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. 

FUT, FUE or Both? Why I chose a combined procedure

Like most guys, I was initially attracted to the idea of having a purely FUE procedure because of the claims of minimal scarring and quicker recovery times. But after seeing www.greathairtransplants.com I realised that an FUT procedure doesn't necessarily mean bad scarring. Because closure techniques have advanced so much in recent years, modern linear scars aren't nearly as bad as they used to be.

Trichophytic closure is a technique that trims the bottom layer of the wound and then tucked under the other edge. Take a look at this diagram :

Click to enlarge

(from feriduni.com) 

The FUT or strip method also has other benefits including fewer transcepted hairs, and a higher yield in terms of area used. 

But FUE still held some appeal for me. 

Then I found a clinic that could provide both techniques in a single session, yielding the maximum possible number of grafts. Whereas I was quoted a maximum of around 3000-3500 grafts if I went purely down the FUE route, with a combined FUE and FUT procedure at the New Age Clinic in Istanbul, I was expected to yield around 4000. 

Having given it a lot of thought, I decided to go for it. This solution gave me three things:

1) A high yield of grafts the first time

2) A fairly conservative FUE approach which would allow further harvesting later if necessary.

3) Trycho closure meant I had fewer worries about FUT scarring.

My before photos.

A few days before my procedure I had some pictures taken, to show you what my hair was like before. Usually I kept it short, and in the last two years had been using Caboki almost everytime I went outside. These days though, I wasn't wearing any concealer and also I hadn't had a hair cut for about 6 weeks.

The main problem areas for me are the crown, the temples and the frontal hair line where I'm missing a big chunk right in the middle. It's very annoying! I can use a lot of concealear to mask most of it, but after a lot of research (including a trip to Istanbul to meet a few surgeons) I decided to go for it in January. 

when I first started looking at a HT, I imagined I would need around 1500 grafts. But after sending my photos to a number of clinics, they told me that the problem was probably more serious than I thought. Judging by what other people have written online, it's fairly normal to assume that you need fewer grafts than you do - I suppose I was in denial about my hair loss. 

Side view. I have been told that my donor area is 'average'. I would describe my hair-loss as a NW6, with the potential to be NW7. Obviously I haven't lost all the hair on the top of my head yet, and I am taking Finasteride to minimise the risk of that, but I do expect to in the future.