Dr. Bicer Saved My Life | Aborted Transplant | Why a High Degree of Doctor Involvement is Extremely Important

[Stines]

Here's one for the books:

 

Last week I headed into Dr. Bicer's clinic for my planned 3500 graft hair transplant, excited to finally knock out the transplant I've been anxiously awaiting for over a year. Upon arrival, I'm greeted by Dr. Bicer and her coordinator Ozen. The next hour or so is fairly typical: I ask Dr. Bicer a few questions, fill out paperwork, discuss potential hair lines, have my blood drawn, head shaved, etc. Things are going smoothly. At this point I'm ready for surgery so I'm fitted into a patient gown and brought to the surgery room. A technician begins the process of numbing my donor area with injections of anesthesia. This hurt like hell but was tolerable. During this period I began to notice a slight trembling in my legs, but I chalked it up to anxiety and didn't think much of it.

Once the initial does of anesthesia were administered, the technician began to prod the back of my head and asked me to let her know if I still felt even the slightest pain anywhere - if there was still some pain in a spot, she'd administer more anesthesia to that area. Crucially, she also began asking me how I felt more generally. She did a good job of asking me this every 30 seconds or so. It was somewhere at this point where I felt a wave of numbness wash over the area around my mouth and upper throat. Thinking this was strange, I informed the technician of this the next time she asked how I was doing. The technician immediately got up and informed Dr. Bicer, who herself was close by preparing for extraction work. Within seconds, Dr. Bicer moved in to take a look at me and immediately recognized that I was showing symptoms of an allergic reaction to the Lidocaine anesthetic. She stopped the procedure straight away and informed me that I was having a serious allergic reaction, and that this meant the surgery had to be aborted. She began talking with the nurses and technicians in the operating room; I don't speak Turkish but I recognized the seriousness of the situation through everyone's tone of voice and facial expressions.

At this point I noticed the numbness in and around my mouth was getting worse: my jaw felt heavy, I could hardly feel my tongue, and I was having difficulty speaking clearly. I apparently also had a massive rash on my upper chest (I didn't notice this at the time, but Dr. Bicer told me about it afterwards). The trembling I talked about earlier spread from my legs to the rest of my body and increased in severity. Mentally, I entered a confused daze and began panicking about the situation (I thought there was a good chance that my vanity was about to cost me my life, and that I would die in a foreign country). Dr. Bicer began administering oxygen to me through a nasal cannula - she said this would help the anesthesia wear off faster. She also administered some kind of emergency anti-allergy medicine to me via IV. The staff began phoning an ambulance. Dr. Bicer was speaking to me regularly at this stage, informing me that my vitals looked good but that I would be sent to a hospital out of an abundance of caution.

I was feeling much better already by the time I arrived to the hospital. It was one of the university hospitals in Istanbul, I forget the name. While there, I met with a neurologist who asked about my medical history and performed a neurological exam by asking me to open my mouth, raise my eyebrows, smile, etc. Everything looked good. I was told to stay at the hospital for about 30 more minutes to make sure nothing else popped up. Dr. Bicer was watching me this whole time and regularly asked me how I was doing. She tells me that Lidocaine is used in pretty much every hair transplant and my allergy means I'm no longer a candidate for hair transplant surgery. After this we went back to the clinic where I was refunded the cost of the procedure, and I collected my things and went back to my hotel. As you can imagine, I was mentally exhausted at this point so I took a big nap. Dr. Bicer asked me to send her regular updates on WhatsApp about how I was feeling and to return to the clinic in the morning. The next morning, I head back to Bicer's clinic and ask a few questions and say farewell to the team. I spent the remainder of the day taking a nice touristic trip through Istanbul; unfortunately it was raining and cold that day, but I enjoyed my time regardless (Istanbul really does live up to the hype, I have to say). I took my flight home the next day.

 

Takeaways

Hair transplants are extremely long and extremely complicated procedures. I know this forum does a good of stressing how important doctor involvement is to these procedures (not only for the final result but also for patient safety), and everyone reading this story should take it as further confirmation of this fact. I am only 29 years old with no major medical issues and have never had an allergic reaction in the past, so this incident really did come out of nowhere. God knows what would've happened if I had gone to a hair mill with poorly-trained technicians and no doctor around: the technicians probably would have dismissed my symptoms as normal and told me to calm down. Proper technician training and Dr. Bicer's presence in the operating room really saved my life here. After this incident, I would also personally no longer recommend any doctors that work on two or more patients at a given time. Things can go wrong suddenly and a medical doctor needs to be immediately available to respond rapidly to any situation. One of the main reasons I chose Dr. Bicer in the first place was because I knew she only operated on a single patient each day, and it seems my decision paid off massively.

So here ends my hair transplant journey, over almost as soon as it started. For the time being, I've resigned myself to continuing to shave my head, but I may give some thought to pursuing SMP in the future. I've been lurking on this forum for years, hoping one day to post a thread of my own chronicling my transplant progress and asking for feedback from experienced members; but alas, it seems it just wasn't in the cards for me. I did learn a lot on this forum, and I wanted to thank all the members who contributed into making this forum such a great repository of information. If it weren't for this website, I'd likely have gone to a cheap hair mill and, as I know now, that probably would've ended badly (to say the least).

Thanks again everyone.

Edited December 20, 2023 by Stines

[hairman4321]

oh wow interesting, glad they took care of you. i wonder also if this is the only anesthetic they can use or if there aren't others? anyway best to prioritise your health and stay safe.

[Britanium]

As you rightly said it could have been a different story had you gone to a typical hair mill. Although those can be done in hospitals you would not have had the Dr's experience/experience to deal with it so swiftly. A allergic reaction is serious in this case, thankfully you had the best possible treatment/outcome. 

Edited December 20, 2023 by Britanium

[Berba11]

I'm really pleased to hear everything resolved well and it sounds like Dr Bicer and her team did a thorough and careful job of responding to the situation and looking after you until recovery.

That said, I do have to ask... Did they not perform a test first to see if you were allergic? At Eugenix, on each occasion I was there (and maybe more than once on each occasion), they administered some aneasthetic into my forearm/upper wrist to make sure there was no reaction. Did Dr Bicer not do something similar? If not I'd suggest they need to improve their pre-op protocol. They obviously knew what they were doing once it happened, but potentially your situation could have been avoided.

[duchaine]

Great.
You have been very lucky.
 

 

[Melvin- Admin]

I have said it before but I’ll say it again. Dr. Bicer is one of the most ethical doctors in the business. She truly cares about her patients. 

[duchaine]

2 minutes ago, Melvin- Admin said:

I have said it before but I’ll say it again. Dr. Bicer is one of the most ethical doctors in the business. She truly cares about her patients. 

I had a free consultation with her and she was stunning.
She is a very good person.

[duchaine]

Did you have pre-op medicines?
Anti-hystaminic and cortisone?

[Steverino80]

Wow, Would never have thought about it, glad you okay. Hope there's someway in the future you can get your HT

[Stines]

On 12/20/2023 at 6:29 AM, Berba11 said:

I'm really pleased to hear everything resolved well and it sounds like Dr Bicer and her team did a thorough and careful job of responding to the situation and looking after you until recovery.

That said, I do have to ask... Did they not perform a test first to see if you were allergic? At Eugenix, on each occasion I was there (and maybe more than once on each occasion), they administered some aneasthetic into my forearm/upper wrist to make sure there was no reaction. Did Dr Bicer not do something similar? If not I'd suggest they need to improve their pre-op protocol. They obviously knew what they were doing once it happened, but potentially your situation could have been avoided.

No, but to be fair I've been researching hair transplants for a while and have only ever heard of Indian clinics like Eugenix doing that. I could be mistaken. Although honestly yeah, the pre-op felt kinda rushed (doctor said my surgery was large and would take a very long time and she wanted to start as early as possible). That's probably my one criticism. I don't think it contributed to this incident, though.

[Stines]

On 12/19/2023 at 11:38 PM, hairman4321 said:

oh wow interesting, glad they took care of you. i wonder also if this is the only anesthetic they can use or if there aren't others? anyway best to prioritise your health and stay safe.

From what I understood from Dr. Bicer, an allergy to one anesthetic suggests increased risk of allergy to others. For an elective cosmetic procedure like a hair transplant, the risk of this happening again probably isn't worth it.

[Stines]

On 12/20/2023 at 10:40 AM, duchaine said:

Did you have pre-op medicines?
Anti-hystaminic and cortisone?

No

[Berba11]

32 minutes ago, Stines said:

No, but to be fair I've been researching hair transplants for a while and have only ever heard of Indian clinics like Eugenix doing that. I could be mistaken. Although honestly yeah, the pre-op felt kinda rushed (doctor said my surgery was large and would take a very long time and she wanted to start as early as possible). That's probably my one criticism. I don't think it contributed to this incident, though.

Thanks for the info. I think it might be wise to suggest they do a simple and easy test pre-op/the night before if you’re still in contact with Dr Bicer. It seems like an obvious oversight to not do such an easy test. 
 

As much as they deserve praise for their handling of the situation as it manifested, I think it’s negligent to not be doing an anaesthetic reaction test beforehand. 

[Stines]

31 minutes ago, Berba11 said:

Thanks for the info. I think it might be wise to suggest they do a simple and easy test pre-op/the night before if you’re still in contact with Dr Bicer. It seems like an obvious oversight to not do such an easy test. 
 

As much as they deserve praise for their handling of the situation as it manifested, I think it’s negligent to not be doing an anaesthetic reaction test beforehand. 

I guess the question becomes how common is it for hair transplant clinics to test for anesthesia allergies in patients who haven't indicated any potential allergy issues. From what I've read it doesn't seem common, but, again, I could be wrong.

Edit: Also, I did speak with Bicer on this subject. She said allergy testing can only be done in a hospital setting to ensure access to specialists in case of a serious reaction.

Edited December 24, 2023 by Stines

[Berba11]

26 minutes ago, Stines said:

I guess the question becomes how common is it for hair transplant clinics to test for anesthesia allergies in patients who haven't indicated any potential allergy issues. From what I've read it doesn't seem common, but, again, I could be wrong.

Receiving anaesthesia isn’t common in general - most people will not know if they’re allergic as they won’t ever have had a local injection, which is why a quick test that takes 2 seconds to administer and 10 minutes to monitor should be mandatory. 
 

If it’s uncommon for clinics to test during the pre-op stage then that needs to change. 

[JoeD]

Not necessarily an allergic reaction…. Everything, except rash, sounds like some of the lidocaine went intra-vascular (ie in a blood vessel, an artery) by accident.  I wonder if the IV med they gave you was steroids for allergy vs intra-lipid for lidocaine toxicity.  
 

In addition, even if this was a true allergic reaction, you can get allergy testing and determine which of the other local anesthetics you can use.  Most common are the “amides” (lidocaine, marcaine etc).  Esters are another type which may still be viable. 

Edited December 24, 2023 by JoeD

[Stines]

16 hours ago, JoeD said:

Not necessarily an allergic reaction…. Everything, except rash, sounds like some of the lidocaine went intra-vascular (ie in a blood vessel, an artery) by accident.   

Well that's concerning. Haven't really considered this seriously until now. Now that I think of it, I am almost certain I heard the Turkish word for "toxicity" being mentioned by the doctor and staff in their conversations with each other when the incident first started. It was one of the only words I was able to make out (it sounds nearly identical to the English word). Maybe they suspected toxicity initially but moved to anaphylaxis when the condition progressed and more symptoms started to show? Can an anaphylaxis episode cause toxicity? I know hardly anything about this sort of stuff.

 

Quote

I wonder if the IV med they gave you was steroids for allergy vs intra-lipid for lidocaine toxicity.

Is there any way to tell? It was a clear liquid in a tube and was administered twice, if I remember correctly.

Edited December 24, 2023 by Stines

[shiba1985]

In your whole life, have you ever had any injections for dental procedures. Sounds weird. Was it lidocaine toxicity or lidocaine allergy. Glad you are safe though. 

[Stines]

1 minute ago, shiba1985 said:

In your whole life, have you ever had any injections for dental procedures. Sounds weird. Was it lidocaine toxicity or lidocaine allergy.

Had a couple of dental procedures as a kid that involved local anesthesia. Didn't have a reaction to any of them.

Quote

Glad you are safe though. 

Thanks

[shiba1985]

1 minute ago, Stines said:

Had a couple of dental procedures as a kid that involved local anesthesia. Didn't have a reaction to any of them.

Thanks

most dental procedures use lidocaine. The oral sensation of numbness and tingling,  you describe is typical of lidocaine toxicity.

 

[shiba1985]

from google:

 

Early symptoms are circumoral numbness, tongue paresthesia, and dizziness. Sensory complaints may include tinnitus and blurred vision. Excitatory signs, such as restlessness, agitation, nervousness, or paranoia, may progress to muscle twitches and seizures.

[JoeD]

36 minutes ago, shiba1985 said:

from google:

 

Early symptoms are circumoral numbness, tongue paresthesia, and dizziness. Sensory complaints may include tinnitus and blurred vision. Excitatory signs, such as restlessness, agitation, nervousness, or paranoia, may progress to muscle twitches and seizures.

Bingo 

 

Can get allergy tested to be certain, but this was a freak thing that can happen with any procedure using high volume of local anesthesia (lidocaine)…. most likely can still get a hair transplant.  

[DermMD]

18 hours ago, JoeD said:

Not necessarily an allergic reaction…. Everything, except rash, sounds like some of the lidocaine went intra-vascular (ie in a blood vessel, an artery) by accident.  I wonder if the IV med they gave you was steroids for allergy vs intra-lipid for lidocaine toxicity.  
 

In addition, even if this was a true allergic reaction, you can get allergy testing and determine which of the other local anesthetics you can use.  Most common are the “amides” (lidocaine, marcaine etc).  Esters are another type which may still be viable. 

See an allergist to have this tested (amide and ester anesthetics). it's unlikely you're allergic to both (I am a board-certified dermatologist), and this is how I would test a patient in this setting. just my two cents. 

[duchaine]

I will be brutal...
From my personal experience, you need to understand that this "clinic" do not have to tools the handle an adverse reaction.
Som if the doc is scared that something could be wrong, he/she abort the surgery. Then the/she say "I aborted to protect you from this or that".
But keep in mind...they try to protect themselves as first thing.
 

[Stines]

On 12/24/2023 at 2:43 PM, shiba1985 said:

from google:

 

Early symptoms are circumoral numbness, tongue paresthesia, and dizziness. Sensory complaints may include tinnitus and blurred vision. Excitatory signs, such as restlessness, agitation, nervousness, or paranoia, may progress to muscle twitches and seizures.

 

On 12/24/2023 at 3:21 PM, JoeD said:

Bingo 

 

Can get allergy tested to be certain, but this was a freak thing that can happen with any procedure using high volume of local anesthesia (lidocaine)…. most likely can still get a hair transplant.  

 

7 hours ago, duchaine said:

I will be brutal...
From my personal experience, you need to understand that this "clinic" do not have to tools the handle an adverse reaction.
Som if the doc is scared that something could be wrong, he/she abort the surgery. Then the/she say "I aborted to protect you from this or that".
But keep in mind...they try to protect themselves as first thing.
 

 

Well this thread is taking a turn. From the symptoms you guys posted (and what I was able to gather from my own research), I agree with you all that my reaction seemed to be much closer to what we'd expect from lidocaine toxicity rather than anaphylaxis. I am still concerned why Dr. Bicer did not mention lidocaine toxicity at all to me; she only described my reaction as "anaphylaxis" and an "allergic reaction." I will reach out to her soon to see what she has to say.

@JoeD you mentioned earlier that lidocaine toxicity is caused by the technician inadvertently injecting lidocaine into a blood vessel or artery. Can lidocaine toxicity be caused by anything other than technician error? If not I will have to demand my deposit back from the clinic.