small grafts or miniaturized hair?

[duchaine]

Hallo guys,

as I wrote, after some extractions, my doc stopped the operation saying I've miniaturized hair that won't grow in the recipient area. I'll never stop to say how honest and ethical he is.
I showed the pic to another top surgeon ad he says that my grafts are small but not miniaturized.
I had a live consultation with another top clinic and they said my grafts are small but not miniaturized.

I do not what to do...I do not know what to think

[Sam818]

No one can tell you what to do. You traveled to that doctor because you trusted him to do the surgery. That doctor you chose to do your surgery wasn't comfortable doing it based on his experience. What I think you should do is go home and reevaluate what you want to do. Maybe consult a few more doctors that are trustworthy before deciding what to do and scheduling an in person consultation with them BEFORE your surgery date to make sure you are a good candidate and get that assurance so you are mentally ok before your procedure. Unless you are fully confident in the other clinic that you went to being ethical and their ability to give you a good result I wouldn't proceed right away. Good luck with whatever you do.

[duchaine]

@transplantedphil
At the clinic (live consultation) they extracted 7 grafts, analyzed them and said: "they are not miniaturized, they are only short, it is your genetic"

One top surgeon that saw 10 tricoscope images said exactly the same thing.
He really took care of me, sending 2 very long mails.
I past attach what he wrote:

first mail
 "I've never canceled a surgery midway because grafts were too short. I study the donor area beforehand to make sure the patient is a good candidate or explain why he is not a good candidate and treat for anything we can treat before booking surgery. Of course all surgeries can have complications, but I don't consider "short grafts" a reason to stop surgery. If there is miniaturization in the donor area, that can be seen by trichoscopy (again, before surgery). Short grafts are more difficult to work with, but in my experience, they can have as good a survival as bigger grafts. I just need to be more careful with them during implantation especially, since they need to be placed just right and tolerances are lower- From the macro aspect (your photos), your donor seems perfectly normal. Of course I didn't see it with the microscope. I also see that you're on long term finasteride, which helps to "cover" us from miniaturization in the donor area. At this moment, you seem like a good candidate to me".

Second mail (after I sent him tricoscope images)
"Looking at the photos, I must say I don't see anything wrong with your grafts. They are short (3mm), but they're not miniaturized. There is a difference between being small and miniaturized. Short grafts are just that way, it's just your genetics, your anatomy. Miniaturized grafts are grafts affected by androgens. And these grafts don't look miniaturized to me. And you are taking finasteride (I assume, 1mg per day?), right? And you improved after starting minoxidil even though you were already taking finasteride?"

[duchaine]

9 hours ago, transplantedphil said:

Great advice @Sam818 ... I agree with you 100% .

If two other top clinics suggested the hair was in fact not miniaturised but merely small, then i think there are a few possibilities with your case; 

1. The doctor only cares about the producing certain results. I have heard of certain doctors being highly selective in who they choose as their patients so as to maintain a steady stream of good results (the same way Ive also heard of doctors that make patients sign NDA's so as to safeguard the public hearing about their bad results). So if you have small or finer hair your results potentially wont be as impressive as say a patient who has very coarse hair. 
2. The doctor might be doubting their own abilities, especially given a past bad result
3. The doctor might have trouble diagnosing the difference between that of smaller hair and miniaturised hair.

But that's if these other clinic's assessments are indeed correct. While it might feel highly upsetting at the moment the only thing you can really do now is get an in person consult to verify what's going on. 

Quite strange though as the doctor seems to be rejecting quite a few patients of late.

IMHO, a doc shouldn't extract 180 graft and stop the OP.
He should:
a) make a tricoscopy BEFORE the op
b) stop at 10-20 grafts if he thought that he needed to extract the grafts to understand the real structure of my UF

The more I think about my story and the more I think there is something strange about it.
 

[duchaine]

2 hours ago, transplantedphil said:

The live consultation was at another clinic?

I agree and also find this strange .... going from my own experience a doctor should be able to tell the difference between small and miniaturised hair before surgery (this happened for my own repair surgery where the surgeon had to work outside the traditional "safe zones" and extract smaller hairs found around the nape). So I really dont understand how someone could only notice this mid operation after 170 grafts were extracted.

The fact this doctor has begun rejecting a few patients in this way (I believe you are 3rd this has happened to) we can only assume this doctor is being overly cautious.

In a larger sense he did you a favour if they did not think you were a suitable candidate for his clinic (I mean how many instances do we hear of a HT doctor being overly cautious towards their patients rather than just try and take them for as much money as possible?),  so I guess all you can do is request a refund and investigate further.

Yes, i went to a very famous clinic. 6 doctors togheter looked at my scalp, saw the pictures of my extracted grafts, made a trocoscopy, then extracted seven grafts...talked togheter and said that i do not have any kind of miniaturized hairs and I’m a good candidate for ht.

they said “they are just short, but they are all the same lenght. That means it is your genetic. Some people have short nails, you have short fu”.

I’m very glad to my doc, he acted ethically. I hope he is not right about his diagnosis, but he acted fairly and I consider him a friend (as e asked to consider him).

[Gasthoerer]

Does Kaan use a similar punch as Keser? 

Keser is performing a non-oscillating/rotating manual punch (to my knowledge) and had some patient rejected for difficulties during extraction (in a domestic forum). 

[duchaine]

18 minutes ago, Gasthoerer said:

Does Kaan use a similar punch as Keser? 

Keser is performing a non-oscillating/rotating manual punch (to my knowledge) and had some patient rejected for difficulties during extraction (in a domestic forum). 

he uses manual punch for sure but I can't tell what kind of punch.

[Portugal25]

@duchaine I have to agree with @Sam818and @transplantedphil you really should go to another clinic just to be sure because from what I understood you went to Dr. Kaan previous place of work in Ankara and those guys might not be very happy he left them and opened his own clinic so they might want to seize any opportunity to criticize his work (it can be a possibility).

Besides your case there was also my friend Gonçalo on December 18th and @lixinfu on October 2019 but Dr. Kaan even has surgeries on Saturday so he could be doing 300 patients per year and only have 1% of those aborted.

That said, when I found out about Goncalo I was super worried that might also happen to me and so I sent several videos and pictures asking them to confirm I didn’t have miniaturized grafts but the clinic rep said that it’s only possible to confirm that in person. I only stopped worrying after Dr. Kaan started taking the first grafts and told me I had good “anagen” grafts. 

Goncalo is going to see Dr. Bruno Ferreira on Monday to ask for a second opinion, I will let you know how that goes. 

Edited January 9, 2020 by Portugal25

[duchaine]

2 minutes ago, Portugal25 said:

@duchaine I have to agree with @Sam818and @transplantedphil you really should go to another clinic just to be sure because from what I understood you went to Dr. Kaan previous place of work in Ankara and those guys might not be very happy he left them and opened his own clinic so there are criticizing him (it can be a possibility).

Besides your case there was also my friend Gonçalo on December 18th and @lixinfu in October 2019 but Dr. Kaan even has surgeries on Saturday so he could be doing 300 patients per year and only have 1% of those aborted.

That said, when I found out about Goncalo I was super worried that might also happen to me and so I sent several videos and pictures asking them to confirm I had miniaturized grafts but the clinic rep said that  it’s only possible to confirm that in person. 

Goncalo is going to see Dr. Bruno Ferreira on Monday to ask for a second opinion, I will let you know how that goes. 

Did Bruno Ferreira look at his pics?
What did he say?

[Portugal25]

No, he just booked a appointment for Monday with Dr. Bruno and might also be doing a thricogram with a  Dermatologist. 
I asked Goncalo to write here but if he doesn’t have the time I will let you know the feedback 😉

Edited January 9, 2020 by Portugal25

[duchaine]

21 hours ago, Portugal25 said:

@duchaine I have to agree with @Sam818and @transplantedphil you really should go to another clinic just to be sure because from what I understood you went to Dr. Kaan previous place of work in Ankara and those guys might not be very happy he left them and opened his own clinic so they might want to seize any opportunity to criticize his work (it can be a possibility).

Besides your case there was also my friend Gonçalo on December 18th and @lixinfu on October 2019 but Dr. Kaan even has surgeries on Saturday so he could be doing 300 patients per year and only have 1% of those aborted.

That said, when I found out about Goncalo I was super worried that might also happen to me and so I sent several videos and pictures asking them to confirm I didn’t have miniaturized grafts but the clinic rep said that it’s only possible to confirm that in person. I only stopped worrying after Dr. Kaan started taking the first grafts and told me I had good “anagen” grafts. 

Goncalo is going to see Dr. Bruno Ferreira on Monday to ask for a second opinion, I will let you know how that goes. 

I suppose that Kaan spoke in good faith and using the best of his knowledge. This is why I opened this topic. 
That said, I disagee with you about numbers
Consider that he takes at least 2/3 days for HT, so that means that he does  100/150 HT per years.
Then consider that not everyone write on this board. 
Among 8-10 of clients on this board, 3 got an aborted transplant. 
That is 30-40%, that is a lot.

[Portugal25]

@duchaine you are right he probably does take on average 2 days for each surgery so he is probably doing around 100-150 patients per year but I’m sure he’s not rejecting 30-40%.

50% of Dr. Kaan’s patients are Italian (so told me his English speaking rep that is also Italian) and as you know very few Italians speak English or come to this English forum (they go to the Italian forum were I also went to see Kaan’s results).

The other 50% still comprise of many Turkish that are posting in the Turkish forum sacekimisonuclari. 

I have read about you and @lixinfu and know about my friend Goncalo but no other user in any other forum is claiming to have also had this experience with Kaan (surely there will be more but not 30%).

I have told the Patient Assistant at Dr. Kaan office that maybe besides requesting us to bring the blood work they should also ask patients to do a thricogram so that they are sure they are a good HT candidate before getting on a plane.

Maybe everyone should do this exam because if the result is ok we should expect a good HT result and if it tells us that the grafts are not great then we know not to expect a great HT result or worst, we are not a suitable candidate for HT.  

Just a thought...

Edited January 10, 2020 by Portugal25

[duchaine]

1 hour ago, Portugal25 said:

@duchaine you are right he probably does take on average 2 days for each surgery so he is probably doing around 100-150 patients per year but I’m sure he’s not rejecting 30-40%.

50% of Dr. Kaan’s patients are Italian (so told me his English speaking rep that is also Italian) and as you know very few Italians speak English or come to this English forum (they go to the Italian forum were I also went to see Kaan’s results).

The other 50% still comprise of many Turkish that are posting in the Turkish forum sacekimisonuclari. 

I have read about you and @lixinfu and know about my friend Goncalo but no other user in any other forum is claiming to have also had this experience with Kaan (surely there will be more but not 30%).

I have told the Patient Assistant at Dr. Kaan office that maybe besides requesting us to bring the blood work they should also ask patients to do a thricogram so that they are sure they are a good HT candidate before getting on a plane.

Maybe everyone should do this exam because if the result is ok we should expect a good HT result and if it tells us that the grafts are not great then we know not to expect a great HT result or worst, we are not a suitable candidate for HT.  

Just a thought...

Don't misunderstand what I wrote, please.
You were said that the doc has at least 300 patient and only 3 per year get aborted, that is 1%.
We both don't know how many patients/year the doc has.
anyway, if you consider the 3 cases on this board, you need to do the math considering bis patients on this board!
Making the statistic with this number, you get the 30-40% here has been refused. 

I'm sure the doc has a lot of clients from Italy but they are not on Italian boards. If it was, you should find at least 50 post year!
By the other side, if they publish a report, that means they got the HT. We don't know what about the others that do not publish a report. For sure, if someone get aborted, it doesn't make sense to publish a report.
 

[Portugal25]

@duchaine my friend Goncalo had his appointment today with @Dr. Bruno Ferreira

Dr. Bruno analyzed his hair under the microscope and said that my friend`s miniturized hairs are not impeditive of him having a hair transplant and that he has treated many patients with DUPA so he can safely confirm that Goncalo does not have DUPA

Dr. Bruno measured a total area of 226cm2 to implant and believes that it will be difficult to achieve a good density because my friend has very thin hair.

Dr. Bruno reccomended Goncalo to have two surgeries the first with 3500 grafts and the second with 3000/3500.

Regarding the beard, Dr. Bruno said that its darker and thicker with a tendency to curl so he won`t use any beard grafts.

The only comments Dr. Bruno made about the 270 grafts implanted by Dr. Pekiner was that the punch size he used seemed a bit too big and that he doesn`t understand why the surgery was stopped.

Goncalo is now booking his two hair transplant surgeries with Dr. Bruno Ferreira.

So far I am very happy with my surgery experience and the 16 day results from Dr. Kaan Pekiner but after the feedback from Dr. Bruno Ferreira, I am inclined to agree with you that Dr. Kaan seems to be filtering his patients so he only does surgery on patients he believes will achieve amazing results. 

I do feel somewhat responsible for Goncalo  because I advised him Dr. Pekiner but in fact this Doctor does achieve amazing results and is very affordable for a Doctor that only has 1 patient per day and does the whole surgery (both myself and my other friend Ricardo that also had a HT in December are very happy so far).
I advised Goncalo to ask a second opinion to Dr. Bruno Ferreira because he works with the foremost authority for DUPA - Dr. Jose Lorenzo as you can see from Dr. Lorenzo presentation on the link below:

Hope my comment has helped you @duchaine and I also hope you can have the same feedback when you ask for a second opinion. I do reccomend that you to chose the Doctor you will ask this second opinion very wisely.

Edited January 14, 2020 by Portugal25

[duchaine]

1 hour ago, Portugal25 said:

@duchaine my friend Goncalo had his appointment today with @Dr. Bruno Ferreira

Dr. Bruno analyzed his hair under the microscope and said that my friend`s miniturized hairs are not impeditive of him having a hair transplant and that he has treated many patients with DUPA so he can safely confirm that Goncalo does not have DUPA

Dr. Bruno measured a total area of 226cm2 to implant and believes that it will be difficult to achieve a good density because my friend has very thin grafts.

Dr. Bruno reccomended Goncalo to have two surgeries the first with 3500 grafts and the second with 3000/3500.

Regarding the beard, Dr. Bruno said that its darker and thicker with a tendency to curl so he won`t use any beard grafts.

The only comments Dr. Bruno made about the 270 grafts implanted by Dr. Pekiner was that the punch size he used seemed a bit too big and that he doesn`t understand why the surgery was stopped.

Goncalo is now booking his two hair transplant surgeries with Dr. Bruno Ferreira.

So far I am very happy with my surgery experience and the 16 day results from Dr. Kaan Pekiner but after the feedback from Dr. Bruno Ferreira, I am inclined to agree with you that Dr. Kaan seems to be filtering his patients in order to only have patients with amazing results. 

I do feel somewhat responsible for Goncalo  because I advised him Dr. Pekiner but in fact this Doctor does achieve amazing results and is very affordable for a Doctor that only has 1 patient per day and does the whole surgery (both myself and my other friend Ricardo that also had a HT in December are very happy so far).
I advised Goncalo to ask a second opinion to Dr. Bruno Ferreira because he works with the foremost authority for DUPA - Dr. Jose Lorenzo as you can see from Dr. Lorenzo presentation on the link below:

Hope my comment has helped you @duchaine and I also hope you can have the same feedback when you ask for a second opinion. I do reccomend that you to chose the Doctor you will ask this second opinion very wisely.

 Thaks buddy, really appreciate your feedback.
I asked Bruno Ferreira for a second opinion and he said that my follicle are not miniaturized and he doesn't understand why the surgery was stopped.

Everybody makes his personal choice and I think it is fair that a doc is looking only for amazing results.
but, if it is the case, he: a) should look for a tricopcpy before the patients go to Ankara; b) he should make his trials extracting very few amounts of Grafs. 180 in my case and 270 in your friend's case are irrational numbers!

[Abi28]

1 hour ago, Portugal25 said:

Dr. Bruno measured a total area of 226cm2 to implant and believes that it will be difficult to achieve a good density because my friend has very thin grafts.

Maybe this is the reason why dr Kaan decided to stop the surgery? 

10 minutes ago, duchaine said:

Dr. Bruno reccomended Goncalo to have two surgeries the first with 3500 grafts and the second with 3000/3500.

It seems like your friend have a difficult case here, he has thin grafts and needs two surgeries for a total of 7000 grafts, maybe that's why dr Kaan decided to stop as he was looking out for him when he saw he has thin grafts?

1 hour ago, Portugal25 said:

The only comments Dr. Bruno made about the 270 grafts implanted by Dr. Pekiner was that the punch size he used seemed a bit too big

This is nonsense, I had a procedure with dr Kaan and he uses a 0.8 or 0.9 mm punch.

Doctors do reject patients often during in person consultation when they feel like they can't achieve a good result for whatever reason but doing it after removing 100 to 300 grafts is a bit excessive I have to stay, maybe there are other factors that come in play here? I am not a doctor but from personal experience I think Kaan is too careful and doesn't like taking risks that might turn out bad for him and hurt his reputation in the future, that's just my opinion..

[duchaine]

1 minute ago, Abi28 said:

 

 

 

Doctors do reject patients often during in person consultation when they feel like they can't achieve a good result for whatever reason but doing it after removing 100 to 300 grafts is a bit excessive I have to stay, maybe there are other factors that come in play here? I am not a doctor but from personal experience I think Kaan is too careful and doesn't like taking risks that might turn out bad for him and hurt his reputation in the future, that's just my opinion..

I agree with you.
I've only 2 minor considerations.
A) the doc should advise we patients that we can go to Ankara for nothing;
b) the doc should advise we patients  that he is going to extract around 200 grafts and stop.

If I knew all this, maybe I didn't go to Ankara and for sure I didn't allow him to extract 200 graft for nothing.

[duchaine]

@Portugal25 thin grafts or thin hair?

[Abi28]

7 minutes ago, duchaine said:

I agree with you.
I've only 2 minor considerations.
A) the doc should advise we patients that we can go to Ankara for nothing;
b) the doc should advise we patients  that he is going to extract around 200 grafts and stop.

If I knew all this, maybe I didn't go to Ankara and for sure I didn't allow him to extract 200 graft for nothing.

I agree with you on that one, to fly to Ankara and have 200 grafts extracted and then stop the surgery is very frustrating. the doctor should be able tell if there is something wrong before doing all that..

[Portugal25]

@duchaine it’s thin hair (sorry). 
@Abi28 you are quite right Dr. Kaan might have been looking out for my friend Goncalo because he believed the results would not have been great. 
Dr. Kaan did use a 0.9mm punch but @Dr. Bruno Ferreira said it looked bigger than 0.9mm and that he usually uses slightly smaller punches (0.8mm-0.85mm). Not sure if this is relevant though because what matters are the results and Dr. Kaan is achieving pretty awesome results. 
I support Abi28 claim that a Doctor can reject a patient if he believes he will get a bad result and also Duchaine claim that maybe we should do a thricogram before doing a HT to be sure we are a decent candidate. 

Let’s see what happens 1 year after my friend surgery with Dr. Bruno and I’m hoping he gets a good result. 

Edited January 14, 2020 by Portugal25

[duchaine]

9 minutes ago, Abi28 said:

I agree with you on that one, to fly to Ankara and have 200 grafts extracted and then stop the surgery is very frustrating. the doctor should be able tell if there is something wrong before doing all that..

If he know that pics are not enough to say if someone is a good candidate or not, he could ask to sent him a tricoscopy before the patient fly to Ankara. Even if a TS is not definitive, at least the risk to fly to Ankara for nothing is drastically reduced.
I know several dermatologist in my home town that make a TS for 100 euro.


 

[davidn]

On 1/13/2020 at 6:14 PM, Portugal25 said:

@duchaine it’s thin hair (sorry). 
@Abi28 you are quite right Dr. Kaan might have been looking out for my friend Goncalo because he believed the results would not have been great. 
Dr. Kaan did use a 0.9mm punch but @Dr. Bruno Ferreira said it looked bigger than 0.9mm and that he usually uses slightly smaller punches (0.8mm-0.85mm). Not sure if this is relevant though because what matters are the results and Dr. Kaan is achieving pretty awesome results. 
I support Abi28 claim that a Doctor can reject a patient if he believes he will get a bad result and also Duchaine claim that maybe we should do a thricogram before doing a HT to be sure we are a decent candidate. 

Let’s see what happens 1 year after my friend surgery with Dr. Bruno and I’m hoping he gets a good result. 

How was your friends result bro?