HAIR TRANSPLANT IN TURKEY: Overview by Dr. Karadeniz

[Ali Emre Karadeniz]

Dear Members and Future HT Candidates,

 

I am writing this short overview about how things work in Turkey hoping that it will be useful for future candidates. As a relatively new member to the forum I am seeing a lot of wild discussions going on at multiple threads about HT in Turkey. I will try and give objective information, avoiding being for or against any clinics in Turkey as I am a Turkish plastic surgeon and hair surgeon myself.

 

It is estimated that there are about 500 hair transplant teams or clinics in Turkey; therefore this country has been one of the main centres in the world for hair surgery and attracting many patients around the globe. The two main characteristics of hair surgery are that the prices are very cheap and surgical teams solely consist of technicians and staff from various backgrounds such as nurses, ambulance paramedics, anaesthesiology technicians, cardiovascular surgery pump technicians, car mechanists, secretaries and even housewives! Hair transplants are not perceived as surgical procedures by this nation and are treated like going for a hair cut. A Turkish billionaire who drives a 1 million Euro car will hope to have a HT for 1000 Euros!

 

There are around 10 medical doctors in Turkey that actually do parts of the surgery such as graft harvesting and recipient site incisions. The remaining 490 teams do not have a doctor that is a part of the operation. Not surprisingly FUE is the only technique used by these teams. They quickly teach each other how to drill down the patients scalp to extract grafts and the teams multiply in number rapidly. To my knowledge there are only 4 clinics left in Turkey that are able to do FUT. Despite being a huge HT country, there are about 30-40 technicians in Turkey that know how to prepare grafts from a skin strip. There are 4-5 technicians that are trained to do slivering; that is less than the number of hair surgeons! The financial balance between the two techniques are altered and it is 3-4 times more expensive for a Turkish clinic to be able to offer FUT, compared to FUE.

 

Under these circumstances, is it a good idea to go for a HT in Turkey? I think it is as long as you know what you are buying.

What do you buy when you go for a HT in one of the technicians FUE clinics and who should go for it? This is what you are going to get: Technicians will aggressively drill down through your scalp for about 5000-6000 times. You can usually see this if you look at immediate postop photos of the donor area. The transection rate is going to be 50-70%, which means you will get 2000-4000 grafts that are severely transected. These grafts will be placed but will show growth less than expected. About 2000 grafts will have disappeared due to total transection. Since partially transected grafts grow some hair, there will be significant improvement despite the wasted grafts. Since these technicians have a very primitive knowledge of recipient site incisions, it will usually look unnatural, or at least too widely spread. The major problem will be at the donor area. When a Turkish technicians operates on your donor area, the donor is mostly finished. Most patients will have significant moth-eaten appearances at the donor area. Patients who have a very strong donor might still not show signs of weakness and permit another session of FUE, but that will be it. There is no hope of doing 3 or 4 procedures. I usually do only FUT if I know a Turkish technician has operated on a patient. I have tried many times to do FUE after a technician and failed to get anything.

Now is this acceptable for a patient? It can be if the patient just wants some hair on his head and feels that he has no hope of getting a proper one in his life time.

 

If the above scenario doesn't suit you, is there a better option in Turkey? Certainly; the 10 doctors in Turkey including the 2 recommended surgeons on this network can provide excellent HT procedures for a much cheaper price than their counterparts in Europe and USA. The only difficulty is to find them, because they typically are much smaller companies than the large technicians clinics who do 10-20 procedures a day. These boutique clinics have a hard time surviving in the market due to the wide unlicensed competition with very low prices. Doing these procedures for even double the price of the technicians doesn't make it a very profitable business, considering that they can do only 1 patient a day. They don't have much of an advertising budget. Agents usually prefer to work with technicians to get more customers and make more profit. So only the patients can find these boutique clinics.

 

I think this is enough information on summarising this topic. I once again want to emphasise that I do not want to be involved in any competition with other clinics and have no intentions of advertising my own. I hope it will serve as a guidance to future patients.

 

Regards,

Dr. Ali Emre Karadeniz

[Garageland]

Thank you for your honest and insightful opinions on the transplant industry in Turkey. I am surprised there is not more comments on this thread. I agree in what you say about the training/competence to perform a fut vs fue procedure. I think most medically trained people would feel comfortable after observing for a while to try to extract a graft with a manual punch very few would be comfortable about opening and closing a donor area and I guess we have to be thankful for this or I couldn't imagine the number of terrible donor scars we would see.

 

So I am thankful at least that fue which in the unskilled hands is a easier method to perform, don't get me wrong it is a skill that takes some time to master to perform it correctly and avoid as much transection as possible. This is the method that these clinics have adopted and people are going to them because of the price thinking that if it doesn't work out they believe can just shave their heads if it doesn't work out

 

I think it comes down to the old saying of you get what you pay for.

[KO]

Yes, thanks for posting Dr. AEK......FUE surgery performed by techs using motorized tools. This reminds me of the discussion happening in the other thread about a certain Turkish clinic to go unnamed.

 

What is your opinion on techs extracting grafts, and the doctor only making the incisions, as appears to be common? Is this something you find acceptable or do you feel the doctor should perform a majority of the steps with FUE?

[lifeisbeautiful]

thanks for the post Dr. Which parts of the procedure should be performed by the surgeon alone?

[Ali Emre Karadeniz]

Dear members,

 

I think that the grafts should be extracted by a physician. Although I am feeling more and more lonely everyday about this. There was a recent message at the ISHRS website called 'Consumer Alert'. I thought it was announced to declare that technicians should not do this, but to my surprise a Turkish colleague pointed out that 'Licensed Technicians' were aloud to do it. I couldn't help but thinking that the old generation of hair surgeons are trying to find a solution to the overwhelming FUE era, and are now coming up with two options: Buy the robot or allow technicians!!

 

There are a few important things that the person who extracts the grafts needs to consider, and you really need the physicians eye to take care about them. Please note that this eye has to be open throughout the procedure to readjust during the course of the operation; a supervising eye can not provide this. These are;

1. Extracting mainly from the permanent zone and entering the transition zone just for feathering purposes.

2. Not extracting from areas that might look depleted like temporal areas and neck.

3. Choosing proper instruments including the punch size depending on tissue character.

4. Doing a proper FUE test and if transection rates appear high offer FUT or cancel operation and give money back!: I believe this is very important.

5. Controlling penetrations per area and keeping equal distance between punches to avoid moth-eaten appearances.

6. Controlling angle and depth of punch and rotation speed to keep transection rate low.

7. Choosing the optimal graft number for both the patients recipient needs and the donor capacity.

 

There may be even more to add to this list.

Can anybody say that a technician can take care of all these factors?

 

About the incisions:

In Turkey the incisions are also performed by the technicians, which I also think is unacceptable. You will see that none of the large hair clinics even have the Cutting Edge blade cutter and the surgical blades. They just cut ordinary razor blades with scissors. They have no idea about preparing blades to the depth and width of the patients grafts. They have never heard of coronal or sagittal incisions. They don2t know at what density they are doing their incisions. And so on...

 

Regards.

[KO]

Indeed, I find it shocking that it is acceptable for techs to harvest precious donor tissue. After all, the core difference between FUT and FUE is the extraction process, and then the preparation of the grafts. Why shouldn't the doctor perform this all-important step?

[PupDaddy]

I find it equally alarming, if not more so, that the certain Turkish FUE clinic which shall go unnamed (and apparently others according to Dr. K) allow techs to make the graft recipient incisions. Yikes! Anyone contemplating a hair transplant from one of these Turkish mini-mills ought to re-read Dr. K's posts in this thread, especially his second post regarding why techs should not be entrusted with the critical tasks of selecting, excising, and extracting the grafts from the donor region and making the recipient site incisions in the recipient region -- the two aspects of an FUE hair transplant surgery that most critically depend on the surgeon's eye, skill, and experience if the transplant is to be functionally and cosmetically successful, let alone optimal.

[fisher4man]

A Turkish billionaire who drives a 1 million Euro car will hope to have a HT for 1000 Euros!

 

 

:)So the Turkish billionaires seem to be not as fool as the American billionaires (and billionaires from the other countries) or docAEK needs American billionaires urgently.

 

There are almost/at least one billion of hair loss sufferers in the world and majority of them are standard wage earners or lower income classes.

 

Who will treat them?

 

How many HT sessions and teams are necessary to complete all?

 

So, what is the reason to cry wolf?

 

Where are the results of docAEK?

[lorenzo]

Are you the same doctor as this thread.

 

http://www.hairrestorationnetwork.com/eve/166406-my-disastrous-journey-transmed.html

[lifeisbeautiful]

It seems he responded on the thread you shared.

[mitchellthesuper]

Dr. Karadeniz, do you claim there is no technician who can do a proper job?

[Ali Emre Karadeniz]

Dr. Karadeniz, do you claim there is no technician who can do a proper job?

 

I believe this question is not relevant to what I have been trying to say in this thread. Ofcourse there must be many technicians who do their jobs quite well. The main point is that they should be doing ONLY the procedures they are trained and licensed to do. I was trying to explain what can go wrong if technicians are allowed to do procedures that they are not trained to do. Even if there may be some technicians that could do the doctors job as well, if you allow technicians do these procedures then we can never be sure if the patient is one of the lucky ones who have found this talented technician or is heading a disaster. Every patient deserves the trained and licensed skill of a physician with a very good chance of getting an excellent result and the chance of being properly treated in the rare incidence if things go wrong; they don't deserve a gamble.

[mitchellthesuper]

thanks for your explanation Dr. Karadeniz.

[Ali Emre Karadeniz]

Recently, I spoke with our publisher Patrick Hennessey regarding physician involvement and whether or not a physician should perform any of the operating procedure in order to be considered for recommendation. This is an important topic since many patients prefer the lead physician to be directly involved in operating on them.

 

What we've concluded is that hair transplantation is a team effort and cannot be completed by the surgeon himself/herself. Some physicians choose to be very hands-on while other surgeons choose to step back into more of a supervisory role. That said, I agree with Pat when he said:

 

"Ultimately the end results and their consistency are the most important measure. If the physician is supervising and maintaining the quality, then who's hands are on the tool is very secondary in my opinion".

 

Now, some patients may prefer a physician who is more hands-on. However, I don't see anything wrong with a physician supervising a procedure as long as the end results and consistency is the same.

 

That said, I do have concerns about clinics who operate without a physician at all where technicians and nurses are the only ones performing procedures. In my opinion, a qualified physician should always be involved and at the very least, directly oversee the procedure and the outcome.

 

Best wishes,

 

Bill

 

 

I think that the grafts should be extracted by a physician. Although I am feeling more and more lonely everyday about this. There was a recent message at the ISHRS website called 'Consumer Alert'. I thought it was announced to declare that technicians should not do this, but to my surprise a Turkish colleague pointed out that 'Licensed Technicians' were allowed to do it. I couldn't help but thinking that the old generation of hair surgeons are trying to find a solution to the overwhelming FUE era, and are now coming up with two options: Buy the robot or allow technicians!!

 

There are a few important things that the person who extracts the grafts needs to consider, and you really need the physicians eye to take care about them. Please note that this eye has to be open throughout the procedure to readjust during the course of the operation; a supervising eye can not provide this. These are;

1. Extracting mainly from the permanent zone and entering the transition zone just for feathering purposes.

2. Not extracting from areas that might look depleted like temporal areas and neck.

3. Choosing proper instruments including the punch size depending on tissue character.

4. Doing a proper FUE test and if transection rates appear high offer FUT or cancel operation and give money back!: I believe this is very important.

5. Controlling penetrations per area and keeping equal distance between punches to avoid moth-eaten appearances.

6. Controlling angle and depth of punch and rotation speed to keep transection rate low.

7. Choosing the optimal graft number for both the patients recipient needs and the donor capacity.

 

There may be even more to add to this list.

Can anybody say that a technician can take care of all these factors?

 

About the incisions:

In Turkey the incisions are also performed by the technicians, which I also think is unacceptable. You will see that none of the large hair clinics even have the Cutting Edge blade cutter and the surgical blades. They just cut ordinary razor blades with scissors. They have no idea about preparing blades to the depth and width of the patients grafts. They have never heard of coronal or sagittal incisions. They don't know at what density they are doing their incisions. And so on...

 

 

Ofcourse there must be many technicians who do their jobs quite well. The main point is that they should be doing ONLY the procedures they are trained and licensed to do. I was trying to explain what can go wrong if technicians are allowed to do procedures that they are not trained to do. Even if there may be some technicians that could do the doctors job as well, if you allow technicians do these procedures then we can never be sure if the patient is one of the lucky ones who have found this talented technician or is heading a disaster. Every patient deserves the trained and licensed skill of a physician with a very good chance of getting an excellent result and the chance of being properly treated in the rare incidence if things go wrong; they don't deserve a gamble.

 

 

Dear members,

 

I would like the community to think deeper about allowing technicians do operations under supervision. At first sight it may sound okay and we may think results should be the deciding factor. However, I see three main problems with this approach.

 

First, results are evaluated through photos at online forums. Photos can be photoshopped, combed and styled to look better, certain angles can be preferred to make it look nicer or bad and dark photos can be deliberately presented to give as little information as possible. For example, there is a patient viewing session at annual ISHRS meetings where reputable surgeons show their live patients. We frequently see that the results are not as impressive as we would expect from previous knowledge about those surgeons.

 

Second, it takes one year to get a result. There is plenty of time to manoeuvre and let followers forget about a patients thread.

 

Third, patients with a low budget choose these technician clinics because they think that otherwise they have no chance of getting their hair restored and they may be right. These patients seem to rigorously defend their clinics not because they believe that they will get an excellent result, but because they believe that they deserve the opportunity to have a hair transplant just like other wealthy patients; I also agree with them. In addition, when they are treated well by the staff they will be so satisfied that any criticism to the clinic will be taken as an offence to them. However, inevitably future hair transplant candidates are mislead.

 

For all these reasons we actually get the information that we are allowed to get. On the other hand, I think that opinions supported on this forum should have scientific and legal bases, not practical bases. Of course when there are many posts about the results of a surgeon, the community is able to get a feel for how good the quality is, but there is enough gray area for followers to be mislead if we don't have clear medical and legal borders.

 

Lastly, I think that the main quality of this network is the recommendation system of surgeons. The acceptance of supervised technicians doing surgery will sooner or later defeat this system. Technicians who show good results will eventually be candidates for recommendation.

 

I apologise to all if I sound a bit arrogant and want to say that this is not my intention at all. It is just that this is a topic I have been thinking about for a long time and the recent progress in the market worries me as a physician.

 

Best regards,

 

Dr. Ali Emre Karadeniz

[Ali Emre Karadeniz]

I see a lot of discussions about my topic on other threads, but instead of being involved in personal debates which don't seem to be productive, I prefer to keep it all on my thread. I can't overemphasise that my goal is only to give information to the community.

 

1. In Turkey law permits only plastic surgeons and dermatologists to be involved in hair surgery. Physicians of other specialties are not allowed to do hair transplants.

2. There is no legal licence for hair technicians in Turkey, thus technicians are not allowed to do any part of the operation including graft placement. In fact there is no licence for a technician that is allowed to do any kind of surgery on the human body.

3. Despite the strict laws, plastic surgeons and dermatologists doing hair transplants in Turkey are such a minority that, when I say that I do hair surgery, people around me don't even understand what I am talking about. They will usually stare at me with a sad and ironic face as if I told them that I can not do cosmetic surgery but I work as a hair dresser. For this reason, it is senseless to criticise any one in Turkey for letting technicians do hair surgery. It is just perceived as a normal thing. There are about 500 hair clinics in Turkey of which I would have a hard time counting 10-20 physicians, forget about plastic surgeons and dermatologist. I have to admit that if one day HTN decides to recommend technician clinics, there will be a lot of candidates form Turkey!

Edited November 5, 2014 by drkaradeniz
misspelling

[FFighter]

I would be interested to see the list of 10 surgeons. Me and 2 friends are considering getting HT in Turkey in December. Thanks in advance

[Blake Bloxham]

Dr. Karadeniz,

 

Thank you for sharing. I don't think we - all the member of this community - had any idea how popular this practice model had become in Turkey. Not only did I see the commentary made by the ISHRS, but I completely share your point of view: the extraction and site creation portion of a hair transplant procedure should be performed by a physician. Now, hair restoration surgery is a team effort; really no doubt about that. However, the "captain" of this team should be a well trained, hands-on, involved physician.

[lorenzo]

Helping Italians patients I am hearing a lot of stories lately. Some of the patients I have met first had surgery in Turkey while other had friends. From my limited experience of patients talking to me I cant disagree with many of the points that Dr. Karadeniz makes.

 

Not only did I see the commentary made by the ISHRS, but I completely share your point of view: the extraction and site creation portion of a hair transplant procedure should be performed by a physician

This is very interesting future_HT_doc. Can you share which recommended FUE doctors actually do this? I am asking because I do not know.

 

Thanks!

[Blake Bloxham]

Fisher4Man,

 

Your argument is a timeless one in the world of medicine. Many have made similar claims about surgeries, procedures, and doctors in the past. However, let me explain why this is a bit of a "logical fallacy:"

 

Say I'm an oncologist (cancer doctor) with the ability to treat very sick patients with expensive chemotherapy agents. I have two patients: one is a rich business man with advanced cancer, and the other is an unemployed homeless man with the same type of cancer. I have, at my disposal, a very efficient, but very expensive chemotherapy agent to treat this exact type of cancer. The businessman can easily afford it; the homeless man cannot. Do I offer the business man the expensive chemotherapy agent and give the homeless man generic aspirin because it is affordable? I know it won't cure his cancer, but it's something; right? Or do I work with him to find financial assistance, and beg, borrow, and steal to find the funds to buy this medication?

 

Now, obviously a VERY exaggerated example, but I think you see the point I'm trying to make. Offering a less proven product simply because it is affordable is rarely - if ever - the right answer. This is really a timeless debate in medicine, and the answer is pretty much always the same.

 

Now, am I trying to saw that physician-managed hair transplant surgery is akin to the fancy miracle drug and a tech-performed FUE is cheap, generic aspirin? No, absolutely not. What I am trying to say is that you are making a distinction between two tiers of treatment and recommending that those who cannot afford it should "settle" for something besides the current medical/surgical standard. I don't think this is the case. ESPECIALLY in an elective field like cosmetic surgery.

 

I have members send me private messages about prices all the time. In 99% of cases, I give the same advice: spending a little time on preventive medications and saving up for that one procedure with one of our elite doctors is almost always the most effective solution in the end. I think the seasoned forum members will tell you that we've seen our fair share of bargain, "too good to pass up" hair transplant experiments go very wrong. This is why I don't recommend this thought process or practice.

[Blake Bloxham]

Lorenzo,

 

I'm confused? You're asking which of our FUE physicians remove the grafts and create the incision sites themselves? Nearly all.

[lorenzo]

As I stated I do not know that is why I asked. That is impressive if every graft is extracted by the physician. I remember hearing that one clinic ( I do not recall) had a tech that was able to extract graft with both hands at a high rate of speed.

[1966kph]

Hello Dr Karadeniz.

As you stated in this http://www.hairrestorationnetwork.com/eve/166406-my-disastrous-journey-transmed.html thread that you were a inexperienced dr in training and this apart from the popping was the reason for the very poor result.

We all start and do things for the first time and the more complex the task the harder it is to master.

Would you if shown consistent good results from a technician led team that do all the work actually say it is such?

A good result is a good result and it is irrelevant who made the result happen.

Now am i saying that there are not technician led teams that are going to produce terrible results i am certainly not there are.

Did the patient in the thread high lighted above care or even know you were a inexperienced dr at the time? it was the final result that matters most to him.

Am i saying that technician led teams should replace dr clinics? no i am not and i think it will never happen but they can in my opinion co exist.

This is the reason i think the idea of some form of recommendation for technician led clinics pre screened showing consistently good results should be implemented to steer vulnerable unaware of being damaged.Whether it is from a novice dr as you were back then or one of the hundreds of clinics in turkey you've mentioned.

You have a nice day

[KO]

I agree with Future HT Doc....it may be very commonplace in Turkey to have technicians to do the whole surgery, and if people want, they can go to them. But as a community devoted to standards and finding high quality clinics, it is not something we should advocate or recommend on here. Just IMO!

 

 

You can always make more money in life....but donor hair is a precious, limited, and finite resource.

[mikeey]

I think Results are what matters , we have read about doctors doing the extractions and the Technicians doing the rest .... YET Poor Results , and I have seen at Dr. edrogan the Nurse doing the extractions and YET Super Results , No Patient wants to know who does what ... we all WANT ONLY RESULTS !

 

Soon we will be hearing about 4 - 5 surgeries in one day , and u cannot blame the Doctor as in all the Best Clinics there is a HUGE Rush as More and More People are Feeling Safe and secure with the FUE Method as Opposed to FUT , which even I get Scared of !!

[PupDaddy]

I think Results are what matters , we have read about doctors doing the extractions and the Technicians doing the rest .... YET Poor Results , and I have seen at Dr. edrogan the Nurse doing the extractions and YET Super Results

 

You are missing one of the main points here: The clinic in question isn't just having techs do all the extractions and seating of the grafts in recipient sites. It is even having technicians create all the recipient sites!! The creation of the recipient sites is the heart-and-soul of ultra refined hair restoration surgery. We have NEVER read of this and we have NEVER read of ANY clinic -- and certainly have not recommended one -- that removes the surgeon from the procedure entirely and allows non-physician technicians to perform the entire hair restoration surgery, from start to finish. In fact, from what I can gather, the physician who owns the clinic in question has no experience performing hair restoration surgeries at all and merely hired a team of technicians to perform hair transplants as a second profit center. This is the kind of clinic that we should recommend to members or even grant Coalition status to?