FUT ~2700 grafts with Dr Karadeniz + ATPv info

[PersonMan]

I'm posting some photos and information about my recent experience (7th September 2018) of a FUT strip surgery procedure performed by Dr Emre Karadeniz of AEK hair clinic in Istanbul, which may be helpful to others considering a hair transplant. I certainly benefited from reading such posts, and there are very few about FUT with Dr K. (just two detailed ones, I think), so this is my contribution.  I was told by email that I had around 6,500 hairs (not grafts) transplanted, and I estimate that this was from 2,700 - 3000 grafts. I forgot to ask for the detailed statistics immediately after the procedure (obvious question, I know!). In any case the number of hairs rather than grafts is the most important figure. These figures are in line with my expectation based on my density, strip size and post-op photos.

I'm 37, and first noticed a thinning patch on my crown 6 years ago. Now this area has expanded a little and is pretty bald, while most of my mid scalp is down to around 15-20% density, with some of the front hairline maybe 30%.

A lot of detail about the experience with Dr K. has been covered by others, so there isn't a lot further for me to add. I had a consultation, head shave and markings done by Dr K. the day before the surgery to save time the next day. I had already decided on FUT and he had answered some emailed questions. I just explained that I wanted some coverage on my crown as well as the front, with the hairline where the existing one is, so it was a pretty brief consultation and he had a good look through my hair. He said that should be ok as my hair diameter is coarse and I had good laxity. He shaved the recipient area ultra short, but everything else is shaved to 2-3mm.

On the morning of the procedure, after the blood test and anesthetic injections by the technicians, Dr K spent around an hour carefully doing the strip removal surgery. He said the strip was 26cm, and it looked to me about 17mm wide. After a short while he returned to do the recipient anesthetic injections and the incisions (which I guess took around 1 hour). Meanwhile, 4 technicians slivered sections of the strip, which are placed in circular dishes containing Custodiol (Dr K's preferred storage medium due to its scientific evidence base). All this takes place in one room. It's an interesting sight to see part of yourself on a table. The atmosphere is very relaxed, the room has lots of windows, and there is music in the background. You have a nice view out a large window towards your feet when you are having the incisions and implants.

Soon after lunch they were ready to start the insertions. Most of the time 3 technicians continued the slivering, while 2 or 3 other technicians carefully implanted the grafts. The last slivering of the strip and insertions occured around the same time, so it seems that this is well choreographed to minimise out of body time. They all seemed very diligent. The insertions took around 3-4 hours. There was no pain, and I drifted in and out of sleep in the first hour or two.

After we were finished I watched a post-op instruction video, received some products to take with me, and saw Dr K. for any questions before leaving. At the same time I met another guy who had been having an FUE to his hairline the same day. I guess Dr. K was able to see us both the same day as FUT is much less time consuming for the Doctor than FUE harvesting. The next day we both returned for bandage removal and scalp washing by one of the technicians.

I had my surgery in the middle of a 16 day holiday in Turkey. I continued my backpacking travels with no problem after 2 days rest in the hotel, wearing hats to protect my scalp from the sun. The hip straps on my backpack kept most of the weight off my back and neck areas. On the first evening I had a couple of headaches and nausea, vomiting once, but felt fine after that. I only experienced pain in some specific places on the donor area when trying to sleep, but it wasn't much of a problem. I brought with me an airplane travel cushion, which made it easier to sleep on my back and keep weight off the staples. The clinic had given me two types of painkillers; paracetamol and a stronger one called Etol Fort. I just had a couple of paracetamol the first night. The 2nd night I needed one Etol. After that the pain was intermitent and minor enough that I didn't bother with painkillers. Swelling was virtually gone after 2 days, so I stopped wearing the headband then. I never experienced any itching, but as is typical, there was (and still is) some loss of sensation in the recipient area, and above the scar at the back of my head. It's gradually improving, and I expect full sensation to return in time. I had quite a lot of crusting in the 2nd week, but it had all come off with help from my fingers in the latter half of that week. During the crusting some hairless cracks/valleys appeared, as is common, but they weren't too bad. Maybe moisturising twice per day would prevent that. I used a surgical staple remover to remove the staples by myself on day 15. Most of them were quite painful, but just for a second.

I will post some photos below. I am pleased with how things have gone so far with the scar etc., but of course I'll have to be patient for many months to see how the growth turns out. I intend to provide updated photos at various points down the line.

Some info on ATPv for those interested

Before my procedure I read a lot about ATPv, a liposomal ATP product manufactured by Energy Delivery Solutions. ATP is a naturally occuring molecule that stores and delivers energy to cells. When hair is harvested, the follicles are in a state of ischaemia (low blood supply) for a few days prior to revascularisation. The idea behind ATPv is to directly deliver ATP to the hair follicles during this period via a post-op spray diluted with saline in 1:9 ratio, and also usually as an additive to the storage solution while grafts are being harvested/slivered and implanted (although I only used it for my post-op spray). I decided to use this in case it could reduce risk and add a little to the end result in terms of quality of the hairs, or yield, or speed up the resting phase. Dr K. doesn't think it makes any difference and his clinic gives good results anyway, but at worst would be a placebo.

I purchased a 25ml bottle of ATPv via the Zavimed website (the official European distributor) a few weeks before my procedure date. I should have explained to them when I needed it in order to get the best expiry date, but it was ok. Zavimed order ATPv from Energy Delivery Solutions based on incoming orders and taking into account the manufacturing schedule to get the best expiry date. You can order directly from EDS, but you need to be a medical professional and it will be more expensive due to delivery if you are outside the US. The ATPv arrived in a box with ice gel packs as it should be kept refrigerated as much as possible to maintain stability of the liposomes. Energy Delivery Solutions knew that there could sometimes be gaps in cold chain transit, so the inventor says that they tested and found that the product can be exposed to temperatures above room temperature for up to 5 days with no changes to their release criteria.

I was able to fit the bottle with a few mm to spare in a wide mouth 0.5L / 18oz thermosflask made by Hydroflask. The base of the 25ml bottle is exactly 50mm diagonally. I kept some ice cubes in the thermosflask to keep the ATPv bottle and spray chilled when I was on the move and didn't have a hotel fridge. I also brought some small sterile saline ampoules with me so I had everything I needed for the spray.

Dr K. doesn't provide a post-op spray because skin is waterproof and the grafts can't dry out once they are below the skin, so there is no point in a spray in his view. The clinic do however provide a moisturiser cream to apply to the scalp once per day (and some baby shampoo).

I can't know whether the ATPv was of any benefit, but I applied the spray as recommended - a few puffs of spray on the recipent and usually a little on the donor every 1-2 hours the first two days, then every 3-4 hours to day 7. A common anecdotal observation is that redness disappears quickly in patients who use ATPv. My redness was un-noticeable by day 7, and I couldn't perceive any difference in colour at all compared to my face by day 10, although I realise this is within the normal range of outcomes even without ATPv.

 

Edited September 27, 2018 by PersonMan
More Zavimed info

[PersonMan]

Here are some pre-op photos

Edited September 26, 2018 by PersonMan

[PersonMan]

The markings for the transplant

[PersonMan]

Some photos 1 day after surgery, and some showing how it looked with the staples on day 10.

I've also uploaded 4 close-up scar photos from day 15 before I removed the staples showing (clockwise from top left) a typical area on the right, back-right, back-left and left. Maybe that's of interest to some people considering FUT. I'm especially pleased with the left side at this stage, with no shockloss and good coverage.

Edited September 26, 2018 by PersonMan

[PersonMan]

And finally, how it looks currently (staples were removed a few days ago). These are from day 18 post op.

Looking at my hair now, the vast majority of the transplanted hairs have fallen out (as expected), much of them as I removed the crusting. They are easy to distinguish from native hairs because the latter are growing. I don't seem to have any noticeable shock loss in the recipient, even at the front hairline, where the thinning wasn't so bad. As for the donor scar, the left side is way better than my expectations. It was well covered when I removed the staples on day 15, with no shockloss, and since then has become pretty much imperceivable. Looking from the left at that side, the only visible difference is the change in hair direction towards the back, and the profile of the slight ridge in the hair at the back of my head. Hopefully this will improve with length and a hair cut. My camera picks up differences in colour that the eye doesn't percieve, so it looks better in reality than the photos, which are picking up the red marks from the staples and make the skin beneath my hair stand out much more.

The back is not doing quite so well yet (the photos make it more noticeable than in a mirror). The scar is also clearly visible all along the right side when viewed from even slightly behind, though still better than I'd anticipated at this early stage. I think it might take another 10 days for the right side to be hidden, mainly because the direction of the hair above some parts of the scar seems to have pointed more along the length of the scar rather than across it, and there is also less hair on that side of the scar. I expect it to turn out well as my hair lengthens and the very thin scar heals.

I plan to have FUE procedures in future (assuming I need them) rather than another FUT because I think the change in hair direction above and below the scar in some areas will be too great if I have another strip. Also I don't want to lose too much laxity. Assuming the transplant turns out successful, and because the scar seems to be going well, for now I'm glad I started with FUT.

Edited September 26, 2018 by PersonMan

[PersonMan]

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Edited September 26, 2018 by PersonMan

[1978matt]

Looks good.  Your hair and loss pattern is very similar to mine...and the grey hair too.

An unusually high strip was taken but maybe this offered the best density.

[alex79]

Looks very clean..

[Kiwiaustria]

Thanks for this posting. I’m gong for a fut with the same doctor in about 5 weeks so it was good to read your postings

Edited September 28, 2018 by Kiwiaustria

[chris39]

Any updates on this PesonMan ?

[PersonMan]

Apologies for the slow update (I've been very busy)!

Here are some equivalent photos at 10 months post op (I tried to replicate the lighting, but no longer have the old camera phone). You can open another browser tab to compare the original pre op photos side by side with these.

I think it has gone well. At 6 months I thought the growth had pretty much run out of steam, but I think there has been further improvement.

I should also mention that I use a DIY topical finasteride solution (very low dose - trying to replicate polichem p-3074 but without the chitosan). For a few months before the HT (about a year after starting to use it) I was starting to see some new hairs growing (very few), and when I washed my hair in the sink there had been a large reduction in lost hairs.

Perhaps in part due to my use of ATPv (see above), the growth came very early. Starting at the front around 6 weeks, the growth  peaked around months 3-4. All the hairs that came through were thick and strong from the beginning. Here are the 10 month photos (I may also add some I took in earlier months and info on the scar).

[PersonMan]

Hard to tell the difference in these, but here are some photos at 6 months. Looks good even a this stage, though I was a bit concerned about the midscalp at this point. I think I have a thin scalp so had lots of "J hairs" there.

Edited July 17, 2019 by PersonMan

[PersonMan]

And finally, some info on the scar. As I expected from the early pictures, the scar has gone very well, especially on the left side (could't be better really, a perfect job). The right is very good, though not quite as perfect. A few times I've had a number 2 short back and sides (3 is always fine). A couple of times 2 was fine, but the 3rd time they did the 2 a little higher so I had to disguise the scar for a week (very noticable). I used a technique I used in the early period post op. To disguise the FUT scar I used a grey make up pencil and / or a few dabs of dark brown dermamatch. This works really well for me.

The photos below were taken 5.5 months post op on the day of a hair cut.

The last photo (taken 6 month post op) you can see a border of grey against dark hair on the right side. That's not the scar showing through - it's just the abrupt junction of hair colours due to the FUT. For the first week or two post hair cut when it's more noticable I use a few dabs of dermamatch which is sufficient to break up the line if I want to disguise it. When my hair is all grey it won't be an issue!

I read recently that Dr K now also offers technician only hair transplants and has some other doctors on board. I recommend you have him do the strip if it's FUT (I've no idea about the other docs) and incisions.

 

Edited July 17, 2019 by PersonMan

[PersonMan]

I forgot to include a clear hairline photo, so here's one from today