10 month - Follow-up visit to New Age Clinic

I'm just back from a few days in Istanbul and thought it was only right to visit the clinic for a follow-up appointment. Although Dr Ilker said he cannot really evaluate me properly until 12 months is up, he did have a look at my hair and could see the progress so far. Particularly when you look at the 'before' photos they took you can see the difference.

Mixed feelings about my visit; the surgeon told me I'm still losing hair from the middle third of my head which is a bit disappointing. He said to keep taking the propecia to slow it down, and encouraged me to give minoxidil another try (it has given me headaches and 'brain fog' before). I was also concerned that my scar is uneven but he said that it's pretty even all the way along and isn't abnormal (though not the least visible). Concerning the slower progress of the hair towards the back of my head, he explained that there is less blood-flow here which means hair takes longer to grow. Finally, if I want to go back in again I can do this any time after 1 year from the original procedure to concentrate on the vertex or clear up any other areas I'm unhappy with.

This photo doesn't really show the progress of the hairline, but does give a good indication of the result. 

9 Month top view (2)

this isn't the best picture but I feel like the top is thickening (slowly!)

9 Month comparison top view

Looks like my hair is thickening up slowly but surely. Although it's still pretty thin and you can see my scalp quite clearly on top, I think it is beginning to happen. I think I imagined by 9 months I would have a full head of hair but obviously still waiting for that point - now I'm prepared to wait at least one year or more for it to thicken up fully.

Here's a comparison shot showing the top view 6 months and 9 months after the procedure

8.5 Months (a week after a hair cut)

The 8 month mark came and went - still reasonably happy with the results so far but growth has not been quite as thick or quick as I expected. The back third of my head hair is growing, but it's taking longer than I thought it would. I keep telling myself it'll thicken up in time. I hope it will!

Overall I feel much more positive about my hair and the way it looks - in these pictures I feel it looks better than it does in the mirror! But then I'm usually under a light in the bathroom which is never flattering. At the least I don't think you can really tell from the donor area that hair has been taken from the back and sides.

Oblique view. If you zoom, you can see that the new hair still has some thickening up to do, but it's coming along. I'm happy with the angle of the hairline. 

Front view. I used to have a big gap right in the middle of my hairline. That's mostly gone although you can still see the hair is thinner (because it's all transplanted hair) under lights. 

View from the top - still thickening up (this is the bit I'm most anxious about) 

View from behind - hopefully when the top thickens this part will be less noticeable

Side view : can you see the strip scar?

Front hair line @ 7.5 months

Not much change really, but my hairdresser left the top longer this time which is a mixed blessing. Somehow the hair seems much finer when it's left longer. But I'm able to sweep it across so maybe it covers more baldness, I'm not sure. I'm still pretty happy with the front and just now waiting for the top / crown to grow in more. I keep seeing the new top hair (which is very fine) and saying to myself that it'll thicken up. Hopefully it will!

Fine hairs on top (7ish Months)

I'm starting to see more fine hairs on the top of my head - they're getting quite long but still quite thin and wiry. I'm hoping these are going to thicken up and cover the thin patch on top. If that's covered, I'm going to be a happy man. Maybe at 9 months it'll be better...

Top view, 3 month & 6 month comparison

The slowest progress seems to be on top, towards the back. I'm not sure if that's because the multiple-FU grafts take longer to grow or simply because the area was thinner initially. But anyway, encouraging to see some of the hairs are growing and thickening. At 3 months I had some new hairs but they were very fine indeed.

As it is those hairs are still very thin, so I'm hoping for more thickening over the next three months

An intermediary before/after hairline @ 6 months

I know the colouring is all a bit messed up, but you can see how I looked before and how the hairline has been filled in. It should thicken up even more over the next few months with any luck. 

6 Month Update

I said I would reserve judgement until 6 months, so here goes!

My position at the moment is : I'm happy with the hairline, even though a lot of the new hairs are quite wiry. The area further back on my scalp has not yet filled in fully, and I expect it to take a few months to thicken up. But I am seeing growth back there. Again, the new hairs are growing, but they're individual strands (from 2 or 3 follicular units), so I hope they will improve over time and reduce the visible thin patch towards the back of my scalp. 

In terms of how far back Dr Ilker went, I can see now that there's still going to be a thin patch on top once everything's grown in. But hopefully I will be able to hide it with clever styling or just plain old concealer (my crutch of choice). A different surgeon might have put fewer grafts in the front third (behind the hairline) and covered my whole crown, but what he did was probably a better long-term strategy. I can have the crown filled in at a later date once I've established how much more hair I'm going to lose. Hopefully the Finasteride will counter some of that loss, or at least slow it down. 

The main thing is to concentrate on the positives so far and not worry too much about how it's going to grow in later. I've had a few hair complements, which is amazingly gratifying! A friend who I'd told said her boyfriend noticed something different about me, but couldn't figure out what - and another who said they liked my 'new haircut'. 

I'm still self-conscious about the back of my head, but I think having an actual hairline is amazing! By the autumn hopefully it will all have thickened up nicely. 

Hairline closeup (5 months)

Took this a couple of weeks ago before having a haircut. You can see where the new hair is coming through and is still quite fine. Hoping it will thicken up over the next few months

Day 139 : Another haircut (this time with clippers)

Last time I had a hair cut I insisted the barber use scissors, because I was worried the scar would be visible. This time, I asked for a clipper cut on the back and sides - doesn't look too bad!

Hard to see the linear scar. I'm just starting to see a bit of hair grown on the top of my head (still very fine)

Actually, you really can't see the linear scar at all. 

The corners are coming along, but the hair is still thinner than the existing hair

I'm happy with the progress of the hairline :) 

My experience so far is that the hair at the front has grown much more quickly. Those single grafts started growing at around the 3 month mark, whereas the 2 and 3 unit grafts are still starting to come through now, 2 months later. It might just be that because my hair is so much thinner on top, the new hairs will have to thicken up before they make a big difference. But I can still feel tiny 1mm hairs coming through, so hopefully they will give me enough density to cover the thin area on top. 

Day 126 : 2 weeks post-hair cut

Slightly more hair coming through on the top, if I run my finger around I can feel little hairs sprouting. The front looks a bit better now, certainly the hairs in the corners are much  more noticeable. I think you can start to see where the new hairs are growing and where they will (hopefully) thicken up.

I had a hair cut about two weeks ago (scissors only) just to tidy up the sides and had a bit taken off the front top. When I told the barber I'd had it done, he just said "really?" and didn't seem at all interested! I don't think even he could find the linear scar from the FUT part of the surgery.

Day 110 : growing in slowly

It's difficult to say how much the new hair has grown in, because I've let the 'original' hair grow quite long - I haven't had the top cut at all since January. However, there is definitely signs of new hair grown at the front. And if I run my finger over other parts of my scalp where hair has been translated, I can feel little stubbly hairs growing.

I read that at by month 5-6, around 80% of the new hairs will have started to grow but will be fine and wispy to begin with. So I am trying to be patient! But at the front, things already are starting to look better.

You can see some of the new hair at the front corners. 

At the back it's less noticeable because this hair is much thinner.

Pleased to say that most of my original hair did eventually grow back. 

This is the part I'm most looking forward to see filled in!! 

No great improvement in this area year, but I can feel stubbly hairs growing 

From the front - I've let it grow quite long but you can see the new hairline trying to break through

How I'm feeling about it all... 3 months (ish)

After the procedure I felt on cloud nine for about a week. All that research, time, money and general effort finally paid off - I couldn't quite believe I'd actually gone through with it. Like a lot of others, I was a little disheartened to see the transplanted hairs fall out, and particularly annoying was the FUE graft sites looking a bit red.

It always looks worse to yourself than others. After 3 weeks, I was told by my friends that it looked like I'd had a bad haircut. I didn't mind that, so I felt I could safely go out without a hat. Actually one of the weirdly empowering things is that I don't care so much that I'm looking pretty thin on top when I go out -- because I know that it's going to grow in soon.

I always promised myself I wouldn't get disspirited, disheartened or be impatient. Unfortunately, it's really hard not to be! Unlike a lot of cosmetic procedures where the results are visible pretty much instantly, a hair transplant does take a long time to get going. Now that I've reached the 3 month mark, I'm pleased to see some of the hair growing in (at the front it's very noticeable) but I can't help worrying that the rest of it won't grow. It's stupid, I know - but I am worried about it. One thing I was worried about at the early stages was losing what existing hair I had had on top. So far most of that seems to have re-grown, which is a relief. So I look pretty much as I did before the procedure.

The reason it's silly is because I'd read so many people blogging about how they were worried it hadn't worked - only a few months in. I would scoff and think 'you need to wait at least six months', and annoyingly I'm having to do the same to myself! Hopefully in six months my fears will be set to one side; keep your fingers crossed for me :)

9 Weeks post-op donor area

I had a haircut a couple of weeks ago to try and even out the different length hair. The hair around the strip was a little longer, basically because the surgeon shaved the strip to be taken at a different length but (I think) did not take all of it.

Everything's growing back in the donor area and looks pretty much as it did before. Certainly a lot better than the 4 week update!

Above : how the donor area looks now. You can't see the linear or FUE scars.

And this is what it looked like before I went to Istanbul...

4 weeks after HT (donor area)

After four weeks, the donor area seems a lot better - and hopefully the untrained eye would have no idea I've gone through surgery. 

I have to admit that the FUE scars are more noticecble than I thought they would be (at least the ones towards the nape of the neck are). The FUE that was taken from above the FUT line are totally invisible and the hair seems just as thick as it always was. The hair has grown over the linear scar so you can't really see it any more. 

It should get better in time

Day 21 : Three weeks after Hair Transplant

Three weeks have passed since the operation. I'm feeling a bit nervous because I constantly worry that my original hair is not going to grow back properly. I am also still wearing hats in public, but my friends have told me that it just looks like I've had a bad hair cut. The FUE area hasn't healed quite as quickly as I had expected, and the growth back looks a bit patchy. However, it's still very early days (hard to believe) and I promised myself I would reserve judgement for at least six months.

Still a bit painful on the back of my head when I'm lying down on a pillow. And also there is still numbness in both the donor and recipient areas. I sent these photos to the clinic and the manager told me that everything looks like it's on track. And other good news- I'm allowed to start swimming in week 4. I've already started exercise at the gym, but nothing too strenuous.

Day 12 : Staples are out!

Initially the surgeon had said it was ok to take out the staples after 10 days, but it turns out that's if the clinic does it. Because I'm now back home, I have to go to the local nurse. I wanted to go private so as not to burden the NHS with my cosmetic/non-essential treatment. But having phoned round several places, none was very helpful nor close by. In the end I just went to my local NHS GP practice and it was done in about 20 minutes. A good thing, because I was flying off the same day.

I thought there had been about 15 staples. The nurse told me it was more like 50!

What does it feel like to have staples removed from your head?

It does sting a bit when they take the staples out, but it's a short, sharp pain. Just have to grit your teeth and think of how much better it'll be without those staples. Some of the tightness in the scalps is relieved when the staples are removed, too. Unfortunately it's still a bit sore when I apply pressure to that area (for example when my head rests on the pillow), but still better than having staples.

A tiny bit of bleeding, but not much. There was quite a lot of scabbing that I couldn't clean off before from where the staples were. However, these are easily removed in the shower. The staples left small marks, but invisible after a day or two.

Here they are! 

Day 10 : two days before staples are out

Here are some clearer pictures on day 10. Most of the redness has gone down in the recipient area, although there are still red punch marks where the FUE was done. The main thing now is realising that my scalp is still quite numb and that it may take two to six months for the sensation to come back. I felt a lot better after a bath on day 9, and scrubbing most of the scabs off the recipient and donor areas. It's also nice knowing that the grafts are secure now, so I don't have to worry about them coming out when I itch my scalp.

Day 8 : donor area

The donor area has been properly cleaned, and isn't looking so bad. I've shown a few friends who have all said that it looks sore but in truth, the only pain is when I wake up in the night and the staples are digging in because they're pressed against the pillow. The only other thing that's annoying is putting the hat on, and taking off jumpers. Basically it's because of the staples. The FUE grafts are itchy but not really painful.

In the recipient area, I've had a few instances of going for an itch and ending up with a graft under my finger nail (with the bulb attached), which is dispiriting. But you have to expect to lose about 10% because of this, and grafts not rooting properly. 

as someone who is rather impatient I am already finding it frustrating, but I'm pleased with the number of grafts achieved and the new hairline. Just have to wait for it to grow!

Day 3 : more pictures post surgery

A few more pictures, the swelling has gone down a bit more. No real pain during the day but I am still taking the one pain pill per day as prescribed. Scalp is quite crusty but avoiding touching  it. Donor area looks worse than it is! 

Day 2

Not much pain, although it isn't very comfortable sleeping with the staples digging into my scalp. Today is a dry day which means no washing, but on day three I have to go in and have my hair washed again At the clinic.

At least the swelling has gone down and I'm able to see more clearly where the grafts have gone. You can see from the second picture how far back Dr Ilker has transplanted the hair. Looks as if in the crown area there is more on one side, but this may be due to the direction of hair in the crown.

Istanbul Clinics for Hair Transplant

There are over 100 hair transplant clinics in Istanbul, although considerably fewer than that advertise in English and have an international marketing bias. I identified four to visit in one day, which all had a unique offering.




New Age Clinic :

No:11, C1-67, 34365 Fulya / İSTANBUL




Set up by three former senior Transmed people - two surgeons and a clinic manager, New Age provides a full suite of plastic surgery options but Dr Ilker Apaydin specialises in hair transplants and has been performing them for over fifteen years. Both surgeons are members of ISHRS

İlker Apaydın




Este World

Kısıklı Cad. No:33/1 Altunizade – Üsküdar / İstanbul




Dr Hamiloglu who is the main surgeon here also has a past life at Transmed and is an extremely experienced and well thought of doctor. The facilities here are impressive; a mini hospital serving I would imagine hundreds of patients per day. Emphasis here is on splitting the time of the surgeon across several patients each day (around 10 hair transplant patients per day), and allowing nurses to do the bulk of the work. You still get a consultation with the surgeon and he plans the operation, but does not do all the work himself. As a consequence, it's a lot cheaper.


FUE only clinic

www.esteworldinternational.com




Este Turkey

Having gained quite a bit of media exposure in Turkey, Dr Aslan operates from this boutique clinic in Osmanbey. It's stylish, and as a reciepient of the surgery himself, Dr Aslan does know what he's talking about. Again, this clinic offers only FUE treatment, and the surgeon prefers its less invasive technique. It also allows nurses to do more of the work which keeps the costs lower than others (though this is not the cheapest by a long way). He also takes an interesting approach which is to make sure patients do not set their expectations too high, which is to be commended.


Not to be confused with EsteWorld!

Este Turkey - Doctor Aslan - Hair Transplantation




Istanbul Hair Center

Although not a member of ISHRS (as far as I can tell), this clinic holds the record for the highest number of FUE grafts ever taken in one session from a patient. Obviously, there is a safe limit to what they would recommend, but performing hundreds of operations per year this clinic is one of the oldest and has considerable experience. Slightly cheaper than the others, you may not know which surgeon will be in charge of your operation until the day, and nurses or technicians will carry out most of the procedure. However, a typical package will include hotel accommodation and is extremely competitively priced.


Another quirk is the clinic's "guinea pig". The driver for the Istanbul Hair Center was offered free treatment in exchange for close monitoring of his progress. So the nice thing about this clinic is that you can be guaranteed of meeting a real-life patient and judging for yourself the results.

http://www.istanbulhaircenter.com/en

After surgery pictures

View from the front

And from above. The surgeon didn't bring my hairline down much, but went quite far back into the crown.

A shot showing some of the FUE and FUT work on the back of my head. 

The strip closure is stapled together for 12 days. 

Day 1 : First washing

Day 1 and I went into the clinic for the first washing. This was done by the nurse for me, and without the use of any shampoo. Because grafts are easily detached from the scalp in the first few days it's important to be very gentle. Nothing can touch the recipient area (within reason), the donor area can be shampooed properly after day 3.

The exciting thing was finding out how many grafts were extracted and transplanted. Initially on the morning of the surgery Dr Ilker had told me that he could expect at least 3500 and maybe up to 4500. The more we could get, the further back he would go in my crown - starting at the hairline and working back. In the end, we got almost 5000 grafts!

Even better, most of the grafts were two or three hairs. Meaning a total of 11990 hairs. Not bad for a day's work! And Dr Ilker said he'd left quite a lot of area free at the sides for further FUE if necessary at a later stage (certainly not before 1 year).

Swolen head! White bandage was taken off on this first day, and from then on I wore the black headband to reduce swelling moving further down my face.

Day 0 : Procedure Time (Part 2)

Just before lunch, and while the nurses were working on dividing the grafts from the strip, Dr Ilker started creating the holes or channels where the grafts were to be implanted. The needles were sharpened (I watched as he did it), and shown to me - everything was explained to me as it was happening.

I forgot to mention the music! This is maybe a silly thing to mention, but during the procedure Dr Ilker played some really cool music. One album of Leonard Cohen covers, a live one of Julia and Angus Stone and some other cool stuff- it really made me feel relaxed. We also shared a few jokes about this and that.

The channel opening took about 45 minutes and was preceded by more anaesthesia being applied. Again, quite painful but it obviously meant that there was very little pain when the channels were being made. It sounded a bit like crunching snow. Any time I felt a sharp pain, Dr Ilker applied more local anaesthetic which helped.

After that, I was cleaned and sat up gradually - then given a plate of BBQ chicken for lunch and watched something on my iPad. Lunch lasted quite a bit longer than I thought it would have done, but there was a lot of work to do and the nurses needed to take a break, too.

Mid-way through the lunch break I started to get quite bad pains in the back of my head and felt a bit unwell. I told the nurse, who immediately gave me a painkiller. I don't know what it was, but it kicked in and within half an hour I was fine again.

Planting the grafts is a long and laborious process and took three nurses over three hours to complete. Later that day I found out I'd had almost 5,000 grafts implanted-  the second largest procedure ever carried out in that clinic.

It was painful from time to time - I guess because the anaesthetic had worn off in parts over the lunch break, but they were ready to apply more to my scalp whenever I wanted it (itself quite a painful thing, I have to say). Eventually at 1930h we had finished.

I nearly fell off my chair when the nurse said to me, "just one more injection". Having had so many through the course of the day, that was the last thing I wanted. At least this one was on my bum cheek, and -though somewhat undignified - didn't hurt nearly as much as the others. Taner told me afterwards that this one was a way of 'making you forget about the pain of the day'. It didn't do that, exactly - but it was probably some kind of morphine derivative.

I was given anti-inflammatory drugs, antibiotics, pain killers, shampoo and some moisturising foam. Oh, and another 10mg diazepam. My head was bandaged, and I was bundled into the car and taken home. It was a long day but, I hope, worth it.

The following days were pretty pain-free. I'd expected to be flat out on the sofa watching rubbish films, but I was able to work and concentrate really easily, without any pain. The clinic had drawn out a day-by-day schedule of drugs and coming in for hair washing, which I stuck to religiously, even though I didn't feel I really needed the pain medication. Everything was really clear, and despite having a head full of scabs, I was very pleased I'd gone through it all. 

Day 0 : Procedure Time (Part 1) - FUT and FUE Extraction

I didn't sleep too badly the night before, the main thing I was worried about was waking up on time. The driver was scheduled to pick me up at 08.30h and was there waiting when I went downstairs. We'd booked an apartment near to the clinic which meant it was only a five minute drive.

As with every time I've been to the New Age Clinic, my mind was put at rest immediately by the charming Clinic Manager there, Taner. I read and signed some papers, consenting to the procedure and to acknowledge my understanding of what was going to happen, the possible risks and benefits. Then I was given a 10mg diazepam.

After some initial photos were taken, my hair was dyed (to make it easier to see transplanted grafts), and before I knew it I was face down having the local anaesthetic applied. Dr Ilker does this himself, as well as the graft extraction, trycho closure and opening of the channels. What I liked about this particular clinic was the amount of time you get with the surgeon. In many of the other clinics I visited in Istanbul, a surgeon will plan your procedure but not carry it out personally - or perhaps will carry out part of it, but not all of it.

For my initial consultation by the way, Dr Ilker explained that he'd been carrying out FUT procedures for the last fifteen years. And because he's a member of ISHRS, I had confidence in his ability. Not to mention the many before and after photos I'd been shown, and the offer to speak to previous patients in my own country.

Back to the procedure. The first bit HURTS! Injections can be sharp, and my heart started racing. Dr Ilker assured me that was fairly normal (I've since read that there is an adrenalin substance in a lot of anaesthetic), and the nurse held my wrist to monitor my pulse. After I'd settled down a bit, the first part was to remove the strip. This had already been indicated and shaved to a different length by Dr Ilker earlier in the morning. This part didn't hurt- it felt like someone drawing a line with a pencil over my skin. Being face down you don't see anything.

I'd also read that the closure technique can smell bad, but this wasn't my experience. After the strip was removed, the FUE grafts were extracted. This didn't hurt either really- just a gentle buzzing/vibration feeling. I actually dozed off a couple of times, waking myself up snoring! Actually, the most uncomfortable part was having my face squeezed through the pillow with a hole in it.

Extraction complete, and end of stage one!

Extraction done, in my scoop-neck gown (!) before the top of my head was shaved.

The three nurses, starting work on dividing the grafts up for me.