NW II-III. FUE HT with Dr. Karadeniz, Istanbul, Turkey, April 2017.
I'll be having an HT procedure this week with Dr. Ali Emre Karadeniz in Istanbul, Turkey, so I wanted to start a report.
I read lots of reports from people about their HT experiences, and I've gotten so much from this forum. It really helped me a lot to see each step they took, from their decision process to the surgery itself and all the way through the many months until the final result. So I wanted to add my report to the collection with a write-up of my experience. I'm not an expert, I'm just a patient who's going through it now for the first time, but I know how helpful first-hand reports from other people were for me, so hopefully some people out there can get some use from my story as well.
I'm 42. Norwood III, NW II according to some docs. Loss mostly at temples and front hairline, with some thinning on the top. Crown and back have thinned, but no loss. All the loss occurred from age 24 to 27. I was worried about further loss, but I was lucky and it held pretty steady for the last 15 years: definitely greyer (everywhere) and thinner (on top), but no real loss or recession since age 27. No meds. Now at age 42, I might progress to NW IV, but I'm probably safely past the point where I have a big risk of reaching NW VI or VII. So I decided that now's a good time to do the hair transplant.
My goal is to make a great improvement on the front. Fill in the temple recessions. Lower the hairline and reduce the forehead size. Increase the density in the centre part-line.
I'm willing to go pretty much anywhere in the world for the right combination of great doctor, procedure and price. I travel a lot for work and vacation, so it's not a big deal for me to fly anywhere. I'm not looking forward to the inevitable attention when walking around airports and planes with a freaky red-holed head, but I'll survive.
I've had a few consultations both on-line and in-person. I've been surprised by the huge range of doctors, service styles, and opinions. The estimates of how many grafts I need range from 700 to 4,000. Some clinics have only marketing/admin people talk to me, in others it's the doctor himself, in one place it's a technician. Price estimates range from (in US dollars) $1,500-2,100 (extremely cheap factory clinics in Turkey) to $3,000-6,000 (better clinics in Turkey and Eastern Europe, factory-ish clinics in the U.S. and Western Europe or doctors just starting their business) to $10,000-15,000 (more professional places in North America and Western Europe). Scheduling options range from "show up any day you want and we'll operate on you" to "choose from one of these 5 days in the next month" to "first availability is in 10 months, but that'll be taken fast, so if you want it, please deposit money asap to reserve."
Deciding which surgeon
In making a decision of who to choose as my surgeon, there were a lot of doctors/clinics which I rejected immediately: anyone who promises perfect 18-year old hair (no joke, a few told me something like that) or otherwise over-promising (e.g., "In 3 days after surgery, no one will be able to notice anything anymore, and in just 3 months, you'll look 10 years younger!!").
I also rejected any places with aggressive marketing tactics like special one-time sales, discounts, pressure to book asap, etc. I understand it's a business, and I'm happy if the doctor and staff earn good money for themselves and live a nice life, but there's a point for me where the commercialism becomes uncomfortable. For example, a marketing investment into a well-done, professional website with lots of detailed explanations and before/after photos is a great sign of a doctor's attention to detail, understanding of the topic, willingness to educate his patients, as well as confidence in himself and his work. In contrast, the decision to hire a big marketing team which toys with emotions and treats patients as leads to convert into sales doesn't reflect the values of a doctor I want operating on me.
That helped me reject many places, including several well-known clinics that get lots of talk on forums and may be great but just don't work for me. But at that point, I still had many doctors and clinics left. How to choose between them is tricky. I talked to former patients, I read everything written by or about each doctor, I communicated directly with the doctors and staff and asked lots of questions.
That all gives a feeling, of course, but the issue is that you just have no way of knowing how the result will be in your specific situation. There's a lot known about the underlying science and techniques, but there are still many open questions. Most evidence you see as a patient is anecdotal or very limited, cherry-picked clinical observations. Even with good intentions, before-after pictures are more limited in value than I'd realized; I've learned a lot (from doctors themselves actually) about how usually it's only the good results which are shown (and every doctor has patients with average results as well as patients with not so great results), how much the pictures are affected by slight angle changes, light, etc., plus a huge number of patients don't want their pictures used, so you get a limited sample.
On top of that, there's a huge variability which is beyond control. Each patient is different in donor hair thickness, density, scalp, healing characteristics, growth factors, present and future hair loss details, etc, etc, etc. Two patients who seem exactly the same and get the same exact treatment could respond in very different ways, heal at different rates, and end up with quite different results.
I really appreciated doctors who are very aware about the inherent variability of HT and consciously work to mitigate the effect of the uncontrollable variables and maximize the chance of a good-to-great result. It's definitely possible that some doctors do a great job but aren't so articulate in explaining their HT philosophy, but I decided that I want a doctor who is very realistic about the procedure, has thought extensively about all the issues and done lots of follow-up study, communicates these ideas well with the patients, and is willing to take the time to tailor each procedure to fit the individual patient's known characteristics to maximize the chances of success.
FUE vs. FUT
Like all of you, I read the endless debates about the pros and cons of FUE vs. FUT, I asked doctors and patients about it.
At the end, I decided for FUE. On my knee and legs I have a bunch of scars from sports accidents that are pretty visible even after many years, so my guess is that even with the best of surgery technique, FUT would leave a pretty visible linear scar on my head. I'd rather take my chances with small dots of hyperpigmentation from FUE; a random pattern is less noticeable to the human eye than a linear scar, and even with fairly short buzz-cuts, it should hopefully not be too noticeable.
Final decision: Dr. Karadeniz
I decided to do the surgery with Dr. Karadeniz. My reasons:
- He does himself all extractions from the donor area and all incision in the recipient area.
Experience, knowledge, artistry/visualization and manual dexterity all are key to the final result. There's big value in having thousands of hours of experience. As far as I can tell, there's no reason that a skilled technician can't be as good - or even better - than a doctor. But with a doctor who does all his own extractions and incisions, you know as a fact that he personally has done the work for hundreds or thousands of surgeries. His name is on the door, his reputation is on the line, patients talk about him and the results he achieves for them. With a technician, you just don't know; the technician(s) might be incredibly good, and of course the doctor is supervising, but it's basically impossible to really confirm their personal experience and skills.
- I'm the only patient for the day, guaranteed.
I feel so self-centred to say this, but I want the doctor focused only on my head on the day that he's doing my HT. I know in my own life how much more concentration I have when I'm thinking only about one issue and not multi-tasking around.
- He really focuses on patient education, both in general (his website, HT forums, and videos), as well as in speaking directly with patients.
He's put out a massive amount of HT information: posts on forums, his own website, videos he's made. Obviously he is marketing himself through this, but to me, that's a good form of marketing. What really comes through to me from all this is that he's a hair geek, thinks about every issue in detail, and is very conscious about each decision and each step of the process.
I also appreciate how he's handled himself. Hair is a really emotional issue for all of us. The forums are great information, but they can get pretty testy. Jumping into the forums can be risky for a doctor, which is why many avoid it or stay on primarily non-interactive forums where the doctors can always have the last word. So I respect Dr. Karadeniz's willingness to engage with people about HT and answer questions. I think he also handled well some very public criticism.
- He brings a scientific perspective to his HT practice.
I have a science/engineering background, so I really appreciate his science-oriented approach. Of course every doctor has a science background, but I've found that some are less open to outside evidence or experiences and rely more on the impressions they've developed through their own practice.
- I'm satisfied with his results, both from his website, from forums, and from a few patients I spoke with.
- I really respect his ethics and integrity.
It doesn't guarantee a good result - you can have a great guy who just does a bad job, after all - but combined with his experience and results I've seen, I feel confident to put my head in his hands.
I'm a very details-oriented guy, so it's important to me that he really pay attention to every detail in my case, spending the time and energy to get as perfect a result as possible rather than cut corners and be satisfied with an average outcome. I like the idea that the doctor's own ethos will drive him to achieve great results for me.
As for going to Turkey, it's no problem for me. I've had clients in Turkish businesses and government, some of them are friends now, so I've been to the country many times and I like it. I know the Turkish hair industry gets canned a lot on forums and by doctors in the U.S. and Europe, and it's definitely justified in many cases: some of the Turkish clinics I talked to were disasters. But it seems to me there's no inherent reason that great doctors can't also be found in Asia, the Middle East, and South America. Research and find what works for you, wherever it may be.
So that's it. I'm definitely a little nervous. The whole idea of surgery to move some hair is pretty crazy, I've never met the doctor, and the country is in the midst of massive issues. Who knows what could happen. But overall, I feel pretty good. At least now, a few days before surgery, I'm a lot more confident than nervous, and I'm happy to finally be doing this.
I know how helpful it's been to me to read other guys' immediate reports on the surgery and the first few days after, so I'll post with pictures when it's done and I'm a freshly bleeding ball of transplanted hair.
Let us know how it goes! I am going there next month.
I'm very interested in the safety/security/climate of city, and obviously your experience
Day 1 Post-Op
I did the FUE hair transplant with Dr. Karadeniz this week.
Overall, very good experience and I'm hopeful about the eventual result. The service was as promised. Dr. Karadeniz did all the extractions and all the incisions himself. I was the clinic's only patient for the day. It was never rushed, and there was lots of time for discussion of not just the hairline design for now but also the plan for the long-term. Lots of attention paid to careful extraction to minimize the transection rate and conserve my donor area. Flat fee for the session so there's no incentive for him to extract more than necessary. There's no marketing, no sales, no bling: it's basically just you and him in a small room all day, with two technicians helping out. He's really a no-B.S. guy and likes to point out the silliness and marketing of the HT industry, which for me is good but I can see might be jarring for some people; you don't get all the pampering, reassurances and feel-good soothing that I noticed in other clinics. So it's not for everyone, but if you're looking for a clinic where an experienced and skilled doctor does all the work and the focus is solely on the surgery and not on all the frills, then I'd definitely recommend Dr. Karadeniz.
Turkish HT clinics
I was curious about the transplant industry in Turkey, so I visited a few clinics: three cheap mega places and the two well-known higher-end clinics.
The cheap places aren't so horrible on the surface. They're much more sanitary and well-organized than the nightmare descriptions I've read. And the technicians I met really do seem to care about doing a good job. But the problems come in all the short-cuts they take. They have 10 to 15 patients per day, every day. Teams of anonymous, name-less technicians do all the work. Their incentive is to extract a lot of grafts and do it fast, so they blast through your donor area and end up wasting a lot of good donor grafts. Hairlines are a one-size-fits-all standard, and incisions are done very quickly with little regard to individual variation. During and after the surgery, there's little accountability and no responsibility to the patient. It's a factory, efficient and impersonal. But they are cheap, around 1,200-2,000 eur with flat-fee pricing.
I was surprised in a bad way by the higher-end clinics. They're clearly nicer in terms of the service not related to the surgery. The facilities are more sparkling, the decorations ritzier, the floors shinier. There are more support staff, everyone dresses nicer, and the girls working there are clearly picked for looks. All the staff hover around you and make you feel good to be there. They also seem to focus a lot on pre-op preparation and post-op care. But regarding the surgery itself, I was surprised by how similar it is to the factory clinics. The doctor only draws the hairline; even with a lot of discussion, the most additional service I could get promised from the doctor is "personal in-room supervision" of the incisions. There is no focus on conserving your donor area. There operate on many clients every day, and you have no way to know who will be the people actually doing the extractions and incisions on your head. There's a massive pressure about price negotiation from when you first start talking with them which never stops. So it seemed a lot less personal and less focused on surgery than I expected, but who knows, it's all about the results and I have no idea how they really turn out.
Dr. Karadeniz's experience and knowledge made me feel very comfortable about doing a transplant with him.
It seems to me that he's at the sweet spot of his career. Old enough that he already has about 7 years of experience doing hair transplants full time every day and has personally done all design, extractions and incisions on over 1,000 HT patients. But still young enough that he can handle the physical challenges of doing the surgeries all himself: he has the energy and stamina, the concentration, the hand-eye coordination, and the manual steadiness to do a great job. In addition, he hasn't gone into dinosaur-mode yet; he actively follows research in the science and new techniques of the HT field, and he builds new evidence-based ideas into his clinical practice. He also has conducted his own experimental HT research, which I thought was pretty interesting. He has a diploma in plastic surgery and worked in hospitals in that before starting HTs.
He can - and does - explain every issue and answer every question in extreme detail and without the marketing gloss I've found in some clinics. I think his style could be overwhelming for some people, especially because the answers aren't always as clear as you want, and the outcomes can't be predicted perfectly and guaranteed. But I like to know as much as possible about the surgery and the decisions he's making, risks and all, so that works for me. His English is native-speaker level fluent.
He takes a lot of pride in being focused on science and reality rather than on marketing and sales. He constantly talks about scientific evidence, results, realistic assessment of risk, and long-term planning for the patient. He likes to contrast that with what he sees as the hypocrisy, false promises, hype, exaggerations, short-term views, and general silliness of much of the HT industry.
As a person, he's direct, opinionated, and (deservedly) proud of his HT accomplishments and knowledge. He cares very much about helping the patient and achieving the best HT results possible - that comes through in everything he says and does - but he's definitely not the image of the warm, reassuring, and comforting doctor. It's much more the style of a very talented young scientist eager to achieve great results, rather than a caring grandfather who wants to hold your hand and understand your psyche. Think of a whip-smart Turkish Jesse Eisenberg, not a wise, reassuring Morgan Freeman or Michael Caine.
He does both FUT and FUE. He prefers FUT: he thinks it's much more efficient use of hair grafts and a more scientifically-sound procedure, and he feels that the advantages of FUE are over-hyped by industry marketing. But patients prefer FUE, so he ends up doing many more FUEs than FUTs.
Clinic and staff
The clinic is located on the Asian side of Istanbul in the neighbourhood of Atasehir, a modern, upper-middle class area with many new high-rise apartment blocks, office buildings and stores. There are several hair transplant clinics in the area; Koray Erdogan's Asmed clinic is about 1km down the road. Public transport in the area is limited; the nearest metro is around 5km away, so a car, taxi or private driver is necessary. The neighbourhood is a business and residential district, not a tourist area, and there are no sites of real interest nearby. If you're arriving by car, Sabiha Gökçen airport (SAW) is much closer to the clinic than the bigger Atatürk airport (IST) and saves you the hassle of traffic jams in crossing the Bosphorus. But by public transport, IST is actually convenient enough and takes about 90 minutes and costs 5 eur in total: from the airport, take the metro all the way under the Bosphorus to Bostanci station on the M4 line, then take a taxi to the clinic.
The clinic is in a non-descript office tower adjacent to the large Brandium shopping centre. There is an office and consultation room on one floor, while the operating room is on the floor directly below. Both offices are about the size of a large 1-bedroom apartment: small, but adequate in size for one surgery each day. The main operating room is clean and professional; it's not fancy, but it's functional and well-designed for its purpose. The clinic is located on a high floor, and the operating table is positioned so that you have a nice view over the Asian side of Istanbul during your operation.
Included in the price is accommodation at the Silence, a five-star hotel next to the clinic in the same Brandium complex. It's a very nice hotel and is just a quick walk to the clinic. Alternatively, if you prefer to arrange your own accommodation and transportation, the clinic will reduce its charge by 160eur. In this case, there are a few three- to four-star hotels for around 25eur that are within 1km of the clinic which you could find and net-net save yourself around 100eur.
Dr. Karadeniz's office staff consists of Omer, a man who handles client communications and Gokce, a woman who works as the office manager.
During the FUE surgery, two technicians assisted Dr. Karadeniz. They each have worked with Dr. Karadeniz for 5 years. They are both professional, courteous, well-paid and very competent, but direct communication is limited as one of the technicians speaks only a little English and the other speaks none.
Dr. Karadeniz drew a hairline that he thought would work for me. Then he gave me the pen and told me to show what I wanted. As he explained, it's the client who has to live with the transplant, so in this phase he views his role as guiding rather than dictating. He explains what is possible, how much of the donor area it depletes, how natural it looks, potential risks, etc. Particularly because in my case it's a front hairline improvement job rather than a big NW VI or VII surgery, he said that he prefers to be very conservative. He personally wouldn't bother with surgery if he were in my shoes, so he is very open to what the client wants. He's had issues with NWIII guys who aren't realistic or are setting themselves up for disaster (for example, 25-year old guys who want to put their hairline down to just above their eyebrows), but in general he tries to work to find a solution that pleases the client, will look realistic, and will stand the test of time.
Based on consultations I had with other doctors and stories I've heard from other patients, I'd say that Dr. Karadeniz is more flexible about hairline design than others, particularly for a NWII or NWIII case. That freedom can be overwhelming to a lot of guys - after all, we're not HT doctors, we don't really know every detail of how it will grow, the counts, the possibilities, the risks. I'd spent a lot of time thinking about my hairline, studying hairlines, and looking at pictures of myself, but I was still nervous to take a pen to my own head knowing that this is real and not just a fun fantasy. But the flexibility is great: despite all the scientific measuring and angles and ratios that some doctors use, the reality is that it's not a mathematical equation and there is no one single "correct" hairline. A lot is based on your personal taste. It is YOUR head, after all, so it should reflect you rather than be a generic one-size-fits all product. So if you do want to have a lot of say in the hairline design, then I'd say that Dr. Karadeniz is definitely a good fit.
Dr. Karadeniz is extremely focused and attentive during surgery. As promised, he personally does every extraction from the donor area and every incision in the recipient area.
For the extractions, he used a motorized punch. He did the extractions in three sections, taking a short break in between each section of my head to rest himself and give the technicians time to do their job. He is extremely focused on minimizing the transection of hairs. As he explains, many doctors/clinics claim low transection rates of <3%, but a) it's impossible to verify what they say, b) it's very time-consuming to count and no doctor actually counts the true transection ratio for every patient, so they don't actually know it themselves, and c) clinics generally are only talking about "full transections", where the entire graft must be thrown away. But there are also "partial transections" of grafts in which just one of the hairs is transected, and that is often not counted. In his view, that is also a transection.
I very much appreciated his intense concentration on transections. His drive to minimize the number of my terminal donor hairs which are transected is a big plus to me and one of the reasons I chose him: I only have a finite number, and I want to keep as many as possible for the future. It's silly to let clinics just destroy your finite reserves only so the clinic can benefit their own speed and ability to treat more patients in one day. I definitely feel that other doctors I spoke with are not as precise about this issue and focus more on the number of transected grafts rather than the more accurate count of transected hairs, so I was very happy about this part of the surgery with Dr. Karadeniz.
For the recipient area, he also did every incision himself. He stopped several times through the procedure to have me sit up, rotate my head around, examine me closely, all to get the exact right placement and angle. As he and I had discussed before, he built what I hope will end up as a very nice transition zone at the front of the hairline consisting of small 1-grafts, little irregularities and occasional random hairs slightly in front of the main hairline, and behind that a denser zone of 2's and 3's, with a particularly dense zone at the front centre. I noticed that he clearly was working with my head and existing hair to make it fit nicely, rather than rushing through with a standard one-size-fits-all approach. I won't know the result of his work for 9 months, but at least during the surgery it seemed to me he was thinking through every issue and putting in the time and effort to make each cut fit precisely.
The role of the two technicians is to pull out the follicles from the head after Dr. Karadeniz has done the extractions, do all the handling of the follicles under the microscopes, and place the follicles into the incisions made by Dr. Karadeniz. They also do a pre-op blood test, prepare and shave the hair, and clean the head post-op.
No one other than Dr. Karadeniz and these two technicians was involved in any way with any aspect of the surgery, which I very much appreciated after having seen the rotating teams at other clinics.
His concentration during the surgery is intense. There is no sound while he is working: no music, no TV, no talking. I'm very glad about that; I'd much rather that he is focused and not distracted than that they pleasantly entertain me.
One of the only criticisms I'd have of his surgical style, though, is that he's so focused that he doesn't communicate to the patient. The reality is that it doesn't matter if the patient knows what's going on, but it would definitely be reassuring to hear little updates during the surgery. It's like a plane: it's not like the passengers need to know anything, but it makes them all feel better to hear the pilot describe the plan and give them any notices of what's happening as the flight progresses.
The only other issue I'd point out is his extreme interest in the business of the hair transplant industry. I'd picked up on this in some of his videos, but it's very strong in person. During his part of the surgery, he is dead silent, but at most other times, he talks a lot about the HT business. I understand the situation. There are a lot of dodgy marketing practices by even the most famous clinics in the U.S. and Europe: pay patients for positive testimonials online, pay money to different forum admins, manipulation of lighting and angles for before/after pictures, cherry-pick patients with the best results and pay them or give them free flights to get their after-pictures, hire "web soldiers" to promote the doctor online and push down competitors, conscious depletion of donor zone for benefit now knowing that it can have big problems for the client in the future, sales and add-ons of treatments with dubious scientific value, marketing that makes empty promises not backed by any science, lack of transparency about the physical toll that extractions and incisions take on the doctor and the resulting use of technicians. And that's outside Turkey. Regarding the industry in his own country of Turkey, he really feels hemmed in: all work done by a huge team of faceless technicians who are paid little, almost every clinic has a business plan which emphasizes quantity of patients treated rather than quality of results, they follow a one-size-fits-all treatment plan, they shirk on patient post-op follow up and care.
My feeling is that he's an honest man who really does want to do good hair transplants and give the best service possible to his clients based on the best scientific evidence and proven techniques. He's been in the business long enough to be very good at the procedures. And in a very good credit to him, he recognizes very clearly that the best way to ensure his continued success is through great results for clients; that really pleases me, obviously. But he has now reached the point where he's recognizing that he's limited in how much he can expand a boutique practice based on these values, and he's become cynical about the empty marketing and patient mistreatment he sees at other clinics. It's an interesting discussion, and his heart is very much in the right place, but during the many hours of the procedure I often had to gently steer him away from this conversation about the HT business and back to my specific questions and concerns about my own procedure.
I had a "limited shaven" FUE. He shaved a band on the back of my head, basically running from one side to the other in the area just above the ears. He left all the hair above and below the band unshaven. He planned it so that my existing hair covers up the donor area. The result is that from the back, my hair looks totally normal. You can't tell at all that there was any change.
He didn't shave at all in the front. I did front hairline work, so the incisions are mostly in front of the existing hairs. They go back into the existing hairs a little bit, but he said it wasn't so bad and didn't make it any harder for him to do the implants.
After the surgery, you can clearly see the implants and the redness when my existing hair is combed back. But if I push my hair forward, it almost completely covers up the recipient area. A little styling, a little gel, and it's totally covered up. Kind of silly hair style, but otherwise no change at all.
I fit perfectly into pretty narrow criteria for this to work: NWII-III frontline work only and not a massive area to fill up, hair at least medium length. Already on the first day after surgery, I can basically get away with no one being able to notice a thing, which is pretty incredible actually.
Dr. Karadeniz currently has a flat fee structure. The idea is that the whole clinic exists on that day only for you: the doctor, the technicians, the room and equipment, it's all for you for the 7 or 8 hours of that day. So he charges a flat fee for that session.
I like this pricing policy much better than a per-graft charge. The incentives of a per-graft system are just wrong: the clinic is encouraged to extract more grafts and to extract them fast. There's no incentive to conserve your donor bank, no incentive to focus on minimizing the transection rate, no focus on the survival rate of the grafts or their precise placement. The grafts themselves have different numbers of hairs, and the hair count can be quite different if you need lots of crown work or if you need single-hairs for the frontline. Even assuming it's an honest clinic and they don't cheat on the actual count, it still puts emphasis on quantity over quality and on posting big numbers on the day of surgery rather than executing a plan which is in your long-term interest. To me, the per-graft pricing policy seems designed by an economist to optimally extract as much money as possible from you, rather than by a surgeon to extract the right amount of hairs you need. The U.S. doctor Ken Anderson in Atlanta describes the problems well here: http://www.atlantahairsurgeon.com/cost/.
Dr. Karadeniz's pricing structure seems very fair to me. In one session, he figures to do between 3,000 and 5,000 hairs. His FUE price is 2,840 eur for the session. Plus 160 eur more if you want two nights in the 5-star hotel and transportation to/from the airport. FUT costs 500 eur more, because in Turkey it's apparently hard to find technicians who are trained to get the grafts from the strip. In contrast to other clinics, he doesn't offer discounts and he doesn't pay patients to promote him (at least, he didn't offer me a discount for any reasons, and he didn't even ask me to write a review about him; in fact, he thinks forum reviews are pretty useless for him from a business standpoint and I found out that he stopped all forum associations and marketing a year ago).
His fee is more than most clinics in Turkey. There are a few hundred clinics that charge a flat fee of 1,200-2,000 eur; those are the disaster technician-only factory places. On the other hand, his fee probably works out cheaper than the clinics which are the most famous among Westerners and get talked about most on these boards. Those clinics charge per graft; I found it's somewhere around 2-3eur per graft, but the price was always fluctuating when I spoke to them, and it seems to depend on how they view you, how busy it is, your flexibility about dates, the season, your negotiation skills, your online social presence and how many good reviews you promise to write them, the weather, etc. So it's tougher to compare their price with Dr. Karadeniz's, plus you have the problem that they might end up doing more grafts anyway because of the per-graft incentive. But hopefully this gives you a rough idea of the prices you're looking at.
In my case, Dr. Karadeniz actually did fewer grafts than initially estimated. Because he had no incentive to do more and more grafts, he was able to do as much as needed for my goal, but no more. And he was able to focus a lot on each extraction, rather than rushing his way through it. You could argue that the flat-fee structure gives him an incentive to be lazy and do nothing, but I'd say the risk is pretty small: he's there with you all day no matter what, the technicians are paid to be there all day, and he's very, very focused on getting a good result so that his reputation gets better and better. I like that.
I know that most doctors charge per graft, including lots of famous clinics in Europe and the U.S. that get great reviews, and obviously they're not all trying to just take advantage of their clients. I could just be over-thinking the incentives. But I've now heard several doctors talk in detail about the problems of this pricing, so it just makes me feel better to have a flat per-session fee. It definitely made me more relaxed during my session; the money was fixed and paid already, so all the focus - both his focus and mine - was on getting the best result. He wasn't thinking about how much additional profit he could make from me, and I wasn't stuck second-guessing every extraction he took. Who knows, at the end it's all about the result and we'll see how it is in 9 months. But at least for now, I'm happy about it.
Turkey and safety
I've seen the messages here asking about safety now in Turkey.
For me, as of now (April, 2017) it feels completely safe. Istanbul is a huge, (mostly) modern city that functions well, has lots of tourists, and is safe in most neighbourhoods. In particular, the neighbourhood of Atasehir, where Dr. Karadeniz and several other clinics are located, is basically an upper-middle class suburb and definitely feels completely boring and safe during the day and the night.
There are real and huge problems. Military coup in July, 2016 and state of emergency ever since. Hundreds killed then, tens of thousands jailed since. Numerous terrorist attacks in the last year in the airport, stadiums, shopping streets, nightclub. Multiple wars on Turkey's doorstep spilling over into the country. Millions of Syrian refugees. Russian ambassador assasinated. Journalists and media under threat. The U.S. and the U.K. banned laptops on Turkish Air flights from Istanbul. Big war of words with Germany and Holland in the last month. And this week, the country narrowly voted in favor of transforming Turkey into an executive presidential system, effectively strengthening President Erdogan's grip on the country.
It all depends on how comfortable you are. Personally, I don't think the risk is so great. Direct crime and muggings are much more likely almost everywhere than terrorism, and I think you're more likely to be robbed in many central neighbourhoods of Berlin or Washington than in Atasehir. As for terrorism, it's so random and one-off that the odds are extremely low; there are terrorist attacks in London, Paris, Madrid, New York, but no one avoids HT surgery in those cities because of it. And ironically, I think that the security at Istanbul Ataturk airport is better in at least one way than most airports in Europe or the U.S.: they scan your bags before you even enter the airport, so no one can just walk in carrying 50kg of explosive as they can in other airports.
You really notice that tourism has been hit by all the troubles. Hotels are much cheaper than a few years ago. Flights from Europe are cheaper and often empty. The Turkish lira is very weak, so locally-priced goods are quite a bargain.
Id worry about trying to open a business in Turkey now, to invest in Turkey, to raise kids there. Trying to freely pursue academic research or investigative journalism would be tough now. Even partying at night, especially in certain areas, I'd probably be more cautious. But to go a few days for a hair transplant, for me it's no problem.
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