Dr. Ozlem Bicer Clinic

Ozlem Bicer MD-3840 Grafts FUE by micro-motor, 8. month result Patient's age: 41 NW Scala : IV Single: 1180 Double:2030 Multiple: 730 Total: 3840

Hi, It is an honor for me to be considered worthy and included in this group. I would like to express my endless thanks and respects to every member, to Melvin, to all my dear friends and colleagues who included me in this coalition. Best Wishes Özlem Bicer, MD

As Dr. Özlem Biçer, who followed and managed the patient throughout the whole process, I will try to explain both the process and the differences between anaphylactoid reaction, which is a type of acute severe allergic reaction, and intoxication in a language that non-doctors can understand. In both cases, some symptoms are common, some are different, and therefore doctors have to make a diagnosis with some differential diagnosis and indication criteria. The correct diagnosis is lifesaving not only during acute treatment but also in the long term, as it has to be taken into account in the medical treatments that the patient will receive throughout his/her life. Patient who has been diagnosed with Jetocaine anaphylaxis should never, ever be injected with Jetocaine for the second time, because if the patient is given Jetocaine for the second time, the possibility of repetition of anaphylaxis reaction is very high. But if you misdiagnose a patient with Jetocaine anaphylaxis and say that this is a Jetocaine intoxication, you bring up the possibility of giving this patient a second chance of anesthesia, in which case the patient's life is in danger with the risk of an anaphylactic reaction that may develop in the patient. This is my reason for sharing this post as a doctor. (The diagnose of this patient is an anaphylactoid reaction, which is a type of rapidly developing severge Type 1 allergic reaction. Because of this diagnose, this patient cannot be given Jetocaine anymore. Jetocain intoxication is a discussion self-displayed by over dosage or intraarterial administration, or by involvement of the central nervous system and cardiovascular system due to perfusion. 1. Although numbness around the mouth is the most well-known and the first thing that comes to mind in intoxication, it is also seen in anaphylactic reactions. Therefore, not all numbness around the mouth is intoxication. 2. Tremor in the hands and feet is a sign of allergic reaction, it is not a sign of central nerve system involvement, it is not epileptic seizure, it is not considered as an intoxication attack. Central nervous system is not involved in this patient. So, it is not considered as intoxication. 3. Hypotensive and hypertensive episodes may occur in anaphylaxis, but bradycardia (i.e. low heart rate) is essential in intoxication. Bradycardia accompanies hypotension in the differential diagnosis. There is no cardiac involvement in this patient. No bradycardia treatment has been used in any way. i.e. the cardiac system is not involved. i.e. intoxication is not considered. 4. Skin rash is very common in anaphylaxis. Allergic skin lesions are not expected in intoxication. 5. This case was brought under control very quickly by applying allergic and anaphylaxis protocol. In case of intoxication, anti-allergy treatment would not have worked, the process would have been uncontrolled, and the progress would have dramatically deteriorated to respiratory arrest. 6. Anaphylaxis is a dose-independent process. Intoxication is a dose-dependent process. The amount of anesthesia used in this patient is half of the daily dose limit that the patient can receive, even after taking into account the patient's weight (on average over 70kg). There was no overdose in this patient. The reaction started before hairline anesthesia was administered. So even the total planned daily dose was not used. So, there is no overdose and intoxication are unthinkable. In the specific case of this patient, needle-free anesthesia was administered by a licensed anesthesia technician. Needle-free anesthesia works on the principle of delivering anesthesia into the skin through pressure, without a needle. Due to the settings of the device, the amount given and the level at which it is given intradermal. There is no artery and vein in this level. For the intoxication, deep plan injection is required to enter the artery and vein network. It is not possible for this device to inject drugs at this depth. In addition, due to the settings of the device, each pulse dose is not enough to cause intoxication. All nurses and anesthesia technicians working in our clinic are postgraduate graduates. And all of them have intensive care experience. They are fully authorized and professional in the technique of administering an injection. 7. If it was intoxication, the patient would have had to be followed up for at least 24 hours at the university hospital, drug absorption would have been rapidly decreased with IV lipophilic solution and a completely different treatment protocol would have been defined. Our patient's condition was not accepted as intoxication in all examinations performed at the university hospital (blood gas, liver enzymes and all intoxication tests), it was accepted as a rapidly developing type 1 allergic reaction (anaphylactoid reaction, considering that all anti-allergic interventions were correct and appropriate, and the patient's symptoms passed very quickly, the process was evaluated as anaphylactoid reaction and our full report was approved. In addition, the reason for transporting the patient by ambulance was to ensure that the patient was safer in intensive care conditions in case of angioedema due to anaphylaxis, and the university hospital confirmed that all the treatment performed in our clinic was correct and satisfactory. 8. ANAPHYLAXIS IS DOSE INDEPENDENT. The anaphylactic reaction may also occur at the test dose. Allergy testing is not performed to eliminate the risk of anaphylaxis. Allergy testing is a test performed on patients with multiple drug allergies in order to select the appropriate drug. It should be performed in immunology clinics. There is no such concept as prophylactic Jetocain allergy test in hair transplantation. So, the answer to the question of whether it could have been prevented if the test had been done: NO. There is no chance to prevent the patient from any anaphylaxis with allergy tests. If the test was done, anaphylactic shock would have occurred during the test also. ANAPHYLAXIS AGAINST ANY DRUG CAN COME TO EVERY PATIENT, EVERY DOCTOR (WITH OR WITHOUT TESTING) Anaphylaxis is therefore a manageable process, not a preventable one. Although there are many more differential diagnosis criteria that can be written, I think this is enlightening enough. As a 26-year physician and 33-year member of the medical community, I am experienced enough to distinguish between anaphylactic reaction and intoxication. I and my entire team are technologically and scientifically equipped for all kinds of emergencies that may occur before and after the hair transplant procedure. The fact that the patient was diagnosed very quickly, and the process was managed correctly is the biggest proof of this. Hair Restoration Network is one of the most reliable and ethical forums that I respect the most. What they do to inform patients correctly is admirable. I am eternally grateful to Melvin and all members for this. As always, I respect everyone's support, criticism and comments on the forum. However, we would like to emphasize that while even no doctor can diagnose the patient without knowing the patient's clinic, without seeing the process, without evaluating the vital signs, without examining the patient in all details, misleading the patient with shortcut research from Google can cost the patient's life. I invite all members to sensitivity in this regard, If anyone has more questions, they can forward to Mrs. Ozen and contact to me directly. Best Regards, Ozlem Bicer, MD

Ozlem Bicer MD-Hair Transplant-4010 Grafts FUE by micro-motor, 10. months result Patient's age: 34 Single: 920 Double:2670 Multiple: 420

Ozlem Bicer MD-Hair Transplant-3870 Grafts FUE by micro-motor, 5. months result Patient's age: 42 Single: 940 Double:2620 Multiple: 310

Ozlem Bicer MD-Hair Transplant-2650 Grafts, Manual FUE , 12. months result Patient's age: 32 Single: 1120 Double:1370 Multiple: 160

Ozlem Bicer MD-Hair Transplant-3560 Grafts FUE by micro-motor, 9. months result Patient's age: 50 Single: 1200 Double:2000 Multiple: 450

Ozlem Bicer MD-Hair Transplant-3770 Grafts FUE by micro-motor, 8. months result Patient's age: 43 Single: 1080 Double:2020 Multiple: 670

Ozlem Bicer MD-Hair Transplant-3650 Grafts FUE by micro-motor, 8. months result Patient's age: 54 Single: 1050 Double:1950 Multiple: 650

11. Months Update

8. Month update

Ozlem Bicer MD-3670 Grafts FUE by micro-motor, 7. months result Patient's age: 35 NW Scala : IV Single: 1420 Double:1900 Mutliple: 350

Ozlem Bicer MD-Hair Transplant-3190 Grafts FUE by micro-motor, 6. months result Patient's age: 32 Single: 1480 Double:1250 Multiple: 460

7. month update

Patient's age: 31 Single: 1139 Double:1267 Multiple: 294

Ozlem Bicer MD-3850 Grafts FUE 9. and 12.Months Patient's age: 38 NW Scala : VISingle: 1720Double:1980Multiple: 150Total: 3850

Ozlem Bicer MD-Eyebrow Transplantation 420+440 Grafts FUE 11. month result Patient's age: 37 Single: 860 grafts

Ozlem Bicer MD-2420+1140 Grafts FUE Patient's age: 26 NW Scala : VII 2 multiple operations 1st day: Posterior zone (neck) Single: 1765 Double:530 Mutliple: 125 Total: 2420 3rd day: Chest zone Single: 850 Double:290 Total:1140

Dear Forum, I would like to thank you for including me to your internationally known and acclaimed forum. I am very proud to be on the list of recommended doctors of your site. I'd be happy to share my surgery results and updates periodically. Kind Regards, Özlem Bicer, MD

Ozlem Bicer MD-3400 Grafts FUE by micro-motor, 2. years result Patient's age: 50 NW Scala : IV Single: 1370 Double:1610 Mutliple: 420

Ozlem Bicer MD-3100 Grafts FUE by micro-motor 12. month result Patient's age: 37 NW Scala : II Single: 1743 Double: 658 Tripple : 497 Multiple: 202 Punch size: 0.6- 0.7mm

Patient's age: 46 NW Scala : IV Single: 1880 Double:1120 Tripple:450 Multiple: 120

Hi again, As he promised, he sent me a new video. When he comes to Turkey to my clinic, I plan to take a video while combing his hair and share it here. https://www.instagram.com/p/CLg1c8ZDFp0/?igshid=1n8pohui9b6lg Best Regards, Özlem Bicer, MD

Hi, Thank you for your comments. I am agree that the photographs are not professional. Post-op images were presented by patient. I had already shared his 6-month video at my instagram account, You may see the result clear: https://www.instagram.com/p/CG2ZuQVD6BW/?igshid=b1xuegrk6r0d And I asked my patient to send new videos of 12. months. He promised me to send. And I will share it here as soon as possible. Best Regards, Özlem Bicer, MD