As a man of a certain age (that is, over 20), you’ve probably noticed some hair thinning when you stare at your reflection—or maybe you’ve noticed a lot of it. Every man experiences hair loss, and it can be a shocking process as you accept the recession, thinning, patchiness, and (eventually) the permanent shaved hairstyle.
So you’ve probably also wondered about a hair transplant, and whether or not you should get one. Aren’t they expensive? Will it look natural? How is it performed? Does it hurt? Does it scar? Also, why is everyone flying to Turkey for them?
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There are a lot of questions to be answered. So for that, we sought the wisdom of Dr. Serkan Aygin, a dermatologist who performs hundreds of hair transplants in Istanbul each year. (He’s also been performing them since the 90s.) Here are our questions—and yours—on hair transplants, along with Dr. Agin’s thorough replies. It should be all you need to book your consulting appointment.
Who is an eligible candidate for a hair transplant?
There are two main things Aygin assesses with his patients.
First, the existing hair loss: “We diagnose the cause of a guy’s particular type of hair loss, to measure the severity, as well as the pattern of his hair loss condition. This will give us a clear understanding of the amount of donor hair a patient has available, the quality of the donor hair, and the size of the balding areas that need to be treated.” The donor hair is typically taken from the rear of the head, in graduated levels so it doesn’t leave a noticeable bald mark or scar, as was the concern with past methods of transplants. This is generally determined based on your specific hair loss classification, using the Norwood Scale.” (The Norwood Scale measures a man’s progression of balding; read on for more information.)
Secondly, the patient’s health: “Although hair transplantation is considered a minimally invasive surgery, there are still risks involved, and being in optimal health is very important. Medical factors can vary from patient to patient and can determine if you’re a good candidate, which would all be discussed during the initial consultation.”
Aygin then sets proper expectations with his patients, once they decide to move forward. “It’s important to have realistic expectations and to understand that your hair loss might continue to progress after surgery,” he says. “Some men have to continue medications after surgery to retain as much of their hair as possible. [This is especially true] if your hair loss pattern has not been stabilized yet.”
When are guys “too bald” to receive a transplant?
Aygin again points to the Norwood Scale, which classifies male pattern baldness based on its severity or progression. “Each stage is given a number—and the higher the number, the more evident the hair loss is,” he says. “Stage 6–7 on the Norwood Scale is considered the most severe stage of male pattern baldness, and this can mean that men who are at this level might not be eligible to have a hair transplant. This does not imply that a hair transplant with this level of hair loss is always impossible. It depends entirely on the patient, the practitioner, and the potential donor area.”
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What are the most common types of transplant procedures being performed today? Which one is right for me?
The two main transplant procedures are follicular unit extraction (FUE) and direct hair implantation (DHI). They are very similar but have one core difference, which occurs at the stages wherein the incision and actual transplantation are performed. Aygin notes that, in DHI transplants, these two final steps are merged into one, whereas in FUE, they’re performed separately.
“The major distinctive feature of the DHI method compared to other hair transplant methods is it employs a pen-like medical instrument called a ‘Choi implanter’ that creates the recipient sites [where the hair is being implanted] and simultaneously transplants the grafts,” says Aygin. “In the FUE method, the recipient sites are created as a first, separate step, and later the donor hair is transplanted into these areas.”
Here are the other differences between DHI and FUE transplants:
FUE transplants: Allows to transplant around 3,000 to 4,500 grafts in a single session (which can last upwards of 5–6 hours). FUE is ideal for covering large areas of loss. To perform FUE transplants, the patients must shave their entire head.
DHI transplants: Allows for approximately 1,500 to 2,500 follicular unit grafts in a single session (also 5–6 hours). Has a faster recovery period and is typically performed with less bleeding than FUE method. DHI is more optimal when you want to achieve higher density. DHI recipients need to only shave the donor area of their hair, not the area that will receive the transplant itself. (“This is usually seen as a significant advantage for female patients,” says Aygin.) The DHI method also requires more skills and experience than other methods, including FUE. Those physicians and medical teams who administer it have also undergone long-term training, to specialize in DHI. They’re also more expensive than FUE transplants.
Which one is best for me?
“During your initial consultation, the physician will determine which transplantation method is best for you based on your hair loss classification, the size of the thinning area, quality and quantity of your available donor hair,” Aygin says.
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Do doctors use anesthesia?
Don’t worry: You won’t feel any pain or discomfort during the process. “A hair transplant is usually carried out under local anaesthetic,” says Aygin. And beginning in 2019, his clinic and many others have started to use sedation methods to help patients feel more comfortable during the operation. “When hair transplantation is combined with sedation, the patient will remain awake without feeling any discomfort, and he/she will not feel the graft extraction, recipient site creation, or transplantation processes,” he says.
How does the doctor decide where to “draw” the hairline?
Your surgeon will assess where your hair grew before it originally fell out. Secondly, they’ll assess the starting point of your hairline. “This is the lowest point on your upper forehead where your hair will start to grow post-transplant,” Aygin says. “We have several muscles on our forehead and it’s not possible to transplant on the muscle, so the hair transplant surgeon must first determine where the forehead muscles sit.” They can do this by examining your face when you lift your eyebrows, which will expose your forehead folds and muscles—which end where the folds stop. “However, this does not mean that the hair should start to grow at this point,” Aygin says. “It varies from person to person.”
The other thing that must be assessed is the angle at which your hair grows in each spot on the head. “Hair has the tendency to grow at a particular angle on different areas of the scalp,” he says. “For instance, at the sides, hair can grow in a downward direction while at the front it may grow outward. So it’s very important to take the direction and the angle of each hair follicle into consideration, while defining the hairline and planning the hair transplantation. Each hair follicle on the hairline is located in a unique position. A hairline doesn’t contain straight lines. If the new hairline is drawn in a pattern of straight lines, the result will look unnatural. To achieve a natural look the hairline design should be created in more of a zig-zag pattern.”
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Will the hair look natural once it’s transplanted? And will the transplant leave a scar?
“When a hair transplantation procedure is performed by an experienced physician and a professional team, the results will look undeniably natural,” says Aygin. “Obtaining natural results from hair transplantation all lies in correct planning. This includes ensuring the hairline is in harmony with the patient’s facial lines. Also, the hair quality of the patient and the hair density in the donor area are important factors affecting how natural-looking results are. Hair grows at different angles and in different directions—so, in order to obtain the naturalness, hair transplantation should be performed in certain thicknesses by taking the growth angle and direction of the existing hair into account.”
He compares the natural-looking results of today with those of decades prior, when scars were common and transplants were less realistic: “During the initial years of hair transplantation, procedures would often have unnatural-looking results called ‘grass head.’ This has inevitably led to a negative perception about hair transplants in the years that followed. Today, hair transplantation is carried out more often than not with the FUE technique, one of the latest and most modern hair transplantation methods. The FUE technique, which has been successfully used since 2004, is now carried out using smooth and sharp ‘sapphire’ tips. The sapphire tips used in hair transplantation allow to achieve a more natural look by transplanting grafts with greater thickness, without leaving any scars.”
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How much do procedures cost? How do you determine the cost?
Aygin operates his business out of Istanbul, so his prices reflect that market. (Coincidentally, it’s a good market to measure, since so many men—and women—fly from around the world to Turkey for a transplant. As a basis of comparison, a FUE hair transplant in the U.S. for approximately 3,000 grafts can run upwards of $ 10K or $ 15K. In Turkey, particularly in Istanbul, the same procedure of 3,000 grafts varies between $ 1,700 and $ 2,500. Oftentimes, you can also buy a package that includes airfare and hotel. Speaking firsthand on my own visit to Istanbul, I saw dozens of recently transplanted men in the airport, who were flying to their homes in each corner of the globe. Aygin posits that there are more than 350 clinics in Istanbul alone.
Why the low costs abroad, though? “Low costs are not an indicator of poor quality,” Aygin says. “Low prices are mostly due to the economy, purchase-power-parity differences and a devalued currency ratio, as opposed to a reflection of low quality.”
What things should I do after the transplant to ensure my hair stays full?
“It’s imperative you follow the instructions and suggestions given by your doctor after hair transplantation,” says Aygin. This might include other methods to prevent hair fall, such as minoxidil, finasteride, and PRP. “Also, eating healthily will help growth and strengthen new hair follicles. At this stage, being prudent about nutrition and prioritizing foods that cultivate hair growth will increase the rate of cell regeneration after transplantation, and will help to shorten the recovery time after the operation.”
Aygin suggests a diet of the below nutrients:
B-Complex Vitamins: “B-complex vitamins such as B7 (biotin) and B12 have a very important role in the structure, quality, and healthy growth of hair strands.”
Zinc: “Zinc also plays an important role in tissue repair, collagen production, cell proliferation, hormonal balance, absorption of vitamins, and protein synthesis.” It’s imperative to slow or hinder hair thinning and fall.
Iron: “Iron deficiency, like zinc deficiency, can also cause hair loss. Iron strengthens hair, improves hair texture, and helps transport oxygen and nutrients to hair follicles and scalp.”
Vitamin E: “Vitamin E has antioxidant properties. Because it accelerates the healing of damaged skin, it’s very effective in healing scars. After the wounds on the donor, and recipient areas are healed, vitamin E oil can be applied to soften the tissue and improve its quality.”
Vitamin C: “Vitamin C acts as an antioxidant, which has a very important role in the production of collagen. Collagen plays a vital role in healing wounds.”
Vitamin A: “Vitamin A is required for the development and growth of all cells in the human body, including hair roots. Vitamin A is also effective in the production of sebum, a substance similar to the fatty tissue that moisturizes the scalp and makes hair healthy.”
Here are activities you should avoid after a transplant, according to Aygin:
Avoid use of saunas, steam baths, and solariums for 2 months.
Avoid strenuous exercise such as running, gym work, and weightlifting that can cause excessive sweating for 15 days. Avoid excess moisture in humid conditions.
Postpone excessive muscle activity such as weightlifting and bodybuilding for 15 days.
Postpone engaging in physical activities such as basketball, volleyball, football and swimming for 1 month.
Avoid swimming in pools or/and sea for 1 month after the procedure.
Avoid getting any direct sunlight sun on the recipient and donor area for 2 months.
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What does recovery look like? How long until I have the results I paid for?
Here’s a typical hair transplantation recovery timeline, as outlined by Aygin:
Day 1: “The first day following the operation [calls for] post-operational cleaning. After cleaning, the bandage on the donor area is removed and a laser treatment is provided.”
Day 3: “Patients may begin to wash their head adhering to the post-operative washing instructions, utilizing special lotion and shampoo. Washing will help with the healing process.”
Days 5–7: “Within 5-7 days following the operation, the transplanted grafts will become stronger, and will not be dislodged by touching. Patients should avoid scratching the transplanted area. They may feel an itching sensation during this period. This is normal and a natural part of the wound-healing process.”
Days 15–30: “The patient’s appearance will turn back to normal within 2 to 3 weeks, as the distinction between their transplanted and native hair will eventually disappear, making the hair transplant procedure unnoticeable to the untrained eye.”
1–3 months post-surgery: “Shedding of the transplanted hair, also known as Shock Loss, is experienced during this stage. This occurs due to the temporary rest phase that all transplanted hair follicles enter after a hair transplant procedure. This is a normal and expected condition.”
3 months post-surgery: “Patients can expect new hair growth usually within 5 to 6 months following the procedure. Moreover, this is also the stage where they’ll start noticing that the new transplanted hair has thickened considerably.”
By 6 to 10 months: “Patients will begin to notice the most impressive difference since the initial procedure. After a full year, they can expect to see the final results of the procedure, however the recovery period may take more than a year, especially when the transplantation is performed in the crown area.”
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Do transplants work differently for different types of hair? Do men with thick, curly hair or afro-textured hair have different experiences?
“Asian hair follicles are found in single and double hair follicle groups in the scalp—while African Americans have grafts with triple hair follicles, and Caucasians have grafts with triple and quadruple hair follicles,” Aygin explains. “Although African Americans have a thin hair shaft, the reason for that voluminous appearance is due to the fact their hair is curly. It also requires fewer grafts in hair transplantation. Although it’s advantageous to have curly hair in this respect, it may cause complications, especially in the graft-harvesting phase of the procedure. The epidermis layer [upper skin] that surrounds the hair follicle externally is thicker and tighter compared to other ethnic groups. This may cause damage to the hair follicles, like ruptures and [graft damage during extraction] in the graft-taking phase. Another possible complication is the risk of ‘keloid’ development on scars in the healing process after hair transplantation. This abnormal wound formation, which occurs as a result of ongoing tissue repair due to the production of excess cells by the body after the wounds are healed, is more common in African Americans than in other ethnic groups. It’s possible to obtain successful results from hair transplantation of patients with African hair, if it’s performed by an experienced hair transplantation specialist and a professional team with modern equipment, proper technique, and care. These risks are not typically an issue for people with Asian and Caucasian hair textures.”
Do beard transplants work the same way? How are they different from hair transplants?
“The technique used for beard transplants, which is generally the DHI technique, is also used for hair transplantation on the scalp,” Aygin says. “A beard transplant procedure uses the same donor area—the back and sides of the head—as is used in standard hair transplant surgery. As with any hair transplant procedure, beard transplants also require a sufficient amount of donor hairs, so patients who are considering beard transplantation should first consult with their hair transplant surgeon to determine whether they’re a good candidate.”
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