Ali Emre Karadeniz

Neither have I seen or heard that happen. However we have to accept that even if it rarely happens it is very difficult to determine the relationship between an unsuccessful result and stress.

Dear Mikeey, I don't think stress has significant effect on the result of a HT. Having said that, stress, or in more advanced situations depression, is such an awkward thing that it has the potential to effect the general health condition of an individual including all sorts of processes related to healing. So, I can't promise that it won't have any negative effect.

Dear Blake, It may have not been clear when I was mentioning this in my overview about HT in Turkey, so let me try and explain it more clearly. My standpoint is mainly from the medical ethics point of view. Laws are also important, but they are secondary as they differ considerably from region to region and some are difficult to explain. In some countries techs are allowed to do surgical procedures and in others they are not. Indeed in Turkey, technicians are not allowed to touch the patient as there is no authority to give a licence to a technician and name them hair transplant technicians. Nurses however are allowed to place grafts. I did mention that I think it is unfortunate that hair transplant technician licensing is absent in Turkey. I gave that information just to show the irony in the country where 99% of the hair clinics are purely technician clinics although they are not even licensed to touch a patient. Unfortunately there are very few trained personnel that know what a hair tech should know that we do use a mixture of nurses and technicians to do graft cutting and placement. In that sense even we, the physicians clinics are sometimes braking Turkish laws, but what is that compared to 500 technician clinics performing thousands of HT procedures everyday freely only by technicians? It is the main system in corrupt countries that they force people who they want to overwhelm to brake laws since birth and attack them whenever they want, while allowing supporters of the system to freely move while not only braking laws but all values of humanity. 1966kph, 500 technician clinics and 10 physician clinics was obviously a rounding up to show how things work. Ofcourse there may be more than 10, however there aren't many more as you state. Those clinics you mention that are on the whatcl... portal are all technician clinics. I was the last physician to be on that portal and left a couple of months ago. It is not worth for the 10 physicians to be listed there as the majority of patients there are looking for a HT for 1000-2000 Euros to be done in Turkey. I am stating here once more that I am not referring to the very few physicians who are recommended here or not when explaining the corrupt nature of the Turkish HT industry. 1966kph, the reason why I am not anymore interested in a discussion with you is not only your destructive language, but you clearly stated that you are in favour of technician clinics and that we have agreed on disagreeing. You suddenly appearing in my thread about HT in Turkey and aggressively criticising me not sharing my opinion on someone else's thread can not be unintentional and the reason remains unclear to me.

I am very calm and as you see I took your question seriously and answered it as detailed as possible. Could you explain to me more directly what your concerns are about agencies? As you might have understood from my explanation, I am not in love with agencies, but I don't see a problem either. There are professional ones out there that provide good service to both clinics and patients. Why would doctors working with agencies end up with agencies being recommended? Why do doctors need approval of being affiliated with agencies? What difference does it make if a doctor does his own marketing or if an agency does it and sends the patients to the doctor? As much as I understand, recommendation here is purely medical, it is not to do with marketing strategies. I have no conspiracy theories and I don't see the names you mentioned as my competitors. I am only concerned about my own results and own reputation. If you make it more clear what you think is the problem with health tourism agencies I may be able to give you an answer that may satisfy you. Have a good day.

I would like to say hello to the community and thank members who have contributed to my recommendation by their questions and comments. I would like to emphasise once again that I will be ready to answer any questions related to hair loss problems and hair restoration in general and I will be explaining my hair restoration philosophy in detail while presenting my results. Meanwhile I will try to keep away from unfruitful conversations that are related to competition with other clinics, comments from members who don't openly represent, but show signs of acting for or against a specific clinic, members who ask questions to damage the reputation of me or someone else. I am sure everyone is aware that hair surgery is a very competitive field and the fight for a better place in the market is fierce. After starting to post on the forum - which is only a couple of months - I have already been hassled on a couple of occasions recently not only on the forum but by directly being contacted by competitors. Turkey is an especially competitive market, so I do expect some moves. Although I will do my best to keep things at a purely scientific level. Ali Emre Karadeniz, MD

Thank you Fisher4man. Before I answer that question, I have some questions of my own. As you are asking those questions, I assume you have concerns about medical tourism agencies. What is the problem with clinics being provided with patients by agencies? What is the problem with agencies advertising HTN recommended doctors? It looks to me like public awareness of the HTN and the value of HTN recommendation would grow and this is a good thing. Practically speaking, the simple reason why clinics work with agencies is that they neither have the investment nor the time to do marketing. In order to concentrate on their real job they need to delegate most of the marketing to professionals. They could have their own marketing manager and marketing budget, but they would still have to be constantly involved in creating marketing strategies and spend time with the marketing team on how things are going. If I decided to do my own marketing I would have to become a businessman coordinating a crowd of workers instead of being a surgeon. In my opinion mainly the clinic is hurt by working with agencies as they are having to give away a big chunk off the income, usually bigger than the fair amount. The patients are not effected much as the value of a doctors work remains constant; whether or not a part of the patients money goes to the agency or not doesn't matter. When the day comes, when I am well known enough to have enough clients coming to me word of mouth and my online presence and technology is at a certain level where I can manage my own business without needing direct external help from agencies I may not need them anymore. I tried to answer your question, although I think it is a topic worth discussing on a separate thread. If you wish to discuss it further, you can open a new thread and I will try to contribute to the discussion.

I am conservative with body hair as with many other things. First of all I reserve BHT to hopeless situations where there is little or no scalp hair available. I don't believe in doing a large number of scalp hair and adding some body hair to increase graft number. When I see combinations like 4000 scalp hair and 1000 body hair to make 5000 I feel it is a combination to increase price. Since body hair is mostly singles, we would be doubling the price to give 10% more hair which feels unfair to me. Besides, I don't like using body hair that has shown to be unpredictable in studies. Body hair to me means mostly beard hair and sometimes chest hair if it is exceptionally strong. Using arm hair to feather the hairline doesn't sound right to me.

That is an important topic. As I mentioned earlier, I will never advertise something that I don't scientifically believe just for the sake of marketing. I am sceptical about FUE without shaving if the recipient area has significant hair. I believe that small to medium sessions like 1500-2000 grafts FUT are excellent for people who can not accept shaving. The time saved from graft harvest can be safely used during incisions and placement. I did a 1500 FUT for the same reason last week on my 2500 FUE patient that is presented above. I will post photos soon. In my opinion the worst thing is to do a large session of FUE like 3000 grafts, shave all the donor area and not shave the recipient. I spend enormous effort to extract grafts and then loose very valuable time while doing incisions and placement. I don't see any benefits in doing this. A small FUE like 1000-1400 could be done by limited donor shaving and recipient site not shaven, but the donor area is not used homogeneously. A medium sized 2000 FUE could be done with a recipient shortened to 3-6 mms instead of totally shaven. I don't think there is a significant problem with yield, but the transplanted density will be at least 30% less than when totally shaven. If you don't need to get a quick result with high density, you can have 2 small sessions of 1500 grafts unshaven 1 year apart, which is what artists and politicians choose. The yield is also excellent in these scenarios.

I don't routinely take photos showing how acute the angles are, but I can say that I usually push the limits on giving acute angles at especially densely packed hairlines. I believe the example with 2701 grafts FUE that was done using coronal incisions had very acute angles. I use only micro motor and see no benefits in using the manual punch. I did share my opinions on previous threads about this. I don't want to open a new argument with anyone on this thread, but I have discussed it with colleagues that ultimately stopped using the manual punch. I insisted during a discussion with one of my friends - who is actually one of the first in Turkey to try the manual punch - that he should continue using it due to its excellent marketing advantage, but he refused to use it after learning motorised FUE. Those who take advantage of its marketing advantages sooner or later end up using their technicians to extract, because it is impossible for a surgeon to do all extractions with a manual punch for many years. I do one patient a day. I might do two patients of 2000 grafts each, but I don't enjoy it very much as most of my energy will go to extractions rather than incisions. I have been doing 2 patients about once every 10 days due to friends wanting it on the same day or patients coming from multiple sources but I am hoping to stop doing it once my business settles more.

Dear Busa, Are you talking about me? If yes I think you are joking From the 13 examples listed above there are only 2 FUT cases of which both patients are female and one of them is an eyebrow transplant. All other procedures are FUE! 4 are combo and 7 are FUE alone. The graft number in the FUE only cases range between 2700 and 3650 and they were all done in one session! Don't you think those are high numbers? I would suppose after the listed examples above that you would ask me to present some more FUT only examples

I was going to add a small remark after this statement, but I thought I would wait for a post like kph1966's. I respect all opinions and I am open to questions as long as I believe they are derived from sheer scientific curiosity and from good will. If I think that someone is making comments and asking questions to promote another surgeon/clinic , a group of surgeons/clinics with a common interest, a specific technique against the other one, or is just trying to be destructive against my presence, I will avoid answering them to avoid unfruitful traffic. I see that physicians almost always avoid to be involved in discussions with members who are present only with their nicknames as this leaves the physicians too vulnerable to destructive posting. I have started off with a riskier style than these physicians by being involved in discussions, however in order to keep my presence I need to protect myself against comments without good will. That is why if I don't answer a question it doesn't necessarily mean that I don't have an answer, but it may mean that I feel the discussion is going to be unfruitful. I apologise if it happens that my judgement is wrong.

Hi all, There are a few things that I would like to let everyone know that may help know me better. Although the number of years I dedicated solely to hair restoration is relatively small, I consider myself pretty experienced in the number of hair loss cases I have handled either medically or surgically within this period. I have had the chance to evaluate, examine or treat close to 10000 patients in a little more than 4 years. I have performed around 1000-1200 surgical cases with every single graft harvested by myself and every recipient site incision done by me with maybe very few exceptions. The period is short, although you can imagine how concentrated I have been on hair patients during this period. I have woken up and gone to bed thinking about hair restoration. I like dedicating time and effort on scientific research and have been actively participating in scientific ISHRS meetings since 2011. I am submitting scientific papers each time and usually being involved in some scientific activity. I am willing to share and discuss with the public my opinions on some interesting topics. I have had the chance to practice FUT and FUE at the same time which I suppose is a rare thing for hair surgeons in the world. We usually see a division between old FUT surgeons who either try to use young doctors, technicians or even a robot to catch up with the current trend of FUE, and young generation FUE-only surgeons who have not even been trained to do FUT. When we follow FUT vs FUE discussions we see that the debates are biased by clinics being in favour of the technique they can offer. We will never see a commercial company in any market that advices a candidate consumer to go next door and buy a product that they do not sell; they will try to sell what they have. The downside is that patients don't get the chance to know the real opinion of a surgeon to objectively compare the pros and cons of each technique to end up with the ideal treatment plan. For this reason, I have decided in the beginning of my career to provide all surgical options to my patients and at a similar price if not the same; the latter I believe is also a rare thing to see. My ethics tells me that only if I am an expert on both FUT and FUE, and if I can provide both at the same price, the patient will have the chance to get my objective opinion. Therefore, I am not for or against one technique neither for practical nor for financial reasons. Whenever I share an opinion you can all be sure that it is patient benefit that it is based on. I am a plastic surgeon. I see hair restoration surgery as a complex reconstructive procedure. I have considerations related to facial aesthetics, wound healing with the best scars, donor area protection, the economical usage of the donor hair, long term planning with a scientific evaluation of the balding pattern and donor capacity and so on. I have very recently started to share my results online. I know it will take time to accumulate results that will be convincing enough for the majority of members. To compensate, I promise to share most of my results in the coming year that are from my most recent patients. I will not choose one excellent result from thousands, but I will include my average results to give a better idea; I have already started doing this. Additionally, you may notice that the photos are as standardised as possible, not taken while using tricks that may make the results look better. I don't want anyone to look at an average result and think it is excellent. Another thing I am intending to do is share interesting cases right after surgery without knowing its result. I am encouraging my patients to share their experiences as well. I believe simultaneous sharing could be useful for surgeons to show their self-confidence in accepting to present their result of a randomly chosen patient or even a difficult one. I appreciate the opinions of everyone and am open to answering questions. Regards, Ali Emre Karadeniz, MD

Dear Number and Busa, It is not very evident from photos how wide the front of this patient actually is, as the third dimension is not completely felt. The transplanted area is about 100 cm2. Given that about 400-500 fine haired grafts were used at the sides, this leaves us at a density of little over 30 grafts per cm2. I actually think the density looks as expected if not better than 30/cm2. Had I lowered the hairline by the slightest, I would be needing more than 1000 grafts more. Some people emphasise a lot on framing, but I think that some patients don't have the luxury to have the ideal framing, otherwise they will run into severe trouble in the future, having an isolated frame in the front without adequate hair behind it.

I can't tell exactly if fin improved the mid scalp as it was okay before surgery, but a close look at the photos suggests that it did help. I do believe in the importance of using fin especially in the 20's and 30's.

Good point KO and that is exactly what I am doing recently. However those photos were taken at the previous clinic that I worked where the photographer was advised to take it this way, although I believe everyone can see the crown from the behind photos.

First of all this thread is about a very important topic that will never be dead. I have the right and will from time to time add information related to the topic in order to inform the public. I don't see why you are annoyed by this and you are admitting that you are hoping that the thread dies as soon as possible. I also don't see why you are insisting that I should share my opinion on someone else's thread. Since you are insisting so much, I will let you know that it is not just that I don't want to trigger arguments on others threads, but the doctor you are referring to personally called me some time ago and asked me not to post on threads related with him! I promised him not to do that so I am just keeping my promise since then. I hope this sounds satisfactory.

As a clinic representative I would assume you know the answer to this, but I will state it here for others to learn about it. Nurses graduate from a school that gives them a licence to practice as a nurse; they are not technicians. There is no such licence as a hair transplant technician in Turkey. When we mention technicians we are actually referring to a variety of qualifications other than nurses. These could be ambulance technicians, paramedics, anaesthesiology technicians, laboratory technicians, biologists and so on. None of these are licences to work in hair surgery but they are widely used. I believe that there should be a system that trains and gives these people a licence, but the current law only licences nurses.

Thanks KO and David. I would love to do another session taking out some more plugs from the hairline, filling in the crown and improving the hairline. Unfortunately he hasn't had the chance to come back for some time.

Thanks Blake. I have to say that I love this type of patient that is over 40 who has thick and blended grey hair. It looks excellent after even a modest transplant. I am expecting him for a smaller session next month to strengthen the crown.

Thanks Busa and Hadenough. Yes, he is actually a physician and is using fin. I am expecting him to come soon for a second session.

Thanks David. You are right, he was happy.

Dear 1966kph, This is my thread and what I am sharing is directly related to my topic. This topic is about HT in Turkey and the main subtopic is technician clinics. As I mention before there are about 500 of these so why should this general information be referring to one of them? Looking at your recent activity I can see who you are getting at, or perhaps even representing, but I have no intentions of being involved in a one to one argument with a particular clinic or its representatives, as there are no benefits of this for members reading it. I can't help but ask what your motivations are in advising me where to post my opinions and the reason why you seem annoyed reading my post. There could be only two points where you disagree: either you like technicians doing HT procedures and that is fine, you have the right to think that way. Or you know something different than I know about Turkish laws, which I would be surprised but ready to hear. I see no problems here.

As I mentioned earlier it is forbidden by law for technicians to not only extract grafts but to take part in HT procedures. In fact the laws are too strict. It allows only plastic surgeons and dermatologists to do HT procedures. Other physicians are not allowed. Only nurses are allowed to place grafts and other physicians are practically like nurses. So, I think there are two aspects of the discussion on how technician clinics should be seen; The first aspect is about medical competency. Although I believe HT procedures should be seen no different than any other surgery, it seems this debate will continue. The second aspect is about law and licensure. In countries like Turkey where technicians are totally forbidden to take part in hair surgery - which I think is too strict - we are also talking about accepting companies breaking laws, which I suppose would be an unacceptable thing from whichever aspect we see it.

Patient in his 50's had a diffuse hair loss pattern. 2500 grafts FUE as performed using a 0.8 mm motorised sharp punch. Sagittal recipient site incisions were made using custom made blades.

35 year old Norwood 6 patient. He had a previous FUT procedure at another clinic that was not successful. 3027 grafts FUE was performed using a 0.8 mm motorised sharp punch. The graft distribution was: 500 singles, 750 doubles, 1777 three and more haired grafts. Custom made blades were used to do coronal incisions at the hairline and sagittal incisions behind it.