NW II-III. FUE HT with Dr. Karadeniz, Istanbul, Turkey, April 2017.

[Asphalt]

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.


About me
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.


Consultations
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.

• Reasonable price.

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.