Hair Transplant

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PHILOSOPY OF DR. KUL

Aesthetic Surgery aims to reform the problems emerging due to aging and to improve the patient’s life both physically and psychologically.the patient’s life both physically and psychologically. By using Science and Art together, Aesthetic surgeons try to catch up the beauty and all the natural-like things. By using Science and Art together, Aesthetic surgeons try to catch up the beauty and all the natural-like things.Hair transplantation is the main aesthetic operation applied for the men. Unfortunately, you may see aesthetically bad results of hair transplantation which even made people psychologically depressed after transplantation.Never let these results to create a prejudice like “Hair transplantation causes that kind of result all the time” in your mind. There a few reasons of the bad results you have confronted; the wrong choice of technique, its being carried out by unauthorized people, wrong planning and the personal features of that person (false expectations, inappropriate hair for the transplantation).The hair line is similar to the frame of paint. A beautiful frame makes paint more beautiful. Thus, first a personal design should be planned (his age, shape of forehead, loss amount on sideburns).The next step is getting a very dense hair having natural-like stemming angle and direction. To do this, we should use “stick and plant” technique which has been approved by many surgeons nowadays. In the event that such kind of hair transplantation is carried out, we obtain a result that cannot be distinguished from the natural appearance whether the hair is long or short.Further, we don’t suggest and apply any techniques which have not been proved in terms of efficiency and which sound like nice but will not satisfy both the patients and surgeons in terms of their results. We try to inform our patients correctly by featuring the scientific side of aesthetic surgery as well as artistic side. While I was working in Brazil, what I realized and desired form y own country was that the people were very conscious about aesthetic surgery and the great satisfaction with the results of operations. There are a few reasons for it; first, people can describe their problem very well and they are aware that they should see a plastic surgeon for that problem; second, they can easily adopt the postoperation process (oedema, wound recovery duration etc); and finally overlapping result and expectations.Therefore, even if we carried out a successful operation, the most important thing is “the happiness of patients”. This web site will eliminate the false beliefs and knowledge of hair transplantation candidates related to the hair transplantation to help them explain their expectations more easily during meeting with their surgeons before the operation.

Science develops via questions. Especially when this is the Plastic Surgery the fastest advancing science branch of medicine. We would like to thank all patients who contribute us with their questions in the way of getting better operations and all plastic surgeons in Turkey and in other countries who contribute our efforts to develop modern aesthetic surgery techniques to be able to get better results and faster.
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HAIR TRANSPLANTATION IS A SERIOUS WORK; DON’T BE A VICTIM!

Even is hair transplantation has enormously developed during the last 10 years in technical terms, we observe that there are still a lot of problems related to standardization of surgical operations (in technical, medical and ethical terms. In addition, that the people who are not Plastic Surgeons, even who are not surgeons try to apply these procedures has been causing very bad results and some prejudices towards hair transplantation in the society.We see that patients who are conscious that hair transplantation is an aesthetic surgical operation apply to plastic surgeons and ask them “Will you yourself carry out the operation?” During the past years when strip method was the only choice in hair surgery, surgeons used to remove the hair roots and give them to their assistants to implant on donor area, which caused insufficient results and also caused very bad results which we call “grass man”.

HAIR TRANSPLANTATION IS AN AESTHETIC SURGERY OPERATION; IT MUST BE DEFINETELY CARRIED OUT BY AN AESTHETIC SURGEON!

Almost every day patients had hair transplantation operation in other centers, but weren’t satisfied with the result apply to me.

When we look at the operation history of these patients, we can see that many inappropriate applications related to hair line planning, removal of the roots and implanting are resulting from false planning and the operation’s being carried out not by plastic surgeon himself.

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WHO WILL APPLY HAIR TRANSPLANTATION?

Your transplantation will be carried out by a plastic surgeon together with his assistant/s. Hair transplantation is a surgical operation, be careful about the person to do this operation!
We often hear the questions from our patients like “Will I have natural-like hair?” or “I’m getting afraid of looking like a grass man”. We all know that all these questions and desires are rightful. Then, what can be reasons of these fears and prejudice?There are many clinics which see hair transplantation as only “opening hollows on the skin and inserting follicle in them” in other countries where the control mechanisms are not sufficient and these clinics are the main reasons of the patients who are walking anti-propagandist and bad results in the society.Please don’t be victim of people and clinics who carries out very cheap hair transplantation in the name of health tourism, even managing more than 1 transplantation in a day only, saying that they transplant impossible number of hair roots and who are not plastic surgeons or even not doctors.

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WHAT IS FUE?

FUE –follicle unit extraction- is a hair transplantation operation in which the hair and hair groups we call follicle unit is removed from the skin by semi-circular movements and the roots are taken from subcutaneous to the outer environment and then transplanted on the hairless area.

Various diametered tools called “micropunch” are moved to the appropriate depth and direction, therefore the roots are not damaged. Although the term “Fue” describes the retrieval process of roots, it represents a hair transplant technique today. Just because the postoperative period experienced is far more comfortable than FUT technique and because of the further advantages that are to be mentioned in the text, majority of patients prefer FUE technique. The reason that the Fue technique is offered as a trackless operation is the fact that wounds smaller than 1 mm in our body heal without a trace.But in fact, on every point from which we removed the roots, very small white spots are created. However, the hair around these spots masks them easily. Even, we have the chance to get root again from the same area. In addition, in terms of FUT technique in which cuts and stitches are used, it is a trackless operation.In FUE method, the hair roots are removed by the help of “punch” which is a sharpened straw-like tool in various diameters (from 0,6mm to 0,8mm) and by which a circular cut around the root is created to remove it. Although the hair roots tightly cling to the surface layer of the skin, they cling to the fat layer under it loosely. After this circular cut with punch, it is possible to track the follicle unit easily by traction and rotation movements with a forceps. During this operation, thanks to the experience of the surgeon, as the depth of the cut made with punch doesn’t reach to the root of the hair, there is no possible of damaging the root. However, when a punch with appropriate diameter is not used (especially when a very thin punch is used for multi follicle units) transection is come across and at least one of these multi follicles stays there and cannot be removed.So, it is not correct to use standard diametered punch for a patient who have Standard hair root. Trying to influence the patients to get hair transplantation by advertising “We use 0,3-0,4mm punches” in printed and mass media is not moral and scientific.

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WHO CAN GET HAIR TRANSPLANTATION USING FUE METHOD?

We stated before that the main advantage of FUE method is its being trackless. Who are the ideal candidates for FUE Method?
1.

The ones who likes short hair. As strip method will leave a horizontal line on back part of scalp, these people should definitely prefer FUE Method. Even if small white spots remains on operation areas from where the roots are removed by FUE Method during recovery period, selecting the correct skin type and obtaining certain roots from 1cm2 area and preferring a thin pointed punch reduce the amount of this tracks to a minimum number as not to disturb even when the hair is short.

2.

The young people who complain about the recessions on frontal hair line and temporal area and may need hair transplantation in the future.

3.

The ones who tried strip method before and need new hair transplantation or the ones who are not satisfied with the current condition and want correction operation.

4.

To be able to mask the tracks on donor area by strip method applied before.

5.

The ones who experienced a trauma ( burn, traffic accident) or who have naturally no hair, beard and moustache.

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WHY DO WE USE “FUE” TECHNIQUE?

Fue has emerged in quest of “how can be the follicles obtained without cutting?” as the scar in the shape of line which remains on donor area with band extraction method disturbs people. In FUT, namely in band extraction method, it is inevitable that a noticeable scar appears sometimes when the hair is cut down and sometimes even when the hair is long especially in the ones whose hair grows uprightly. This scar emerging in donor area disturbs people both for visual and health reasons, so the interest to FUE technique has increased day by day. Today, we are carrying out the hair transplantation operation by using only FUE technique.In the first years when FUE method was discovered, it wasn’t accepted much because of the reasons such as it takes long time, the roots cannot be properly removed from the scalp by inexperienced people. The reason why FUE method was not accepted so much in early periods was the visible point scars in donor area when the hair is cut as a result of using thick pointed punches. During the last five years, technological advance and increase in the experience of people resulted in overcoming some disadvantages and thinner punch diameters which are used for removing the roots.The removal time has been shortened by the help of micromotor-assisted punches; it has been determined “how the scar is eliminated by using in which diameter punch for removing roots from 1cm2.” But, every method is misunderstood and some details are failed to notice when it is first discovered as FUE method has caused lots of unsuccessful results may be due to the intense attention it has drawn or maybe due to the technique used while removing the roots or may be due to the very old technique used while implanting the roots.Today, many centers which call themselves “transplanting centers” has been using FUE method, but because of false donor choice, false planning and false technique they use, we have met many unhappy people. I want to express that everybody may get hair transplantation but the results that will make the people happy change from person to person. What makes the successful is the happiness of that person. Therefore, I always try to show my patients the results which are close their operation results. I prefer to approach more carefully towards the people who want to get transplantation after seeing the result of his or her own friend and try to tell them that the result that may be obtained can be different for everybody as their hair follicles are different.

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MICROMOTOR-ASSISTED FUE

Should the roots be removed manually or with micromotor? Does micromotor harm the roots? While removing the roots, we create 0,6-0,8 mm circular cut around the point where the follicle unit stems from the skin, but we stop the cut at surface layers of the skin. If we make these circular cuts manually, we use reverse half-round movements towards right or left, but if we use micromotor, we benefit from the continuous circular movements of a punch in the same diameter and placed at the end of a motor.In both situations, what is important is the thinness of the punch diameter and not going deep towards the layers under the skin for the vitality of the roots. An important point to be cared while working with micromotor is that the rotative speed shouldn’t be high. If these issues are taken into consideration, I believe that there is no difference between removing the roots manually or with micromotor. However, as many of the clinics using micromotor removes the roots with thick pointed punches in high speed, some white spots are formed on donor area where the roots are taken. However, this must be kept in mind that this is not the fault of micromotor but the removal technique using thick pointed punches.Together with technical and technological advances, the design of punch points differs. What makes the punches made of titanium or stainless steel different is the durability of the sharpness of points. Titanium pointed punches maintains the sharpness for a longer time period. The points may be circular or in zigzag shape or in two intrusions in reversed V form. What is important here is not to cause trauma on the skin or peripheral roots with excessively thick punches and also not to affect the aliveness of the roots by using too much thin punches.
In the past years, while vertical channels were opened using 11 no bistouries ( very sharp pointed ), now channels with horizontal slits and with not very sharp points, which are called lateral slits have been opened. Although lateral slit technique partially provides the stemming angle of the follicles to be more natural, we cannot get a natural direction and stemming design as in needle implanting technique.

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A SPECIAL TECHNIQUE IN FUE HAIR TRANSPLANTATION; “STİCK AND PLANT”

The first factors to provide hair to look natural after transplantation are implanting them in right direction and growing angle. This is possible with surgeon’s microsurgical experience, manual dexterity and artistic perspective. Our hair stems from the skin with more acute angle near frontal line than posterior area and this angle enlarges towards the back parts of head. Hair stems spirally on the top part which we call vertex. These are the features of natural hair structure.And now, there is a well-known fact; we can obtain a natural-like hair with an attentive planning, a correct technique and a dedicated study. When we implant hair roots on especially temporal area downwardly and backwardly, we obtain so natural-like results that nobody can distinguish. As the operations of opening channels in which the roots will be placed and the placement will be carried out at the same time, we may determine the desired stem direction and angle. That is, everything is under our control. A correct hair line design is the only thing we need.

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WHAT DO WE DO TO GET A NATURAL-LIKE HAIR BY HAIR TRANSPLANTATION?

There are few factors to make a hair transplantation operation successful, thus a natural-like result;
1. Factors related to removal technique of roots:

Removing the hair roots using thick pointed punches causes to get thick diameter follicle units.Namely, the tissue particle in 2 or 3 times bigger than the hair follicle units including 2 or 3 hairs requires opening large channels during implanting. Otherwise, a thick diameter follicle causes trauma while placing it in a small channel. A thick diameter channel, on the other hand, causes hollows at the bottom of hair follicles as it recovers by causing contractions. Small diameter follicle unit means small size channel which means a fast recovery.Even though the thick follicle units with thick tissue particles around it has been defended to be more livable and fed better so far, the things needed for growth and holding of the hair roots are – which will be explained in detail in further parts- transplanting the roots quickly without waiting them very much and during removal operation protecting the “bulge” area where the stems cells required for the roots to grow are included. One the most discussed issues recently is whether to remove the roots manually or by micromotor. While removing the roots, we make 0,6-0,8 mm circular cut around the point where the follicle unit stems from the skin, but we stop the cut at surface layers of the skin without going deep. If we make these circular cuts manually, we use reverse half-round movements towards right or left, but if we use micromotor, we benefit from the continuous circular movements of a punch in the same diameter and placed at the end of a motor. In both situations, what is important is the thinness of the punch diameter and not going deep towards the layers under the skin for the vitality of the roots. An important point to be cared while working with micromotor is that the rotative speed shouldn’t be high. If these issues are taken into consideration, I believe that there is no difference between removing the roots manually or with micromotor. However, as many of the clinics using micromotor removes the roots with thick pointed punches in high speed in our country, some white spots are formed on donor area where the roots are taken. However, this must be kept in mind that this is not the fault of micromotor but the removal technique using thick pointed punches.

2. Factors related to Implanting Technique:

In implanting technique, the implanting direction of the hair and stemmingfig 39 angle from the tissue should be designed personally, especially for the ones who have thin hair on implanting area, implanting direction and angle will look more natural by the help of the direction and angle of these thin hairs. The needles we use to insert the roots in the tissue should be in the same or smaller diameter than the diameter of the root and simultaneously the channels should be opened and the root should be inserted in the channel. The channels opened with horizontal sharp slits made of bistouries or blade cannot be successful to insert the roots in the tissue properly and in desired angle. This causes the hair to stem in same type and in the same angle on every areas (the roots generally stems in right angle from the skin), which causes Grass Man appearance.In slit techniques carried out by inexperienced teams, the hair roots stem in quite different angles and directions. In implanting technique with needle, very small channels that will immediately close after the root is inserted without any contact on the roots. As the channels are quite narrow and opened without making any cuts it holds the hair root inserted in it closely and maintains the direction of implanting. Moreover, as the cuts on the skin are very small due to thin pointed punches, it reduces the trauma amount on the skin and the recovery time after operation is completed rapidly. If we want to insert a lot of roots in 1cm2 area, we have to open vary small channels. Otherwise, large and too close channels violate the feeding of that area.

3. Factors related to the design of hair line:

We have to consider aesthetic perspective, artistic personality, the facial anatomic features of that person and the age factor while designing the hair line. I have to assert that as an aesthetic surgeon I can easily understand whether a person got hair transplantation or not by looking at the hair line design. There is a very important issue that is ignored by many hair transplantation centers: our hair lies in different parts on our both sideburns while it starts opening and being lost entirely and in certain proportions. If we don’t shift the hair up to front part and create the triangle part on sideburns on a person who has Norwood 3 type hair loss, we create a disproportioned and unbalanced hair line. If we apply hair transplantation on an old aged person who has an advanced hair loss pattern, we should plan the hair line quite conservative and start from the upper parts and shouldn’t leave hair inserts as much as possible and so we could obtain a natural-like appearance.

There 3 points that determines the attractively of a face; SYMETRI – BALANCE – PROPORTIOON. According to the proportions of Da Vince, an ideal face can be divided into three equal parts.
The points to be taken into consideration for a correct hair line for men;

* the apex, the finish point of our frontal hair line should be just on the vertical line from the peripheral part of our eye.
* apex shouldn’t be round-transitioned. This is the common mistake on the hair line of the people who we can easily understand that they had a hair transplantation.
* hair line should look like a large bottomed U when we look through front,
* the hair line should be seen as a horizontal line when we look through sides.
* if we want apex to be in a good proportion with sideburn parts when we look through side, apex should create a triangle insert by going through the sideburn part.
I especially design the hair line for the ones who has large opened areas as to be not in very frontal parts but more conservatively; in addition, I provide the hair to be transplanted more intensely. Because, if you bring the hair line 1 cm through the frontal part, you enlarge the implantation area 8cm2, that is, you need at least 400-500 additional grafts.

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IS THE HAIR PLANTING A COMFORTABLE OPERATION?

Although hair transplantation is admitted as an Office based operation in Europe and America, in country Ministry of Health Issues made it compulsory to get it in within the body of hospital. The purpose of this obligation is not the contribution of the hospital in terms of technical equipment, but to prevent unauthorized people and institutions to carry out hair transplantation in any environment. However, even though hair transplantation has been carried out as an Office based operation, in the operation area, all kind of medical techniques to be used in case of a change in vital functions of the patient. Another important point is realizing the hair transplantation under sterilized conditions. Although hair transplantation (FUE) is a minimal invasive surgical operation which doesn’t requires large stitches and cuts, it needs attention as it is a skin –subcutaneous operation. Fortunately, hairy skin is a well-blooded area and this is an important protection against infections.FUE is an operation in which the areas the hair roots are removed and implanted are locally anesthetized and thus during both operations (removing and implanting) the patient doesn’t feel any pain. Our skin has different nerve receptors for different senses (such as touching, pain, heat etc.) Local anesthetic substances remove the feeling of pain totally. In addition, as only one sensory feeling can be perceived at the same time, patient will not feel the pain when we made pressure and heat to eliminate the pain of the injection and thus the operation becomes very comfortable. We prevent the feeling of pain to be transmitted to the brain by applying vibrant massage and ice on that area just before the anesthesia to eliminate the pain of injection during local anesthesia. Besides, we prefer very thin pointed injections.FUE has a two-phase process. In the first phase, the roots are removed from the donor area while the patient lies face down. In the second phase, the implant is carried out while the patient lies on his back and on his side. Contrary to what is believed, FUE is not an operation carried out while “you are reading your newspaper or book”. However, we try to do our best to provide the comfort of the patient.In the light of our traditional surgical knowledge, we can say that the less trauma we create on the skin the quicker it will be recover itself. Thus, using microsurgical techniques, smaller diametered punch points while removing the roots and thin pointed tool during implanting will shorten the recovery time and give you the chance of returning to your business and social life as soon as possible. Moreover, that skin is not injured too much will relieve you during the night just after the operation (or you may use just 1 oral painkiller). If the operation is planned to be long during local anesthesia, we prefer local anesthetic substances with long-time effect. Reducing the bleeding of the skin temporarily by injecting adrenalin serum will provide us, surgeons, to work easier and also provide less cicatrization and faster recovery time.

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PREOPERATION AND POSTOPERATON PERIOD OF HAIR TRANSPLANTATION

You should cease taking Aspirin and similar anticoagulant medicines and other vitamins at least 15 days before the operation. You should inform your doctor about your illnesses you had or you have now. You should definitely state your alcohol and cigarette use amount. Wash your hair with shampoo before transplantation; never use an additional hair care product. As an advantage of the technique you will have, you can continue your normal life by only wearing a hat. In the morning of transplantation, choose clothes which are not polo-neck and a T-shirt or a shirt easy to put on and put off. Take a sports hat with you to use after operation.
Follow these instructions to be able to recover after hair transplantation operation.
•Follow the medical instructions of your doctor.
•Avoid sports and sexual activities and heavy Works after operation and during implanting process, however after 5th day of washing your hair, you may return your normal life.
•Within 1 week period, you shouldn’t use cigarette and alcohol as it may interact with the medicines.
As the implanting technique we use is different from the traditional techniques (as 1000 – 1500 grafts are transplanted every day), the implanting area should be moistened with normal saline till the washing process starts. For this purpose, we provide you with normal saline that you may use as spray. 48 hours after completion of implanting process, washing period will start.
The washing operation should be done as following: Put on some Bepanthol lotion of implanting area and wait 1 hour till the scabs on that area soften. This area should be cleaned and the scabs should be removed by using a recommended shampoo.
While washing your hair, the lotion and the shampoo should be cleaned by very soft touches, but you should keep in mind that the scabs will be cleaned within the 1st week gradually. After the scabs are removed, the result will reflect partially what we want to have. If an additional medical treatment is applied by us (5% minoxil spray or 1mg propecia), you will have to continue this treatment during recommended time. Because, the hair roots grow approximately 0.5cm in this time. However, after 3rd – 4th week, it is an expected situation that most of the parts may be lost. After 4th – 5th months, you can see that your hair grows. You can see satisfactory result only after 7th – 8th months. The time your hair is maturated and you start combing your hair is at the end of the 1st year.

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Repairing unsuccessful hair transplantation results

Remember that, hair transplantation is a very popular procedure demanded and applied both in our country and all over the world. However, these high demands and lack of control mechanisms are causing abuses and hair transplantation turns into a commercial way of earning other than a state of surgical operation. Thus, it is a very normal situation to come across with numerous people that we call hair plantation victims.We believe that the inaccurate view to hair transplantation can only be changed by successful hair transplantation results around us, which we couldn’t realize due to its natural appearance and the facts and mistakes can be cleared and understood by sharing them with other people. In addition to this fact, we try to do our best by providing medical support for the people who suffer from psychological problems as to isolate themselves from the society after hair transplantation. The people who experienced unsuccessful hair transplantation can apply to us in these conditions:

*incompatibly designed hair line
*transplanting the follicles vertically on the skin. (Grass man looking appearance)
*transplanting the follicles in low density – thin appearance
*opening ducts with slit technique using large and thick pointed tool and causing holes in hair follicles during recovery.