All You Need to Know: A Guide to Hair Transplant in Turkey

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From soft spring rains playing tunes of nostalgia on the surfaces of ancient monuments, to busy bazaars stocked with ethnic herbs, spices, and antiques; Turkey gained recognition as the perfect holiday destination for any time of year. And although millions of people come down annually for sightseeing and to enjoy the rich ottoman culture of this Eurasian country, traditional tourism is not the only sector drawing in the curious minds of wanderers.

As one of the fastest growing industries, Turkey’s medical tourism and particularly hair transplant; has managed to attract thousands of patients from all around the world. The Turkish medical field of hair transplant surgeries in the last decade escalated rapidly in popularity making it surpass its competitors, in Europe and the US, to claim the number 1 spot as the world’s leading country for hair transplant operations. The average number of health tourists flooding into the country for hair transplant alone, verges around 5000 patients per month with a vast majority of those tourists coming from Europe and the Middle East. Additionally, the numbers are projected to exponentially grow in the coming years.

 

How Turkey became the go-to hair transplant destination:

 

Cost efficient

Multiple factors come to play when considering why Turkey’s 1-billion-dollar industry appeals to such a grand number of health tourists, but the most prominent of which is lower costs compared to clinics located in the US or Europe – while maintaining the same level of professionalism. The average hair transplant surgery in Turkey, performed by government certified surgeons under standard sterilized conditions, would sit anywhere on a scale of $1500 to $2000. The inviting prices to quality ratios are just one of many factors luring in potential patients from diverse locations and ethnicities around the globe.

Operates in accordance with medical guidelines

Another element contributing to the exponential growth of this industry is the strict abidance of Turkish medical institutions to international clinical practice guidelines. The ministry of health in Turkey conducts frequent spontaneous inspections on every medical establishment encased within its grounds, to monitor the quality of care being rendered, examine the credibility of doctors, and ensure that the environment and equipment are being decontaminated according to international guidelines of decontamination and sterilization [1].

Internationally Accredited

Not only are hair transplant clinics in Turkey accredited by their own government and ministry of health, but a vast majority of those clinics are certified by multiple international medical associations and hair transplant boards such as the Joint Commission International (JCI) and the International Society of Hair Restoration Surgery (ISHRS). As a matter of fact, Turkey retains the highest number of JCI accredited health care institutions in the world [2]. Instinctively, patients are drawn to the legitimate medical practices and strict work ethics displayed by hair transplant clinics in Turkey.

Experienced surgeons

The rapid swelling of this industry and the thousands of clients pouring in from miscellaneous ethnicities subjected the hair transplant surgeons in Turkey to intense incessant training on hair transplant for numerous hair types. The average hair transplant surgeon in Turkey has performed thousands of surgeries, and the result is over qualified and experienced hair transplant surgeons of very high caliber compared to the average surgeon abroad.

Constantly advancing

As a result of this almost instantaneous growth of Turkey’s hair transplant industry, numerous clinics have emerged in the past decade to meet the growing demand of thousands of patients pouring in to this country on the daily for hair restoration. This myriad number of hair transplant clinics creates a fierce competitive environment in this domain, which consequently ignites a rivalry between local hair transplant clinics in Turkey that motivates them to constantly progress and develop to entice more patients. Hair transplant clinics in Turkey are persistently endeavoring to eclipse their counterparts and outshine by aiming to employ cutting-edge technological advancements in the field, staying up to date with modern methods and techniques, and providing the best of what this medical surgical branch has to offer.

International patient services 

Abreast their affordable rates and above-board medical practices, hair transplant clinics in Turkey offer service packages which, more often than not, include greeting health tourists from the airport, accommodation, transportation, and translation services. These service packages are designed for the sole purpose of facilitating the trip of potential patients and catering to their needs during their stay away from home. The warm welcoming greetings and attentiveness exhibited by hair transplant clinics in turkey are determining variables in why thousands of health tourists are seeking this country for hair restoration.

In conclusion

Separately, the aforementioned points may contribute trivially to attracting health tourists. But when combined together, the result is a blooming industry where the patients are the biggest winners. Turkey would not have deservingly leaped to the spotlight and maintained its position as the go to destination in the domain of hair transplant, if it weren’t for its dedication and commitment to always offer the best. Affordable prices, high quality, satisfied patients; is a slogan hair transplant clinics in Turkey seem to be working by.

Patients are to kindly note that the information provided in this guide is not an alternative to professional medical examinations. The information is solely informative and exclusively limited to hair transplant in Turkey, patients should refer to a professional doctor for an accurate evaluation.

What patients need to know before embarking on a trip to Turkey for hair transplant:

Due to the global rise in popularity of hair transplant surgeries, particularly in Turkey, it has become very common for health tourists to undervalue the complexity of the surgery and disregard critical precaution measures. Any patient looking to perform a hair transplant surgery in Turkey needs to look out and keep a few points in mind before commencing on a trip to Turkey for hair transplant. The listed tips are put to ensure the safety of patients considering this procedure and to guarantee them a rewarding trip.

1- Who is an eligible candidate for hair transplant in Turkey?

Before contemplating going under the knife for hair transplant in Turkey, it is essential for patients to understand whether they make for a perfect candidate to begin with. This will help them build realistic expectations and eliminate any future disappointments from unsuccessful results.

Disclaimer:
This is not to say we do not recommend professional consultation from accredited experienced dermatologists to patients considering hair transplant via surgical or non-surgical methods, on the contrary we highly recommend that patients discuss their case with doctors of high caliber in the field who are qualified enough to analyze their case.The information provided in this guide is solely for educational purposes.

With that being said, becoming familiar with determining factors that influence the decision of a patient’s eligibility for a hair transplant in Turkey, will help bring attention to crucial key points that might have been neglected as well as help patients construct specific questions related to their case upon consultation.

  • Cause of hair loss

If the cause of hair loss or baldness in localized areas stems from trauma (scarring or burns), androgenic alopecia, traction alopecia, or alopecia marginalis, the patient is considered to be a perfect candidate for hair transplant surgery in Turkey or other countries [3] [4] [5].

Patients suffering from hair loss caused by an autoimmune disorder, full androgenic baldness, alopecia universalis, alopecia totalis, or diffuse un-patterned alopecia are not eligible for hair transplant in Turkey or other countries [6] [7].

  • Sufficient donor hair destiny

having abundant donor hairs is a critical factor in deciding candidacy, as it can impact the results of the surgery. The more adequate donor hair regions a patient has, the more hair the patient will have implanted. To word it differently, the higher the donor density is the better the results.

Patients who do not have sufficient donor hair density are not eligible for hair transplant in Turkey or other countries.

 

  • Age is not a very determining factor when it comes to hair transplant surgeries in Turkey. However, being above 23 years of age makes a patient a more fit candidate for hair transplant. It is estimated hair loss patterns would have stabilized by then. Undergoing a hair transplant surgery before hair loss has stabilized might yield unsatisfying results.
  • Medical conditions

Patients suffering from metabolic syndromes and homeostatic imbalances such as diabetes or hypertension, need to be under medication for their conditions and in a stable state health wise in order to undergo hair transplant surgery in Turkey. And even then, not call cases are considered eligible.

Patients suffering from other chronic disorders  or health issues need to consult their doctor and notify their hair transplant surgeon before surgery.

Patients suffering from blood-borne diseases such as hepatitis B, hepatitis C, hepatitis D, HIV etc. are not eligible for hair transplant surgery in Turkey. They might be eligible for hair transplant in other countries.

 

2- Choosing the right hair restoration treatments:

Once a consultation session has been completed and it is determined that the patient is indeed eligible for the surgery in Turkey, the second step is picking the right hair restoration method. This at times can be a very puzzling process, given the diverse range of treatment methods currently being employed. In order for patients to receive the best treatment choice, it is important to begin with understanding the procedure of each separate technique along with its advantages, who are the candidates for each particular treatment, and how it differs from other treatments.

For starters, current hair transplant treatments in Turkey could be divided into two categories, surgical and non-surgical treatments. The surgical treatments comprise mainly of follicular unit transplantation (FUT), follicular unit extraction (FUE) and its variants: sapphire FUE, and direct hair implantation (DHI) Choi. Non-surgical hair transplant treatments comprise of Minoxidil, Finasteride, and platelet rich plasma (PRP) therapy.

Surgical hair transplant treatments offered in Turkey:

Procedure over view:

Regardless of the surgical procedure implemented, all hair transplant surgeries follow a similar series of events that includes 7 basic steps starting with drawing the hairline, followed by shaving, applying local anesthetic, extracting hair follicles, separating follicular units, creating channels, and ending with implanting hair follicles in the incisions [8] [9] [31].

  • Drawing the hair line

On the day of the scheduled surgery appointment, the patient will be escorted by nurses to the operation room. They will be asked to change into an operation gown provided by the clinic. The doctor will then use a marking pen with an alcohol base ink to draw the borders of the hair line, once the patient approves of the drawn-on hair line, the procedure begins.

  • Shaving

Shaving is not necessarily crucial in every hair transplant procedure, it depends on the technique utilized and number of grafts to be harvested. In FUT the entire donor strip to be excised is shaved. In FUE or variants of this technique such as sapphire FUE and DHI Choi FUE, shaving is not always necessary and will be determined upon clinical scanning. However, it is advisable for patients to shave the site of donor region as to reduce the risk of infection.

  • Injecting local anesthetic

Patients undergoing a surgical hair transplant treatment will be administered to local Anastasia prior to the start of the procedure. An anesthetic will be injected into the donor regions from which hair follicle units will be extracted and on the recipient region where incisions will be made to prepare for implantation.

  • Extracting grafts

Hair will be extracted from either the scalp or body. Depending on the density of the donor regions on the head. The extraction is done using either a manual punch or a motorized punch. In FUT alone, the donor region is surgically excised from the scalp. In FUE and variants of FUE, a punch is used to isolate the hairs to be extracted. Following their isolation, they will be individually extracted via sterilized medical forceps.

The number of hair follicle units harvested depends entirely on the bald areas to be covered and number of hairs to be implanted. Immediately following their extraction, hairs will be preserved in a petri dish containing either a Saline or HypoThermosol  solution. Depending on the technique and number of hairs to be extracted the process can last anywhere between 1 to 3 hours maximum.

  • Separating follicular units

Separating follicular units is the process of separating hair grafts depending on the number of hairs contained in each follicular unit and then placing them in a sectioned Petri dish containing Saline or HypoThermosol solution. Grafts that contain 1 or 2 hairs are often implanted in the hair line to achieve an authentic look and need to be separated from other grafts. Grafts containing 3 or more hairs per unit are preserved for the middle and back regions of the scalp.

  • Opening channels

Using a steel micro sized scalpel blade or a gauge needle, several punctures on the surface of the scalp are created to open channels for implanting.  In DHI Choi however, a pen is used to combine both the incision and implantation steps. This step takes an average of 1 to 3 hours depending on the method of opening channels and the number of incisions required.

  • Implanting follicular units

Once channels for implantation have been made, the extracted and grafted hair will be carefully inserted in the channels using angular medical forceps.

 

Surgical hair transplant techniques offered in Turkey:

 

FUE and FUT are the most commonly known standard methods for hair restoration. Other techniques such as sapphire FUE and DHI Choi are considered to be variants of the standard FUE method.

 

A. Follicular Unit Extraction (FUE): 

FUE in Turkey is an increasingly popular minimally invasive hair restoration surgery performed under the use of localized Anastasia. Once the application of anesthetic on the donor and recipient sites is done, comes the second step of this surgery: hair follicle extraction. The hair transplant surgeon will begin by extracting individual hair follicles via a punch specifically designed to isolate the hairs. Which will then be extracted via forceps. The micro size of the punch leaves behind trivial scarring on the donor region.Once the hair follicles are extracted, they are placed in a petri dish containing a solution of either Saline or HypoThermosol for separation.

Separation of follicular units is done according to the number of hair sets each individual unit contains. Once the separation process is completed, implanting begins. To prepare the recipient area for implanting, a steel micro sized scalpel blade or gauge needle is used to create several punctures on the surface of the scalp. Once enough punctures have been made, the previously extracted and grafted hair follicles will be inserted in the prepared incisions in the direction of natural hair growth via right angled forceps [9] [10].

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Follicular Unit Extraction (FUE) advantages:
  • Trivial microscopic scarring that cannot be noticeable with the naked eye.
  • A minimally invasive surgical procedures that is not traumatic on the skin.
  • Permanent natural looking results.
  • Body hair can be used as donor region if head hair donor density is insufficient.
  • Rapid recovery rates.
  • Negligible pain or discomfort after the surgery [9] [10].
 Who is fit for Follicular Unit Extraction (FUE):

Patients

  • suffering small-scale balding areas.
  •  looking to restore or transplant hair on the eyebrows and beard.
  •  who can’t grow hair due to keloid scars from burns or other injuries.
  • who have undergone failed FUT surgeries and are no longer eligible for FUT given the amount of scar tissues formed.
  • with low donor density areas.
  •  with busy schedules and in need of a surgery with rapid healing and recovery rates.
  • looking for a minimally invasive surgery to restore lost hair [9] [10].
B. Sapphire follicular unit extraction (FUE): 

Sapphire FUE is a variant of FUE that comprises of the same steps and work chart as a standard FUE hair transplant surgery. Which includes: application of local anesthetics, extraction of hair follicles, separating follicular units, opening channels, and finally implanting. The only difference between the two methods is the material from which the surgical equipment is made of, and the significant impact this minor distinction brings about.

Sapphire FUE utilizes scalpel blades made from sapphire gemstones as opposed to the regular steel blades used in the standard FUE method. The characteristics of this gemstone allow for the scalpel blade to be made in such a way that the end point is V-shaped compared to the U-shaped steel scalpel utilized in a standard FUE. The scalpel blade is an equipment used to create incisions for implantation on the recipient area, when the scalpel is made of sapphire the V-shaped end allows for more specific and immaculate minuscule punctures without inflicting damage on healthy follicles in the vicinity of the recipient area [9] [10].

Sapphire follicular Unit Extraction (FUE) advantages:
  • Permanent natural looking results.
  • No scarring.
  • No damage inflicted on neighbor follicles.
  • Rapid recovery rates.
  • Negligible pain or discomfort during and after the surgery [9] [10].
Who is fit for sapphire follicular Unit Extraction (FUE) ?

Patients

  • with fairly thick hair looking to increase their hair density without damaging neighbor hairs and surrounding tissue.
  •  who suffer advanced hair loss.
  • who have low donor density areas.
  • with busy schedules and in need of a procedure with rapid healing and recovery rates.
  • looking for minimally invasive surgery to restore hair transplant [9] [10].

 

C. Follicular Unit Transplant (FUT): 

Follicular unit transportation is a surgical hair restoration method that comprises of the basic steps: applying local Anastasia, extracting donor hairs, separating follicular units, creating punctures, and lastly implanting grafted hairs. The procedure is fairly similar to the follicular unit extraction method except for one major difference in the process of collecting donor hairs.

In FUT the hairs are not extracted individually, rather the donor region or strip is excised entirely from the scalp at a depth of 5-7 mm to ensure the subcutaneous tissue is encompassed within the strip. The scalp is then stitched and the extracted tissue is dissected. The follicular units are separated under a microscope and later transferred and stored in a petri dish containing a Saline or HypoThermosol medium. Next comes the process of creating incisions on the scalp using steel scalpel blades, followed by the process of implanting the previously grafted hair follicles in the incisions [10] [11].

Follicular Unit Transportation (FUT) advantages:
  • Significantly more hair follicles can be extracted per session in comparison to FUE.
  • Less follicles need to be extracted and transplanted than FUE or its variants.
  • Permanent natural looking hair.
  • Fairly lower in price compared to other methods [10] [11].
Who is fit for Follicular Unit Transportation (FUT)?

Patients:

  •  who do not mind having a linear scar induced by the invasive nature of this surgery.
  •  with low donor hair regions.
  •  who are comfortable with relatively longer recovery rates compared to other treatments [10] [11].
D. Direct Hair Implant (DHI) Choi pen:

Direct hair transplant using Choi pens is a relatively modern hair transplant technique similar to FUE. Every hair transplant procedure follows the same basic steps: applying Anastasia, extracting donor hairs, separating follicular units, opening channels, and finally implantation.  As a matter of fact, DHI follows the same procedure as the standard FUE up until the incision and implantation steps. The difference however relies in the equipment used. DHI hair transplant employs a pen like hollow needle referred to as Choi implantation pen. When utilizing the Choi pen two of the aforementioned steps can be combined in one step. The Choi pen is firstly loaded with individual extracted grafted hairs at a time, the pen will then simultaneously open channels and implant the hair follicles by loading them in as the incisions are being made [32].

Direct Hair Implant (DHI) Choi pen advantages:
  • Permanent natural looking results.
  • Trivial scarring that can not be seen with the naked eye.
  • A minimally invasive surgical procedures that is not traumatic on the skin.
  • No damage inflicted on neighbor follicles.
  • Rapid recovery rates.

Negligible pain or discomfort during and after the surgery [32].

Who is fit for Direct Hair Implant (DHI) Choi pen?
Patients:
  • who can afford it. Seeing as DHI Choi hair transplant is a state-of-the-art technique, it is costs more than other methods of hair restoration.
  • with busy schedules and in need of a procedure with rapid healing and recovery rates.
  • Who do not mind a slightly longer procedure.
  • Looking for minimally invasive surgery to restore hair transplant [32].

Non-surgical hair transplant treatments offered in Turkey:

Minoxidil (Rogaine):

Minoxidil is one of two FDA approved treatments for hair loss in both men and women. This treatment comes in liquid form. And should be rubbed on the scalp daily for a minimum period of 6 months for hair loss to halt and regrowth to appear. This treatment is long term and needs to be continuously applied  to maintain hair growth [12].

Finasteride (Propecia):

The second non-surgical FDA approved treatment for men only is Finasteride. This treatment is taken orally in the form of a pill every day to notice a diminish in hair loss, and possibly new growth. This treatment is long term and needs to be continuously consumed to maintain hair growth [12].

Platelet rich plasma (PRP) therapy:

This treatment is not FDA approved, however it has gained popularity in the recent years as both a separate treatment for hair loss and a complementary treatment to hair transplant. This treatment collects platelet rich plasma from the patient’s blood by centrifuging it. The collected plasma, which contains growth factors, is then injected into the scalp of patients to trigger growth. Multiple monthly sessions are recommended over a period of 6 months to a year until results are observed [13].

 

3- Choosing the right clinic and doctors for hair transplant in Turkey:

The results of the treatment depend on the skill and experience of the surgeon just as much as the method of treatment implemented. Choosing the right treatment alone will not yield the best of results.  Even though Turkey practices regulations and spontaneous inspections, taking the right measurements to check the credibility of the clinic is still a precaution that patients should practice.

The following tips will highlight the important key points patients should consider when looking for hair transplant clinics and surgeons in Turkey:

  • Check for accreditation from international medical associations such as JCI or ISHRS. This will be a telling sign of how well the clinic follows surgical and medical guidelines.
  • Make sure the clinic in question offers a free consultation session to diagnose and evaluate the underlying cause of hair loss. This will help patients choose the appropriate treatment technique accordingly.
  • Check if the surgeons are government certified and have ample experience in the field of hair transplant.
  • Before and after pictures are the most accurate indicators of the skill and caliber of the surgeons, its crucial to check the catalog of pictures prior to entrusting a clinic.
  • Check the reputation of the clinic by reading reviews of previous patients on google. Google star ratings can be a measure of the quality being rendered by the clinic of choice.
  • Given that hair transplant surgery results are not instantaneous, the clinic of choice should provide follow up services to track the recovery of its patients until the end.
  • It is safer to operate in clinics that charge costs within the average, often very low prices indicate low standards and unqualified surgeons.
  • Make sure that the surgeries are performed by surgeons and not hair transplant technicians.

4- Preparing for a hair transplant surgery:

Precautions and instructions to follow 1-2 weeks before surgery:

  • The use of blood thinners and anti-inflammatory drugs should be abandoned a fortnight before the surgery.
  • Vitamin supplements are not be consumed 14 days before surgery.
  • Smoking and alcohol consumption are to be ceased a week before surgery as they can alter healing time.
  • Massaging the scalp for 10-30 minutes per day is highly recommended to improve blood circulation in the area a week prior to the surgery  [14] [15].

Precautions to consider 24 hours before surgery:

  • Hair should be thoroughly washed using a regular hair shampoo.
  • Patients are not to go for a haircut.
  • Resting before the surgery and getting adequate sleep is advisable [14] [15].

Preparations to take on the day of the surgery:

  • Have a light breakfast.
  • Avoid consumption of coffee or caffeinated beverages as they can increase the risk of bleeding.
  • Do not apply hair products. The scalp should be thoroughly cleansed.
  • Wear clothing items with wide collars to easily put them on before and after surgery to avoid irritating the scalp [14] [15].

 

5- Instructions for a smooth recovery from a hair transplant surgery:

Instructions for the first week after surgery:

Immediately after a hair transplant surgery, patients will first notice the new defined shape of their hair line. The area on the scalp might not look very appealing due to some Scabbing around the follicles and swelling. But given the micro size of the incisions, both the swelling and scabbing will heal rapidly and diminish within a week. The patients will be provided with aftercare instructions from their surgeon, which if abided by will reduce pain and swelling to a zero in the first week and ensure a smooth recovery. Patients are expected to able to resume normal daily activity right after the surgery [16] [17] [18].

  • Refrain from drinking alcohol, smoking, consuming caffeinated beverages, or using anti-inflammatory medicines for the first 7 days of the surgery.
  • To reduce the risk of swelling, patients are advised to sleep at an inclined angle of 45 degrees for a week after surgery.
  • Patients are to abstain from showering during the first 2 days after an implant.
  • Showering is to be kept to a minimum after the first 2 days, however while showering; patients are advised to avoid applying pressure or using fingernails while washing the scalp. Water should not be applied directly on the scalp with force. It is recommended for patients recovering to gently pour water from a cup on the scalp to prevent damaging the implanted follicles.
  • Patients should request sterile saline spray to apply daily on the scalp using a gauze for around 3-4 days.
  • The use of a blow drier or application of heat on the scalp should be completely ceased.
  • Direct sun rays should be avoided for a week after, it is advised to protect the scalp with a cap or a light cloth against the sun.

Instructions for the second and fourth weeks after surgery:

During this period, shedding of the transplanted hairs is to be anticipated. However it should not be a cause for alarm to patients. This is in fact part of the procedure. Patients need to remember that what is shedding is just the hair and not the unit. The unit is still entrenched in the scalp and thus viable to regenerate new hair [19].

  • During this period patients are expected to continue protecting their scalp from direct sun rays.
  • It is safe for patients to have their hair trimmed or cut during this period [19].

6- Hair growth timeline and Results:

As time progresses significant changes will be noticeable. Following a hair transplant surgery by 3 months, the scalp might become ridden with acne. However this should not be a cause for worry. The appearance of acne is most likely due to folliculitis as the hairs are growing in through the scalp than it is a symptom of inflammation. This can be treated with oral or serum antibiotics or ointments that contain Benzoyl Peroxide or Salicylic Acid. It is also preferable to run warm showers on the scalp during this period. Significant improvements should be noticed within a few days’ time [20] [21].

During the 4 to 5-month mark, patients will be able to judge the pattern of hair growth and predict the final results. Hair at this point might be growing out to be brittle or light in color. But as time progresses, the hairs will gradually start growing stronger and darker. By the 8th – 10th month, the hair will have reached their growth threshold.

After crossing the 12-month timeline, major transformations will come to a halt. Pattern and density of hair growth will have settled and the patient will be left with the final result. Had the patient wisely picked an accredited clinic to operate at and followed their surgeon’s post-surgery instructions, the final appearance should be very natural; both appearance and behavior wise. The transplanted hair can be treated fully like natural hair: washed, combed, trimmed or even dyed.

 

Recommended complementary treatments for optimal results:

To achieve the full potential of the surgery, patients should strictly follow any instructions given to them by their surgeons. Aside from that, there are complementary treatments to hair transplant surgery offered in Turkey that accentuate the final results:

  • Platelet rich plasma (PRP) therapy for hair loss as a complementary treatment can further stimulate and activate growth factors in the implanted grafts [13]
  • Shampoos or lotions containing Minoxidil can strengthen the implanted hairs [12].
  • Hair supplements are essential for the overall hair strength; deficiencies in vitamins that constitute building blocks for hair proteins will result in brittle damaged hair. Hair vitamin supplements are recommended to strengthen the hairs [22].

7- Risk of infections after a hair transplant surgery:

Once a cut has been made on the skin, due to surgical purposes or accidents, infections become a possibility. Risk of infections and open wounds, regardless of size, are mutually inclusive; where one exists the other will tail it. With that being said, hair transplant surgeries include extraction of follicles and opening channels on the scalp. Both of which provide a pathway for germs leaving the scalp susceptible to contamination. According to statistics only 1% of hair transplant patients suffer serious infection [33]. Although the risk is very small, infections are not to be regarded as insignificant for they can have serious effects on the results of surgery as well as general health of the patient. Thereby, it is important to know how to eliminate this risk, learn its symptoms, and learn how to handle it.

Symptoms of Infection after Hair Transplant surgery:

Symptoms of infections are often times confused with healing signs after a hair transplant surgery. The best way to differentiate between the two is to understand that if healing signs do not alleviate within a week, and actually get worse, patients might be dealing with an infection. Look out for bleeding, itching, swelling, redness, discomfort, or burning sensation in the scalp that persists and/or aggravates, in which case patients should seek professional help.

Instructions to avoid infections:

    • Patients are advised to abstain from touching or scratching the donor regions and implanted follicles. This reduces the risk of spreading contaminants to the wounds.
    • Scabs around the healing follicles are not to be picked.
    • It is recommended that patients use the prescribed or recommended shampoo and lotion for the first 14 days.
    • Patients are expected to strictly adhere to aftercare instructions and hygiene regimens provided by their surgeons.
    • Smoking and drinking alcohol should be avoided in the first week as it hinders the healing process of wounds.

 Wound care:

  • To care for the transplanted hairs, spray saline solution on a gauze and gently tap it around the scalp twice a day for 30 minutes during the first 3 days.
  • For the donor region apply antibiotic ointments such as Polysporin, Bacitracin or Aquaphor twice per day to prevent the site from getting infected. The aforementioned ointments can also be used to reduce drying and crusting [35].

8- How to alleviate recovery symptoms:

  • Bleeding
    Spotting and mild bleeding can occur during the first few days, this will progressively diminish within days as the wounds heal. The bleeding can be attended to by lightly applying pressure using sterile gauze on the bleeding area. It is important to note that vigorous rubbing of the scalp is harmful as it could dislocate hair roots [17].

If bleeding does not diminish within a week, professional help should be sought.

  • Itching
    Itching occurs when wounds are healing, it is best to refrain from scratching the areas as there could be a possibility of dislocating grafts. Promoting wound healing by following after care instructions can eliminate itching sooner. Gentle washing of donor regions and implanted hairs will hasten the process of shedding crusts. Patients can request antibacterial serums from their surgeons if itching becomes unbearable [17].
  • Pain
    Patients will be prescribed pain killers by their doctors after surgery, which should be taken as instructed. The medication alone should be sufficient in keeping discomfort and pain under control[17].

 

9- Services for international patients in Turkey:

Hair transplant clinics in Turkey are one of the most considerate toward international patients in regards of their comfort. Most clinics provide an array of services that cater to the needs of international patients. These often include warm greetings from the airport, accommodation in 5-star hotels, transportation to and from the clinic, all day long translation services, and occasionally a complementary PRP therapy.

 

Planning a medical tourism trip to Turkey:

Once a patient has made-up their mind and decided to undergo a hair transplant surgery, next comes planning for the

Step 1: Free consultation

After wisely choosing a hair transplant clinic in Turkey, the patient should then contact the clinic and schedule a free consultation session. During this session it will be requested from patients to send recent pictures of their scalp, hair loss regions, and donor regions. These pictures will be evaluated by doctors to determine the candidacy of the patient based on donor region sufficiency.

The patient will also be asked to send a copy of a recent hair loss diagnostic test results and a routine blood test results, as their candidacy will be analyzed based on it. Please refer to the list of factors determining candidacy.

If the patient has not previously run tests to discover the underlying cause of their hair loss, they are advised to request a diagnosis from their local dermatologist. Even though international patients have the option of choosing to run hair loss diagnostic tests at the clinic of choice in Turkey, it is not recommended. For if the results deny the eligibility of the patient, none of the service fees will be covered.

During this session patients are also expected to share their medical history and inform the clinic about any illnesses they suffer from.

Diagnosing hair loss:

Since some cases of hair loss cannot be treated with hair transplant, it is crucial for patients considering hair transplant to identify the underlying cause of their hair loss.

How hair loss is diagnosed:

1- Blood tests: Blood tests are run to determine if the cause of balding stems from an autoimmune disorder such as lupus or an over active thyroid, irregular hormone levels, and vitamin deficiencies.

2- Hair analysis: A sample of the patient’s hair will be examined by a dermatologist under a microscope. Hair analysis is performed to assess the rate of hair loss, look for the presence of lice or fungus, and evaluate structural damage.

3- Densitometry: Utilizes the use of a densitometer (a magnification device) to check for the occurrence of shrinking in hair follicles.

4- Scalp biopsy: A scalp biopsy is performed by removing a small tissue from the scalp using a micro sized punch. The extracted tissue is then sent to a lab for testing. This test is only requested in very rare situations [34].

 

Step 2: Booking a flight

If it is decided that a patient is eligible, an appointment will be fixed based on the patient’s schedule. Clinics in Turkey do not cover flight fees. Upon arrival, patients will be greeted by a representative of the clinic and a driver. The accommodation and transportation (to and from the clinic) fees for 2 or 3 days will be covered by the clinic of choice in most cases.

 

Step 3: In-person consultation (day 1)

Upon their arrival to Turkey, patients will be greeted from the airport, transported to either the hotel or directly admitted for a consultation session in person, depending on the time of arrival. During the consultation session the doctor will request to run blood screening tests and medically scan the scalp condition and donor hair density to confirm the patients candidacy. Method of treatment and number of grafts will all be assessed and decided in this session.

Step 4: The surgery (day 1 or day 2)

If the patient arrives to Turkey in the morning, they can be directly admitted to surgery after the consultation session.If they arrive late, a consultation session may or may not be assigned, but surgery will be scheduled for the day after.

Step 5: Washing (day 2 or day 3)

The day after surgery, patients should visit the clinic for scalp washing. Nurses will begin by gently rinsing the scalp with warm water. Followed by applying a solution designed to dilute blood clots to ease the process of rinsing the clots off. This is done carefully to avoid inflicting damage on the implanted follicles.

 

Recovery and tourism in Turkey:

 

Following the treatment, patients are free to either travel back home or spend a few days in one of the most beautiful countries. There is a range of activities that can be done, monuments to visit, and food to try in Turkey. For that reason, it is fortunate that hair transplant surgeries have rapid recovery times and do not require hospitalization.

The following is list of activities and places to visit in Turkey that we recommend to medical tourists recovering from a hair transplant surgery:

Patients are not to forget to keep their scalps covered and remain hydrated.
  • Have a Bosphorus cruise: Having a cruise on the strait that divides Asia and Europe is a phenomenal experience that should not be missed.
  • Visit the Hagia Sophia: Famous for its beautiful architecture, the Hagia Sophia, originally built as a church and later turned to a mosque; is one of the biggest tourist attraction spots in Istanbul.
  • Visit Topkapi Palace: An ancient palace where sultans of the ottoman empire used to reside.
  • Museum of Turkish and Islamic Arts: with over 40,000 items on exhibition, this museum captures the essence of life during the 8th century to the 19th.
  • Grand Bazaar: Built 500 years ago, the grand bazaar consists of 5000 shops dispersed over 60 streets, all stocked with ethnic spices, Turkish delights, and antiques.
  • Galata Tower: This tower is ideal for enjoying a panoramic view of Istanbul.

 

Frequently asked questions about hair transplant:

  • What is the duration of a hair transplant surgery?
    Hair transplant surgery is a multi-step procedure with a total duration of 8-10 hours. Time range dependson the technioque utilized and the number of grafts to be extracted and transplanted. The longest of steps are extraction and channel opening. Both of which have a timeline of anywhere between 1-3 hours depending on the number of follicular units to be implanted. Breaks will be given to patients in between steps, where they can have a light meal and rest a bit.

The surgery can be performed in one day. Next comes washing; this process is done the day after. In general the entire process takes 2 days.

  • Are results of a hair transplant surgery permanent?

    Yes, the results of a hair transplant surgery are permanent. The transplanted hairs are extracted from safe donor regions which are genetically adapted to be resistant to DHT. DHT is an androgen that triggers hair loss and destruction of the follicles causing baldness [23]. Hairs in regions of hair loss are not resistant to DHT and hence why they fall out. When transplanting DHT resistant follicular units from safe donor regions to bald regions, the follicular units do not lose their DHT-resistant properties and remain viable to re-generate hair growth [23] [24].

  • Does the transplanted hair fall out?

    Around 3 weeks after surgery hair will begin to shed out. However patients should note that it’s specifically the hair falling out and not the follicular unit. Meaning the unit responsible for regenerating hair growth is still intact. With that being said, hair loss during this period should not be a cause for concern, the follicular unit is still intact and will continue to grow hair [24].

  • How many grafts do I need?

    The graft number needed depends entirely on the degree of baldness a patient is suffering from. The final word regarding the number of grafts needed belongs to the surgeons. However, the following table cludes several classes of hair loss and the approximate graft number needed for every case.

Over grafting will not yield natural looking results, as the average hair density per cm square is between 60-85 follicular units [25].

  • Will I be left with scarring after undergoing a hair transplant?

    Scarring is only visible if the patient opts for an FUT instead of an FUE hair transplant [26]. That is because in FUT, the entire donor region is surgically excised from the skin and the area is stitched; whereas in FUE, the follicular units are extracted individually using micro sized punches and implanted in channels created by micro sized needles. The scarring produced by FUE is trivial and cannot be visible to the naked eye. However, if the patient is looking to fully eliminate scarring for an immaculate end result, sapphire FUE is recommended.

  • Will I feel pain during and after a hair transplant surgery?

    No, the surgeons will inject anesthetic into the sites to be operated on by a needle with a micro-sized gauge at skin depth. After the initial sting of the syringe, no pain will be felt during the surgical procedure. Directly after the surgery, and before the anesthetics wears off, patients are given pain killers so no pain or will be felt. Pain depends on the patient’s threshold, but generally it is bearable. The patient will also be prescribed pain killers and instructed on how to take them during the recovery.

  • When can I get back to work?

    Patients can resume regularl activity almost instantly after the surgery. We, however, recommend patients rest a few days before going back to work.

  • What do I need to consider before getting a hair transplant in Turkey?

    Do your research about the topic, knwoledge is power, the more you know the less the risk of disappointment is. Choose clinics accredited by international medical associations and check the surgeon’s credibility. Read reviews of previous patients and always ask for before and after pictures.

  • Will another hair transplant surgery be needed in the future?

    Unless the first surgery was performed in a non-professional clinic by unskillful surgeons and yielded failed results, a second surgery is rarely ever needed. Patients should wait 12 months for optimal results to appear before considering a second surgery.

Another case where another hair transplants surgery might be needed is when a patient undergoes hair transplant before the hair loss has stabilized. In cases like that, the transplanted hair does remain of course, but the original natural hair might continue to fall out creating bald regions which might need to be covered with another hair transplant surgery. It is for that reason it is recommended that patients should wait for hair loss to halt.

  • Can women undergo hair transplant surgery in Turkey?

    Women can perform hair transplant using the same hair restoration techniques practiced for men. For women to be eligible for the surgery hair loss needs to not stem from an autoimmune disorder. A condition where the immune system is constantly attacking hair follicles. Women suffering from full androgenic baldness, alopecia universalis, alopecia totalis, and diffuse un-patterned alopecia are not eligible for hair transplant [5].

  • Can patients suffering from hepatitis A or hepatitis E undergo hair transplant surgery in Turkey?

    Seeing as both viruses don’t belong to the category of blood-borne pathogens, there is no problem performing the surgery [27] [28].

  • Is there an age limit on who can undergo a hair transplant surgery in Turkey?

    Age is not a deciding factor in determining candidacy. It mostly depends on whether the pattern of baldness has stabilized and receding of hair has halted. It is advisable to wait until 23 years before considering a hair transplant surgery.

  • What is the difference between number of grafts, follicular units, and number of hairs? 

The medical definition of a graft is any living tissue on the body that has been removed from its original place and translocated to another region on the body to substitute a damaged tissue [29]. In hair transplant, follicular units are extracted from their original place in the donor region and transplanted to areas of hair loss. Hence follicular units are often referred to as grafts. The number of follicular units often varies from the number of hairs, that is because a follicular unit can contain anywhere from 1 to 5 hairs [30].

 

 


 

References

 

1- https://dosyamerkez.saglik.gov.tr/Eklenti/3699,sashastaneingilizcesonbaskirevizepdf.pdf?0 

2- http://www.medicaltourisminturkey.org/docs/Day1S2RusenYildirim.pdf 

3- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965333/ 

4- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469375/ 

5- https://www.webmd.com/skin-problems-and-treatments/hair-loss/women-hair-restoration 

6- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573125/ 

7- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569105/ 

8- https://medlineplus.gov/ency/article/007205.htm 

9- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825128/ 

10- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956961/ 

11- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4271754/ 

12- https://www.dermmatch.com/hair-loss-drugs 

13- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622412/ 

14- http://www.medic8.com/healthguide/hair-loss/hair-transplant/preparing.html 

15- https://www.dummies.com/health/dos-and-donts-before-hair-transplant-surgery/ 

16-  https://www.wikihow.com/Care-for-a-Hair-Transplant 

17- https://depts.washington.edu/skinsurg/documents/HairTransplantPostOp.pdf 

18- https://www.lybrate.com/topic/hair-transplant-do-s-don-ts-you-must-be-aware-of/fd2378cfdc632385fd5bf9d153af2139 

19- https://www.iahrs.org/q-a/is-it-possible-to-keep-a-shaved-head-military-cut-after-a-hair-transplant  

20- https://www.livestrong.com/article/314233-scalp-pimples-after-hair-transplant/ 

21- https://www.livestrong.com/article/72275-normal-hair-growth-rate/ 

22- https://www.docdroid.net/pML8iT6/supplements-to-promote-hair-growth-after-hair-transplant.pdf#page=2 

23- https://www.medicalnewstoday.com/articles/68082.php 

24- https://www.ncbi.nlm.nih.gov/books/NBK278957/ 

25- https://www.ncbi.nlm.nih.gov/pubmed/10417585 

26- https://www.ncbi.nlm.nih.gov/pubmed/24470718 

27- http://www.who.int/news-room/fact-sheets/detail/hepatitis-e 

28- http://www.who.int/news-room/fact-sheets/detail/hepatitis-a 

29- https://www.medicinenet.com/script/main/art.asp?articlekey=3627 

30 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634176/ 

31- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825128/ 

32- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764754/ 

33- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212293/ 

34- https://www.health24.com/Medical/Hair-loss/Overview/hair-loss-diagnostics-and-tests-20160130

35 – https://www.medicalnewstoday.com/articles/68082.php

 

2 Comments
  1. Mohamed Rabti says

    Utterly fabulous article

  2. Sara says

    This is interesting

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