Welcome 2022

It’s time to say hello to 2022. To look forward, to build upon 2021 and to set course for the coming year.

I’m very pleased with how 2021 went for us. We did excellent work, we helped so many people and we continued our evolution into the best that we can be. I feel proud and accomplished for the team we have, the diligence we put into each case and the care and attention we give to each patient. We still want to be better though. Reduce response times, make patients feel even more at-ease and supported. I think we’re already very good at it, but I see ways in which we can improve.

As far as results, I am well-aware that we’re getting amazing results that me, that team and - most importantly - patients are very happy with. But I still see things I want to improve and there are always ways of achieving better and more. So I’m working hard on that.

I think we added some really great members to our medical team, who will be crucial going forward. I think efficiency has also improved. But, as I’ve said, there are still ways to go.

As we move in to 2022 with the whole year booked, we must also look to 2023. And I have some great ideas for 2023. You’ll hear about them soon. As for now, we’re focused in treating each patient as the most important person in the world when he is in our OR. Everyone is supposed to feel like a VIP. That is intentional.

This year, we’re going to continue improving our online presence and making our digital resources more useable and helpful for patients and non-patients. Improving efficiency and our ability to offer quicker turnarounds for new patients.

I wish everyone a prosperous 2022. We’ll see each other very soon. Until next time,

Reflecting upon this year’s ISHRS World Congress

I guess I just repeat myself a lot when talking about these meetings, but I have to say it every time: the ISHRS World Congress is always amazing for me! I just love it. You get to see your friends, hang out and talk about hair the whole time (but not just hair, of course). There are a lot of discussions, ideas and “pearls” floating around the whole time. It’s just a privilege and I’m so happy that I get to be part of it all!

This year was special for me. The congress was held in my home country - Portugal. And I got to be the go to guy (or one of them) for my friends to find cool places to visit and stuff to do. Actually, some are still visiting as I write this. There’s just this pride I take in sharing my culture and our way of life with people from around the world. I can’t get enough of it. 

April 25th Bridge by night.

There’s of course, the “elephant in the room”, i.e., COVID-19. 

Yes, this was a smaller meeting than usual due to a lot of us not being able to come, but also an awesome win for us since we were having trouble figuring out if we’d be able to do it when we first started discussing it. Fortunately everything went without a hitch and I’m happy to say that there were no reported incidents during the meeting. A lot of work went into planning and I’m delighted with the result.

Respecting safe distancing. It was a very big auditorium with lots of space.

I had the honor of being part of the scientific planning committee and sharing my thoughts and ideas, as well as offering my help and collaboration in what I could be of assistance. Of course, being a local and Portuguese native allowed me to get quick updates, especially about COVID-related rules and guidelines. But I must say that Melanie Stancampiano, the Programs Director did such a good job that that made me almost redundant. Haha 

During out panel discussion. Left to right: Dr. Washenik, Dr. Nader, Dr. Zontos, Dr. Harris and myself.

Scientifically, this was a super interesting congress. Dr. Marie Schambach, Program Chair, did a stellar job and there were a lot of insightful moments with great interactions. She’s a great doctor who has brought a lot to the scientific community, thus she had set her own bar pretty high. And she totally nailed it! Congratulations to her.

I’ll talk more about the news in the scientific part of things in a later post.

As for me, I played a small part this year in the discussions as a panelist. They always feel too short when you’re up there and you always want to do more. But that’s how it goes. Time is of the essence and we need to keep the “show” on time. Needless to say that I’m super happy about the invitation and I hope I brought something useful to the discussions with my contribution.

The customary “poster” photo with myself, Dr. Pinto, Dr. Junior and Dr. Costa

And of course, it was fun! I spoke to many great people and I made new friends and acquaintances during these days. I really appreciate those of you who took the initiative of coming to introduce yourselves to me. I am honored that you enjoy my work and I hope I’ve offered something useful to you in our chats.

We also got to share some “quality time”, going for dinner and drinks. Being it “hittin’ the town” (;D), at the cocktail reception or the Gala Dinner. It’s so much fun! I sometimes almost have to pinch myself to believe that this is my life. And I’ve missed this. I’ve missed it a lot…

And now, I’m taking a couple days off to relax a bit. But I am super Pumped to get back into that O.R. and smash some amazing results for my patients! Got some amazing ideas out of this meeting (all written down of course) and you’ll be benefiting from those really soon.

Until next time,

PS: Oh, and look at how skillful these doctors are! :P As pointed out by Dr. Mejia, here’s a before and after:

Before

After :p

ISHRS World Congress - October 21-23, 2021

Traveling to Lisbon today for the ISHRS World Congress. I've been going to these for a while now. And this time I get to be a bit of host in my home country. :) It's an honor to have many of my esteemed colleagues with me in Portugal. Unfortunately, many could not make it due to the pandemic but will join us online.

I'm excited with the topics we're discussing in this year's program and hope to bring you some interesting updates from the world of trichology and hair restoration surgery.

I'll also be part of the discussion panel for the "Best Practices During a Pandemic" session, hoping to provide a valuable and helpful contribution to it.

Tonight I'll be at the ISHRS Presidents’ Leadership Reception where I hope to meet old friends and enjoy reconnecting offline. :) And tomorrow it's an early rise for the first General Session at 8:30.

Pumped for this!

The World’s Top 25 Hair Transplant Surgeons: 2021 Edition (by ApetoGentleman)

Men’s grooming blog ApetoGentleman have released their Top 25 Hair Transplant Surgeons list for 2021, and I’m very pleased and honored to announce that Spencer Stevenson, the writer of the list (more commonly known as Spex Hair) has considered me and our work to be amongst what he considers to be the Top 25 in the World. 

This came unexpectedly to me as I was not aware that he’d been following my work closely. So it was in fact a pleasant surprise. We did a quick video interview that we released last week, and now I wanted to write a bit more about it in the blog. I have been aware of Spencer for quite a while now. Whenever I had time, I listened and watched Spencer Kobren’s Bald Truth Blog as well as Spex Hair/Bald Truth UK little after I started working in this field. I was aware of his story, which unfortunately is similar to many that I’ve seen in my office over the years. He had his first hair transplant at the age of 24, with a terrible outcome, making him have to work over many years (around 15, if I’m not mistaken), learning, researching until he was able to find a good doctor, able to help him and finally set him on the right path.

I quite admire that he took what he learned and decided to share it with others, helping them find skilled and reputable surgeons, avoiding a similar fate as his.

Once again, I’m quite happy that my work has been of the high-quality and standards required to find its way into this list. I strive to be a better surgeon every day, and I do have an amazing team. People who work very hard and diligently every day. Together we produce amazing work, of which I am proud of. Thank you!

I’d also like to thank our patients. They are the ones who allow me to do what I love every day. And of course, I’d like to thank Spencer. For keeping aware of what goes on in this field, for helping others find solutions for their hair loss, for taking enough interest in my work to consider me for his list.

You can watch the video interview here

Hair Transplant Repair Surgeries are Challenging but Rewarding

Repair work has always been a frequent part of my practice. However, I’d say that in the last half-decade, it has become increasingly more frequent. Unfortunately, the amount of people getting procedures done by inexperienced, unethical, or just plain bad and scammy “professionals” is still on the rise. I believe that this is a lot due to misinformation. Something that we all (myself included) should play a part in combating. I definitely intend on making more and more strides in the direction of bringing good, honest and trustworthy information to the public, so expect to see some new segments and resources from us on that.

That being said, that is not the purpose of this post. The purpose of this post is to talk a bit about hair transplant repairs.

First of all, I’m completely and utterly dumbfounded by the amount of disregard for human dignity, anatomy, physiology, aesthetics, ethics and common sense that I see on a weekly basis. Some of the stuff I see, you couldn’t make it up. It’s that bad.

So a lot of the times, my job is to find a way to fix these proverbial train wrecks. It’s something I really enjoy. I’ve always loved solving puzzles, fixing things and being creative in my solutions. So it gives me an opportunity to really flex those muscles and put all my knowledge and experience to work. 

Sadly, it’s also heartbreaking… To see patients who were already suffering from their hair loss, put into an even tougher position, not only psychologically, but also making it harder for them to achieve the results they were looking for in the first place. Sometimes, a goal that would take a quick and small procedure to achieve, becomes a multiple procedure repair case.

And socially, it’s harder to be a bad transplant case than to simply be bald. Because everyone will look at your unnatural hair transplant result - and they may not know what’s up, but they’ll see “something is wrong”. You see, humans are very good at picking up on “off” things about others. Even if it’s just subconsciously, we pick up on it. And they may find themselves having their look deviating to the other person’s hairline, but not really understanding what’s wrong.

On the other hand, if you suffer from baldness, you’re just another hair loss sufferer along millions of other hair loss sufferers. There is nothing inherently “wrong” going on. There is no dignity lost in hair loss.

So, why are repairs harder?

For starters, the approach is completely different. We’re starting from a point of disadvantage. So, the initial assessment is different. I have to have a good look at the patient’s result, take a detailed medical history, know more about the details of the previous surgery or surgeries (sometimes they have none!), take a close look at the donor area with microscopy and understand the patient’s wishes going forward. This is one of the reasons I sometimes require repair patients to come for a live consultation. There are things which are impossible to see even with good photography.

After that, I design a plan for the patient. This can include multiple procedures, medication, hair removal, etc.

I’d like to talk about 5 of the most common challenges of repair cases:

Challenge #1 - Donor Depletion

This one is basically the worst thing you can show up at my office with. If your donor area has been depleted, then where am I to find the “building blocks” to restore your hair? When you can already see little hair in the donor area and you clearly see the scalp from 5 meters away, even with longer hair, we’re in dire straits.

But wait! There may be a silver lining: a lot of the times, there is laziness involved in the harvesting process. Well, not only laziness but also inability. So we can (more than a few times) find some areas which are completely untouched. Big Thumbs Up!! Of course, these may not be enough for our repair and we may need to get more hair from the beard area or, dare I say, body hair (not a fan).

I’m still able to go in on a lot of depleted areas and strategically get grafts that won’t change the coverage or the anatomy. I sometimes have to really explore and expand the donor area, so my anesthesia is required. I also have to use more punches (don’t worry, nobody is hitting anybody :P) as there is sometimes fibrosis in the donor area.

Unfortunately, patients with heaver donor depletion are the repair cases I more frequently have to consider not a candidate for surgery. 

Challenge #2 - Fibrosis

This is a nasty one. Bad technique, misuse (and bad selection) of instruments, poor diligence and poor care lead to lots and lots of scar tissue. The worse the care given by the surgeon, the more scar tissue the patient will get. And the more scarred your scalp is, the less quality your skin will have, the harder it will be, the less elastic and accommodating it will be, the less blood flow it will have. You know what that leads to, right? 

I was going to say “poorer survival”, but I will begin by saying that it leads to a super hard surgery where I want to tear my own hair out!! Ha Ha

It’s not that dramatic, but it’s true that fibrotic skin has a lot higher risk of heavy popping during implantation. It also makes me burn through my implanter needles much quicker, making me have to switch them more often.

Challenge #3 - Bad hairline design

Pretty self explanatory. Sounds like a simple thing, but it’s one of the worser ones to fix, since a common issue is that it’s not only poorly designed, with heavy asymmetries, deliberate sawtooth patterns, weird shapes, etc. but also it’s too. Damn. Low!. Look, I love cars and I love fast cars. But if you also love cars, you’ll quickly agree with me that lowering a car a bit is cool, but lowering it a lot, that just starts to look comical. Same thing with hairlines. The natural anatomy of the face must be respected. There is room for improvement. We don’t need to make it exactly as is was natively, but we shouldn’t lower a hairline 4 centimeters when it was originally 7 centimeters high.

I think this image makes my point perfectly. Credit: Clickhole.com

Challenge #4 - Bad graft placement

This goes in tandem with the previous item. And I see this one so often.

As you may be aware, follicular units may have more than a single hair. As a matter of fact, most of them have more 2-4 hairs. But the hairline is almost exclusively built (natively) with single haired follicular units. So why do I see 2, 3 (even 4!) - haired follicular units in hairlines. Yes, it’s true that a couple of double-haired units may appear in the hairline natively. But not a hundred of them. And certainly not triple-haired ones.

Another common issue is when grafts are placed in a pattern. Humans are also really good at picking up patterns, and we’re also good at building them. I see this a lot. 

As in most if not all things in nature, native hair doesn’t distribute evenly and equidistantly. Hairs are not supposed to form an obvious pattern. And yet I see this so frequently. Jagged hairlines with perfectly formed triangles, perfectly straight and aligned supermarket isles of hair, shapes that look like crop circles, and hairs distributed so evenly that you’d think some kind of template or robot was used. 

I understand it’s hard not to fall into patterns. It’s really easy for your brain to subconsciously find patterns for you. So I actively check myself for this when I’m implanting. If an obvious pattern starts to form, it’s very important to break it.

If the hair is sparse and the hairline sufficiently high, then it’s not too difficult to fix this.

Challenge #5 - Bad graft angulation

Another make or break aspect of any hair transplant. Understanding that there is a certain angulation that hairs in different parts of the head must have is crucial for naturalness. In some cases, hairs are so terribly “out of wack” that I have no choice but to remove them. If it’s something that I can work around, I will. Removing an enormous amount of grafts leads to that dreaded scar tissue we don’t want (plus we want to keep those hairs), so you have to weigh if you can make it work like that and disguise the bad angulation. It’s never the same as originally planting hairs in the correct way, but it can look good enough.

So there you have it. Repairs are difficult and time consuming. They require a lot of planning and critical thinking. It’s a very bespoke and detailed approach, with some improvisation needed as well. 

Sometimes it gets worse before it looks better, but in the end they can be very rewarding. Patients who were desperate and depressed about their hair, start to see the light at the end of the tunnel and in the end they finally get to the result they were hoping for in the first place. You can really tell how happy they are. I find it amazing how these patients can get over their bad transplant, not beat themselves up too much about it and even forgive the doctor/clinic who made them go through all of this. But that’s really the best way to go about it. “Let the past make you better, not bitter.”

Until next time.