diffuse Dr. Bruno Ferreira | Sept 2024 | 3201 grafts (9929 hairs) | Diffuse NW5V | 33 years old

[Ccd99]

  Background Info

• I have a pre-surgery thread you can browse (see link below) which shows the start of my hair restoration journey (approx. 13 months ago from today) - it has my initial photos before I started medical therapy and I have also documented my progress as the months went by leading up to my surgery so you can see directly how much of a benefit medication has been for me.

Overview

• So, I just completed my 2-day surgery with Dr. Bruno Ferreira in Espinho, Portugal.
  • I am still recovering, currently on Post-Surgery Day 3 with minimal swelling or pain. 
• I had 3201 grafts transplanted to cover my diffuse hair loss over the frontal half, these grafts yielded a ratio of 3.10 (which was so much higher than I expected) and meant I achieved about 9929 hairs.
• I will be coming back May 2025 (date is already secured) for another 2-day surgery to cover the crown + remainder mid-scalp.
  • Dr. Bruno suggested 1500-2000 grafts there and touch up if anything needs touching up + look into the potential of lower temple points slightly more.
  • Maybe a 2500-3000 grafts surgery - we will see.
• Dr. Bruno mentioned I have a whopping 9000 grafts still left in the bank - that is after this surgery (so a grand total of 12200 grafts).
  • He mentioned after this amount my donor would still look acceptable/good
  • Beyond this he can extract more but it would start to look thin, not that I would ever need that many since I am medicating.

Medical Protocol

• I have been on the following protocol for approx. 13 months:
  • 0.5mg Avodart (Dutasteride) - once a day
  • 2.5mg Loniten (Oral Minoxidil) - twice a day
  • Hair vitamins ("Hair Forte" by Zenement) - once a day
  • 2% Ketoconazole shampoo - twice a week
• I stopped taking Loniten and the Hair vitamins 2 days before surgery as instructed, and I resumed them on day 1 post surgery
• As mentioned at the start of this post I have seen tremendous regrowth with this as I was close to a full bald NW6 (you can see my pre-surgery thread for more info).

Surgery

• Due to my diffuse hairloss I always knew I needed to got a surgeon that is skilled with diffuse cases and can implant in between native hairs with minimal transection
  • Dr. Bruno reassured me can do this and that is one of the major reasons I chose him, in addition to his reputation.
• I arrived Monday morning, already provided the blood results from my local GP the week before so I could just rest when I arrived.
• Early start Tuesday morning around 7:30 AM
  • I got changed into the surgical gown and then the staff and nurses explained the process to me and answered some questions and put me at ease.
• Dr. Bruno then came to see me, answered all my questions and we both signed the consent form to proceed.
  • He was very pleased to see my regrowth since my consultation back in Nov 2023 and straight away said that this means he can cover more surface area without jeopardising the result and also go lower on the hairline.
• A series of photos were taken: pre-shave, pre-shave wet hair, partial-shave, and full-shave with design.
• I then spent some time with Dr. Bruno discussing my hairline
  • He drew the hairline and asked for my input
  • He drew my mid-point at about 6cm
    • This is low yes but thats where my natural mid-point is/was - he used various measurement tools to ensure this is the right place for it.
  • Temple corners around 8 - 8.5cm
    • I would have liked them slightly lower and Dr. Bruno said he can do that if I wish but suggested to keep it like this and to go lower at the next one
    • I thought about it and ultimately agreed with his judgement and suggestion.
    • I do have some baby hairs in this area due to Oral Minoxidil which Dr Bruno said he would work with to blend in the new hairline and allow for a soft and natural appearance
• That's it, we then went into the operation room and started extractions just before 10 AM
  • The anaesthetic injections really did not hurt much, maybe a 2 out of 10 - I could tolerate it fine
  • I did have to ask him to top it up a few times throughout the surgery as he prefers to use as little as possible
• Punch size used was 0.85mm and 0.9mm due to the way my hairs sit together and the hair calibre, they are clumped together so needed a slightly larger punch
  • I hope this does not cause visible issues with respect to donor scarring
• I also opted for PRP 
  • This is a relatively new service Dr Bruno provides, I don't really believe in it for regrowth and neither does Dr Bruno but there are supposedly benefits from a recovery point of view so I decided to go ahead with it
• After initial extractions, Dr Bruno start implanting with implanter pens
  • The only assistance was from his 3 nurses who counted and sorted the grafts, Dr. Bruno did everything else by himself
  • With the implantations, I did have some "popping" just like @Rolandas so this round of implantations took longer and Dr. Bruno had to adjust his approach.
• I then had lunch (which was really good!) and then we did the second round of extractions at 14:45, followed by implantations again
• First day finished with 1451 grafts / 4059 hairs, mainly on the hairline (total ratio 2.78, slightly skewed due to the singles)
  • Extractions were easy but my back started aching from lying still during implantations, so I did have to ask to stop for a few seconds so I could stretch, which was of course not an issue for Dr. Bruno
• Second day pretty identical 7.30 AM start but he started the surgery earlier as there was no need for shaving/photos etc
  • Again two sets of extraction/implantation sessions totalling 1750 grafts / 5900 hairs (ratio 3.37)
  • This covered the remaining areas up to and including some of mid-scalp
• I finished around 4PM and was given all the post-op instructions + post-op after care kit to take with me
  • After care kit includes:
    • Ice pack to apply to reduce swelling
    • Anti-inflammatory meds I have to take to manage the swelling
    • Set of soft sterile sheets to cover neck pillow/pillow case
    • Gauze (just in case it is needed)
    • Neck pillow
    • Full post-op instructions
    • Aloe vera bottles
    • Shampoo bottles
    • Saline spray bottles (NaCl 0.9%)
• I then made the final payment and secured my surgery dates for the second surgery (May 2025), and that's it really!

Grafts Breakdown

Day 1

Day 2

Total

Post Surgery

• The only complication I had was that I somehow scratched my head during sleep post-op first surgery day (before second surgery day) despite using a neck pillow (quite gutted about this!) and that lead to the loss of 8-10 grafts
  • Tip for others: Take a bath robe belt and tie your hands down if you are a heavy sleeper like me that likes to move a lot. I did this on subsequent days and had a great sleep without issues
  • As for the loss of grafts, Dr Bruno had a look the next day and reassured that everything else still looks good and he will touch these up at my next surgery.
  • I guess in the grand scheme it is no biggy and you probably wouldn't even be able to tell I lost these grafts unless I pointed out where it happened.
• Been applying saline spray every 30 minutes religiously and generously, already gone through 6-7 bottles but the clinic is 10 minutes by foot and they happily refill the bottles for me
• I've been applying ice pack to my forehead every 3/4 hours for 10 minutes and then just leaving it in the hotel room fridge freeze compartment, it seemed to have worked really well and I have minimal swelling, my forehead is still a bit engorged but it is reducing as the days go by
• I've had the donor washes done at the clinic on the 2 days post op, today is Saturday and they are closed so I had to do the wash myself, but it is pretty simple with the instructions and shampoo they supplied me
• Tomorrow will be my full head wash but I know exactly what to do and everything seems to be healing really well, my donor is looking great too from what I can tell
• I fly back Monday so I have just been taking it easy at the hotel and ordering in food via Uber
• I look forward to going home, maybe next time I would do a shorter stay

My Thoughts

• Dr. Bruno was very friendly and kind, and it is clear he is brilliant at what he does.
  • I have a USB microscope I brought along with me and I can clearly see how he has retained my native/diffuse hairs on the scalp and basically worked around them.
• Likewise his staff are some of the nicest medical personnel I have met, so caring and accommodating.
• Absolutely 0 regrets with the choice of my clinic, but of course only time will tell as ultimately what matters is the end result - I will keep this thread updated over the next 5-6 months.
• I am going to start the Dr. Thiago Bianco Leal protocol for dense packing - my surgery was not a a dense packing but I still think this protocol could be useful for me as I have a lot of diffuse hairs and I do not want to lose them. So this may help boost quicker growth and maybe also help prevent shock-loss.
  • This is all anecdotal obviously and there are no studies on this precise stack post-HT I am doing this at my own risk.

Photos

You can find pre-op and post-op photos in the subsequent posts in the following order: 

1. Pre-Op
2. Pre-Op Wet
3. Pre-Op Partially Shaved
4. Pre-Op Shaved
5. Post-Op

Edited September 7 by Ccd99

[Ccd99]

Photos: Pre-Op

[Ccd99]

Photos: Pre-Op Wet

[Ccd99]

Photos: Pre-Op Partially Shaved

[Ccd99]

Photos: Pre-Op Shaved

[Ccd99]

Photos: Post-Op

[Ccd99]

Attached a HQ video close-up from yesterday morning, you can really see how Dr. Bruno has implanted in between my native/diffuse hairs.

Diffuse Bruno Ferreira Surgery Day 2.mov

Also in the video, you can probably see I had a bit of fibrin exudate some of which hardened, that's why the saline spray is so important.

Furthermore, if you look closely you can see where I lost those 10 grafts - right in the middle of the forelock above the hairline - ironically this is where I already had a scar from childhood (nature finds a way?!)

Sorry for the lengthy post + photo dump but I hope this is useful for others who are considering Dr. Bruno Ferreira

Edited September 7 by Ccd99

[Hairwolf]

Great write up and you really had a Lazarus like comeback with the meds here. More power to you and look forward to seeing how this turns out 

[Eli_Avdikian]

Looks extremely clean. A very meticulous work by Dr. Ferreira as always. I am very happy for you man. Happy growing

[Eli_Avdikian]

Btw I just noticed the hair per graft ratio. What on earth man !? I am so jealous 😂

[Ccd99]

6 hours ago, Hairwolf said:

Great write up and you really had a Lazarus like comeback with the meds here. More power to you and look forward to seeing how this turns out 

Thank you! Haha, the meds have been an absolute game changer - cheers for the encouragement!

4 hours ago, Eli_Avdikian said:

Looks extremely clean. A very meticulous work by Dr. Ferreira as always. I am very happy for you man. Happy growing

2 hours ago, Eli_Avdikian said:

Btw I just noticed the hair per graft ratio. What on earth man !? I am so jealous 😂

Thank you, that is re-assuring to hear! Of course I am biased but the work is so clean, like when I look at myself in the mirror I see the scabs are slowly forming but they are absolutely minuscule and not clumped together - testimony to the precise work by BF and of course me spamming my head with saline 😂

Regarding the hair per graft ratio yeah I could not even believe it myself, apparently I have an abundance of triples and quadruples in my donor. If you take a look at the graft breakdown report and disregard the first extraction session on day 1 which was mainly for the hairline and therefore consisted of a substantial amount of singles, I have averaged around 3.3 which is absolutely nuts - fingers crossed this will translate into a good, dense appearance!

Edited September 7 by Ccd99

[Al - Moderator]

Congratulations on having the HT done. Good luck with the growth. You had a lot of 5+ hair grafts, so it should end up very thick and dense. 
 

[son2]

Great write up. Insanely nice donor. Did you ask what is the hair diameter?

[Ccd99]

2 hours ago, son2 said:

Great write up. Insanely nice donor. Did you ask what is the hair diameter?

Thank you! I did ask and he was going to check and let me know as they took samples of my donor area, but then I forgot to ask again - I will bring it up via email to see if he remembers.

When I did my consultation last year he eyeballed it and suggested it is around the 60 micron mark, which is probably right? It's not fine hair for sure but it's also not the most coarse hair either, it might be slightly more 65-70 microns but I doubt it's any thicker than that. One of these days I may just invest in a micrometer and measure it myself

[Eli_Avdikian]

Dude, more than 60 microns is already pretty coarse😅

[Ccd99]

44 minutes ago, Eli_Avdikian said:

Dude, more than 60 microns is already pretty coarse😅

Really, I thought the average was around 55-60?

This study seems to indicate the typical scalp hair thickness range is 60-80 microns: https://pubmed.ncbi.nlm.nih.gov/12789162/ (as referenced by https://bionumbers.hms.harvard.edu/bionumber.aspx?s=n&v=0&id=114258)

I know beard hair is coarser etc, but I thought scalp was always finer

[Eli_Avdikian]

That may be. But you seem like you have straight hair. Over 60 microns is coarse enough for straight hair

[Ccd99]

29 minutes ago, Eli_Avdikian said:

That may be. But you seem like you have straight hair. Over 60 microns is coarse enough for straight hair

Fair enough, yes my hair is relatively straight. Don't get me wrong I'm definitely not complaining! Coarse hair + high hair per graft ratio should equate to good coverage then  

[arcobalenoeterno]

Amazing write-up! Congratulations on taking your first step, it‘s looking great.

I think it's generally a good decision to stay a few days post-op, I did the same. The first days are the most important for the overall result, so you should be extremely careful with everything you do. 

[Ccd99]

54 minutes ago, arcobalenoeterno said:

 

 

Amazing write-up! Congratulations on taking your first step, it‘s looking great.

I think it's generally a good decision to stay a few days post-op, I did the same. The first days are the most important for the overall result, so you should be extremely careful with everything you do. 

Thank you very much! How is your progress going? I look forward to seeing your updates!

[arcobalenoeterno]

I guess everything’s going according to plan. Nothing much happens, I’m in the middle of the shedding phase now and have lost it all 😄

 

I’m pretty optimistic that you’ll see an incredible transformation next year. The amazing results you’ve been getting from the medication, combined with both procedures, are likely to make a huge difference for you!

[GeneralNorwood]

Good write-up. Follow. 

[Gatsby]

This is an excellent write up @arcobalenoeterno. Excellent donor management and you have gone to one of the best. Happy growing! 👍

[Ccd99]

Thank you @GeneralNorwood @Gatsby!

6 hours ago, arcobalenoeterno said:

I guess everything’s going according to plan. Nothing much happens, I’m in the middle of the shedding phase now and have lost it all 😄

 

I’m pretty optimistic that you’ll see an incredible transformation next year. The amazing results you’ve been getting from the medication, combined with both procedures, are likely to make a huge difference for you!

Glad to hear! I guess that was to be expected, we all hope we might be that 3% that does not shed but unfortunately the shed happens

Thanks for the encouragement!

[Myles23]

Excellent write up @Ccd99. Excited to see how this develops.  donor looks impeccable.