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Combined FUT/FUE, 4,244 Grafts (9,601 hairs) January 2024, Norwood 5/6 Diffuse - AEK Clinic Istanbul Dr. Ali Emre Karadeniz, aka Dr K.

Fred2023

Fred2023

member
Hello Folks,

This is a log of my experience with AEK Clinic in Istanbul, which I hope others considering AEK will find helpful. I hope to provide periodic updates of my journey for the first 12 months and perhaps a final 18th-month update.

The cost was €6,500, including airport transfers and accommodation (including breakfast), but not including flights and other sundry expenses such as medical insurance, meals, neck pillows, etc. My goal was not to get a ‘cheap’ transplant but rather to get better value for money, i.e. the same quality that could be achieved locally but at a reduced cost that would suit my budget. I, therefore, opted for Dr Ali Emre Karadeniz (Dr K).

Overview:

AEK is a small boutique hair clinic run by Dr K. Being a small operation. Dr K is a plastic surgeon, Fellow of the International Society of Hair Restoration Surgery (ISHRS), and American Board certified who has been practising hair surgery since 2010.

The clinic is modern, secure, and clean. The team was friendly and welcoming, and you were treated as a patient, not a number. The clinic has 3 (perhaps 4) operating rooms, but there were no more than 2 patients in total on any day for the four days I was at the clinic. Overall, I observed appropriate hygiene protocols. In addition, the toilets were clean. The canteen was clean, and the food provided was tasty and substantial.

The FUT scar looks good, and I have experienced no pain, scalp tightness, facial swelling, or infection and have manageable itchiness. One cause for concern I have is that there were fewer grafts transplanted than AEK forecasted as being required to give the desired density (AEK forecasted 5,000 to 6,000 needed versus 4,244 actual). However, they advised that ‘there was no room in the transplanted area’. Transplanting too many units into the recipient area risks tissue damage, poor growth, skin necrosis and damaging my existing hairs (I have diffuse hair loss). I am cautiously optimistic Dr K has delivered the promised ‘full coverage with great density’. It is early days; ultimately, it will take 12 to 18 months to confirm its success.

Detailed Review:

I am 56 years old with diffuse hair loss. I took no hair growth medications before the transplant, but following the transplant, I started on Finasteride 1.25mg on Monday, Wednesday, and Friday. On week 3, I began topical foam minoxidil 5% (Regaine) three weeks post-transplant.

I had no previous hair transplants and have seborrheic dermatitis controlled with prescription strength Nizoral twice a week. I have no other health conditions.

My consultation was with Ahmed, and it was through WhatsApp. There was no direct contact with Dr K before I arrived at the clinic.

I had a combined FUT and FUE procedure. The first day was an FUT with 2,110 grafts (4,599 hairs), and the subsequent day was an FUE with 2,134 grafts (5,002 hairs).

In total, I had 4,244 grafts (9,601 hairs) transplanted, consisting of 746 singles, 1,897 doubles, 1,343 triples and 258 Quadruples.

I was in Istanbul for a total of 5 days.

Day 1 (Arrival): I arrived at Istanbul airport in the evening and went to the designated meeting point at exit 14. I waited outside for 10 minutes until their transport rep (SR25) brought me to my taxi. The cab was a mini-van, which was clean and comfortable. I was the only passenger, and my driver, Mehmet, was delightful. The clinic is on the Asian side of Istanbul, so the drive from the airport took about 1 Hour. The hotel I stayed in was the Selectum City Ataşehir. The rooms were spacious, clean, and well-appointed, and the bed was comfortable. The food was tasty (breakfast was included – it is buffet style, but they can make you an omelette on request), and the staff were friendly and helpful. The clinic is conveniently located adjacent to the hotel and can be walked to in less than one minute.

Day 2 (Consultation): In the hotel lobby, I met Asmed, the AEK clinic consultant with whom I had been interacting via WhatsApp. He speaks English fluently and is very friendly, helpful, and responsive.

We walked to the clinic, where I was offered something to drink and signed documentation. I signed that Dr K had explained the process, the pros and cons, and the alternatives to hair transplant, but in reality, they weren’t explained to me at any time. I also signed that the possible complications of the surgery had been explained to me, and I had been provided with a list of possible complications, but they also weren’t explained at any time, nor was any list provided. Additionally, I signed that future hair loss was discussed with me; again, it wasn’t discussed at any stage. There was no discussion on any medical treatments such as finasteride, minoxidil, etc., although Dr K very briefly alludes to them in his aftercare video. I signed the document as I felt I had acquired the relevant information elsewhere from Doctor Nel, from forums like this and from physician-created YouTube sources such as The Hair Loss Show. Plus, I had travelled so far and put so much time and effort into arranging everything that I was keen to get started, so rightly or wrongly, I was hesitant about doing anything once it did not negatively impact my health, which may mean my procedure might not go ahead.

However, I believe that if a clinic gets you to sign a multipage document, they ethically should ensure you can answer yes to such questions by the time you get to this stage. The patient has travelled a considerable distance to a foreign country and is in a foreign environment, has invested a lot of time and energy, including emotional energy, paid a deposit, is likely tired or jet lagged and is keen to get the transplant. Consequently, they are more likely to be under psychological pressure just to sign whatever is put in front of them. In hindsight, I should not have signed those sections and brought the discrepancies to the clinic’s attention. Regarding the sequence, the form should ideally be signed at the end of the consultation with the doctor and in his presence. Indeed, the way the document is written is as though that was the original intent of Dr K.

I then had blood tests and blood pressure measured. I paid the balance of the money due before meeting with Dr K., who designed the hair. I was happy with the hairline he recommended and for the density of the frontal zone to be prioritised. I noticed that the recommended hairline was slightly more convex than my existing one, as the new hairline went slightly behind my existing hairline at the frontal temporal angles. I pointed it out, and Dr K explained that those existing hairs would blend in with the newly created hairline as they were miniaturised hairs. It all sounded reasonable, so I trusted Dr K’s expertise and years of experience designing natural-looking, age-appropriate hairlines.

The consultation with Dr K lasted under 10 minutes, and it did not involve him asking me any questions other than if I was happy with the recommended hairline. Judging by his YouTube consultation videos, I had expected a more detailed consultation. Aek’s consultation process is certainly not as thorough as I experienced with Dr Nel; however, it may not be a fair comparison as a lot of the information was already gleaned by AEK from the virtual consultations I had before I arrived at the clinic. To be fair, Dr K asked me if I had any questions, and I did not ask him any. But also, I reasonably assumed that he was aware of the details of the virtual consultations.

A minor gripe is that during the hair design, Dr K and Ahmed conversed at length in Turkish while Dr K was analysing my hair. As they are both fluent in English, I think it would have been more inclusive and created a better sense of patient agency if they had spoken in English. I later learned from Ahmed that the conversation was that Dr K was happy with the quality of my donor area; apparently, he thought it was ‘perfect’. I have read that some people surmised from Dr K’s videos’ that he is arrogant. As I was not there to make friends and was more interested in the quality of the end result, I would not have really cared if he was arrogant. However, I did not find Dr K arrogant; instead, he came across as friendly, knowledgeable, and passionate about his work. I get the impression that he is a professional who, unlike a salesman, tells patients what they need to hear, not what they want to hear.

Another minor gripe is that they forgot to do laser light therapy, which was meant to happen on the consultation day, so I missed out on it. In addition, they also nearly forgot to do the PRP until I reminded them.

Something to note is that after the hairline has been drawn, the marks remain on your head until surgery, so if your consultation, like mine, is the day before, then the morning of the consultation is the last time you can wash your hair. Also, if you are self-conscious about walking around with your head marked up with your proposed new hairline, you should consider bringing a hat. Finally, you will need to put a towel on the pillow; otherwise, the marker will stain the pillowcase.

Day 3 (FUT): I arrived at 8:45 am and was greeted by Ahmed. I was soon brought to the operating room, where I was changed into a surgical shirt and slippers. My hair was shaved, and my donor area was dyed with henna, so my silver follicles were more visible for extraction. I was given an antibiotic. I then had anaesthetic injections into the donor area. I was provided with laughing gas to relax and ease the pain. The injections were relatively painless. I would rate the pain as between 0 and 2 on a scale of 1 to 10. They made sure that all areas were numb, and I then waited for the doctor to arrive, which took about 20 to 30 minutes. When he arrived, Dr K did the strip removal and wound closure in roughly 45 minutes. The strip length was 25 cm by 1 cm. One of my daughters is a surgical nurse and is very impressed with Dr K’s handiwork, which is unsurprising as he is a plastic surgeon. Although Ahmed advised that Dr K does not recommend scalp laxity exercises, I did nonetheless perform them daily in the two weeks leading up to the operation as they are something many other FUT doctors prescribe in advance of FUT surgery to allow for a larger strip to be extracted and for less pressure placed on the scar line (the general guideline is to start laxity exercises at least 30 days out from FUT surgery).

Using high-powered microscopes, two technicians carefully dissected the graphs from the strip (they allowed me to look into the microscopes and view my follicles). I then had anaesthetic injections into the recipient area. It was more painful than the donor area injections, most notably in the forehead area (I don’t know why, although the forehead injections were done by a different person). The pain occasionally hit a 7 briefly, but the injections only took a few minutes. I waited for Dr K to return; he was making customised incision blades according to my graft size. On his return, the doctor did the recipient site incisions using the customised blades. Coronal incisions were used for the hairline, and sagittal incisions were used for the rest of the area. A total of 2,110 grafts (4599 hairs, 422 singles, 887 doubles, 801 triples, and 0 quadruples) were transplanted. Curiously, the strip yielded 0 quadruples (in comparison, the FUE yielded 258 quadruples).

Other than the anaesthetic injections, I experienced no pain whatsoever. We stopped for lunch around 12:30. The meal was substantial and tasty. We started back at 1:10 pm, with two technicians working on either side of me. The technicians were preparing to start the implantations into the frontal zone of my head, but the doctor arrived and instructed them to start from the vertex instead because, as explained to me at the time, he felt the grafts from the strip would give a better illusion of coverage in that area for the graft density he had chosen. During the implantation, the techs took two 10-minute rest breaks, which I could use to go to the restroom if needed. They finished up at 3:10 pm. Notably, during the procedure, I could feel the female technician using pressure to insert the grafts (no pain, just pressure), whereas I could barely feel the male technician. This was not a function of the level of scalp numbness, as when they switched the sides of my scalp they were working on (lying down versus facing up), there was still the same difference in applied pressure. Whether something like that has any bearing on the end result, I don’t have the expertise to comment on?

Ahmed provided me with a link to a YouTube video of Dr K providing aftercare instructions. He gave me a bag containing 300ml of shampoo, 50ml of moisturiser, antibiotics, steroids for swelling, pain killers and a camouflage (bucket) hat (the shampoo bottle and moisturiser were much smaller than the ones shown in the clinic’s aftercare video). Thankfully, I have not needed to use any painkillers. To Dr K.’s credit, unlike what I have read in the reviews of other clinics, there were no pressure sales by AEK for aftercare kits containing things like ‘special’ shampoo and lotions, which I have read many other clinics pressurise you into taking even though they are not needed and can cost over six hundred euros for a 6-month supply. Instead, Dr K. simply advises you to revert to your usual shampoo after 14 days.

The staff were very amicable and seemed focused on wanting to do a good job, and there was a great sense of camaraderie and teamwork among them. They chatted with each other while they worked, but not incessantly; they always appeared focused on the task and worked harmoniously. A TV was facing the operating chair in the room, but it was not in use. To pass the time, I listened to music or an audiobook on my phone using a single earbud, leaving the other ear free to listen to instructions. I was not offered free Wi-Fi, but it was unnecessary as I had purchased a 1Gb data eSim from NOMAD for only €5, and the hotel had free high-speed Wi-Fi.

Day 4 (FUE): As requested, I arrived before 8:45 am, but we did not start until 9:50 am. I reminded them about the PRP and had blood taken for it. Then, I received another set of anaesthetic injections into my donor area, which was, as before, practically painless. One Tech punched the grafts using a 9mm motorised punch, and another removed the grafts with forceps. The doctor entered the room only once during the graft extractions and then only briefly. The extractions took approximately one hour.

I then had my recipient area numbed up, and as before, it was on a pain scale of 1 to 5 with an occasional 7. Next, technicians completed the graft insertions using forceps, one on my hairline and another two on the rest of my scalp. It took roughly two hours, and we finished early at 1:10 pm. The technician doing the hairline seemed quite particular about her work. Even when I was finished and sitting up, she did a visual inspection and had me lie back down as she made further graft adjustments. They then injected the PRP into my scalp. Followed by a nice lunch. I then returned to the hotel. A total of 2,134 grafts (5002 hairs, 342 singles, 1010 doubles, 542 triples, 258 quadruples) were transplanted.

Day 5 (Wash/Departure): I arrived at the clinic at 9:15 am for my bandage removal and hair wash, which took about ten minutes. I was advised that the Clinic would like a progress update at the 6-week, 6-month and 12-month marks. No advice or information was given regarding what I have left in the donor bank in case a future operation is needed.

I was picked up by the same driver, Mehmet, returned to the airport, and dropped off at departures in plenty of time. Being concerned, I would bang my head off something as I did on the flight over, or another passenger would accidentally make contact with my head; I upgraded to business class for the flight home as I got a good last-minute deal.

Miscellaneous:

I would have liked for the doctor to have called in more than just once to supervise and check on progress or at least to have inspected the technician’s work before the end of each day and given it his stamp of approval. I appreciate that his technicians are very experienced, and unlike most other clinics, they are not freelance and have been with Dr K for many years. He states that he has personally trained them to a high standard, so perhaps Dr K feels he does not need to monitor their work so closely.

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Month 1 Update:

I have looked at myself in the mirror more times this month than in all my years combined. I look back fondly on the days I was in denial about my hair loss.

On the plus side, I have been spared common side effects like scalp numbness and facial swelling. Additionally, the swelling at my lateral humps, my scalp redness, as well as any scalp itch have all rapidly subsided. Although I still have the occasional itchy sensation in the recipient area, it is nothing bothersome. In addition, I don’t have any scalp tightness or pain, although there is still a momentary slight discomfort when I first rest the back of my head against any surface. I had the staples removed on day 14, which was a relief, relatively pain-free and easy to do at home. It was great to get back to sleep without the aeroplane neck cushion and lie on my side. I invested in some silk pillowcases to reduce hair friction. I also invested in some light cotton gloves on the off chance that I tried to scratch my head when asleep; at least, it would mean, if it did happen, I could not dig in my nails and dig out those valuable grafts.

Hair washing went well, with all scabs naturally falling off by day 10. However, the small amount of moisturiser the clinic provided proved insufficient for larger cases like mine, and I ran out of it on day 8, so I had to buy more.

On a negative note, I developed a bad case of folliculitis around my donor area on day 13 (apparently, those having a FUT have a higher risk of developing it). When it appeared, I reached out to Ahmed, the clinic rep, to have him ask Doctor K what it could be; he said he would check with him and get back to me, which he never did, which was disappointing. In the meantime, I visited my local doctor, who immediately recognised it as folliculitis. Folliculitis is mainly bacterial, so he prescribed a short course of oral antibiotics and steroids. It can also less commonly be fungal, and as I suffer from seborrheic dermatitis in my donor region, I resumed using my Nizoral 2% in that area twice a week. In any event, the condition cleared up over four days.

follicultis.jpg


At the end of week 3, I started with topical foam 5% minoxidil (Regaine) to hopefully help the transplanted follicles and my native hairs in the recipient area (I am a diffuse thinner) thrive. I am using foam as it is less likely to irritate the scalp. No adverse side effects so far. The plan, at the moment, is to use it for the next six months and then, at the end of the 12 months, reappraise whether I need to reintroduce it (or possibly the oral form) for ongoing maintenance.

Finasteride has also, thankfully, produced no adverse side effects so far. Supposedly, seeing any sign of benefit from Fin will take at least 3 to 6 months. It is a big regret of mine that I did not take it at least a year before the procedure to make sure it worked on me firstly (it does not work on everyone) and secondly to give my thinning native hairs in the recipient area the best chance of not falling out due to shock loss.

I have noticed some slight oiliness on a small area of the forehead where the widow’s peak is normally located, and from my research, that is apparently entirely normal.

Following are my month 1 comparison pics;

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From my inexperienced eye, my donor area looks well on the way to recovery. I am delighted with the surgeon’s handiwork with the scar; my hair was already covering it at the end of week 2.

scar back.jpg


Shedding started at the end of the third week and continues at a slow pace, and there appears to be evidence of some shock loss on my lateral humps. Hopefully, the Finasteride and Minoxidil will keep any further shock loss at bay; only time will tell. However, I have read that a shed can also occur after 3 to 6 months of Finasteride treatment, and if it does, it will last around two weeks. To add to my worries further, there is a suggestion that too many antibiotics significantly impact beneficial microorganisms in the digestive system. This makes the body’s ability to manufacture nutrition from B vitamins more difficult, which might result in thinning or shedding, which may occur within two to three months following the use of antibiotics. I have had three courses of antibiotics in the last month – antibiotics as part of the HT procedure, antibiotics for folliculitis, and antibiotics for a chest infection secondary to a case of RSV. I have commenced some pro-biotics to hopefully replenish the good bacteria.

I guess I will remain on tenterhooks, waiting for further shedding and any potential shock loss; I find myself at times scrutinising the hair shafts that appear to have not grown at all from when they were implanted, reassuring myself they are in the resting phase but also find my mind drifting to wondering what if they are dead. I have to counsel myself not to stress, or the stress will induce hair loss and make it a self-fulfilling prophecy. The healthy thing would be to forget about everything, put it all to the back of my mind and get on with my life for the next 12 months, but with something so visible that has no guaranteed success, that’s not going to happen lol.
 

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Bigmac

Bigmac

Administrator
Staff member
I like the hairline design and the placement pattern. The work looks good and should produce a nice result for you. Just try to be patient and don't stress. I`m looking forward to following your journey.
Thanks for sharing a great write up.
 
Fred2023

Fred2023

member
@Bigmac, thank you for the feedback. Getting feedback (positive or negative) from users as experienced as you are is helpful, and the fact that it is positive in this instance is all the more reassuring and much appreciated.
 
S

suman295

member
I really like the hair transformation done by combine technique of FUT & FUE done by best hair transplant clinic in Delhi.
 

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Fred2023

Fred2023

member
Month 2 Update

Can feel hairs sprouting.

Encountering some pimples but easily treated with a warm compress.

Crown filling in slowly

I ditched wearing a hat to hide the ugly duckling phase.

The donor area is looking good.
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Bigmac

Bigmac

Administrator
Staff member
You look to have healed well. A nice positive sign feeling growth this early. The donor closure is looking good.
Thanks for the update.
 
Fred2023

Fred2023

member
Three-month update: The crown is definitely showing signs of filling in and the hairline seems to show some signs of thickening. No complications to report. I had a number 4 back and sides the week after the two-month mark with no visible sign of any scarring. The next six months will be telling - fingers crossed.
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Fred2023

Fred2023

member
Four-month update: The crown, hairline, and top are all continuing to show month-on-month improvement.
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Bigmac

Bigmac

Administrator
Staff member
Looking good. Your donor has recovered very well. Seeing early growth at 3 months is nice.
 
Fred2023

Fred2023

member
FIVE-month update: It is continuing to show month-on-month improvement, notably the top and the crown. I am keeping my fingers crossed that it continues on this trajectory and that I continue to see growth and thickness over the next 7 to 11 months.
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