Fred2023

I recently had a FUT and was advised for the first three months not to engage in any activities that may put pressure on the scar and, therefore, cause it to stretch. For instance, no heavy lifting in the gym, such as squats, bench presses, or deadlifts, and avoid activities like sit-ups.

Wow! That is outstanding, and only 6 months in.

This is an alternative explanation related to stopping medication and harvesting from the 'unsafe' donor area.... I don't know which is the most plausible explanation, they all have merit, so I thought I would share a different perspective.

It's a really good question and very well written. I will follow this post to see what others say. What Melvin said is the best advice: ' Ignore hearsay posts'. I recently went with AEK in Turkey for a combined FUT and FUE procedure. When researching them, I read (including on this forum) that they had recently turned into a hair mill, and the quality of work had deteriorated. However, I could find no proof, either first-hand or pictorial evidence, to support the assertions. I went to them recently and found they are not a hairmill - the doctor does the planning, design, and incisions, and they have the capacity for at most three patients a day, and I am happy (so far) with the quality of the work (I am by no means an expert but I have posted my journey so far with no negative comments about the quality)

Thanks, Gramatik, for the reassuring comments... starting to second guess myself and need to get a grip.. what is done is done I just have to be patient and pray to the hair gods

There were three operating rooms, so there was the capacity to do three a day, but on three of the four days, only two people were being operated on, and on the other day, there was only one. The doctor was heavily involved in the FUT and overall hair design and planning. But for the FUE, he was only involved with the incisions and only one inspection, which occurred during the extraction phase. The only caveat regarding the number of inspections is that the operating seat faces this wall of glass that overlooks the city, so you don’t get to see who is behind you. Therefore, if the clinic said he inspected more than once, I could not necessarily categorically dispute it, but if he was, he certainly did not make himself known to me. Additionally, to be fair to the clinic, they did not mislead me; I went in with my eyes wide open regarding his level of involvement. Dr Bicer, who does all the work, would have cost €12,732 for the same number of grafts, but at that price, when you add in flight costs, etc., then the value proposition for going to Turkey changes considerably. But as someone else wrote about not being able to afford a good surgeon – don’t let cost be a deciding factor as can you afford not to use a good surgeon and end up with a botched job? I really do hope I made a good decision, and of course, there is that little nagging doubt in the back of my mind that I should have done nothing if I could not afford the very best. I have seen the recent AEK review (November 2023) of a gentleman who had a FUT with neither his donor nor recipient area shaved. From how I read it, his issue was not about the actual quality of the work, but his concern was that insufficient grafts were harvested from his FUT, and he felt he, therefore, he did not get value for money. They harvested 1,976 grafts from his strip, but he maintains that in a previous FUT, the doctor managed to obtain 8,000 to 10,000 grafts from the strip. This did worry me when I read it. But when I researched the yield from a FUT, I discovered in a person with average donor density, there are approximately 100 follicular units per square centimetre; therefore, a typical strip of 15cm long strip would yield slightly less than 1500 grafts due to the tapering of the strip ends. In a hair transplant of 1500 follicular unit grafts, one should take out a 17 cm x 1cm strip (that includes the tapered ends). To have achieved 8,000 grafts in his previous FUT, he would have had a massive strip of 25 x 3.2cm removed, and to achieve 10,000, it would have had to have been 25cm x 4cm. Unfortunately, the gentleman in question stopped posting on the 26th of November, so there is no way of tracking the quality of the work. As to whether 1,976 grafts were enough to provide the result the gentleman hoped for, I do not have the knowledge to comment on that. My strip was 25cm x 1cm, and my calculated FU was 80 fu/sqm. Theoretically, it should have yielded 2,000 grafts. In actuality, they harvested 2,110 grafts.

My doc also said 14 days

Hi Streethhawk, Thank you for the comments. I knew beforehand that Dr K would only perform the incisions for the FUE element. But I had expected his level of supervision of the other elements to consist of more than just checking in on their work once. To be honest, I was not overly concerned that his technicians would be performing the extraction and placement. Firstly, from what I understand, the hair design and the incisions are the most critical, and technicians can be easily trained to a high standard for the other elements. His technicians are not freelance and have been with him for a long time. I believe him when he says he does not recruit technicians trained elsewhere in case they have picked up bad habits. Secondly, using technicians to carry out tasks other than hair design and incisions seems to be an acceptable business model increasingly adopted by the recommended hair clinics from reading online reviews. I would love to have been in a position to afford to pay for a highly reputable doctor to do all the work, but my budget would not stretch that far, and at my age and financial situation, it is doubtful I could ever save that much and even by the time I did I would too old and what would be the point. They seem to have changed their rep as the name differs from what I read in older reviews ( a chap called Ahmed now), and I did not find him too salesy. That said, I was under no illusion that his motivation was to get the business. Like you, I would much prefer to deal directly with the doctor and to be honest, it did cause me to question whether the answers I was getting were the salesperson’s or the doctor’s answers. But I did reach out to the other clinics, such as Eugenix, Dr Bicer, Dr Dogany, Dr Gur and Dr Turan, and Dr Yaman, and with all of them, it was also a case of dealing with a rep. He may well be narcissistic. I can’t comment, as I was not in his company long enough. However, being a little narcissistic might not be a bad thing, as he likely would want people to praise his work and so be motivated to do good work. I had read the doctor was arrogant, but it did not bother me if he was (although I did not find him like that). I was solely interested in the quality of his work and not his bedside manner. My perspective was that a charismatic Conman would have an excellent bedside manner but do poor-quality work. It would be nice to produce quality work and have a great bedside manner, but for me, quality took priority. Regarding quality, although I had read some people in 2019/2020 had said that he was turning into a hairmill, I could not find any direct firsthand evidence or pictorial evidence to show he produced poor-quality work. I guess I am the guinea pig, and my progress pictures will help provide proof one way or the other; fingers crossed, I chose wisely.

Thanks Napoli for the reassurance, time will tell but looking good so far!

Thanks, JackDaniels, I hope it does, as I know how useful it would have been for me.

Thanks, JackDaniels, I hope it does, as I know how useful it would have been for me.

Thanks 0-Myles59. Recovery is going well so far🤞

Hello Folks, This is the beginning of a log of my experience with AEK Clinic in Istanbul, which I hope others considering AEK will find helpful. I intend to provide monthly updates of my journey for the first 12 months and a final 18th-month update. This initial post is a long read, but I wanted to be thorough as I could not find any detailed recent reviews of AEK to help me when I was deciding whether to go with them. 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. The total cost equates to approximately 50% of what I would have paid to have it done locally. 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 Turkey, considering they have a much lower cost base and perform many hair surgeries. The hair industry in Turkey, I discovered, is a minefield. My journey eventually brought me to Dr Ali Emre Karadeniz (Dr K). Overview: AEK is a small boutique hair clinic run by Dr K. Being a small operation, it does not readily appear on a Google search of hair transplant clinics in Turkey. I only encountered them when researching the ISHRS site for ‘qualified’ Turkish hair surgeons. 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 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 (I use an antihistamine if the desire to itch gets too intense). To my untrained eye, the work looks good. One cause for concern I have is that there were considerably 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’ (I feel there is space in my crown for more, but I recognise that I have only limited knowledge, and at least I have beard hairs in the bank if needed later). 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). There is a significant element of artistry as much as science in delivering a successful hair transplant, as different surgeons can produce different results with the same number of grafts on the same candidate; therefore, 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 that began in my early 40s, and the loss appears to have stopped or slowed down considerably. I took no hair growth medications before the transplant, but following the transplant, I started on Finasteride 1.25mg on Monday, Wednesday, and Friday. If my scalp tolerates it, I will also begin topical foam minoxidil 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. Before approaching AEK, I attended a paid (€200) face-to-face consultation with a local reputable hair surgeon (Dr André Nel) who, like Doctor K, is a fellow of the ISRHS and American Board Certified. He reported: ‘The hair shafts have a slight curve and wave. The hair shaft calibre is average at approx 68 microns. DONOR: Approx 80 FU/sq cm. Lateral humps are at average height. The donor area is average in size and density. Calculated density approx 2.3 hairs/FU’… ‘… the Frontal Zone by transplanting at least 2500 follicle units …. The Mid-Scalp area by transplanting at least 750 follicle units … Crown area by transplanting at least 2000 follicle units …. harvesting will be done via FUT/FUE combo technique, combined with FUE from the Beard Area below the Jaw Line… the beard be strong enough for at least a 1000 graft harvest… This procedure will be done over two days’. Interestingly, you will note that the total number of follicle units (grafts) transferred by AEK is 1006 units below the minimum figure estimated by Dr Nel as being required (4244 vs 5250). You will also note that 1,006 grafts correspond to the 1,000 grafts Dr Nel intended to transplant from the beard area. In my WhatsApp consultation, I raised the possibility of a Beard Hair Transplant (BHT) several times. Also, I provided AEK with extracts of Dr Nel’s report recommending BHT, a recommendation which benefited from face-to-face consultation and the use of technology. The clinic responded that if Dr K felt I needed extra grafts from the beard, he would do the BHT on the FUE day with no added cost. Dr K obviously decided, as explained above, that I did not need to add beard hair. I will, of course, be highly disappointed if I find that in 12/18 months, better density could have been obtained if beard hairs had been transplanted. At my age and stage of hair loss progression, I wanted to maximise what could be achieved in density over the two days without overharvesting. 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 ISHRS 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, but should be more than adequate for the 14 days post-op). 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. Conclusion: Other than the concern regarding the lack of use of beard hairs and how that will translate into density, particularly in my crown area, I am happy with AEK. However, it is only in 12 to 18 months that I will be in a position to recommend them. If it transpires that I need a touch-up and it is anywhere in the region of 1,000 extra grafts, then I would consider Dr K’s work a failure. Fingers crossed, I will be celebrating this time next year.

Why? Technicians do all the work for Blue Magic and my hair design and FUT is being carried out by a qualified plastic surgeon who is a fellow of the IHRS and american board certified and is on Realself. Granted for my FUE he will only be doing the excisions which is a crutical element of the process but for my budget it is a big step up. Also I could find very few real world examples of bad work coming out of AEK. However I am here to be educated so please share.

Hi James Bond, I am reading you post and have just signed on with AEK for a combined FUT/FUE procedure ( thanks to this forum I avoided making the mistake of going with Blue Magic, I lost my deposit but I would rather lose a deposit than lose my hair). Anyway, I cannot afford to lose another deposit, so other than your disappointment with the number of grafts, how would you rate the rest of the overall process? My understanding and others more experienced on here can correct me, is that FUT is a lot quicker than FUE. Also, when you say Dr Shapiro did 8,000-10,000 grafts, do you mean 8,000-10,000 hairs, which would be roughly 3,200 to 4,500 grafts? As RisinStar said it is only 2 months in so I hope it all works out for you. Thanks Freddie