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November 30 th, 2015 / Erkut Özdamar MD.

While succesfully performing FUE hair transplantation to thousands of patients, it was impossible omitting myself. That's why I made my schedule and had a hair transplant operation in July 2012, when I was 40 years age.

In Turkish, there is a proverb '' if bald had an oinment that cures baldness, first applies on his own head '', therefore I applied the ointment to my head! Unhealthy teeth of a dentist, an overweight dietician, or an eye specialist who is performing Lasik surgeries but wearing glasses, all these remind you that proverb. If the doctor consulting you about hair transplantation, didn't have hair transplantation despite he needed it; definitely is a mistrusting situation.

I applied the operation that I trust, to myself first, then suggested it to my patients. I thought that this will convince and give confidence to my patients, and offering a live case for an example of the result that should be expected. Referring to the saying '' Don't ask to a doctor, ask to a sufferer '', I suppose that I can answer all questions of patients as both doctor and sufferer.

In a hot morning , July 10th 2012, I was little scared and excited on my way to hospital. Because today is not an ordinary work day, normally I was the operator, but today I will be the one who will operated on. Although I knew every single step of the procedure and had great confidence to the team, I was feeling weird, kinda confused. If I felt like this, how would patients who don't know details of the procedure, the doctor and his team, feel like? So, some fear and anxiety is normal for a patient before operation. That's why the patient's being able to trust his doctor, to entrust himself to his doctor, and to believe that the doctor will do his best, is very important for relieving anxiety and fear before the operation.

In the clinic, I noticed that not only me but the entire crew was excited. An extraordinary day for the whole team, not just for me. The whole operation day recorded by camcorders and cameras by a professional crew, for this reason the clinic was quite crowded and chaotic!

Consultation, drawing of the frontal hair line, including hair-cut, all preparative steps are recorded by cameras. The duration of preoperative preparation is normally half an hour, but in my case it took 2 hours.

FUE Hair Transplantation:

Finally, I laid down on the operating table. It is not easy to lie there, no matter who you are, you feel uneasy. We decided to begin with recipient site creation first, that is making the holes (slits) into which hair roots will be implanted. I already draw the hair line by myself, not an adolescent hair line but proper one for age 40. Starting from the possible acceptable highest level, aymmetrically aymmetric ( because human skull is aymmetric, not a perfect sphere , the two halves of the frontal hair line can never be the same). A planning (distribution of the grafts to frontal – middle – crown areas ) was made so as to give density to the frontal area as much as possible.

The most troublesome part of the procedure is surely '' local anesthesia '' that is injections, pinpricks. I can not say it is a pleasant sensation, it hurts, injected anesthetics causes a burning sensation and incresed pressure in the area. But it is not untolerable, you don't feel so much pain during injections as exaggerated by some of the previous patients.

Nowadays, we use anesthetic agents that don't cause burning sensation. For patients with injection phobia, that much injection can be unbearable. In these cases, sedation analgesia may be used for passing through injection step with much more easily.

After completion of the local anesthesia, we started to '' recipient site creation ''. Most often we start with '' graft harvesting ''. Because my donor area is full and the yield of graft number was predictable, we started with recipient site creation. That is not valid for most of our patients because donor area yield is the main limiting factor.

Before the operation my plan was implanting 4500 – 5000 grafts, because I didn't want to exhaust my donor area and to prolong the operative time. I believe that ; in an ideal hair transplantation operation, graft number shouldn't exceed 4000 – 4500.

Recipient site creation completed and the number was 6000 !!!

I again want to emphasize that, rather than 6000 grafts in a single session, two sessions with (4000 + 2000 ) one year apart from each other, will be much more successful. So , why it wasn't done to me? Because it was necessary to get the result of the operation as soon as possible, if we had divided into 2 sessions, the final result would be reached two years later. This probably would be best interest of me, I still believe that the result of my operation would be more ideal if it was done in two sessions.

Recipient site creation takes approximately 1 hour, depending on graft number it may be between 45 – 90 minutes.

Then we proceeded with '' graft harvesting ''. It is not easy to have a target like 6000 ahead. The most bothersome part of graft harvesting, at least for me, is face down ( prone ) position. During graft harvesting they turn your head to left and right hand sides. Between the eyebrow and the chin is left open for breathing comfortably. For patients who have neck and waist problems like me, muscle relaxants and pain killer are given for patients relief. Frequent positon changes, movements can be done, when the patient requests, a break given.

Graft harvesting completed in 4 hours, my donor area was challenging. Normal graft harvest rate is 1000 – 1500 grafts per hour, if the donor area is not problematic even 2000 grafts can be harvested in an hour.

Meanwhile, video recording was going on, breaks for interviews, visitors and friend, being an operation with much action.

I checked the harvested grafts, they were arranged regularly in petri dishes and ready to implant. It was a different feeling for sure, seeing my own hair roots on the table. I had two points of view while inspecting my grafts, both professional and personal.

Now its time for the '' implantation ''. The position of the patient during implantation is more comfortable. Your face is up , you are lying on back, you may watch TV, check your cellular phone, reply your messages. The only thing not to do is moving your head without permission of the implanters.

Pain is not an issue both during graft harvesting and implantation. Some small areas may not be anesthesized, additional local anesthesia is applied to these areas immediately upon your claim.

The duration of implantation phase may vary according to graft number, ease of implantation ( tissue and patient factors ), the experience of the team. My implantation phase completed in 5 hours. As the graft number increases, implantation rate decreases due to fatigue and possible motivational loss of the team and sometimes factors related with the patient.

Hair transplantation is not an easy operation, often exhaustive for both patient and the team, but I didn't experience many of the problems expressed by patients. The main reason for this, I suppose, my professional experience about the procedure. I would also like to admit that hair transplantation should not be considered as an easy, comfy or cushy opeation. At least the procedure is long in duration.

Postoperative Period:

We were all very tired when the operation completed. The entire team had the happiness of completing the operation successfully, even camera crew!

I was feeling better than I expected. The actual process for me was starting now on. I had 6000 hair roots to care for, proect and to grow. We dont recommend our patients to drive within 6 hours after the operation. I thought that I could drive to home, after this long operation. When I was on the way of car park area, I suddenly felt that my blood pressure will fall, there was a slight nausea and blurred vision. Frankly I got into the car and rest for a while. Fortunately I recovered soon, felt better and began to drive home. But I'm scared, what if it happens again on the road? Thanks God, I reached home uneventfully. Do not drive after the operation not to risk your and others lives.

I can't tell you that I slept at first night after the operation. I didn't have any pain but I was uncomfy. My head was still numb, could not determine the position of my head definitely, for this reason I had to be very careful not to hit my head to anywhere. I lied at head 45 degrees elevated position and face toward ceiling not to side walls.

In the morning, the biggest surprise was for my son who was 21 months old at that time. He recognizes something different with his father but he couldn't figure it out exactly. He didn't let me alone at home. The best choice was to return to the clinic, anyhow I had to go there for removal of the dressing. Dressing removed and I spent the rest of the day in the clinic. The second night is the first time that I slept without the protection of the dressing. The dressing actually behaves as a protective pillow at the back of your head.

Again after an uncomfortable night, I returned to hospital in the morning, because my patients was waiting for me. We had 3 patients on that day, did my routine work without any problems.I wanted to emphasize this because it is a frequently asked question; you may begin your work 2 – 3 days after the operation, especially if you have an office job.

The third night was relatively better than the first two. I was already so sleepless that I had to sleep anyway. I slept well. In the morning, when I got up, I didn't recognize myself when I looked at the mirror. My eyes and face was swollen so much, I had worked previous day with my neck bent forward, fluids injected during the operation was accumulated around eyes and midface due to gravity. Also I have to confess that I removed head band before sleeping. The head band is an effective physical barrier for the downward movement of fluids that injected during the operation. Actually I supposed to remove the head band after first wash that is on the third day after the operation. Concisely, you have to follow your doctors instructions after the operation, because there is a logic and experience behind these instructions.

On the third day after the operation, the first head wash done. Head wash is really very relaxing but needs to be done very carefully in order not to damage the newly implanted hair follicles. After 3-4 head washes all of the crusts, blood clots, scabs faded away, my hair looled immaculate. My head washes done by professionals and some days two times a day, this the reason of faster cleaning. Normally all crusts – scabs gones at 8 – 10 even 12 days after the procedure.

I didn't wear a hat or tried to hide my head after the operation. Everybody get used to see hair transplanted person in daily life, so it is not very attention catching thing, even familiar. If the hat contacts with the newly implanted hair may damage them.

Although I paid much attention not to hit my head anywhere, I hit the back of my head to car door roof when I was taking out something from back seat on the post op day 8. Fortunately I was moving slowly and hit smoothly.

On the tenth day after the hair transplantation, everything was almost normal. No clues of operation was evident, except for a slight redness.

Sun protection was very important because we were in July. I was very careful not to be exposed to direct sunlight.I was already so busy that I could never go out in the day always indoors.

My new hair began to grow slowly and was looking so good till 15 th – 20 th days, when they began to shed. Although I did know that this is an awaited situation, losing my hair again, demotivated me. This normal shedding period completed in about two months and the redness was also completely faded away. So after 2 months you are returning back to the state where nothing has been done ( preoperative state ).

One month after the operation I went on summer holiday. There is no problem with swimming in sea after 3 weeks, before this time salty water may cause burning sensation at your scalp. We don't recommend swimming in pool before 2 months, because pool water contains many bacteria, fungi, yeast, and chemicals like chlorine and acids.

I took great care for sun protection, used a hat or bandana, not exposed to direct sunlight more than 10 minutes. Also I used sunscreen (30 F) lotion because my hair was still short.

Two months after the operation, I started using minoxidil % 5 lotion, after the redness completely subsided. Minoxidil %5 used for providing support for new hairs and speed up their growth, not for creating new hair. Also miniaturized hairs benefit from minoxidil. I haven't used any tablets, vitamins, or hormonal medications.

Waiting for your hair to come out again is really a process that requires patience. I followed normal development without worrying about it. It may take 3 – 4 months to see new hairs. Some growth can be seen at 6 months at the earliest, only % 60 – 70 of the total. Of course these periods may vary from person to person. You have to wait at least 12 months to see the final result. It ıs not wise to comment on the result before 12 months have been completed. You can even see changes, maturation in your hair up to 18 months. Newly implanted hairs develop adaptation to their new location.

The reactions of my relatives, friends, patients were generally positive after my operation. As I mentioned earlier, people now accept hair transplantation more easily because it turned out to be a routine operation. Almost everyone's common opinion was that I look younger than my age. Especially hair in the frontal part, even if not so dense, have a youth effect visually.

Having hair transplantation to myself made my patients more confident about what I told to them. Probably most of them thought that I can better empathize.

As a result, hair transplantation is a professional necessity for me , but I am very happy to have it as a normal person also. The person I see when I look at the mirror is happier, healthier, and younger when compared to before. By the way, my son is 6 years old now, when he looks at my old photos he says '' my dad was bald before '' and he also likes my appearance.

The result may not always be as expected for sure. Hair transplantation is a surgical procedure and the result of a surgical procedure can't always be predicted. It is not possible to prevent unforeseen risks, correct choice of surgeon, proper operative plan and timing, realistic expectations, and a little luck ( for uncontrollable factors ) will suffice for a satisfactory result.