Dr. Pekiner - 1805 grafts - Feb 1 2021

[giegnosiganoe]

Age 26, Norwood ~3V + retrograde + diffuse thinning (including donor)
Medication: dutasteride 0.5mg/day, foam minoxidil 1-2mL/night
Hair characteristics: high contrast with skin, fine, straight
Cost: 2.15 euros/graft which is a discount from 2.25 euros/graft because I agreed to provide them anonymized photo updates for their own use. Posting this thread is my own choice. Though, I wish clinics would offer discounts for patients to post threads from start to finish. I see nothing wrong with that. Also, I think the price has gone up recently.

Hair loss timeline:
18 - Looking back at old pictures, I had signs of thinning at the hairline
20 - Barber mentioned uneven nape, now I know it was the beginning of retrograde. Started noticing loss at the hairline/crown, found out about finasteride and tried to get on it but my awful dermatologist wouldn't prescribe it to me saying my loss wasn't bad enough
22 - Went back to the dermatologist, still wouldn't prescribe finasteride to me (I think because of side effects? don't remember). He instead prescribed topical minoxidil (requires a prescription in Canada) but he didn't make it sound like it was worth it (annoying to apply, need to use it for life), so I never went through with it
24 - Hair was looking awful, finally decided to do something about it - did my own research, went to a different doctor who was not a moron, and got a 5mg finasteride prescription. Quartered that for 6 months. Also started 1mL liquid minoxidil at the same time
25 - Didn't notice any changes after 6 months, seemed to have maintained. Switched from finasteride to dutasteride to keep as much hair as possible. Got a microscope and analyzed my donor, saw greater than average thinning
26 - Seem to have continued to maintain. Switched to foam minoxidil because liquid takes forever to dry
Moral of the story - Many doctors are crap. Take medical matters into your own hands and leave nothing to chance. I carried those learnings over to my HT research.

Choice of surgeon:
I sent the following clinics (in no particular order) pictures/videos of my hair/recipient/donor. The main point of contention between their opinions was regarding the microscopic videos/images of my donor.

• Hasson - "Dr. Hasson felt there was more miniaturization than the typical 10-15% and therefore a procedure would involve a bit more risk."
• Wong - "Dr. Wong on the other hand did not believe there was any signs of dupa and would have no reservations performing a procedure."
• Bhatti - He was concerned, felt that my donor density was quite low and wanted me to get evaluated in person
• Bloxham - Wasn't concerned, was more interested in if I noticed any changes in my hair, and said a proper in person examination would be in order
• Konior - Not concerned, said my donor area was about average
• Bisanga - More miniaturization in the donor than they would like to see for someone my age, and suggested an in-person consultation
• Ferreira - Said my donor isn't great, but that I'm far from DUPA, and that my prognosis is good
• Lorenzo - Said I didn't have DUPA but didn't go into any more details. I feel like they may not have seen the microscopic videos. Wish they would have at least acknowledged my weak donor. Tried following up multiple times to get clarity, but they never responded
• Diep - saw him in person since I was nearby, he said I had 10k+ grafts available in my donor. 'nuff said.
• Rassman/Bernstein - said I have more thinning than average but not yet DUPA, suggested I wait a few years, but said I could get a small HT
• Hattingen - said they would not operate on me, suggested I send them yearly updates of my hair loss situation to see if their opinion changes
• HLC - didn't want to say anything regarding my microscopic videos, said I would need an in-person dermascopy evaluation, but didn't seem too concerned
• Pekiner - noted the miniaturization but said my donor was good enough and that they select the highest quality grafts

At some point, I decided I was mostly interested in clinics where the surgeon does most, if not all the work. I understand the benefit of technicians doing parts of the procedure like extracting/implanting grafts, but I just feel more comfortable knowing that the surgeon is doing all the important aspects of the procedure themselves, and that I can hold them fully accountable. This left me with a few options at the time: Konior, Ferreira, HLC, Pekiner.

• Ferreira - I couldn't travel to Portugal because of COVID and wanted to see more results
• Konior - I think he is one of the best, but I was disappointed that he didn't acknowledge the miniaturization in my donor. My guess is he did notice it but that he's confident in his skills/work and doesn't want his patients to overthink things. I'll likely still see him in the future for temple point work or if I need any touch up on the hairline
• HLC - Didn't like not knowing which doctor would work on you, and the fact that you could have multiple throughout your procedure. Also have seen some cases where I felt the graft count was a bit aggressive for the patient's age. Have heard communication is also an issue
• Pekiner - I liked the technique, the small number of grafts per day (~1000), the fact that he is conservative and honest with his patients. Liked that he had a lot of patient reviews from start to finish (mostly on the Italian forum). Very experienced with hairline work and liked his hairlines and density (especially needed with my fine hair). Communication with his rep Alex has been very good. Aborting was a concern, but they told me that they now inform the patient of any findings but ultimately let them decide whether to proceed. Given he would select the highest quality grafts available, I was not too concerned. Also knowing that the graft count could be adjusted on the day of procedure (say down to 1500), my mind was more or less at ease. In the end, he said my donor was slightly better than expected. 

Procedure:

Each day lasted from around 8am-5pm. On the first day of procedure, I had a discussion with Dr. Pekiner about my hair loss history and goals. We then took the photos, designed the hairline, and shaved the head. Then we moved on to the actual extraction/implantation. The way it works with Dr. Pekiner, similar to HLC, is you have two sessions of extraction/15min break/implantation per day, AM and then PM. In between these sessions, they have a chef who provides a meal for you (bonus points for catering to a vegan diet - the food was delicious). At the end of each day, they wrap your head in a bandage to protect the grafts/donor. On the third morning, they give you a final clean up and provide you with the aftercare kit including saline spray for the recipient and bepanthol lotion for the donor.

1 hair: 249
2 hairs: 682
3 hairs: 710
4 hairs: 164
Average hairs/graft: 2.43

Recovery:

Sleeping - I'm normally a side sleeper, and started practicing to sleep on my back a couple months in advance. I don't think this is necessary, I just wanted to learn to sleep on my back anyway. Regardless, you'll need a travel/neck pillow anyway to make sure you don't turn in your sleep, and I think you'll be tired enough to fall asleep on your back even if you're not used to it. Another recommendation I have is to zip your arms inside a sweater, so you don't damage your grafts in your sleep. I've seen this happen enough times on these forums, even over the past few months, that I didn't want to take any risks. At one point I was very tired and fell asleep without zipping up my arms, and I actually caught myself lightly reaching up and tapping my recipient area as I was waking up. Nothing bad happened, but I was much more cautious the next times I went to bed and ensured that I zipped up my arms each time.

Swelling - I noticed swelling mostly on days 3-4, but nothing too bad compared to what I saw online. I just let it pass with time.

Pain - No pain for the first week really. From days ~6-10 I had some donor pain when I'd lay down on my pillow, so I'd just take paracetamol 20 mins before going to bed.

Crusts/scabs - was instructed to start gentle massaging them starting day 6, increasing intensity with each day. By day 9, pretty much all of them were gone.

Redness - I started using aloe vera as I've read that it helps. Haven't noticed too much improvement yet by day 30. The donor is still red but it's harder to see as the hair is growing longer. The recipient is still red, and the shedding is making that more visible.

Feel free to ask any questions.

I can add some recent photos soon. I'll probably update monthly.

Edited March 3, 2021 by giegnosiganoe

[BDK081522]

The work looks pristine. Extremely clean post-op shows the attention to detail through each step of your procedure. Very dense packed and I think your result is going to be fantastic. I think you're selling yourself short on your pre-op evaluation though. You don't seem like a 3V with DUPA or retrograde from the pictures posted. Your donor actually looks quite average without any signs of DUPA and I think you were more of a 2/2A. Regardless, you're in for some fun over the next year. Congrats on doing your homework and putting in the necessary research time to give yourself the best chance of success. Happy growing!

[kiokbs]

density and hairline design look spectacular mate I ll be following your journey.

[Marco Van Basten]

Looking forward to seeing your results mate

[TommyLucchese]

Your description set us up for a very balding fella in the pics but you looked pretty good anyway to be honest. What did they say about the donor quality in person compared to the average patient? Was it better than expected but still below average? Or were the concerns unfounded?

Looks like great work anyway, look forward to seeing the end result!

[BLE123]

Pekiner's work always looks very clean and meticulous, hopefully you will have a great result like @kiokbs

How did the design of the hairline go? Did Dr Pekiner draw what he thought would look right and then you gave your input or was it more the other way around? Either way it looks good.

[nicoandgello]

Do you know how big was your recipient area exactly? Looks clean, happy growing.

[Captain Haddock]

Looking really good. Congrats mate. Gotta say, 1000 grafts a day is reassuring as a patient. Hope you hit a home run. 

[Datsun213]

Looks very nice.  You're design and amount of grafts look very similar to mine and we got the surgery around the same time.  I like how your surgeon made the hairline a little more jagged than mine.  Mine seems to too straight to be honest and I'm starting to worry about my future results.  Best of luck to the both of us!

[UnbaldEagle]

It's very commendable you took your time and did your research so thoroughly, contacted so many top clinics. There's nothing wrong with your donor if someone like Pekiner accepted your case.

Work looks very refined and you have a high avg. of hairs/graft. I think you'll be happy with the result. Good luck.

[giegnosiganoe]

Thanks for the comments guys.

10 hours ago, TommyLucchese said:

Your description set us up for a very balding fella in the pics but you looked pretty good anyway to be honest. What did they say about the donor quality in person compared to the average patient? Was it better than expected but still below average? Or were the concerns unfounded?

Looks like great work anyway, look forward to seeing the end result!

Thanks!

Haha, I can see that. It's a bit difficult to accurately describe my situation just over text. Between NW2 to NW3 I wasn't completely bald, but very diffuse, maybe 25% remaining density. Similar for the vertex/crown, maybe 50% remaining density - the whorl doesn't help with coverage. The retrograde is obvious, I think. The diffuse thinning elsewhere (midscalp, sides, back) isn't too visible at the length I had my hair, but I'd say it's around 66% remaining density. I think this will be more obvious when I post pics with short hair. I get that some people have a much worse starting point though.

He said it's below average in terms of density and % of miniaturization, but the hairs/graft were better relative to that. For example, I met up with a guy who had his procedure the days after mine, who had an average donor in terms of density and miniaturization, but only had around 2.2 hairs/graft. Regarding the aspects which were below average, I just need to stay on DHT blockers to try and avoid them from getting any worse.

8 hours ago, BLE123 said:

Pekiner's work always looks very clean and meticulous, hopefully you will have a great result like @kiokbs

How did the design of the hairline go? Did Dr Pekiner draw what he thought would look right and then you gave your input or was it more the other way around? Either way it looks good.

Thank you I hope the same, @kiokbs has a wonderful result. At the same time, I have realistic expectations and know that anything can happen.

I just let him draw the hairline. He made some minor adjustments, and his technicians were offering their input. Honestly, I found it hard to evaluate at first, but I trusted his judgement. It followed my existing hairline pretty closely so it was easy to get the shape right (always had a bit of a widow's peak, and not so much a rounded hairline), and looks very similar to the hairline I had when I was around 20, so in the end I'm super happy.

7 hours ago, nicoandgello said:

Do you know how big was your recipient area exactly? Looks clean, happy growing.

Thank you. The recipient area was 31cm, which he calculated at 50 grafts/cm = 1550 grafts, plus a couple hundred for reinforcement on the connection areas. My head is probably bigger than average though.

2 hours ago, UnbaldEagle said:

It's very commendable you took your time and did your research so thoroughly, contacted so many top clinics. There's nothing wrong with your donor if someone like Pekiner accepted your case.

Work looks very refined and you have a high avg. of hairs/graft. I think you'll be happy with the result. Good luck.

Thank you! My donor is below average apart from the hairs/graft though. Actually that's one of the reasons I chose Pekiner - he is pretty good at targeting those better quality/higher hair grafts. And even though my donor is below average overall, given that I am on medication, have noticed stabilization, and only needed a relatively small number of grafts for hairline work, he didn't see any problem with taking my case.

[nicoandgello]

10 minutes ago, giegnosiganoe said:

Thanks for the comments guys.

Thanks!

Haha, I can see that. It's a bit difficult to accurately describe my situation just over text. Between NW2 to NW3 I wasn't completely bald, but very diffuse, maybe 25% remaining density. Similar for the vertex/crown, maybe 50% remaining density - the whorl doesn't help with coverage. The retrograde is obvious, I think. The diffuse thinning elsewhere (midscalp, sides, back) isn't too visible at the length I had my hair, but I'd say it's around 66% remaining density. I think this will be more obvious when I post pics with short hair. I get that some people have a much worse starting point though.

He said it's below average in terms of density and % of miniaturization, but the hairs/graft were better relative to that. For example, I met up with a guy who had his procedure the days after mine, who had an average donor in terms of density and miniaturization, but only had around 2.2 hairs/graft. Regarding the aspects which were below average, I just need to stay on DHT blockers to try and avoid them from getting any worse.

Thank you I hope the same, @kiokbs has a wonderful result. At the same time, I have realistic expectations and know that anything can happen.

I just let him draw the hairline. He made some minor adjustments, and his technicians were offering their input. Honestly, I found it hard to evaluate at first, but I trusted his judgement. It followed my existing hairline pretty closely so it was easy to get the shape right (always had a bit of a widow's peak, and not so much a rounded hairline), and looks very similar to the hairline I had when I was around 20, so in the end I'm super happy.

Thank you. The recipient area was 31cm, which he calculated at 50 grafts/cm = 1550 grafts, plus a couple hundred for reinforcement on the connection areas. My head is probably bigger than average though.

Thank you! My donor is below average apart from the hairs/graft though. Actually that's one of the reasons I chose Pekiner - he is pretty good at targeting those better quality/higher hair grafts. And even though my donor is below average overall, given that I am on medication, have noticed stabilization, and only needed a relatively small number of grafts for hairline work, he didn't see any problem with taking my case.

I think you are too harsh for yourself. Your hair looked pretty damn good before. If your density is 66% of what it was before those 50 grafts/cm will look great in 12 months.

[giegnosiganoe]

Just want to add I just got a prescription for 1.25mg/day oral minoxidil so I'm excited to try that out and see if it helps with my diffuse thinning. I've never noticed any real benefit from topical minoxidil.

[Sitries1]

Like others have said, your description of your case makes it sound much worse than it looks. Your donor and hair in general looks very strong. Looks like you done a tonne of research and chose wisely. Would you say that getting the microscope analysis was worth getting In the end or did most surgeons dismiss it and want to do their own analysis ?

Edited February 23, 2021 by Sitries1

[giegnosiganoe]

Just now, nicoandgello said:

I think you are too harsh for yourself. Your hair looked pretty damn good before. If your density is 66% of what it was before those 50 grafts/cm will look great in 12 months.

Oh trust me, I'll add some more revealing photos soon  but yes, I do think the midscalp density is passable. One example of a change I've noticed is that around the age of 20, I could put a comb through my midscalp hair and it would stay there. Now if I tried that, it falls off.

[giegnosiganoe]

14 minutes ago, Sitries1 said:

Like others have said, your description of your case makes it sound much worse than it looks. Your donor and hair in general looks very strong. Looks like you done a tonne of research and chose wisely. Would you say that getting the microscope analysis was worth getting In the end or did most surgeons dismiss it and want to do their own analysis ?

It must be due to the long hair + flash. I agree that the crown photo makes my hair look quite good, but the back + side photos are more telling. I'll post more before photos soon. You can also check some of my previous threads where I've posted photos.

I don't think anything can beat in person evaluations (including microscopes), but I didn't have any good surgeons nearby who were willing to do that. For my case, given I have general diffuse thinning and had a hunch that my donor was below average, the $30 USB microscope was worth the investment. It made me slow down and take a step back instead of rushing into surgery. If I was able to travel more freely, I would have been open to visiting many of the top clinics in Europe for consultations before booking any surgery. But given COVID, I couldn't wait. I've been putting my life on hold for too long over these past couple years.

Edited February 23, 2021 by giegnosiganoe

[giegnosiganoe]

BTW I updated the OP with some more info about the procedure/recovery.

Pics from around 2 weeks. Also ignore the eccentric colors/art in the background, I'm in an airbnb lol.

 

 

 

[giegnosiganoe]

Pics from 1 month - shedding is in full force, donor/crown in a bunch of different lighting

[EvansLawrence]

Hey man. Congrats on your surgery! And specially on the wise decision of going to Kaan Pekiner. I was very very close to do my surgery with him, but I ended up with HLC. For me both are the best option in Turkey. 

Your shock loss is normal and the appropiate of a 1st month. I am now at my week 3 so I am also preparing myself for it.

I really like your design btw!

 

Happy growing

[giegnosiganoe]

Month 2

 

[giegnosiganoe]

Month 3. Took some close ups. Seems like more hairs sprouting compared to month 2. Hoping growth starts to kick off this month.

[giegnosiganoe]

Month 4. Got a haircut. Seem to be on track, but hoping for a big improvement in density this month as the transplanted hairs catch up to the native hairs.

 

Notes:

1) I have one hair on the hairline on my right side that angles downward, ND doesn't want to stick up no matter how hard I try. It's only a single graft so not a big deal, but I'll see if I can better manage it as it grows longer.

2) I noticed a couple grafts on my hairline that weren't growing. Plucked them out without resistance. Seems like they're just dead grafts. There are probably more that I'm unable to see, but doesn't seem like a big issue in the grand scheme of things. Still interesting, and curious how common it is and what can cause it. If they do end up growing, I'll report back.

[Parasol]

Pretty nice improvement from last month!

[chimpaneasy]

Woah, amazing results!  Congrats man!

[giegnosiganoe]

Here are some pics of my crown area, for comparison with the ones from above when my hair was rather short.

You can also kinda see my donor area. I agreed with the barber to leave the back and sides slightly long until my transplanted hair gets more dense. The problem with my hair is that it's very straight, and so if I cut the back/sides to a medium short length, it sticks out like a porcupine. So I need to go very short or long. But very short is difficult as it will expose my recipient more on the sides, plus I have very fine hair so my back/sides will be more see through. Will probably start experimenting with shorter back/sides in the coming months.

Regarding my crown, and even my temple points, how many grafts do you guys reckon it would take for a noticeable improvement? I could probably live with them as is, but if it'll only take 1000 grafts or so to completely escape the appearance of balding, then I'd seriously consider it. I could also then sprinkle in a couple hundred grafts to fine tune the hairline. Interested in your thoughts.