transplant techniques to teach and pass on to others and for the well-being of the patient, now and in the future, he is a member of the International Society of Hair Restoration Surgery (ISHRS). To learn more, visit www.bhrclinic.com

How to Plan Hair Line Design for a Hair Transplant with Dr. Chris Bisanga

2010-04-06T23:17:00.001-07:00

Any good doctor understands that the front hairline is generally considered to be the most important aspect of the entire head of hair. This is because it frames the face, and will change the appearance most dramatically; so every care and touch of artistic ability is required to achieve the desired look.

: Conservative Hair line Design Can still frame the face in a pleasing natural way

Hairline planning can be a compromise between the patient and the surgeon. On occassions people have a tendency to want the hairline too high or too low. The low rounded adolescent hairline will look fine on a younger man but not match the age and facial features of an older man. The younger man still has vivid memories of his hair line and generally wants to create the same appearance; whereas the middle-aged man may fear that a hairline that is not adequately receded at the temples may seem unnaturally low for his age.
It also has to be understand that hair line placement, density and thickness can vary from ethnic origin and genetic background. It is not always advisable to just follow a trend in hair line but best to mimic nature and your pre exisiting make up. Temple point recreation and the flat look hair line are becoming more common, but it must be within the boundaries of nature. The apex is always the lowest aspect of the hair line and all measurements must take this in to consideration, as well as facial bone structure.
When designing a hair line for a man with minimal receding it has to be understood the priciples of the hair transplant; the amount of FU required and the density that looks natural.

: Temple Points are an important feature in framing the face, by Dr. Chris Bisanga

Follicular units placement in the very front zone will be made of one hair follicular units and then further back two, three and four hair follicular units. The single hair units are placed closer together to mimic nature and provide a natural progressive increase in density, rather than a flat, straight block, or wall of hair. If the desired look is to have a thick, almost no gradient in density then the number of grafts will have to be that much more and the potential for poorer growth must be understood.
It is unlikely placing like for like density when the man had a full head of hair is possible; the effects of trying to reach the same density can result in trauma to the skin and a poor yield from the placed grafts; or by placing two hair units in the frontal line will create the thickness of the adolcent hair line but look "pluggy" at closer inspection.
Therefore some of the art is to give the cosmetic effect that the density is the same, this is most obvious when the hair is longer because it blocks the reflection of light on to the scalp. But when the hair is short or shaved this effect is less because there is no apparent density; although this is obviously not true.

More examples of hair line rebuilding can be seen here

The "Trico" FUT/Strip Closure Hair Transplant Technique by Dr. Bisanga

2010-04-02T09:14:00.000-07:00

Any good Doctor who wants to improve his techniques and therefore improve the quality of service and work to his patients' will compare his FUT/Strip donor linear closures performed by other surgeons.

Dr. Christian Bisanga takes a great deal of pride and care in ensuring that the incision he makes is as narrow and depth controlled as possible to ensure the neatest closure possible.

Video to Trichophytic Closure

Dr. Bisanga is probably better known as one the worlds best FUE doctors but having perfected his Trichophytic Closure over the last 6 years and uses it on all patient cases. His developments in this incision making procedure have also allowed him to be able to offer patients with average donor laxity and density more grafts in one session than before due to his incision technique and strip removal protocols.

The doctor's technique allows for the removal of the strip without going deep in to the scalp so the incision is smaller and aids faster healing, with numbness and nerve damage is greatly reduced. Dr. Bisanga performs “trichophytic” closure routinely on all FUT patients, and this technique has greatly improved the appearance of the traditional strip scar line, once just naked scar and now hairs to grow through the line allowing for even shorter hair cuts and more styling options than before for the patient.

bhr clinic

exclusive hair transplants

contact for more information

Does FUE Hair Transplant Extraction Cause Visible Scars? Partial Shaving and Over Harvesting

2010-04-02T05:53:00.000-07:00

FUE DONOR MANAGEMENT: Partial Shaving or Over Harvesting

The surface area for removing FU (follicular unit/s) via FUE may be larger than that of FUT because it opens surface area rather than a thin linear strip BUT this does not mean there are more FU available to be extracted safely. Sometimes over looked or not even understood is the surface area of the scalp remains the same with FUE BUT the amount of hair on that surface is reduced and lowers the density.

Because FUE doesn’t cause a linear scar it doesn't mean no damage can occur. Even when using small punches 0.75 or 0.8mm the pattern the follicular units are taken is very important, if taken all in a small area it will reduce the density compared to the surrounding areas, it will cause more obvious hair less areas and potential scarring, also possible cause the surrounding hair that is left to be traumatised and miniaturise.

It is important to try to make use of the entire safe zone when selecting FUE grafts and not isolate an area and remove. FUE can be used with great effect to fill scar lines from Strips and because the number of grafts needed can be small it is still important to try and spread the extraction. A downside for some with FUE is having the shave the donor, so it’s common for people to ask for partial shaving, grow their hair a little longer and just have a band of hair or patches shaved that can be hidden under hair while it grows back. While this is possible the surface area should still be relative to the density so when a few hundred are removed the density loss is very minimal.

The problem with partial shaving is when the number of grafts needed is bigger, and then it is important to use the entire safe zone and not just remove from a small area. This can create an imbalance in the distribution of the hair on the scalp resulting in effecting the healing laxity of the skin and cause over harvesting in isolated areas, results in the donor potentially being too thin for further extraction even from a relatively small number being removed.

It’s also easier to harvest only from the back of the scalp, around the occipital area, around the sides the angle and direction of the hair changes so more time is needed when extracting, more changes in body position to ensure no grafts are transacted when being punched, generally it is harder. As the back generally has a higher density anyway and is easier to extract from it’s not uncommon to see even with 2000 plus grafts only the back being used and the sides left. This will cause obvious scarring in the back, over harvesting and make even a Strip procedure difficult because of the density loss.

Here are a few examples of uneducated extraction patterns, over harvesting in small area and the effects it has. If the pattern had been spread more for the number of grafts removed and performed well it could have been possible to shave with no obvious signs of extraction, but as it is in these examples it is obvious.

Does Facial Bone Structure Dictate Graft Numbers and Design with a Hair Transplant

2010-03-05T07:09:00.000-08:00

: BHR Clinic

How our bone structure can impact on the graft numbers and design.

Genetics dictate the way we look, the bone structure of our face, hair characteristics and hair growth/loss patterning to a large extent.
A hair transplant is a cheat on nature; using nature’s reserves we have the ability to design a head of hair a person never had, create a hair line lower than even as a pubescent was not.

The NW scale is generic to give us an idea of the pattern hair loss can take in a male, but does not take into account the facial bone structure, and how this can change graft numbers and design. If we take two NW6 cases it is possible for there to be a vast difference in surface area maybe from 250 to almost 400 cm2 to cover due to bone structure.

: Variables In Hair Loss Pattern and Surface Areas

Bone structure can result in the recipient area being larger than the donor area and this being the case it is not wise to design a low flat hair line either because it used to be or through desire but to design with the future loss in mind. It is important to restore facial balance, not just from the front elevation but sides and top.

By restoring just the frontal hairline you may create an unnatural facial proportion so the rounded wide design should be avoided at all cost.

: High NW Scale Hair Loss. Hair Line Design and Recipient Zones

The idea is to bring the hairline design until or before the curve of the forehead, when the hair grows longer it will give greater illusion of coverage and facial balance anyway and even short the design will be pleasing to the eye, naturally match the bone structure and blend with the temporal angles.

The forehead bone structure could be more square, round, oval or triangular and the hairline design must match it to ensure facial/special awareness. The hairline is unique to a person’s bone structure and not a set template, or sometime not even to match the hair line from younger years as the facial expressions and bone structure change over the years.

Larger facial bone structure can be recognised with a broad forehead, flatter surface and a crown that drops twice, maybe three times. Larger or more pronounced bone structure can require maybe 30% more grafts to cover the average zone; if the hair line does not match the bone structure in relation to the patterning of hair loss this can result in a front loaded design, many grafts being used to restore an area and the creation of an unnatural pattern of hair growth, high frontal density and a design not fitting the patterning of hair loss behind the frontal.

Follicular Unit Extraction: Graft Yield Problems? FUE Hair Transplant Surgery

2010-03-03T04:31:00.000-08:00

It is always easy to blame a technique/tool for poor results regardless of profession, but sometimes it is simply the manner in which the technique is performed that dictates the quality of the result, FUE is a case in point, the FUE technique, for this let’s assume a manual punch is used.

FUE results can mirror those of FUT in respect of yield or growth, BUT it is technically much more demanding to perform, more areas that can cause imperfections so much greater understanding, knowledge, patience is required by the doctor to ensure that the yield is high. As such each punch is a can be a separate procedure making the chances of error greater and especially the larger the procedure. Direction of the hair when leaving the scalp and how this can alter the angle in which the extraction has to be made has a large impact on the extraction. This can vary greatly in different areas of the head, as too can the depth of the FU. This can make extraction very slow at times, with constant adjustments to the doctor’ seating position to accommodate each FU required. This does not mean it has to affect the quality of the result if the nuances are understood and time is taken to perform the extraction, and care is taken over the grafts when removed and handled. If reaching a set number per day though is the goal regardless of the quality of graft then of course this can affect the quality.

If the yield is not good regardless of the graft numbers it is not good, obviously the larger the numbers and the lower the yield the problems increase. Also transection problems, if the yield is good but from the donor double the numbers had to be removed to achieve this then this does not make for a good procedure.

So, a smaller procedure will not necessarily mean a higher yield, it will depend on the technique of punching, speed, graft care whilst out of the skin, placement technique also as the grafts can be more delicate than a traditional strip graft. If the risks are minimised then this can negate the problems such as weaker yield. No different to strip, if too larger strip is removed it could increase the chance of wider scarring, so by not pushing or trying to achieve the highest numbers regardless the risk is minimised.
If it takes time to perform FUE and maintain high yield then so be it as long as the growth and quality of result stands that is what is what is important. If it shows that FUE is slow and maybe better suited to smaller procedures, not sure it is necessarily a bad thing, just a fact, no good trying to make a cat bark, it’s a cat! If it is found possible to perform FUE faster, more efficiently, increasing the numbers and maintain the quality, as far as growth is concerned and donor quality then it can only be a good move forward and open the door to extend the use of FUE. Practice, the more procedures performed, variants in each case help to expand the knowledge and understanding, also help to become more efficient whilst maintaining high standards. It was only a few years ago FUE procedures of 500 where considered the norm, then 1000 in a day, maybe 1500 in a day; same again with Strip 2000 used to be considered huge a few years ago, now it is common to see 3000 plus, even 4000 plus procedures now are not really considered uncommon.

It could possibly be that FUE is not the same as Strip, not meaning it is better or worse but simply they have different strengths and weakness, and when trying to make one as the other neither can compete. Because FUE is more time intensive and technically more demanding and harder to maintain the quality of the grafts compared to Strip then maybe it cannot offer some of the benefits of Strip, but then if both performed well Strip cannot offer some of the benefits of FUE either.

Body Hair and Beard Hair FUE, Follicular Unit Extraction Hair Transplantation Technique

2010-02-27T05:21:00.001-08:00

Like any hair transplant scarring and graft survival are major issues, to make the effect of the extraction as minimal as possible to the eye and remove intact FU to preserve the state of the donor and maximise the yield in the recipient.

Beard hair especially is so prominent on the face that scarring would easily be noticeable, especially if clean shaven, and the last thing you want to do is leave someone scarred on the face and having to grow a beard to hide it, and that beard looks thin anyway because of the extractions. Chest hair for example if living an out door lifestyle again can be visible and the signs of small white dot scarring on the chest could be unsightly and hard to explain.

Different areas of the beard make extraction harder and easier, the laxity of the skin and bone structure in some areas will cause potentially high transection when trying to punch. So, to take all the beard although possible you have to ask at what cost. Dr. Bisanga generally will do a smaller beard session initially, make sure healing is good then increase the size of the session. Even so, space has to be left between each punch to "design" a natural looking beard still and not just leave patches of thick and thin hair, and different people, skin types heal better than others, some for example are more prone to keloid formation.

Smaller session seem to be the optimum way to go, healing is better, trauma to the skin and surrounding hairs minimised and yield improved; obviously this takes longer to gain the desired result, but as the result is the goal it must be prudent to go slower if required to achieve the best result possible, in the recipient and donor areas.

Hair Transplant Repair Testimonial by Zionaxel

2010-02-10T05:37:00.000-08:00

"Where it all went wrong..

Basically where do you start,about myself im not going to give too much away but im almost 41 yrs old and made a very serious mistake when i was 26yr´s old.
My hairloss had most likely started when i was at school,luckily it was mid 80´s and long hair was in so i grew it long to cover the hairline.It eventually became a kind of come over so i decided to have it cut very short but still trying to cover the receding hairline which by now was very obvious so i had started to get some comment´s about it which for some seemed to find funny but to me was like a kick in the teeth.
The hairloss got a lot worse as time went on but i seemed to be able to cope with it.I had a girlfriend who never judged me by this and was totally supportive about it.She could see how it had affected me ,she became my wife and we are still together today with a beautiful daughter.I know without her there was no way i could of handled the disfigurement which i was about to have done to me........................"

To follow Zion's own blogg.........

To read of his experiences on the forum.......

Hair Transplant FUE Donor Extraction Pattern

2010-02-09T14:35:00.001-08:00

Extraction Pattern

“Allowing for an educated and well planned extraction pattern will not compromise the donor as much and give greater options for more grafts using Follicular Unit Extraction, FUE in the future. The pattern of extraction is random to the point it is has to be calculated to not leave obvious areas of no hair or any uniform signs of pre meditated extraction, “factory extraction” with an obvious pattern seen when short/shaved.”

We have so many hairs in the donor area so........

1. why do are there not more large FUE sessions

2. or why do many people feel the results not the same as Strip yields,

3. and what are the implications to the donor area?

FUE may not leave a linear scar like FUT but if not performed correctly with an educated extraction pattern scarring can become obvious and areas of the donor can become compromised making future FUE or FUT a problem.

Spread the extraction pattern over the largest area possible, try not to limit the surface area whenever possible. It is known that different areas of the donor are easier to extract from than others and also, for example, the “better/bigger” follicular units (FU) groups are also in an area easier to harvest from. The occipital or back of the scalp is richer normally in density and in the number of hairs per FU, making it easier to extract and richer zone to take from.

The amount that can be removed from the donor is always up for debate, Dr. Bisanga feels around 25-30% per cm2 on a good donor density and little to no miniaturisation is about the limit without causing potential problems in the future.

Why do we not see bigger FUE sessions like FUT?

Dr. Bisanga limits his FUE sessions to 3000 grafts over two consecutive days; he has learnt over time to harvest more puts added strain on the scalp during the crucial first days post op healing with the potential to increase visible scarring in the donor and reduce yield in the recipient due to so many multiple open wounds reducing the capacity for the scalp to heal to its best.

The more extracted at one time means the closer each punch has to be to the other, this makes it harder to not leave visible “hair less” areas as the extraction pattern becomes more confined. Each extraction has to allow for FU’s to surround that point, you cannot punch two points adjacent to each other, so the more removed makes this pattern harder and harder to adhere to.

Possibly another reason is time; to manually punch each FU and ensure transection is kept to a minimum, considered by Dr. Bisanga to be below 5%, takes time. Physical and mental pressures play a part when working in so close proximity to the scalp and under magnified conditions as the doctor is dealing with scales less than a mm at times. There is also the strain on the patient having to be in the same position for lengthy periods of time and remaining still becomes harder mentally and physically. The time aspect though is connected to the rate of extraction, be the doctor only able to extract 500 or 1500 per day, realistically an FUE procedure should not last more than 2 consecutive days for the wellbeing of the patient.

or why do many people feel the results not the same as Strip yields,

An area that is not often discussed is the direction of the hair when entering or leaving the scalp and how this can alter the angle in which the extraction has to be made. This can vary greatly in different areas of the head, as too can the depth of the FU. This can make extraction very slow at times, with constant adjustments to the seating position to accommodate each individual FU. Incorrect understanding of the direction and splay of the FU within the scalp can increase transection rates very quickly and easily. With time and knowledge it is possible with a manual punch to actually feel the FU with the punch when entering the scalp, so although the technique is fundamentally blind it is possible to gauge the quality of the extraction being made and learn from each extraction as to the characteristics of the hair within the scalp.

and what are the implications to the donor area?

A big debate with FUE is why it cannot not match graft numbers with FUT, either in one op or over multiple. One argument for is that hair loss does not become noticeable until around 40% plus has gone so why not take half the donor; but this observation was originally to describe the recipient area hair loss stage, not the donor area.

The two areas are very different and cannot be compared in this context; the hair lays in different directions, angles and has very different illusion qualities of thickness. Also the comparison loses credibility as we are talking about an area that naturally loses density in many men (recipient) and needs to be replaced with a hair transplant, where the illusion of density with the artistic placement of the grafts can in some create the look of very good thickness even though like for like is not replaced.

Obviously more than 30% can be taken but we have to be mindful that almost all of us will thin as we age, even in the donor area sometimes; so not over harvesting preserves the donor in the best possible fashion. Is this conservative or realistic, that is for you to decide when you make your choice of doctor and his protocols.

A benefit to the donor removing with FUE is the lay of the hair, from the base of the crown the hair generally lies down so each hair covers the next moving down to the base at the nape of the neck. Because each hair lays over the next more coverage and thickness is achieved, so be able to remove the FU without it being obvious. This to a point is why it is possible over 30% is removed; will the donor feel thinner, yes, it will be say 50% thinner, will it look obviously thinner, maybe not dependent of hair characteristics and how the hair is styled. Can removing such a high amount create potential problems, for sure.

By removing much more than 30% either in one procedure or over multiple procedures can lead to the ripple effect, peripheral micro trauma to the surrounding hair, and obviously the more concentrated the extraction pattern the greater the chance of damage to the surrounding hair. Damage can be in the form of transection to surrounding groups of hairs, miniaturisation, more obvious scarring, changes in hair characteristics and direction as well as laxity. With planning an average donor can give 4500 FUE but to remove in one pass would potential cause problems and the chance is if the full potential was 4500 it would not be possible in one pass, but with planning over multiple smaller procedures the maximum number can be achieved and still leave the donor in good condition.

By limiting the extractions in an area the scalp maintains more of its natural characteristics and this has to be beneficial short term and long term. If this means FUE is more suited to small procedures or lower NW scale levels then so be it; there is no reason to push a technique into an area it is not suited just because we may want to, it is not the fault of the technique if a poor result is achieved it is the result of either poor planning or the technique being poorly carried out.

more information

The Crown Surface Area, Density of Grafts and Coverage with a Hair Transplant

2010-02-01T13:39:00.000-08:00

The crown sometimes it may be felt is the neglected area when it comes to a hair transplant. Where does the crown start? Some like to make demarcation lines as to where it starts, but it's not really that easy, probably easier to measure hair line, frontal third, mid section and then crown as approximate regions. The crown opens on all sides, from the frontal, sides and dropping down the back, some cultures almost have a double size when it thins on top and then drops down, almost potentially doubling the surface area.

A small crown can easily be almost a circle say 6x6, and for easy measuring, but for those in to their maths comes the PI equation, this calculation is designed to give the values of a circle.

This makes it much harder to treat a crown, where to start, how many grafts to use and where to place them because the probability is the surface area can increase easily my just a little thinning, for example if the crown opened by 1cm more all the way round the surface area has dramatically altered.

This is why, and this goes for the frontal sides receding down also it is important to bite into the existing hair a little to ensure for future loss to some degree; rather than only place in the obviously thin area only for a year or two's time the thinning progress and being left with an island of hair.

The crown also because of design and surface can have an insatiable appetite or need for hair, the placement differs from the frontal areas so needs more to give the same appearance of thickness, and because of this it could need a good 1/2 again compared to the frontal/mid. Generally someone’s donor cannot give this so a thinner look from a HT or lower density placed is common in the crown.

IF you start working in the crown first then we must be mindful not to "back load" the HT, using most of the resources available only in the crown and not enough to address frontal loss and being able to balance the look of a natural if thinning head of hair.

So, from the hairline back to a line drawn between the two temporal angles measures an area of roughly 50 cm2. The top of the head, from behind the frontal area to the front border of the crown may be about 150 cm2. The crown, as we pointed out can vary widely in size, but in a Class 6 or 7 can be as large as 175 cm2. Even if we transplant a minimal density (15 FU) to a fully bald crown (175 cm2) we have used roughly 2600 FU. If we transplant a higher density, 40 FU, then we have used 7000 grafts, this is more than the average person has available in their donor area and this is just in the crown.

hair transplant help

hair transplant questions answered by email

exclusive hair transplants

When to decide to go FUT/Strip or FUE Follicular Unit Extraction Techniques

2010-01-26T08:35:00.000-08:00

There are many aspects to consider when deciding which hair transplant technique to use; some examples maybe not wanting a linear scar, money, hair style, no obvious signs of surgery etc to name a few. Another aspect to consider, more from a technical side, is your starting donor density. FUE lends itself better to smaller sessions certainly, who wants a strip scar for 1000 or so grafts?!

That said when the numbers start to reach 2500 required grafts there can be an argument for both techniques to be considered. 2500 grafts is not an excessively large procedure with FUE, Dr. Chris Bisanga has been performing up to 3000 FUE cases for some years with well documented results; but the starting donor density does play a part. Obviously with FUE the skin surface area remains the same but the hair density decreases because of the FU removed, and this will obviously reduce the amount of grafts able to be extracted at a later date if/when your hair loss progresses.

If you have around 75 and above density then FUE would work well as long as the extraction pattern is spread over the entire donor safe zone with an even distribution of extractions per cm2, and not concentrated around the back where the hair is generally thicker. If it is removed from the entire safe zone and with a good starting density it will not make a great impact on your overall density, so not impede greatly on future procedure, FUE or Strip.

If your density is slightly lower though there is an argument Strip maybe more viable; to remove 2500 FUE from an already lower density donor will leave it thinner again, maybe even expose areas depending on your hair character; so Strip maybe in this case a wiser option as effectively there will be no real density change, and future extraction can be used with either FUE or Strip again.

For more information

Safe Donor Extraction Area: FUE Hair Transplant Surgery with Dr. Chris Bisanga

2010-01-24T11:12:00.000-08:00

“FUE relies much more than FUT on the candidate having a good donor hair density to reach higher numbers, all round good density and not just in the occipital (back). If by splitting the safe zone into areas prior to extraction it is possible to calculate whether the donor is viable for FUE and how many grafts can be extracted now and in the future. It is unlikely FUE will ever be able to reach the same number of transplanted follicular units than FUT assuming not to over harvest. As one benefit of FUE is no linear scar it can also be said that a benefit is the hair can be worn shorter or maybe shaved, but this can only apply if the supply of the donor is not over harvested otherwise although a linear scar is not left obvious signs of surgery can be evident. “

We have said this many times about the FUE donor, the surface area is wider than the Strip donor but that does not mean more grafts can be removed without making the donor too thin and obvious scarring or large hair less areas. Remember the scalp surface area is not altered with FUE, it remains the same, BUT the number of hairs in the area is reduced, the more hairs removed the thinner the hair density becomes.

Different areas of the donor will have different hair characteristics, generally the sides have a slightly lower density than the back and the hair groupings are smaller also, more 1, 2 hair FU opposed to more 3, 4 FU around the back. When assessing the FUE donor multiple points must be examined to get a mean density and hair count, it is possible the contrast between areas is very different and gives a very different result in terms of what can be achieved with the graft numbers.
For example, dependent on the hair loss pattern maybe the sides around the side burn area are very strong with no signs of receding or showing very obvious signs that this area is weak. If weak the area has to be discounted for harvesting any grafts, one because it will thin the area further and secondly that maybe the FU are not DHT immune. This will reduce the surface area available to harvest. Other areas that can show these traits are the nape of the neck and around the ears. When measuring a conservative approach should be taken, assess the safe zone and then reduce it slightly further to play safe.
Once the surface has been measured and the density/mean hair count been taken it is possible to have a very good idea how many FU cover the safe zone, this is not the amount that can be removed but an approximate of the total in that area.
Generally the above is common sense to understand, the next step is a little harder and requires knowledge of anatomy and how the skin and hair cells react to a punch extraction. The amount that can be taken from the safe donor relies largely on educated extraction and harvesting patterns and I’ll go into this in another post.

For a full and detailed assessment of your situation if you have not done please email your pictures and details of your hair loss history to either info@bhrclinic.com or your Patient Advisor.

TopCat Hair Transplant Repair Testimonial Updated

2010-01-19T14:48:00.000-08:00

My experience at the BHR clinic in Brussels was more then I could have ever hoped it would be. The clinic is both honest and open and lays the truth right on the table for all to see. Sometimes the truth might not be what we want to hear, but it is the truth. The fact is you need the truth in order to make an educated and informed decision.

I have been hoping to have some type of repair work done for the last 10 years, but I have been frozen with fear in what I have seen over this time. Some will assume I am biased, after all this was a pro bono offer that I received from BHR. In all honesty if I were given this same offer by some of the other clinics I have consulted with, I would have had to decline. I have just seen too many red flags to ever feel comfortable. I simply could not afford to make a mistake and be wrong. I needed only the absolute best clinic and doctor in the world to perform this work. I could not let distance be a roadblock. In all sincerity I could not give false praise and cause another human to go through what I and other victims have gone through.

I have personally spoken to many of the repair patients we have all seen. To this day they are still portrayed as success cases. Many of them in reality are very disappointed in both their results and the treatment they received. They hide in the shadows and are afraid to reveal the truth for too many reasons that others here would have a hard time understanding. Being repeatedly taken advantage of and being victimized is only something another victim can truly understand. It gives one a sense of shame that they carry around for a lifetime.

Over the years I have seen hideous body scarring, doctors with God like attitudes, clinics knowingly using deceptive advertising where their showcase results actually failed in the long run, clinics with little to no fue experience, hairlines meant for a 12 year old boy with little regard for future needs, forums that deleted threads that didn’t suit their bottom line, doctors that cancelled consultations at the drop of the hat with little regard for the prospective patient and clinics that actually used pictures of results that were not their own. These are not things I saw 25 years ago when I got butchered, but they are going on today as I write. To believe that people are not still being victimized is naïve, but I can also understand how easy it is to be deceived.

Dealing with hair loss can be both uncomfortable and embarrassing. Being disfigured by a bad hair transplant can be 100 times worse. The clinics and forums have a moral and ethical obligation not to mislead. But unfortunately when there are substantial amounts of money involved, greed rears it’s ugly head. One only needs to look at the news headlines the last few years. It goes on in almost every industry, including the practice of medicine. It very easy to take advantage of someone who has hope, it’s the easy road. Couple that with the highest risk takers out there, males in the 18-29 age group. One can then see how lucrative the hair transplant business can be. BHR takes the road less traveled, the high road and in the end I think it’s just a matter of time before this becomes evident to others.

Dr. Bisanga has the highest degree of ethics, because that is who he is as person. As I said before, he is an absolute master at what he does. This is a skill that can only be honed from years of hard work and repetition, along with being gifted with a natural ability. It’s no wonder that other doctors seek to be trained by him and learn the secret to his skill. But this skill is simply not something that can be acquired in a few weeks or months, but takes years. Repetition is the mother of skill and it’s only with time that it can be achieved. Dr. Bisanga will not sacrifice his ethics for a little more profit. He lives by the Hippocratic oath and he will do no harm, nor will he be involved with others that potentially might do harm.

Of course I have seen other clinics that use drills, or new mechanical type extracting devices. But I have also seen too many unproven techniques and therapies over the years that didn’t quite pan out and are easily forgotten along with their victims. I can’t afford the luxury of being a test patient or a victim once again. I needed to have something that has had proven results over the long term. Sure these new ways of extracting grafts might lower costs, but I will leave that for others to experience and wish you all the best in the experiment. I have experimented enough when I was younger and no longer have the will nor the intestinal fortitude to test the waters. I like to think that I have done my share and helped pave the way for the advancement of hair transplants. But it has come at a tremendous personal cost, both financially and emotionally.

I never imagined in my wildest dreams that I would be traveling to Europe to have my repair work done. It just never occurred to me that the solution to my predicament would be anywhere except what I thought to be the greatest country in the world, the United States of America. I always felt in the area of medicine, the USA was the most advanced and compassionate. Well it took a clinic and a great doctor on the other side of the world to change my view.

When I got to the hotel in Brussels I will admit I was starting to feel a little doubtful. All these terrible feelings started to come back to me from my first ht 25 years ago. I stayed in a hotel all alone after that procedure and was anxiety ridden by what I had done. That one mistake 25 years ago was life altering for me. It’s only something another victim of a bad hair transplant can understand. I asked myself what was I doing here in Brussels, and thought maybe I was making just another mistake. It turns out this was one of the best decisions I could have ever made. I am truly ecstatic with what Dr. Bisanga has done for me. The clinic and the staff went well beyond my expectations and my stay in Brussels was very enjoyable.

Dr. Bisanga was able to extract a total of 828 grafts. 490 scalp, 238 beard, and 100 chest fue's. I never even thought about doing that many body and beard extractions. I thought about doing only 10 each before I left the USA, I was just too uncertain about potential scarring. But after meeting and speaking with Dr. Bisanga I felt very comfortable leaving my fate in his hands. I was that impressed by both his character and ability.

Well I am thrilled to say that at this point there are absolutely no signs that any surgery was even performed. Dr Bisanga doesn’t need machines to extract fue’s, he is literally a machine himself. I say this with no exaggeration, he extracts fue’s with the greatest of ease. The healing has been amazing and is still hard to believe. I actually went out to eat at a local restaurant the very next day. It was unnoticeable that quickly even with over 200 beard hair extractions. I have seen plenty of pictures of body hair extractions, and the results were never this good. The donor areas always seemed still quite red even a month later. It’s hard to see the extractions from the chest area already, and it’s only day 6.

Philip at BHR is an incredible source of knowledge and information on the ht business. I encourage each and every person who is considering surgery to do your self a favor and tap into this base of knowledge. He is happy to share and help others. Regardless of if you use the services of BHR or not, you will be armed with knowledge and be able to make a better decision. Phillip is a very good-hearted and kind person. After speaking with him I got the impression that he is equally disgusted by what he sees transpiring in the ht business. I believe he is helping to try and change it. But the business will not change without a fight. It will go kicking and screaming.

Stephen is one of the nicest and friendliest people you will ever have the chance to meet. I was able to view his 7000 fue work up close within inches. It is absolutely impossible to tell that any surgery was ever performed in both the donor or recipient areas.

The rest of the staff at BHR was fantastic. Each and every one of them excels at their work. Dr. Hesam, Leith, Natasha, Genta, and Katarina make up part of an amazing team that simply gels together.

I look forward to good growth and I am already planning my next procedure in my mind. I have every intention of being back in Brussels one year from now. Of course my situation is different then most. I am limited in what can be achieved and will more then likely still need to use a concealer. I have just made too many poor choices in the past. But I would like to take my repair work as far as it can go.

To all the repair patients, there is hope. To all those considering their first procedure, take your time, become informed, and don’t believe the hype.

I will be posting pictures tomorrow including the results at the 1-week point.

Total fue count 828

                 1 hair              2 hair         3 hair

Scalp           220                 470

Beard             32                 108          98
Chest             98                    2

____________________
http://hairtransplantrepair.blogspot.com/

Topcat on hairlossexperieces with pictures

Previous Bog http://bhrhairtransplant.blogspot.com/2009/12/topcat-hair-transplant-repair.html

Hair transplant, What do I ask?

2010-01-16T17:51:00.000-08:00

PRINCIPLES OF A HAIR TRANSPLANT

A Hair Transplant works on the basis that hair remains around the sides and back of the scalp (donor area) and some of this can be moved to the top (recipient area). This hair is genetically programmed to continue to grow throughout our life, although in some occasions it may become thinner.

GRAFT NUMBERS

An average scalp can harvest around 6-7000 follicular units or grafts. The amount that can be taken relies on the quality of the donor area, mainly the density of follicular units calculated per cm2. The average density for a male is around 75 FU per cm2.

COVERAGE

Hair loss is progressive, and the surface area of hair loss will increase the older we become. The surface area can exceed 200 cm2 for a NW5/6/7. With this surface to cover more than 7000 grafts can be required, some patients cannot achieve total coverage and will have to settle for little or no crown cover.

FOLLICULAR UNITS & HAIR CHARACTERISTICS

Grafts are follicular units, from 1 to 4 hairs in a natural group; the amount of grafts that can be removed from the donor area will depend on scalp laxity, density of hair in the donor and the technique used, either FUT or FUE. Another aspect that has an effect on the result is hair characteristics, hair colour, calibre or diameter of the hair, number of hairs per follicular unit average, curl or wave of the hair. The same number of grafts placed on one person may cover a different surface area on another person or give the appearance of more or less density per person.

DENSITY

Density is the number of follicular units placed per cm2 to achieve a natural looking result. The density placed is unlikely to be the same as your original hair density and must be lower than the density of hair in your donor zone otherwise the balance of hair growth can look unnatural. The density needed to attain a natural looking result is also dependent on your natural hair characteristics; hair line work can require 50-70 follicular units placed per cm2 of single hairs, behind the hair line the density placed can be lower because multiple hair follicular units are placed, slightly less density placed but more hairs per cm2.

TECHNIQUES

FUT & FUE are the two recognised techniques for harvesting hair from the donor area. Both are legitimate techniques with proven results in the correct hands. Not one technique is better than the other, they are different and have positives and negatives to both techniques and one should not be considered better than the other, just different.

FUT Technique is the removal of a fine strip of hair bearing tissue from the donor; the size depends on the amount of grafts required. FUT is normally used for procedures over 2500 grafts and up to 6000 grafts, maximum numbers depend on the donor hair density and scalp laxity. FUT is performed in one day and is the most efficient way to have a hair transplant. The donor hair does not have to be cut and while the strip suture is healing it can be hidden under the native hair. FUT leaves a fine linear scar, today with the Tricophytic closure method the line is diffused with hair making it harder to find and enabling shorter haircuts. FUT can be performed more than once with good healing and generally will give more grafts than FUE can over multiple operations.

FUE Technique is the extraction of follicular units one by one with a small punch less than 1mm in diameter. The extraction is spread over the entire donor safe zone to limit the reduction in the hair density. FUE is better designed for procedures less than 2500 grafts in most cases and over 1500 grafts is scheduled over two consecutive days. FUE is technically demanding and requires strict harvesting and extraction protocols to ensure the quality of the result in the recipient and donor. FUE will limit the amount of grafts that can be harvested compared to FUT, many cases over NW4 will not be able to continue FUE restoration after one procedure because the density of hair in the donor will become too thin. In many cases with NW4 and above hair loss and when starting with a large FUE surgery the patient will require a FUT surgery to continue restoration, especially if the hair loss continues.

OPEN DIALOGUE

Another important aspect of you being happy now and in the future is the dialogue between doctor and patient. It is important that you express clearly your goals and what you wish to achieve from a hair transplant, you cannot rely on the doctor to predict and so it is very important you make clear what you are looking to achieve.

BHR look to always provide the best quality education, patient care and medical hair transplant quality, a hair transplant is an individual experience and a difficult decision to make, life changing hopefully in a good way; because of this many BHR patients are very willing to tell you their good experiences and some even willing to meet.

For a full and detailed assessment of your situation if you have not done please email your pictures and details of your hair loss history to either info@bhrclinic.com or your Patient Advisor.

Stephen's Update 22nd December 2009. 7000 plus FUE Video

2009-12-24T05:48:00.001-08:00

A Hair Transplant Consultation

2009-12-15T15:42:00.000-08:00

A consultation with a hair transplant doctor is very important, this will let you talk to the doctor and get his opinion on how he sees your case, now and in the future. Many doctors including Dr. Chris Bisanga believes it is vital a potential patient becomes educated and understands the principles of hair loss and hair transplant.

Hair Transplant Technique: FUE and FUT Basic Extraction Information

2009-12-14T15:25:00.000-08:00

A hair transplant relies on the basis of removing hair from one area of the scalp to another area; the basic principle is men lose hair on the top of the scalp, called the recipient area in HT, this can to a degree be replenished by taking hair from the sides and the back, known as the donor area.

The donor area is finite and cannot replace like for like but in the right hands and with the skill required provide an excellent result. There are two recognised techniques to treat hair loss with a hair transplant, FUE and FUT, also known respectively as Follicular Unit Extraction and Strip Surgery. The two techniques are very different in the extraction process but in the right hands will provide excellent results for the right candidate.

It is very important that before you consider a hair transplant you research and consult as many doctors and patients as possible, it is not suitable for everyone and there are many aspects to consider that make a good candidate.

Stingray's HT Repair with Dr. Chris Bisanga FUE Technique

2009-12-08T10:10:00.000-08:00

TopCat Hair Transplant Repair Testimonial

2009-12-02T14:05:00.000-08:00

"I have been on the forums for well over 10 years. After being what I have been through, choosing a doctor and clinic is probably one of the most difficult choices I have ever had to make. Even with my present condition, it’s been easier to do just nothing, then to take the chance and make the wrong choice one more time.

My first choice would be not to have to travel. It’s difficult enough to have to deal with this situation in daily life. Having to go through airports and security while having had surgery on my head is going to be quite an ordeal. I wish that I could go to someone local or at least someone here in the USA. But I have to be extremely cautious in my choice. I need a clinic that is highly experienced in fue. They also have to have extensive experience in body and beard hair. A bonus would be that the doctor has a natural artistic talent. Dr. Bisanga happens to be highly gifted in this area, one only need view his work to agree. But most important of all, the doctor and clinic need to be caring, compassionate and have my best interests at heart. Over the last 10 years I have finally narrowed down my choice to one clinic, the BHR clinic in Belgium. The BHR clinic meets each and everyone of these points.

I came to this conclusion about 1 year ago. Even though I knew it was the only clinic that I really felt comfortable with, I was still hesitant in taking the leap. Read my blog and view my pictures and I think you can understand why. It was only recently when the pro bono offer was made to forum members that I thought I really need to get this process started and maybe this offer was my one chance in a lifetime.

There are so many individuals out there that are in need of repair I wasn’t sure that I would even have a hope of winning, but still I had to at least try. Well you can imagine my elation when I found out I had gotten the most votes from the members of hairlossexperiences.com and I was chosen to have the repair work done for free. The clinic phoned me that same night and congratulated me. I was so excited I could hardly believe it.

The voting was so close that the BHR clinic offered the next to two runners up to also have pro bono work done. What does this tell you about this clinic? It’s the same conclusion I came to 1 year ago when I first spoke to Phil B over at BHR. I had already consulted with at least a dozen clinics here in the USA and abroad. I have spoken to at least a dozen repair patients that have had work done by other doctors. It was only after I spoke to Phil along with seeing the artistry of Dr. Bisanga’s work that I knew I had found what I was looking for in a clinic."

You can read more of Topcat's blog and follow his progress with his repair with Dr. Bisanga

Hair Transplant testimonial of Sparky with Dr. Bisanga

2009-11-09T12:53:00.000-08:00

"Booked up a couple of weeks ago to have surgery with Dr Bisanga mid October.

First surgery is to remove a fair few mis-angled grafts from my hairline and relocate them into my scar.

Second surgery which should be in Feb next year, I'll have 1500-1800 fue put into my hairline, and just beyond.

really looking forward to it, and I will post pics once I'm all done."

To follow Sparky's full story go to his blog of hairlossexperiences

BHR Clinic

Hairtastic Hair Transplant Testimonial with Dr. Bisanga

2009-11-09T12:25:00.001-08:00

It was about a year between when I started to look into HT and when I finally got it done with Dr. Bisanga. All other clinics I looked at rang alarm bells, the 1st suggested 700 strip for my front. At the time I was none the wiser as to how many I would need but what got me with that one was that they never gave me an answer regarding FUE so I left it. Another guy just sounded rather dodgy on the phone as if he was a builder saying 'Yeh we got all the different size FUE punches mate', I stepped away from that one!. I then came across what seemed a very promising clinic, their website was comprehensive, however when they asked for 100% payment BEFORE the procedure I told them to stuff it not to mention that they wouldnt accept credit cards, they would only accept cash or Bankers draft.

My search finally took me to Dr. Bisanga, I did my research. I even played the devils advocate by doing searches on google for things like 'Dr. Bisanga rip off' or 'Dr. Bisanga dodgy HT'. I couldnt find a thing. All I did find from that was positive feedback about him. Being the sceptic I am, I wanted to have 100% confidence in the procedure so in spite of what I read I still gave it a couple of months to be convinced.

The actual procedure was a cakewalk. after I sat with Dr Bisanga and dicussed hair line design and my age, this was a pleasant surprise because he suggested a little less receded than I expected. It was established that about 2500 grafts would be the best option for me. We went through to the surgery room and began. Little to no pain throughout, just the anaesthetic, not the best nights sleep the first night, but I've had worse. The donor area became a little itchy but by the time I had the stitches out day 12 all was fine.

I would like to say a thanks to Phil who played a big part in my decision and has throughout and after always had my best interests in mind. One of the main things that won me over was that he strongly reccomended me NOT to have my vertex (crown) area done because it was not bald enough to justify it meaning that upon future baldness I would have a halo effect. The major difference between him and the rest was that the rest would give me whatever I want regardless of whats really best while knowing I wouldnt be any the wiser, in other words they just wanted the money. I originally wanted FUE but Strip harvests more from the donor area, so that for future procedures (If I choose to use them) there would be more yield when if I use FUE. Im sitting here now whith a grade 2 shave on my back and sides and the scar is not noticable!. Hair is starting to grow and I can’t wait for the next few months for more hair growth.

BEFORE PICTURE

AFTER

HAIRLOSS-REVERSIBLE

FUE & FUT. Compete or Complement Each Other. Dr. Bisanga

2009-11-09T12:01:00.000-08:00

Dr Bisanga's presentation to the European Society of Hair Restoration Surgery in Brussels (June 2005) on "FUE and FUT Strip".

Although first published a few years ago the principles still hold strong, in fact many aspects are only now being considered as important although Dr. Bisanga wrote about them some years ago. A thank you also to Peter Mac whose contribution was invaluable in making the study.

The study was designed not to be negative to FUE or FUT/Strip but to look objectively to the techniques and what both can offer.

BHR CLINIC BRUSSELS BELGIUM

Dr. Chris Bisanga

Dr. Chris Bisanga FUE Hair Transplant Surgery

2009-11-08T08:44:00.000-08:00

Dr. Chris Bisanga has been developing, improving and teaching his FUE (Follicular Unit Extraction) technique for almost ten years. Over time he has developed and adapted his personal technique of manual extraction and donor harvesting and management protocols to enhance the quality of this difficult and demanding hair transplant technique.

FUE or Follicular Unit Extraction is a hair transplant extraction technique; in real terms it can be argued it is the refinement of the old punch grafting techniques from the 70's and 80's with a refinement in the size of the punch.

FUE in the purest form is the removal via a cylinder punch tool of a follicular unit (FU); a follicular unit is a natural group of growing hairs in the scalp or body normally housing between 1 to 4 hairs in a group. The removal of a single FU requires a great deal of precision not to damage the removed FU and or the surrounding hair groups.

Dr. Bisanga is credited over the years with writing papers and researching FUE in relation to existing hair transplant techniques, how they compare and whether one has a greater place in hair transplantation than the other. Dr. Bisanga believes FUE in the correct hands and under the correct candidate circumstances is a viable and credible hair transplant technique, he does not however believe FUE will remove other hair transplant techniques and very importantly believes the criteria of being a suitable candidate should be very strict otherwise long term donor limitations can be caused.

FUE is a physically demanding technique for the doctor to perform as every FU must be removed individually, this requires a great deal of concentration to ensure each FU is taken without damage and with a tool that is small enough to not create any great impact of the skin and surrounding hair. Dr. Chris Bisanga has long preferred the use of 0.75 to 0.8mm diameter punch tools, he is able to remove safely and without damage even larger 4 hair FU groupings. On occasion and more so in repair cases he feels the need to use a slightly larger 0.85mm tool, but this is rare. When first applying FUE his tool size was larger but he soon realised that a larger diameter punch caused multiple contraindications to the scalp and surrounding hair, and was actually harder to apply FUE in the pure sense of one FU removal at a a time.

Using a smaller punch tool Dr. Bisanga found it was much easier to only remove one FU and not transect adjacent FU's thus damaging them, he also found scarring became smaller and less visible to the eye. The tool size was also accompanied by his improvement in technique of extraction, the movement of his hand, the "touch control". "Touch control" Dr. Bisanga believes is vital to a successful FUE procedure and why he prefers the use of a manual punch and not mechanical. He is a firm believer that it is vital to be in total control of the movement, depth, angle of the incision and be able to feel the FU as the punch enters the scalp to provide the least amount of torsion to the skin tissue and thus resulting in the clean removal of the FU and minimal change to the surrounding skin.

Dr. Chris Bisanga is also a firm believer that FUE can be technically demanding on the donor if not managed correctly. Because the surface area of extraction is wider than that of the conventional Strip technique more damage can be potentially caused. The perception that if a small punch is used and no linear scar is created means less trauma or damage is an incorrect assumption. If the extraction pattern is not thought about in relation to the person's hair characteristics, if too many FU are removed adjacent or within a small area to each other, if the entire safe zone is not used, if too larger punch is commissioned just to name a few reasons then this can cause damage and consequences to having more procedures.

FUE has shown to be a proven technique in the correct hands, Dr. Bisanga has many documented and grown out cases from the years he has been performing this technique, but he is always mindful of the techniques limitations.

Larger baldness NW cases may not be suitable for full restoration with FUE alone and it is important the candidate is made aware of this before starting with a hair transplant. Without over harvesting the donor area most candidates do not have the capability to reach much more than 4500 grafts/FU with FUE, then requiring Strip if their hair loss progresses and they wish to gain more coverage.

Large FUE sessions are not advisable to be undertaken; FUE maybe minimally invasive in respect of one small punch entering the skin, but multiple this by 1000's and it then becomes a different story. The scalp is vascular but even so the more open wounds created in both the donor and recipient areas will mean the body will find it harder to heal each wound effectively to the point in the donor more scarring can occur and in the recipient area the yield could be impaired. Dr Bisanga concludes that a maximum of 3000 FU should be extracted in one procedure, and maybe less dependent on the donor quality to ensure the best healing and yield are attained.

What FUE has been able to bring as a positive to hair transplant is not having to have a linear scar and a small procedure, still being able to shave your hair with little to no obvious signs a surgical procedure has been performed.

FUE has also opened hope to patients' who have suffered poor hair transplants in the past and could not have more Strip procedures. FUE for these candidates have given hope to gaining more hair because the donor surface is wider and being able to extract from areas a Strip could not, and the advent of Body Hair or Beard Hair.

Dr. Bisanga has performed body and beard hair for a number years, he does feel it can be a viable option for those that have minimal to no scalp donor, but he also realises that BH in any form has limitations. The yield from BH can be lower than scalp hair, some have little growth. BH requires testing first before any notable size procedure is performed, the patient needs to understand the limitations of the BH, potential yield, coverage per hair, the amount of potential grafts required and the way it blends with the surrounding scalp hair.

In conclusion, Dr. Bisanga's extensive experience with FUE has enabled many happy patients be able to take advantage of this technique, his teachings and posts he hopes help to educate others, doctors and potential patients alike to understand FUE and use it in the best possible way to achieve the best results possible, now and for the future.

BHR Clinic

What Density of Follicular Units I Needed

2009-11-07T16:05:00.000-08:00

Density of the grafts/FU placed is just one issue that determines the natural look of a hair transplant; factors such as hair calibre and characteristics and the angle and direction on placement also play very important parts.

The illusion of thickness and a natural look is due to be able to block the light from reflecting back of the scalp, if this can be achieved a natural looking density is possible, it is when the light penetrates the hair that it can look thin and unnatural. Therefore the first aspect the doctor has to look at is your natural hair calibre and characteristics, then decide what density he has to place to achieve the goal.

A man with very curly, coarse, low skin to hair colour differential, high number of 3-4 hair follicular units will require considerably less follicular units per cm2 than a man with straight, fine, high skin to hair colour difference and mainly 1-2 hair follicular units; in theory he may need double the amount of FU to achieve the same looking density.

That said there is obviously general guides to what is required to block the penetration of light and achieve the look of a natural density; the hair line will always require a greater number of FU per cm2 because single hairs are being placed and then the calibre of hair has to be recognised because coarse hair can look "pluggy" if incorrectly placed; so the varient in density can be wide, maybe between 60-80 FU cm2 on average, that is not to say a higher density cannot be reached if required. Behind the hair line the density is increased with the use of multiple hair follicular units, 2,3,4 and sometimes 5 hair units. These are not randomly placed, the area is designed to ensure the FU maximise the coverage and density, so planning of the design and placement is very important. The depth the FU is placed and the direction/angle of placement will also effect the effect the look of density, so the slit size, direction and depth must be customed to each varient in FU size (1,2,3 hair FU etc), this is important to ensure not just the coverage and density is maximised but for the growth, yield and cosmetic appearance of the hair transplant.

As the number of FU will alter depending on the number of hairs and hair characteristics it is possible to have a varient in density behind the hair line but the same looking thickness all over. Again, like the hair line there are averages and guides to follow, and it is considered to block the penetration of light and achieve the look of density over 50-55 FU cm2 is required.

Whether this density can be achieved in one pass will depend on the slit placement design, placing each follicular unit in close proximity to each other; achieving this is always better than having to go back into the same area again with a second procedure. Every time the skin is cut it causes micro-trauma to the tissue and cardio vascular system and this can impair the growth of the existing and newly placed hair, by placing in one procedure this is less of an issue. There is also a cosmetic benefit of reaching the correct density in one procedure also, the result is achieved much quicker and with generally less personal inconvenience. It can take 12 months for all the growth and hair to mature from a hair transplant and it is not recommended that a further procedure in the same area is carried out until after this time, for the reasons stated. This means that for the first 18 months you have a less than natural density that may look unnatural, especially in the frontal area, then there is the inconvenience of time, healing and added expense of having another procedure. These factors are side issues to a degree as the most important factor is the result and a good growth rate; that said there is no reason why a natural density cannot be placed in one procedure so they are factors that should be considered.

dr. chris bisanga

Grafts & Follicular Units vs Coverage

2009-11-07T15:46:00.000-08:00

Grafts or follicular units (FU) should be the same thing when discussed in a hair transplant, an FU is the natural group of hairs in the donor and the graft is the extracted natural group of hairs, anything from 1 to 4 hairs together.

Above is a high magnified picture of the scalp with follicular units in their natural state. These should be extracted, be it FUT or FUE as they are in the donor, not transected or split to make up more "grafts". The hair count is a very important aspect to a HT, 4000 grafts means very little unless you know how many hairs, could be 4000 or maybe close to 10,000 hairs and that will obviously give a huge difference to a result.

The FU are distributed in a educated pattern over the recipient, not just randomly but in certain areas; the single hair FU are always used in the immediate front of your hair line, slightly feathered placement so not a flat straight line but one that looks slightly uneven and natural. The number of singles required can be around 600 FU/grafts to make a hair line just 2-3mm depth because they have to be placed at around 60-70 FU per cm2 otherwise the result will look thin and pluggy.

Behind the hair line the larger hair groups are used to increase the density, 2,3, and 4 hair FU are distributed in specific areas to ensure the result is not thin or see through. The density placed per cm2 is less than the hair line, and can range from maybe 30 to 50 FU cm2 dependent on hair calibre and number of hairs in each unit. Although the placed density drops you will achieve more thickness than the hair line because more hairs are being placed.

The crown works differently to the mid and front of your scalp, the placement of the hair moving almost in concentric cycles does not allow for so much coverage or thickness being achieved per FU/graft, the crown is notorious for requiring a good 30% per surface area to cover with the same thickness than the mid and frontal areas. This is why many doctor's are reluctant to treat crowns, partly because the artistic design is hard and many cannot do and secondly because unless your donor supply is very good you may use a large part of your reserve on a relatively small area and not be able to effectively treat your long term hair loss properly.

A crown of 60 cm2, a very low placed density of 20 FU cm2 will require around 1200 grafts, this would cover but not look thick in anyway, 40 FU cm2 placed density 2400 would be able to give you more like a normal looking coverage and density. The frontal area of 72, forget the immediate hair line of singles for a moment, this will need a density between 35-50 FU dependent on the number of hairs per FU, so could require 3000 or so plus the singles for the hair line will take the area close to 3500 to 4000 grafts.

The above is only a calculation and HT is never as simple as that, many variables, but it is obviously an indication, around 6000 grafts would give you a coverage as a NW5 with a thinner density look on the crown than the frontal and mid sections. Obviously other aspects like hair line position will play a large part, the more aggressive you go the less coverage you will achieve and crown cover may not be possible.

FUE Surgery Hair Transplant Surgery: Important Points to Consider

2009-10-24T09:39:00.000-07:00

Dr. Chris Bisanga has been performing and involved with developing FUE for almost ten years now. He has developed and helped to train others in this demanding technique that requires a great deal of understanding to be able to perform to the highest standards.

FUE Donor

FUE relies much more than FUT on the candidate having a good donor hair density to reach higher numbers, all round good density and not just in the occipital (back). If by splitting the safe zone into areas prior to extraction it is possible to calculate whether the donor is viable for FUE and how many grafts can be extracted now and in the future. It is unlikely FUE will ever be able to reach the same number of transplanted follicular units than FUT assuming not to over harvest. As one benefit of FUE is no linear scar it can also be said that a benefit is the hair can be worn shorter or maybe shaved, but this can only apply if the supply of the donor is not over harvested otherwise although a linear scar is not left obvious signs of surgery can be.

Miniaturisation

The % per cm2 of miniaturisation in the candidate’s donor must be calculated and assessed before considering FUE as it could preclude certain areas of the donor to be left untouched and not suitable for harvesting. Most people will have a degree of miniaturisation in the donor but if it reaches too high levels for FUE can make the candidate unsuitable. Simply the hair gives less thickness so if more good hair removed and the miniaturised left it will reduce the thickness of the donor and maybe even leave it see through in places.

Hairs per FU

Under the average hair count will greatly restrict the usage of FUE as a technique, regardless if the donor FU count is average to good. Low hair count can minimise the coverage and subsequent result achieved.

Harvesting Protocol

Regardless of the size of the surface area to harvest and the obvious that it is larger than the FUT safe zone does not conclude that more FU can be removed. FUE safe zone is only the indication of where the FU can be removed from and as this surface does not change in size even when the FU are removed the amount of FU will be restricted other factors so as not to leave large gaps/holes/hair less areas or visible scarring between each extraction. Dependent on hair count, density, miniaturisation and general hair characteristics can determine the % viable to remove whilst maintaining a “clean” looking donor.

Harvesting protocol is important almost regardless of the size of procedure large or small can have a lasting effect on the donor. It can effect the long term number of FU that can be removed from the donor and literally make the difference of maybe 1000 plus less or more FU available to take.

Extraction Pattern

Allowing for an educated and well planned extraction pattern will not compromise the donor as much and give greater options for more grafts using FUE in the future. The pattern of extraction is random to the point it is has to be calculated to not leave obvious areas of no hair or any uniform signs of pre meditated extraction, “factory extraction” with an obvious pattern seen when short/shaved.

Punch

Diameter of punch will have a consequence on removing an intact Follicular unit, partial unit or more than one unit in a single punch. This can cause increased transection and loss of hairs in the donor that cannot be used, it can create larger scarring and peripheral damage to surrounding hair units.

The design of the punch will obviously have a role in the cosmetic and precision to punch, size, motion etc but the usage and innate skill of the Doctor extracting will override this as the tool is only the “instrument” of the master. Direction, depth, force, skin texture to name a few are all measured by the Doctor and the more understanding of this and more will result in low transection, less scarring and a greater number of FUE grafts available to harvest long term.

FUE Grafts

FUE grafts are generally leaner and more refined than FUT grafts, greater care must be taken with them, when extracting, cleaning and during placement to ensure they are not traumatised, damaged or killed.

Laxity

This can lead on from Extraction Pattern as too many punches adjacent or in an enclosed area can affect the laxity of the skin and in turn make future procedures harder to perform, be it FUE or FUT.

Hair Direction & Characteristics

1. Again leading on from Extraction Pattern, the skin is flexible and incisions into the skin will have a “ripple effect” across the area, too many ripples in a confined area will knock on to adjacent un touched areas and can affect the surrounding hairs, again making future extraction technically harder.
2. Variants in hair characteristics will make some candidates better suited to FUE than others, as FUE is a blind extraction technique it is only possible to see the hair exit the skin but under the surface it is a calculated assessment of the direction, especially in cases of very curly hair for example when the hair can exit one way and do a total U Turn in the scalp.

FUE & Repairs

FUE has given a real and notable benefit to those who have had procedures in the past and the typical strip option is no longer available either due to laxity or over harvesting. As FUE opens the safe zone wider it allows for hair to be removed away from the previously worked areas and can add valuable grafts to a candidate who maybe thought their donor was tapped out.

FUE for High NW cases

Although FUE will not yield in one or multiple procedures more than FUT or by combining the two techniques it can still be used on higher NW cases. Obvious restrictions apply as exampled above and of course the goals of the candidate, as in any HT. But for example, and this is becoming more asked for those that are not looking to have a “full head of hair” and still want to keep their hair short or even shaved especially in the donor can still benefit from FUE even NW6. This is under specific circumstances generally.

BHR Clinic

ScarredUp's Procedure with Dr. Bisanga. Pro Bono From BHR Clinic

2009-10-21T12:33:00.000-07:00

As most of you have probably read Scarred has had something like 20 procedures and several scar revisions. His hair characteristics are salt and pepper with around 40-50-60 density of follicular units per cm2 dependent on the area of the scalp. We discussed at length the day before and the morning of the procedure what were Scarred’s main concerns, where his priorities lay and what long term was realistic and achievable. Some was a reality check for Scarred but it was important that he understood what was available now and future.

The main areas of concern for scarred5 was his hair line, temple angles/connecting to the sides and the frontal 1/3. His scarring in the donor he has been treating so it was not priority for this procedure. The occipital area and generally the back of the scalp was not open to harvesting due to covering the existing scars in the area leaving only the sides available, so realistically with the limitations of surface area and density very little donor.

Dr. Bisanga shaved down the sides and felt that safely he could extract somewhere in the region of 300-400 grafts; the left side being careful to avoid the scar area already filled by grafts from a previous procedure. A strip was an option but Scarred (with some understanding) declined this at this stage. Dr. Bisanga assessed the shaved nape but felt the hair quality was just too fine and miniaturised to make them viable to use.

The final count was 448 scalp FUE and a smaller number of beard hair taken from the side burn to assess the regrowth quality. The graft breakdown of hairs per graft is

1 Hair 227, 2 Hair 209 and 3 Hair 12

The result was to treat the left and right temple angles and recession points, as well as the left side addressing directional problems; this would allow for better framing of his face and natural angles and directions of hairs in the hair line and temples that he has not got now and restrict any styling, having to camouflage.

Here is a selection of pictures of the day and Scarred will give his say on his visit with Dr. B; just to say it was a pleasure to meet him and hope we could help in any way possible to improve his situation and Scarred feeling happier.

FOLLOW HIS PROGRESS HERE HAIRLOSSEXPERIENCES

BHR CLINIC BRUSSELS BELGIUM

FUT or Strip Hair Transplant Technique with Trichophytic Closure

2009-09-30T05:01:00.000-07:00

This involves the removal of a hair-bearing strip from the back and side of the head. The donor area is sutured to leave a thin, almost invisible line that the surrounding hair grows through and over to cover. Because the closure causes little tension even immediately on the tissue this allows the minimum of strip invasiveness and cosmetic change to the scalp.

The Tricophytic closure is offered as the standard closure to all Strip patients with amazing results. This involves a triple closure of the donor site after the removal of the epithelium on the lower edge. The results are excellent even in larger sessions.

It has to me kept in mind that regardless how good the closure is, a scar line will be the consequence, this can be hidden within existing hair and with today’s Tricophytic Closure a person’s hair can be worn shorter than previously, but if shaved close or totally shaved the line would be visible.

Strip/FUT is a proven and successful method of extraction in the right hands but the patient does carry some responsibility with donor care. Superficial healing is relatively quick and generally hidden behind existing surrounding hair; a suture has to be removed at ten days post operation and this is advised to be undertaken by a medical practioner. Once the suture is removed the scalp will start to return to normal pigmentation, do not be surprised if this takes a few months as this is normal. A very important factor is stretch back and you as the patient must ensure over the first two months that minimum pressure or stretching is applied to the scalp; this generally involves less activity or heavy work out sessions due to skin laxity returning to normal without being pulled in differing directions. Even the best closed suture can stretch if too much pressure is applied.

Strip procedures are a team effort; the Doctor heads the Medical Team, guides and directs the cutting and placement, but it would not be possible to place the amount of grafts without an efficient and technically adept team.

The amount of hair that can be removed is dependent on certain factors, density within the donor area, size of the safety zone and scalp laxity. Scalp laxity can greatly alter the width of the strip removed and the doctor will measure what he feels is safe to extract without putting pressure on the scalp. As with the closure method, the evolution of strip removal has now allowed for larger graft numbers to be achieved even on those with average or lower laxity and density. Dr Bisanga’s strip removal technique has enabled many patients with average characteristics to achieve greater graft numbers than before, with 4000 plus grafts from average patients and even up to 6000 grafts; one of the largest FUT sessions successfully performed worldwide and the largest in Europe.

Even large Strip procedures, 4000 FU plus, can be repeated over again if the donor area is suitable, this allows maximum hair placement in minimal time.Time must be given for the scalp to relax and the laxity/density rechecked, so it is advisable that at least 12 months is given between sessions.

BHR Cinic Brussels

Examples of Dr. Bisanga's work with FUE and FUT can be seen here, just a small selection.

Being Prepared for a Hair Transplant

2009-09-16T12:03:00.000-07:00

Being prepared for a hair transplant is very important, when possible it is obviously better to have a personal consultation first, then the doctor can check your hair characteristics and give a good indication as to what can be achieved. As with any hair transplant there needs to be an open dialogue between doctor and patient so both understand and agree the goals and the patient is aware that limitations can apply to what can be achieved and how his hair transplant will evolve.

A person puts a lot of trust in the doctor he chooses; some may make their decision on personality that they feel comfortable with, others make it more on ability and techniques used and results, whatever the reason it is important there is a feeling of trust.

A hair transplant is a technically demanding procedure to perform, it takes time and patience and a lot of skill by the medical team, from the Dr to his technicians. For the patient the procedure can be demanding and hard, larger procedures can last many hours and need the patient to be still for long periods of time.

Making the decision to have a hair transplant is never easy and most people agonise long and hard, BUT for many the post operation is much harder. Once the decision has been made and the operation performed many questions and concerns can come back, will it grow, will it look natural, will my scar be thin, did I make the correct choice, basically will I be happy?

Post op is when you as the patient take over responsibility, the clinic or doctor have performed their side, and every good doctor always does his best to perform every procedure to the highest standards. When you are home the care is down to the patient. The Doctor sets out his protocols for post op care, many have their own instructions so it is important to keep to the instructions your doctor has given you; it is also important to keep a good relationship with your doctor and inform him of anything you do; he can only advise if he knows the facts. You want to make sure that all you have done, your investment, financial, time, goals and expectations you have so give yourself the best chance to ensure that the hard work and dedication put in by the doctor and his team gives you the result you want and deserve.

The months post op can sometimes go very slow, the first weeks of healing, the redness to the skin, waiting for the scar to heal over the months, and waiting for the hair to start growing. The post op almost goes in stages, the healing process, and then the first growth around 3 months, then 6 months and final result around 12 months; all are milestones and for some they can forget and for others it seems like an eternity. This is another reason to keep a good dialogue with the clinic, to help you through this time, keep updated pictures to give to them, and if possible even visit them. If patient and clinic work together it can outcome in you getting the result you want, it is a team effort with everyone having responsibility to gain a great result.

bhrclinic

Hair Transplant Press Release ISHRS

2009-09-15T05:07:00.000-07:00

NEWS RELEASE

NEW SURVEY FINDS EVEN DURING A RECESSION, MAJORITY OF PEOPLE
WOULD RATHER HAVE MORE HAIR THAN MORE MONEY

Brussels hair restoration surgeon advises professional consultation can pay off
in determining degree of hair loss, treatment options

Brussels, Belgium 27th May 2009. While lately most people are skeptical about their return on investment from stocks, some seem to be more inclined to invest in their locks.

According to a new online survey conducted by the International Society of Hair Restoration Surgery (ISHRS), 59.8 percent of people who were asked whether they would rather have more hair, more money or more friends chose more hair. By comparison, only 26.2 percent of respondents chose more money and 13.9 percent said they would rather have more friends. Of the 1,407 people polled, slightly more women (64.2 percent) than men (59.1 percent) indicated they wanted more hair than more money or more friends.

“In our practice, patients often comment that they view treating their hair loss as an investment, both personally and professionally,” said Dr. Christian Bisanga of BHR Clinic Brussels “This survey shows that men and women really place a high value on having more hair. In today’s tight job market, getting their hair restored could help people look more youthful and even more marketable to employers.”

Other key findings of the survey include:
• More than half of respondents (54.8 percent) said yes to the question ‘if celebrities or public figures were more open about hair restoration surgery would you be more inclined to consider having a hair transplant?’ When analyzed by gender, men were more likely to agree with this statement than women – 56.8 percent said yes among men vs. 45.3 percent said yes among women.
• When asked what locations hair can be transplanted to, a surprising 46.7 percent of respondents answered that hair can only be transplanted to the scalp. In reality, hair can be transplanted to several areas of the body, including the eyebrows, beard, eyelashes, and pubic areas.
• When asked what percentage of hair loss was needed to be cosmetically visible, only one-quarter (25.5 percent) of respondents correctly chose 50 percent as the response.

An estimated 80 million American men and women suffer from male or female pattern hair loss. Fortunately, recent scientific breakthroughs have made hair restoration an option for almost everyone. Hair restoration surgery and proven medical treatments are an effective combination in treating people with thinning hair and limiting future hair loss.

About the ISHRS
Founded in 1993, the ISHRS is a non-profit medical association dedicated to the advancement of the art and science of hair restoration. With a membership of over 750 physicians worldwide, the ISHRS provides continuing medical education to physicians specializing in hair loss and restoration surgery and serves as a resource for the public on the latest medical and surgical hair restoration treatments for hair loss. For more information and to locate a physician, visit www.ishrs.org.

About Dr. Christian Bisanga, BHR Clinic, 12a Avenue Brugmann 1060 Brussels, Belgium. Email: info@bhrclinic.com, Web: www.bhrclinic.com, Tel: +32 (0) 2344 7178

Study Background
The purpose of the International Society of Hair Restoration Surgery’s (ISHRS) Hair Transplant Challenge Survey was to gather information on attitudes towards hair loss; knowledge about hair loss and hair restoration; and to test respondents’ ability to identify hair transplant patients.

The survey was made available on the ISHRS website to visitors interested in participating in the Hair Transplant Challenge Survey. Data collection began in late May of 2008 and continued through January of 2009. As of January 2009, 1,878 respondents had participated in the survey and provided valid responses. A sample size of 1,878 has a margin of error of about +/- 2.3% at the 95% confidence level. For a full reprint of the Hair Transplant Challenge Survey report, prepared by RH Research of Chicago, IL, visit www.ishrs.org

Hair Transplant Repair Procedures from Medical and Patient expectations

2009-09-15T05:02:00.000-07:00

Repair procedures are not just medically difficult to perform and hold many complications that a virgin scalp does not have; but it can also hold with the patient high expectations and emotions as to the result. Firstly it must be understood that be it a repair or first procedure a hair transplant is not a miracle cure, it does not hold the answers to hair loss, it cannot give you back the exact hair you have lost and may not meet your expectations because of medical boundaries and the simple fact that perfection is not a reality. Then there is the care taken by the patient and the patient’s natural healing attributes, two aspects that are not liked to be discussed because it is felt removes blame from the doctor, but none the less it is a factor that has to be considered; medicine is not an exact science and many parameters go into a result, and each member has a part to play, the doctor to ensure he does his job technically, medically and cosmetically to a high standard and the patient to ensure he cares for the healing as much as possible, and possibly be even more careful after a repair.

A repair procedure is greatly different from a virgin scalp procedure; the scalp has been impaired and this brings with it complications. It also has to be understood that it may not be possible to repair all the damage previous caused, and it may take multiple procedures to achieve the goals set. When assessing a repair case it is usual to set out priorities, areas that cause the greatest concern are given priority to ensure that these areas are treated with optimum effect; if areas have to be left until a later procedure there is a good reason, the ultimate result. It is a normal and understandable for a repair patient to want to treat all areas with the same intensity and to want to return to a “natural” appearance as soon as possible. Having already been through a poor procedure/s it is not an easy decision to undergo another, therefore there are many emotions involved, memories of the previous procedures, the waiting, the disappointment, not to mention the realisation that every procedure means the donor area is being depleted and so an ever decreasing chance to resolve the problems.

As with any hair transplant there needs to be an honest and open dialogue between doctor and patient, so both understand and agree the goals and the patient is aware that limitations can apply to what can be achieved. This is very important because a natural result can be achieved but if the patient’s expectations were greater they still will see themselves as flawed without understanding why the procedure only went so far. On occasions it may be necessary for the doctor to override the wishes of the patient and only agree to proceed if the patient can dramatically re-evaluate their goals because they are too high, unachievable or will not resolve aspects of the look. This is not going to be easy for the patient to do obviously and a disappointment, but better that than go through more trauma later and potentially end up in a worse situation.

It is obviously hard to prioritise when every aspect is important, but if one area is possibly more cosmetic importance it will be the hair line; and then the donor management to ensure care is taken to maximise the hair available and care for the donor at the same time. The hair line is the first area that you and others see; it frames the face and because of this can change the look, for the good or the bad. Incorrect hair line design and placement of the grafts can alter your appearance, then the size of the grafts be they FU or micro or plugs can add to the unnatural result. Many times it will be necessary to remove the old grafts and redesign the hair line, the best way for this is to remove the graft with a FUE punch, if the grafts all too big or placed too close together a punch may not be possible and the area needs to be sutured together. It may not be possible for all grafts to be removed, and some may grow back, and as a result a future procedure may be necessary. The next problem is that with poorly placed or angled grafts normally comes pitting and ridging of the skin; this is either a “crater” created when the graft is placed or a raised area of tough skin around the placement area. Pitting can repair after the graft is removed and over time the skin return to normal, but this can depend on the size of the graft and how difficult it was to remove. Ridging or cobblestoning is less forgiving and impairs the skin, sometimes never to be repaired, even with resurfacing treatments. Both factors will impair the placement of new grafts and may cause a lower yield than expected from a virgin scalp because of the scarring. This may affect the density or thickness of the result, either because the yield is lower, the placement was decided to be lower to protect the yield, or possibly the donor area could not supply enough grafts.

The donor area is vital to a repair and will determine a result that can be achieved now and what can be achieved in the future. The donor area has already been impaired, this may mean over harvested with a large punch via FUE or incorrect position of the strip scar or stretching back of the scar.

Over harvesting with FUE will lower the overall density of the donor and in extreme cases by as much as 50%. This will make further FUE impossible and even a strip will not yield a high amount of grafts, partly because of the are being over harvested and because of the damage within the skin and the directional changes making it harder to slither the strip.

A Strip incision can cause other problems, mainly with the position the strip is removed from, the laxity, the depth in which the strip is removed and the healing. The skin laxity will play an important part in the width of the strip and the position, if too wide, too deeply incised and incorrectly positioned then the increase of stretch back occurs as does reducing the laxity even further for future procedures. When dealing with an old strip scar there are options, either to englobe the scar if wanting to remove more grafts, revise the scar or add grafts into the scar to camouflage it. Englobing or revising do not ensure a thinner scar than before, it is impossible until the incision is made to know the depth of fibrosis under the skin or determine how the new scar will heal. Do not assume the scar will be smaller, and certainly not invisible. To add grafts into the scar can be a good option depending on the size of scar and how well it has healed. It is considered that the yield will be lower when placing in a scar line and it is prudent to place a lower density initially and measure the yield before using too many precious grafts that do not grow.

The donor will also determine how may grafts are available for now and future, this is very important especially with major repairs when hair supply is vital, expectations and demands high, and loss of hair cannot be an issue, every one counts. This brings us back to priorities verses available donor. All due care and attention is taken to ensure that the very best is achieved, it does not go unnoticed the trauma, the anxiety and expectations a repair patient has; and that is why a solid education, balanced expectations are required as well as good dialogue between doctor and patient prior to any decision being made.

This covers broad aspects of repairs and does not go into medical specifics, it is written to educate and provide a better knowledge of what to expect and what can be achieved.

bhrclinic.com

Hairs vs Graft Numbers: Which is more important to a hair transplant

2009-09-15T04:34:00.000-07:00

Much of the talk when someone is enquiring about a hair transplant revolves around the topic of density, how many FU per cm2 will be placed in the hair line and behind, will it be natural, and will it be thick. Of course this is a relevant question but possibly too much emphasis is placed on this and other factors that make up the result are forgotten about; such as hair characteristics and one rarely discussed; the number of hairs per follicular unit. There is always a mean number and some say there are more hairs per FU with FUE or Strip/FUT but the fact remains if an intact is removed it will average whatever the person has, and generally it works to approx. 2.2/3 hairs per FU. This is not necessarily the natural average but normally the extracted average, hence being able to easily calculate it. And this can vary dependent on the procedure and the placement, hair line requiring more single hairs so the number drops whereas if the placement was behind a hair line with mainly multiple hairs the number increases.

FUE and FUT/Strip both rely on the number of grafts placed to give a result, but more importantly is the number of hairs per follicular unit because this can make a large difference in the result; this is the distribution of hair. The placement of the FU in a skilled and artistic manner will get the most thickness and coverage to assimilate a head of hair.

Depending how the FU are extracted with FUE will determine whether a “true” FU is removed and this will be a large factor in the result. For example if an FU is removed intact be it one hair or a multiple FU up to 4 hairs then the hairs per graft will reflect this in the % split. A number of factors can attribute to the number of hairs per graft, for example incorrect extraction could lead to removing more than one FU or transecting an FU; this can either mean larger grafts or if transacted could mean more grafts are created accidently but the hair count is greatly reduced per graft.

This is important to understand as the distribution of FU decides the result; as most realise, a hair line will typically take 600-800 SINGLE hair FU and if there is temple point rebuild this can be over 1000. Behind the hair line a gradual increase needs to be created from 2 to 3 to 4 hair FU. BUT if a greater number of single hairs are placed then this will impair the distribution, so a larger number with lower “thickness” in a smaller area. You may be able to place a density of single hairs at 90 FUcm2 behind a hair line, but the actual THICKNESS will be less than three hair FU placed with a low density of 35 FUcm2; almost a third density placed but more hairs and more importantly more thickness.

DISTIBUTION of intact FU= results, the number of grafts is relative to the number of hairs, if there is not a balanced distribution of hairs the appropriate placement will not equal the density and coverage required to achieve what probably everyone would aspires to in a hair transplant.

Naturally some people have smaller hair numbers (groupings) per FU and in some cases this may render them not suitable for a hair transplant; or possibly transection when punching may cause the FU to be split into a smaller hair group, either way it must be recognised that graft numbers are only relative to the hair count and the distribution of the FU when being placed. Either way, be it natural small groups or transacted it can lead to a sub standard result and so when calculating density for example in the donor area the hair count should also be considered as a major factor.

bhrclinicinfo@bhrclinic.com

Hair Transplant & Treating the Crown Area

2009-09-15T04:26:00.000-07:00

As the crown can open on all sides it is important to look at the persons age and patterning before deciding if it is a good idea or not, a crown can sometimes measure the same as the frontal 2/3rds in surface and this can require more grafts than the donor can allow, so it is always important to judge when crown work maybe a good idea. In this case the patient is in his early 40’s and had been using meds for years and continues to do so.

A hair transplant in the crown is very different from the frontal area; an obvious difference is the creation of the swirl or spiral with the hair coming from a central point out. This in itself is artistically difficult to achieve when making the slits and then there the density and the distribution of hair over a deceiving large area whilst preserving the donor. Because the lay of the hair is different from the frontal areas the illusion of thickness is harder to achieve. This is due to the hairs almost lying in concentric circles and less over each other until the crown blends with the surrounding hair. Each hair in the frontal overlaps the other better hence blocking the light better; so the skill with the crown is to place a relatively small amount whilst create the spiral look and enough thickness, and in this case even with very short hair the patterning of the crown is not only present, the blend with the existing hair is seamless and for the number of grafts a good surface area covered.

bhrclinic

FUE. Study in Motion & Miniaturisation

2009-09-12T09:09:00.000-07:00

FUE, Study in Motion & Miniaturisation

Dr. Bisanga has adapted and improved his FUE punch technique over the years, one obvious example is the size of punch he uses has dropped in diameter to minimise traumatic impact on the scalp and surrounding follicular units. Another aspect is the technical ability and objective technique, the ability to feel the follicular unit and surrounding tissue when entering the scalp and gauging the depth and angles of each FU.

FUE has and will always be technically a very difficult technique, the fact that each FU has to be removed individually and the average op is 1000 grafts plus obviously multiplies the room for error as each extraction can be different in some cases. Dependent on the area of the scalp the angle the FU exits the scalp changes, dependent on the area it can be easier to extract the FU as the lay of the FU can be more consistent and also the position of the head when resting on the bed allows for easier extraction. For example the back of the head, around the occipital area is much easier to punch. It is important the doc can understand his position needs to change otherwise there will be a greater scarring impact and potentially increased transection. The constant need to change position is not something that can be avoided regardless of tool size or the type of tool, this is about the technique.
Pressure control is also important to achieving minimum transaction and the least potential trauma to the surrounding FU. A largely forgotten aspect to FUE is the effects on the surrounding FUE that are left in the donor; an FUE donor maybe be spread over the entire donor safe zone and if used well can leave minimal to almost no signs hair has been removed but incorrect punch and extraction can greatly reduce the potential for future FUE and the graft numbers and even hinder Strip extraction.
The greater the friction created when the punch enters the skin the harder to balance the direction of the hair with any potential changes as there becomes less sensitivity between the fingers and the tip of the punch. The tension can be micro but Dr. Bisanga has found through changing his technique that even manually the tension can be reduced and this improves graft survival and collateral damage. The finger to the punch pressure helps gauge the skin characteristics and even possible to feel the FU with practice. With this technique of punching Dr. Bisanga has minimised transaction to as little as 1-2% in most cases and even on demanding cases rarely increases to above 5%; this is only made possible by the touch sense gained through minimal transference of distance and resistance between his fingers and the punch.

The next aspect that is over looked much of the time is miniaturisation existing in the donor and the potential to create miniaturisation. Dr. Bisanga feels that anything near 20% miniaturisation in the donor can rule you out from surgery, certainly FUE. Miniaturisation does not affect the density of the donor hair as such because that is just the calculation of FU per cm2 but it will affect the number of FU that can be removed. We have seen miniaturisation spread all over the donor and also just in isolated areas, either way it will reduce the numbers that can be extracted. By definition the miniaturised hair cannot be used so they must remain in the donor, this creates the problem of how close to the miniaturised FU can the extraction take place. Too close and the thickness of coverage will drop and could potentially traumatise the miniaturised hair and cause it to fall out. So, the extraction pattern has to become wider thus less FU per cm2 are removed to retain the integrity of the donor, especially for the future. Miniaturisation can also be caused with the extraction, going back to the tension or resistance in the punch movement, this can create a ripple effect, like a “skin quake”, the punch hole being the epicentre and the vibrations moving out from the central point. As above Dr. Bisanga has minimised aspects of this by his punch motion technique, he has certainly found less resistance was caused creating obviously less contortion of the wound and the surrounding FU’s. This is very important, we have seen miniaturisation created post FUE surgery that has possibly rendered the areas non- harvestable due sometimes to over harvesting but also peripheral damage creating miniaturisation.

Dr. Bisanga’s feeling on these problems is to lessen the motion when making the punch action, the least friction or motion allows for greater sensitivity and feel between punch and fingers and this in turn has reduced transection, decreased peripheral damage either to the skin or surrounding FU with changing directions as well as miniaturisation. With the many documented FUE cases he has to his name as well as the many more he has performed and internally documented he feels confident to say that in respect of physical technique he has reduced these negative factors a great deal but then research is ongoing obviously.

BHR Clinic

7000 FUE Scalp & Body Hair

2009-09-07T01:15:00.000-07:00

Stephenl is one of few in the world to have achieved over 7000 grafts while only using the FUE, Follicular Unit Extraction Hair Transplant Technique. The majority of his FUE has been scalp, he started prior to any surgery with a higher than average donor density, over 100 FU per cm2; this allowed for around 6500 scalp FU to be removed and without causing any obvious signs of scarring or hair less areas. Stephenl likes to keep his hair very short even now when he has a good head of hair, so no signs of scarring was very important to him. Even with stephenl's good hair characteristics it was not possible to cover from his hair line to crown, what we call total restoration, for this he has to rely on BH or body hair. The majority of stephenl's BH has been beard hair, Dr. Bisanga feels this has a better yield factor compared to traditional body hair and has more resemblance to scalp hair. To date he has had 2 beard hair procedures, first a smaller 200 grafts 9 months ago that are growing well, then more recently another 400 grafts that are just beginning to come through. Watch for updates as stephen goes for total restoration with FUE and no linear scar. bhrclinic web site Email: info@bhrclinic.com

Updated Pictures of Stephenl