ASMED, 2050 grafts_January 18th 2018_12 months result

[Astaldo]

INTRODUCTION

Dear forumers,

Greetings from a fellow forumer and former/recent ASMED patient.

It's been a while since my last visit, but a lot of things have happened regarding my hair loss (problems) in the meantime. Some of you could remember me as I was posting about my 3200 FUE HT journey with ASMED a few years ago. Since my last forum post in January 2017, I've undergone second transplant with the same clinic (and third in total) in the January 2018.

Almost a year passed since my second transplant with ASMED (and third in total), so I decided to open a new thread to share my journey and result with the forum, as it is fair considering how much it and its members helped me in my hair restoration battles. Seems like a whole life has passed since I started to battle hair loss and jumped into HT chair.

Unlike my former thread, this time I practically waited for my full 12 months result before posting anything, so I will present most of the materials and pictures through several monthly progress-themed posts, but in relatively short time frame.

I hope you won't find unconvincing if this time I skip most of the details about my stay in the clinic/hotel, or the procedure, since most of the other recent Asmed patients described everything in their threads, as did I in my own old thread. However, I will point out on several details, because nowadays it seems that the discussion about ASMED practices is threatening to 'escalate into a full blown forum war' (just joking ;).

I'll try to be as brief as possible, and if someone is interested in specific details you can ask everything via thread or PM.

BTW, my old thread is still available in the patients results sub-forum (ASMED, 3200 FUE grafts in hairline and mid scalp, link:

 

So, let's get to the point.

In my old thread I mentioned several times that I was considering another, smaller HT to address my once severely thinned crown, which was stabilized and improved through continuous use of finasteride, and cca 1200 grafts from my first FUE HT with one Hungarian clinic (that HT unfortunately did not yield optimal result). However I was not satisfied with the amount of improvement, as it was still very see through in strong sunlight or artificial light, not to mention that certain longer hairstyles with such crown were looking unconvincing because of the lack of volume.

I also mentioned that I was willing to increase density in my hairline. Honestly, there was no real need for that as my hairline result from the former HT with ASMED was nothing short of excellent considering the awful condition before 2nd HT. But hair greed really did struck me, and I couldn't stop debating with myself how it would look like if I add just a little bit more. Also, I wanted to be able to wear my hair a bit longer, in reminiscence to my hair glory days in high school (I was convinced back than that I have top quality hair, and was pretty much identifying myself with that particular image of a semi long-haired dude). Ahh those blessed memories (excessively exaggerated, ofc) I couldn't get my mind off!

As my hairloss was and is pretty much stable due to the finasteride use, there were no real cons except for being conservative for the sake of future planning, finally I decided to jump into chair again!

So, 3,5 years after my HT with ASMED, in July 2017 I contacted the clinic and sent updated photos for Dr. Erdogan's evaluation. That went smoothly, again I was considered a good candidate due to before mentioned factors, and Dr. Erdogan evaluated 2000 grafts procedure could be executed, with 1000 grafts for crown and 1000 for frontal part. This time, Sema was communicating with me as I was informed that my former patient coordinator no longer worked for the clinic. I filled in the forms, sent the 1000 EUROS deposit via bank transfer and booked the flight. My surgery was scheduled for January 18th 2018.

 

First set of photos include pre-op consultation dry&wet pics:

Edited January 11, 2019 by Astaldo

[Astaldo]

PRE-OP, OP, IMM POST-OP, Day 2&3

Fast forward, I arrived in Istanbul on January 16th, Asmed driver picked me with clinic mini-van and drived me to the Radisson Blue Asia hotel. I was sight-seeing that day as my consultation was scheduled the next day, January 17th. In the morning, I ate breakfast and joined 4 other guys that were going to consultations that day. Many greetings to them BTW, I don't want to write their names but have to say they were really good company, from all over the globe.

And yes, I was very well aware of how Asmed is doing business with multiple patients per day, and nobody forced me to jump into surgery with them. Great result from my previous surgery was a true deciding point for me.

 To address some other related things, it really seemed that patient number increased from 3 or 4 to 5-6 per day since my last visit in 2014, and consultation with Dr. Erdogan (at least in my personal case, but I also presumed because he already had documentation since I was his former patient) indeed wasn't that elaborate (but was informative and respectful to my wishes, and he did every inspection and planning by himself, along with medical team assigned to my case) and felt a bit rushed, but everything else was nothing short of professional and careful. I also got new patient coordinator, Suzana. As she comes from the same region as myself (one of the former Yugoslavia countries that neighbors my country) she speaks my language and communication was even faster than before, although I really didn't have any problem with their English. Many greetings to Suzana for being such a nice and pleasant coordinator and all her guidance through every part of my stay in Istanbul.

I had my share of pre-operative introductions, information, planning, photos, tests (EKG and such), paperwork, haircut, laser head scanning. It was a long day.

Next morning, January 18th, me and guys I've met previous day had surgeries. Mine lasted from c ca 8:30 to 15:30 I think, as I wasn't paying that much attention to time frame since I already had two previous procedures and wasn't that interested in the process. I could track the rate of extraction via tablet they presented to me occasionally or on my demand.

 

Summary (timeline info is somewhat speculative, as I wasn't paying the due attention):

1.       Extractions/graft quality control/counting – medical team, cca 2,5 hours

2.       Lunch break (1/2 hour)

3.       Incisions – dr. Erdogan, cca 1 hour

4.       Grafts Placement – techicians/medical team via KEEP, cca 3 hours

5.       PRP into my recepient and donor

6.       Laser treatment post-op

7.       Post-op photos and check-up from dr. Erdogan

8.       Bandaging and cleaning of the head

9.       Instructions about medical package use

10.   Went back to the hotel for the rest (and spraying my recipient area every 2 hours)

 

SURGERY STATS:

Date of surgery: January 18th 2018

 

Total grafts: 2050

Hair per graft: 2.04  (Temporal 1.92 hair/graft, Parietal 2 hair/graft, Occipital 2.09 hair/graft)

Hair caliber: 60 microns

 

Singles:          411    (20%)

Doubles:        1167 (56.9%)

Triples:          447    (21.8%)

Quadruples: 24       (1.3%)

Quintuples:   1

 

Total hairs: 4187

 

Last day of my stay I went for the first wash, post-op package, and my last clinic check-up. Next day in the morning I was on a flight for Zagreb, Croatia's capital. Although I didn't use the hat in Istanbul and during the flight, I became very much self-aware once I landed in my country, and especially during the waiting time at the central bus station (very crowded place) and five hours drive to my hometown. During that last part of my voyage, I was wearing a baseball cap, which I took off from time to time to spray my recipient area and let my skin breathe for a while. Due to careful handling, I did not damage any of the grafts and there was no bleeding to account for. I was very relieved when I finally got home, as the 'real' recovery process could begin.

Edited January 11, 2019 by Astaldo

[Astaldo]

7/10 DAYS

First few days it was very discomforting to sleep with a neck pillow, more so than during my previous recoveries (probably because I'm older now). However, this time I had almost no swelling, which was a pleasant surprise. I was rigorously following post-instructions from Asmed (everyday application of foam and washing with their shampoo/rinsing with mild to cold water with very low pressure) and was almost scab-free by the day 7, and completely clean by the day 10. I continued washes with their shampoo until I run out of it few months later. Weather was very cold so I didn't go out that much, with or without hat. Density seemed very good at this point, but the great shed was around the corner, I knew as much.

First 4 pics are day 7, the rest is day 10

[Astaldo]

DAY 22

The great shed was already kicking in, slowly but steadily. I was losing hairs with every wash, or when I was combing my hair with fingers (no fingernails). There was also issue with dried, flaking skin (basically harmless, but irritating), so I treated critical areas with some aloe vera gel. Also I hit my vertex on a lowered garage doorway and there was some blood (stupid fool), but no lost grafts as much as I could see. The wound was only on the skin surface. Also, beware of the hard lumps under the skin in the donor...

[Astaldo]

DAY 63_2 MONTHS

Ugly duckling phase in its full glory. Along with transplanted hairs shed, I had some minor shock loss in hairline, midscalp and crown. Nothing unexpected, but it was impossible not to notice the thinning impression. Was very much self aware at this point, to the extent that I disregarded Asmed reccomendations about concealers (reccomendation was not to use hair products for first 6 months) and used nanogen hair fibers (although without anything else like locking spray) to make my hair impression thicker as it was before surgery. I hope I didn't cause damage to transplanted grafts, it was one of the rare cases I couldn't reason with myself.

[Astaldo]

DAY 92_3 MONTHS

I had some regrowth in my hairline and mid scalp, and noticed some new growth of the transplanted hairs in treated areas. Hair was looking very much like the pre-op. Crown was lacking, as before, so I still covered it with fibers.

[Astaldo]

DAY 117_4 MONTHS

Finally I could say that I was seeing visible improvement. Although it was an early phase, the growth in the hairline (and in the crown, but on a lower rate) was visible, and overall hair grew enough that I could properly style it, but without products. I only used blow drier at this point. The feeling was optimistic, to say the least.

[Astaldo]

DAY 207_7 MONTHS

So I skipped month 5 and 6, as I was very busy at the time, and my hair kept getting longer. At month 7 I got a haircut to assess the condition. The overall thickness improved, especially in the hairline, but the crown was still very see through in my opinion, and I must admit that, although there was constant improvement, I was somewhat dissapointed that it wasn't fully covered with dense hairs by the time. It was not visible enough to track it day by day. Even the 'HT veterans' aren't immune to reckless hair greed.

[Astaldo]

DAY 258_9 MONTHS

Saw additional improvement in hair quality, especially in the hairline. Crown was better, but still lacking behind in comparison to hairline regrowth. At this point I decided to let my hair grow until I can assess the possibility of sporting a longer hairstyle without looking ridiculous or somewhat thin/receding.

Edited January 11, 2019 by Astaldo

[Astaldo]

DAY 355_12 MONTHS

Well, almost 12 months have passed since the procedure, and I haven't been taking any photos in the last 3 months. Hair grew substantially longer, and it was the time to evaluate the result.

First set of pictures is related to hairline at 12 months:

[Astaldo]

Second set is wet hair 12 months post-op:

[Astaldo]

Third set is dry hair, unstyled and little bit combed, but with no products. I tried to expose weak spots under realistic everyday light.

Edited January 12, 2019 by Astaldo

[Astaldo]

SOME FINAL IMPRESSIONS...

In the last 3 months, I must notice that I had good hair and bad hair days, days when I wanted to get a haircut because it looked ridiculous, and it was getting harder and harder to maintain. I forgot how greasy my hair is becoming after just 2 days when grown longer. Also, since nowadays longer but very 'usual' hairstyle isn't that popular or common, I get conflicting comments about my hairstyle. Family suggests that I look better with shorter hair, some others say it is great and makes me look younger. Anyway, I decided not to listen anyone's suggestions, and grow it out a bit more. Objectively, I know that shorter hairstyle with pompadour or spiked up or whatever probably makes me more masculine or trendy, or commonly better looking (especially for the ladies), but how to explain to people that this shit is something that I figuratively cried for for the last 12 years of my life, since my receding and diffusion made any attempt at sporting longer hair left me looking ridiculous and dissapointed. So I want to see where can I go from here until it gets to the point of 'too long, too much' (no way there is such thing as too much hair, especially for us former baldies and our not so fortunate, still balding brethren).

I am continuing with finasteride rigorously, and am aware that someday my hairloss might come back at me, the reason more for me to enjoy  this comeback of abruptly halted youth (I literally lost 6-7 years of my life obsessing with hair. It is of course, only my own fault, nobody else is responsible. But I also learned so much during my fight back).

While it lasts, it lasts. I did almost everything I could to reverse the 'curse' that was really bothering me.

Although not a perfect overall result (because we all aspire for the perfection, and perfection is not achievable in this industry due to the limitations of donor, we all know), this is the densest and best hair that I had literally since I was 19 years old, and it is all just my hair. And I am really pleased with it. Ofc there are some minor gaps I would like to fill in some more, but I think I've come to the point that anything more would be just waste of the remaining resources. If I want to thicken the crown I just have to put minimal amount of fibres and it looks great.

 

[Astaldo]

SUMMA SUMMARUM,

if I hadn't pursued the HT/meds route, I would've been Norwood 4-5 with recognizable 6 pattern in my thirties, as I have almost identical hair loss as my father did. My brother is NW 3V going to NW4 at  his 30. And he has had less aggressive hair loss than me in the beginning. I was a diffusing 3V at age 26 when I first pursued HT. Now at 32 years old I have almost full head of hair (with some recession) and NW 1.5-2 hairline.

 

In total, I had around 7500 in 3 FUE HT-s, out of which first one (cca 2500 grafts) was semi-successful and yielded less than 60-70%. According to dr. Erdogan, I still have some donor supply (cca 2000-2500 grafts), if my crown loss progresses. I will certainly keep them for the future use. I've been very lucky that I've recognised my initial mistakes in time, informed myself about the HT industry, chose a good clinic (for my case at least), and had good response to meds. It's all about the sinergy of various factors, not just one of those.

Final picture in this set is evolution of hair loss and restoration in my crown during the last 6 years.

 

If you had patience to read all of my posts, and still have some questions, feel free to ask. The only thing I am asking potential commentators is that you do not please wage war on Erdogan practices (either pro or contra) on my thread because I want to stay objective as much as I can, and I won't participate in fruitless discussions. Thanks in advance.

Edited January 11, 2019 by Astaldo

[JayLDD]

Tends to depend on where you’re from whether that’s an acceptable hair style but personally I much prefer seeing this occasionally than everyone getting the same fade with the front spiked up. Also seems to suit your face.

in my experience the longer it gets the more of an issue one has with bad and good hair days though.  Hair transplants tend to work best in a middle ground but yours looks very good for this length.

[wheretogo]

Hey Astaldo,

congrats on your last HT.

i went through your threads and i must say you looked amazing at the front before this last procedure, why did you add more grafts and weren't you concern about shock loss of the post transplanted hair at the front?

are you using hair products?

[Astaldo]

@jonyny, thanks man, I am really pleased with the final outcome. Hope you'll get a great result too.

@JeanLDD, you're absolutely right about the subject, when hair is shorter it is much easier to style it 'properly', and just let it go because even when a bit greasy, it will hold up to desired shape if you used some product. I sported classic spiked up with fade for some time, but I grew bored of it, as as you noticed, most of the guys around had similar or identical variation of the same haircut.

I can't help myself, just like the longer hair on my head, and I am not very bothered with people commenting it. Much less now than before when they pointed at my hair and commented I am balding.

Related to that last sentence, it is very interesting how people who know me for a longer time (and don't know that I had HT-s) somehow forget that i had pretty obvious hair loss just a few years back. Some minor amount (usually relatives) notice how my hair is looking better (although they cannot figure why), but friends who openly pointed to my hair loss problem now do not even notice, or at least never mentioned anything. I didn't even get a suspicious glance from some of them during all those years of slow, but steady improvement. It somehow amuses me.

I am also following your thread. Seems you'll get great result from your 2nd ht yourself!

Edited January 12, 2019 by Astaldo

[Astaldo]

@wheretogo,

thank you very much.

I'll try to answer your questions. Well I agree that my front and hairline looked quite as good before the last surgery, and there was no real need to add density. However, as you could see in the posts above, I wanted to be able to have longer hair that looks a bit fuller and more voluminous. With my previous result, I felt like I don't have enough of hair mass for such longer hair not to look thin on the sides when parted in the middle, with still relatively denser and more voluminous donor sides.

So basically, shorter hair with fade cut and spiked up - indeed great, no problem whatsoever, could style it any way I wanted. Longer hair with side and middle parted style - not so much, it looked like I was really trying to hide some recession in my temples, as I was doing during the first few years of hair loss. You could notice the difference in hair density and volume when looking at my pre-op hairline wet pictures. That was my main issue.

About shock loss... yes, I was worried a bit, however I decided to go for it and had confidence that Dr. Erdogan will make incisions without transecting surrounding grafts, as he did during my previous surgery (although the original density back then was indeed much lower). I was on finasteride, so risk of permanent shock loss of the native hairs was reduced to minimum.

However I did experience permanent shock loss after my first surgery with another clinic, but back then I wasn't using any meds (I used minox up to few months before that first surgery, but it has lost its effect and my first doctor instructed me to abort the usage few weeks before the HT). You can clearly see in the pictures comparison in my last story line post that 12 months after 1st surgery my crown was almost identical to pre-op. Part of the transplanted grafts grew back, but I lost a lot of miniaturized native hairs (and ones that survived continued to miniaturize).

About hair products... currently I am not using any on a daily basis. Sometimes I use small amount of fibers in top of my crown when I go to places with brutal artificial lighting. Except for that, I occasionally use some hair volume mousse when it is windy outside to hold my hairs in place as hair can get quite messy when longer and exposed to strong wind.

I recently bought some Hanz de Fuko product like Claymation, but I am saving those for period when I cut my hair shorter.

 

Here is the comparison of the hairline density before and after this last transplant (improvement is visible, but subtle I think), and picture with density issue with hair grown longer before last op (not that it looks bad, it just wasn't enough for me).

Edited January 12, 2019 by Astaldo

[Astaldo]

Also, when I mentioned my high school glory hair days, I found one old pic from 2004 (I was 17 back then) just for a comparison with hair loss period (that started year later, when I was 18), and my post restoration current condition.

Edited January 12, 2019 by Astaldo

[wheretogo]

Thanks for that detailed response.

the reason i asked that because i'm about 11 months post op, 3558 grafts to my third front of the scalp.

in about a 1.5 month i plan to go back and continue with my mid scalp plus crown and i really want to add density to my hairline or behind the hair line, i don't really understand where it's thin. i didn't take any meds and don't want to take either so i don't know.

[Astaldo]

I wish you good luck with your future surgery then.

You are of course aware that nobody can guarantee you won't have shock loss of the native hairs, especially if you're not taking any meds to strengthen them up. Maybe you should ask your doctor to determine the % of miniaturization in your recipient to assess how much of a risk would be to transplant between existing hairs and is there a serious possibility of permanent shock loss?

Also, choosing a surgeon that consistently produces top quality work in cases such as yours (with no meds at all) could be a desirable option.

Anyway, I really hope that in the end you'll get the desired result.

[wheretogo]

Thanks you very much.

i did chose top surgeon, Dr Maras from HDC.

i must say my recipient area is almost all transplanted hair, so the question is does that new hair can get shock loss like a native one.

[Astaldo]

Two short updates, first one is from the end of April, and these pictures come with my hair at its longest before the haircut. It looked good after the washing, but became increasingly difficult to maintain and style properly. Also, when the wind was blowing, it constantly filled in my eyes 🤣.

[Astaldo]

Afterwards, I had 2 haircuts, and the second set of pics (taken today) is app 2 weeks since my last haircut.

Since this set represents condition 18 months post my last surgery, I think this is going to be a last update for a while. Generally, I am happy with looks and density, but still have some second thoughts about the density in the crown.

Condition is better than before, for sure, but it is still a bit see through in sunlight and artificial light (blame it on a crown as a black hole for grafts, or I had only partial growth of those 1000 transplanted grafts, I cannot tell), and I tried to present that through my photos, since I spend around half a day in such conditions. I am regularly applying a bit of fibers to mask this 'issue', but do not intend to do anything about it, because I am saving whatever donor I still have for the future.

So greetings to all, and enjoy the summer!

Edited June 28, 2019 by Astaldo