3382 FUE - Lupanzula
I wanted to share my recent experience with Dr Lupanzula in Brussels. I've benefited a lot from reading people's experiences and watching their surgeries mature over the years before choosing to take the plunge, and in turn I hope somebody will find mine helpful. Thank you to Dr Lupanzula and team, and I want to give a shoutout to Mickey85 and Joe Tillman. Both have helped me tremendously over the years when I was researching HTs and helped me with my decision. I will follow up with pictures soon.
After arriving from Brussels, I took a cab to the Hotel Catalonia (didn't want to bother with public transport). I had thought the hotel's name sounded familiar, as it turns out, it is directly across the street from Dr. Bisanga's clinic (which looks a little bit like a castle). So it's nice that they regularly get HT patients. The hotel is affordable, and in a nice area.
The surrounding area is very picturesque, very old world, and not heavily populated. Most people speak English well, so you can get around. The main language here is French, and it's helpful to know it. But you can get by with English. Near the hotel there is a Chez Frances restaurant for breakfast, and a nice Thai place called Thai Cafe. I chilled in the area for a day before heading to the clinic.
The clinic is about a ten minute walk directly south from the Hotel Catalonia. Upon entering, I was greeted by the clinic's patient coordinator Giancarlo. Giancarlo is fluent in multiple languages. The clinic has a very modern design, very "Bauhaus", with plenty of white, and clean lines throughout.
We then met with Dr Lupanzula. He looked through my donor and recipient, and went over my family's history. He noted that while the area to cover was significant, I was a good candidate for a few reasons: 1) Good donor hair - coarse, wavy hair that aids in the illusion of coverage. 2) Darker skin, which reduces contrast, and 3) A good number of multi follicular units. He snipped off hairs to measure the shaft caliber. Then he shaved my head.
I admittedly was not looking forward to this. But it was a good idea, not only does it save time the next morning, it puts you in the "zone" mentally for surgery. What's more, I decided that a shaved head, while not the best look, wasn't the worst one either for me, so it's good to know. Post shaving, he measured my donor density under magnification, with the parietal areas having just below 100 grafts/cm and the occipital around 110. He estimated that my donor capacity, if we harvested 30%, would be around 7,000 units, and if we harvested 40% (which would be on the border of over-harvesting), about 9,000. All in all, he considered me a good candidate.
He drew a hairline, which I was fine with. I wanted a conservative hairline, but at the same time we still want to make a visual impact. The plan was to harvest and implant most of the grafts on day 1, with the hairline to follow on day 2.
Day 1 began early, since you're supposed to eat before, I grabbed some croissants from a bakery right across the corner that happened to be open at 6:30am. The Dr gave me the meds and it was time to roll. After changing into hospital scrubs, he gave me anesthetic injections in the back of the scalp. Btw, I knew anesthetic injections were the most painful part of the surgery, and it was true, I found them to be very painful, and they are required multiple times throughout the surgery as a different area is operated, either for harvesting, or implantation. Then again, they are obviously required, so there is no getting around it.
Dr Lupanzula uses a a CIT handle manual punch to score grafts. He harvested grafts from the back and sides, one after another. He has a distinctive punching motion where at the end of the forward twisting motion he pushes in the tool slightly, which was noticeable. Afterwards, the grafts were plucked out. This is a weird feeling, you feel a slight popping sensation, similar to how a grape or a berry is plucked off the stem.
Keep in mind, you have to stay very still during the procedure, and notify the Dr before moving. Staying still can get difficult when the parietal areas are being harvested because you are lying on your side.
The team inspects the grafts under microscope and prepares them for re-implanting. Grafts are stored in ATP Hypothermosol. After harvesting we had lunch. The clinic eats lunch together in their break room, which is nice. Everybody in the clinic speaks English, so language is never a problem.
Two steps to implantation, recipient site creation and placement. After anesthesia, the doctor used needles to make incisions. This is an interesting process. He moves very quickly in creating the incisions. There is a lot of power, and you can feel the fibrotic scalp being punctured. Given the speed and power, it feels powered by a machine, but it is manual. This process is actually surprisingly pleasurable. Who would think that having 2-3,000 holes poked into your scalp feels good, but it does. Patients who have been operated by the implanter pen also report the same thing.
Afterwards, his team places the grafts. This last part takes time. Afterwards they had me bandaged, and I was off to the hotel at about 6pm. Afterwards, I sprayed my grafts every 15-20 minutes with saline.
This day was going to be shorter by design, as 2K grafts were harvested on Day 1 with 1K to follow. The same process followed as the day before, however we were done earlier. Then the clinic bandaged me up and I headed home.
Day 1 Postop
Day 1 was the first clinic hair wash. His wife, Sandra washed my scalp, spraying Betadine shampoo on both donor and recipient, and massaged the donor vigorously, and then applied an antibiotic creme to the donor. This is to be done everyday for the first 7 days (which I have done) and afterwards the recipient site should be gently massaged after applying Betadine shampoo.
The clinic had a driver take me to the airport afterwards for my flight. I had originally chosen to fly immediately to avoid traveling while swollen, but I didn't experience visible swelling, in retrospect, I would have stayed in Brussels longer, just to give my grafts more time to set before moving. The flight was fine, and to note, it was not uncomfortable or painful to fly after surgery. I had a neck pillow to prevent the donor area from touching the seat rests. I wore a bandanna outside, but took it off when inside the plane, and regularly sprayed with saline.
I have finished 1 week postop, and the clinic has remarked that all looks appropriate.
Total Grafts: 3,382
Hair caliber: parietal/temporal: 55-60 mic., occipital: 60-70 mic.
Density: 45 grafts/cm in outlined area, 40/grafts/cm behind it.
Medications: Finasteride and Dutasteride alternated daily, Minoxidil Foam 1x day.
Great write up, KO. I couldn't remember the name of the Thai restaurant but I remember it being really good
Your donor density measurements are above average but do you recall what the hair shaft diameter measurements were?
Thanks Joe, the name of the Thai place I went to was just called "Thai Cafe" off the intersection of Ave Brugmann and Chausee de Waterloo.
My hair shaft diameter was 55-60 on the parietal donor and 60-70 in the occipital. So about 60 microns is probably a midpoint.
Attached is the Day 21 image. My native hair is growing, not the implanted hair though, and I believe they will shed soon.
Those numbers for your hair shaft diameter are healthy, much better than mine. This latest photo is interesting. Do you feel you've shed very much? It looks like you shed some but overall it looks like you've hung on to some of the grafts in the front.
Yeah, this is something I'm concerned/curious about. When I look at most experiences, they typically look "cueball" bald at the one month stage or maybe two months. I'm seeing moderate shedding but not a crazy amount, with many implanted hairs persisting, but lying flat against the scalp. I tend to be very gentle with the implanted area and gently pat it with shampoo while washing instead of rubbing....do I need to be more aggressive?
Before I got to the end of your post I was guessing that you were being too careful with your grafts. At this point you can wash your hair with the normal pressure and vigor you would have before your procedure. In fact, this was the case two weeks after your procedure. By all means confirm with Dr. Lupanzula but I have seen this many times. There is a case to be said for the grafts taking root (so to speak) and growing without shedding as I've seen this as well and it tends to be the case more often with the use of Hypothermosol but you should be careful not to be too careful, if that makes sense.
Originally Posted by KO1
Keep us updated.
Ok, I understand, I was super gentle with my hair even before the transplant, so this is my normal routine, but I'll be more aggressive with my hair.
In the following video I originally showed how vigorously I wash my own hair, but it was edited out for time considerations. But afterward you can see how vigorous I am with towel drying. This is about as vigorous that you can be while washing and drying as well.
Originally Posted by KO1
OK. Good call, went aggressive today, and many more hairs came out. So "too gentle" is a thing to watch out for.
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