Dr. Yaman 03/24 difficult case

[Matthias]

Hi all,

 

I'm balding since my early twenties and lately it got so drastic especially in the frontal zone that the only way to restore a healthy appearance seemed to be a large hair transplant, so in march of 2024 I had a megasession from Dr. Yaman.

I use topical minoxidil since a couple of years primarily on the crown hair with seemingly diminuishing effects (gives me some nice eyebrows though). I never touched finasteride, and I'm very hesitant to use it orally since I feel that I have a fragile testosterone production and that the limited benefits of a low dosage aren't worth the sides and risks. Since the top of this year, I use oral saw palmetto (lately I switched to a pure extract powdered form). Since a couple of weeks, I use Pilexil shampoo also containing saw palmetto and perform ca. 2 minute daily skin-over-skull scalp massages. For a few months prior to the hair transplant I tried to induce some regrowth on the hairline using microneedling with a dermapen (combining it with minoxidil) but that showed no satisfactory regrowth and I doubt that I would be disciplined enough to stick to it consistently. Because I had been treated for folliculitis in my early adulthood that seemed to occur chronically then, I preventively went through a 50 day supply of antibiotics that I convinced my doctor to prescribe me prior to the operation to suppress any potential flare up of it (Certain clinics got cautius in relation to this). Other than that I consume vitamin supplements, generous amounts of creatine and medicate a thyroid insufficience.

In my inquiry to Dr. Yaman I expressed my interest to look younger and have the facial proportions restored.

Consultation pics:

How would you classify my hair status according to the Norwood scale?

After consulting with a handful of turkish clinics and receiving some offers, I chose Dr. Yaman because of the affordable pricing, an early operation date, his affiliation with the IAHRS, doctor involvement in the operation, and because the Yaman implanter showcased his expertise and exceptional contribution to his profession to me. Also I did not want to be sedated or put to sleep as some clinics routinely do, however I would have been ready to do a FUT.

Communication and organisation prior to the operation was handled by Doga in an exemplary and uncomplicated manner. During blood sampling, I almost passed out presumably due to going too heavy on the hotel's breakfast while having to pass on the several cups of coffee I'm accustomed to, and was prescribed 1 to 2 hours to rest before the operation would start in the noon. The consultation hadn't taken very long but I didn't raise too many questions either after getting confronted with a close-up of my miniaturised and weak front hair, Dr. Yaman then pretty much aced the hairline which doesn't surprise as the Yaman clinic also offers all sorts of other aesthetic procedures (Normally this would be a point of concern but I think it's his relatives who provide the other services in the clinic). The operation went according to standard except for that ca. 500 grafts more were planned than were ultimately extracted. The explanation given by Dr. Yaman was that one of his assistants warned him about a risk of overharvesting the donor (Extraction was motorised, too) and we hadn't planned for the necessity of a beard extraction. My request to get a glance at the Yaman implanter could not be granted because it had already been put into the autoclave directly after the procedure while my eyes were still covered.

So far, I'm pleased with the experience, however the result is what will ultimately count. Dr. Yaman and Doga are both super friendly and competent guys. Dr. Yaman's assistant team seems to be relatively young and while they didn't give me any apparent reason to doubt their technical skills, I would have felt more comfortable if there had been a senior assistant with them instead of just Dr. Yaman or Doga checking on them every once in a while, especially during implantation lasting well into the late evening hours. About half of the assistants speak English, if I recall correctly.

Donor post-OP:

3 month status (the contrast between healthy donor hair and bald scalp looks horrible...):

After 3 months, I had the sides trimmed (Recipient area was kept untouched). This is what the donor area looked like trimmed after a little bit more than 3 months:

4 month status

Top:

Donor:

I think it's safe to say that even by 4 months I had still not fully recovered from shock loss of the native hairs... A little while after consulting with Doga and getting his permission, I shaved my head including the recipient myself after ca. 4 and a half months. According to Dr. Yaman's website this is permissible after 2 – 3 months although the Post-OP instructions prescribe to wait 5 - 6 months. There seems to be some sort of unevenness going on which some might diagnose as cobblestoning, and I think I found the occasional doubles in the hairline.

4 and a half month status

Top:

Front:

4 and a half month status shaven:

Top:

Donor:

5 month status:

Top:

Donor:

Growth, while probably according to schedule, is happening but relatively slow, which is why I seek your advice to put myself in a position to act fast and informed towards my goal of presenting a full head of healthy-looking hair by 1^st of May next year. I would also like to know what you guess my graft number is.

Potential measures could include:

• Schedule a potential second hair transplant this December, maybe at Smile Hair Clinic or comparable, ideally with a focus on tolerability (can't have shock loss all over the scalp) but where you don't have to pay in advance for reservation in case I'm still on track in December and don't need it. I'm currently willing to spend up to 6000 Euros despite being capable of breaking the bank and financing most world-class surgeons.

• Start of a topical finasteride therapy for the crown and maybe later also the remaining frontal hairs instead of relying on hair fibers, as to me it is unclear if all crown transplants grow in, especially by the 12 month mark, and if they will provide sufficient crown coverage given that the surgery plan called for ca. 500 more grafts

• Apply topical minoxidil solution orally (My doctor refused to prescribe tablets)

I'm looking forward to hearing from you!

Matthias

 

 

 

 

 

[Berba11]

3 hours ago, Matthias said:

Schedule a potential second hair transplant this December, maybe at Smile Hair Clinic or comparable

Oh mate. You'll be getting yourself into a world of trouble going to a notorious hair mill like Smile with an already depleted donor. How many grafts did Dr Yaman move?

5 months is still very early and it's hard to know what your progression between month 4 & 5 has been because you buzzed everything off.

[Matthias]

24 minutes ago, Berba11 said:

Oh mate. You'll be getting yourself into a world of trouble going to a notorious hair mill like Smile with an already depleted donor. How many grafts did Dr Yaman move?

5 months is still very early and it's hard to know what your progression between month 4 & 5 has been because you buzzed everything off.

Thanks for the hint, some of the doctors at Smile seem to be quite reputable and there should be VIP packages... I also would need a clinic with no significant waiting list. At Dr. Yaman they moved somewhere in the ballpark of 4000 FUs but you tell me your estimate.

[baddecisions]

- Not taking finasteride or dutasteride considering your situation at least one year before surgery was a huge mistake, well, as huge as not taking it now. You mentioned your concerns, i.e., hypothetical side effects, in order to not taking such medication. But, at the same time, you are not afraid of undergoing a surgery, not small at all, but rather a megasession in Turkey (????????)

- You are considering "Apply topical minoxidil solution orally" because your doctor doesn't prescribe tablets. I am not sure if I am understanding this point: do you mean drink the minoxidil??????? I hope and assume I got it wrong. Why didn't/do you just search another doctor (local dermatologist, thricologist) to have that prescription?

- Smile clinic???? No, god, no.

[Matthias]

18 minutes ago, baddecisions said:

- You are considering "Apply topical minoxidil solution orally" because your doctor doesn't prescribe tablets. I am not sure if I am understanding this point: do you mean drink the minoxidil??????? I hope and assume I got it wrong. Why didn't/do you just search another doctor (local dermatologist, thricologist) to have that prescription?

Yes, I mean to calculate a starting dose and drink a small drop of the topical solution using a dropper, the topical solution has no toxic contents or anything, severe dose-dependent potential side effects for your cardiovascular system though.

[Berba11]

7 minutes ago, Matthias said:

Yes, I mean to calculate a starting dose and drink a small drop of the topical solution using a dropper, the topical solution has no toxic contents or anything, severe dose-dependent potential side effects for your cardiovascular system though.

Just get yourself the pills instead of getting involved in your own lab experiments in which you're the examiner and the test subject all rolled into one.

As for estimating your grafts from Yaman... Why? Is there some dispute over the numbers? I was asking because to get full coverage on your level of loss would likely need a minimum of 7,000 grafts. You donor looks a bit battered and bruised so will need to be handled with great care. You'd be insane to put your donor in the hands of Smile Clinic or any of their analogues (there's no "VIP package" - this is marketing rubbish). You say you have the budget to use a top surgeon... If you're not satisfied with the outcome of this surgery then you only get one more shot at getting it right. This arbitrary deadline of getting everything looking ideal by May next year will turn into a catastrophe if you attempt to achieve this using crappy Turkish hair mills.

For now you need to let this current HT run it's proper course. You can make more accurate assessments about its success around the month 10 mark and then consider your options. My best advice is to forget about having this all sewn up by May 2025 as you're putting an intense time pressure on yourself and forcing yourself to use second rate options that can book you in at the drop of a hat. That's never a good idea.

[Matthias]

On 8/26/2024 at 7:39 PM, Berba11 said:

As for estimating your grafts from Yaman... Why? Is there some dispute over the numbers?

Dr. Yaman's guaranty states that his clinic takes the cost of a second procedure if 10% or more of the grafts should get lost.

On 8/26/2024 at 7:39 PM, Berba11 said:

You donor looks a bit battered and bruised so will need to be handled with great care.

This is my donor pre-OP:

I think it's quite solid. The growth pattern had been kind of uneven ever since. Of course it will need to be handled with greater care down the line as Dr. Yaman extracted a massive number in a short time-span using a motorised punch. Does anyone know which punchsize he uses?

On 8/26/2024 at 7:39 PM, Berba11 said:

You'd be insane to put your donor in the hands of Smile Clinic or any of their analogues (there's no "VIP package" - this is marketing rubbish).

Of course it's a marketing buzzword but at least one of the Forum recommended surgeons (Dr. Gür) offers a VIP package...

On 8/26/2024 at 7:39 PM, Berba11 said:

You say you have the budget to use a top surgeon... If you're not satisfied with the outcome of this surgery then you only get one more shot at getting it right.

I have the budget but I guess their waiting list is too long for my requirements. I do think that I have at least two more attempts just counting FUE and maybe a fourth doing a FUT, just considering scalp hair.

As of now I'm considering doing an unshaven FUE transplant for density right after the 12 month mark. I read a bit of Dr. Michalis Georgiou who specialises in this combined with a manual extraction.

[Berba11]

4 minutes ago, Matthias said:

Of course it's a marketing buzzword but at least one of the Forum recommended surgeons (Dr. Gür) offers a VIP package...

So?

You need to be specific... What does this "VIP package" include that is surgically superior to the usual package? I'm dying to know!

[Matthias]

Just now, Berba11 said:

So?

You need to be specific... What does this "VIP package" include that is surgically superior to the usual package? I'm dying to know!

In the case of Dr. Gür it means he does the (motorised) punches as opposed to his techs doing it in the standard package.

I think with Smile you would get to choose the doctor but I‘ve heard of stories where the doctor wasn’t available ultimately.

[Berba11]

12 minutes ago, Matthias said:

I think with Smile you would get to choose the doctor but I‘ve heard of stories where the doctor wasn’t available ultimately.

Wow, you get to choose your own doctor! How very VIP...

Come on man. You're not seriously thinking about going to Smile.

[Matthias]

6 minutes ago, Berba11 said:

Come on man. You're not seriously thinking about going to Smile.

Haha, nah 😉

[Gatsby]

@Matthias I’m not a doctor however you really need to be doing more research. Medication is the first port of call when it comes to MPB. Surgery is always a last resort. Again I’m not a doctor but I suggest you see yours and give Finasteride at least a year to see how your hair responds. It doesn’t matter now nice the people are at Smile hair mill. You will be left butchered for life Are you saying you don’t know the graft count you received from Yaman? Don’t have any more surgery until you have allowed this hair transplant 12 months to mature so you will know what you are working with. All the best. 

[Matthias]

4 minutes ago, Gatsby said:

@Matthias I’m not a doctor however you really need to be doing more research. Medication is the first port of call when it comes to MPB. Surgery is always a last resort. Again I’m not a doctor but I suggest you see yours and give Finasteride at least a year to see how your hair responds. It doesn’t matter now nice the people are at Smile hair mill. You will be left butchered for life Are you saying you don’t know the graft count you received from Yaman? Don’t have any more surgery until you have allowed this hair transplant 12 months to mature so you will know what you are working with. All the best. 

I'm likely going forward with my topical finasteride plan for the crown and also will try my best to get a oral minoxidil prescription... The graft count and breakdown had been given to me in a certificate by Dr. Yaman. Via Doga I could also get the analysis form where they wrote down how many grafts Dr. Yaman planned directly pre-OP for the front, mid-scalp and crown, which was quite a bit more than what was ultimately transplanted:

[Gatsby]

Did they tell you how many more grafts you still have left in the bank? 

[Matthias]

3 hours ago, Gatsby said:

Did they tell you how many more grafts you still have left in the bank? 

Not directly but as far as I remember Dr. Yaman was optimistic that I could have another procedure. I could ask, still need to get their pictures and punch size amongst others. Take a look at my third picture from the initial post though (3 month status), that looks like a lot left to me (although of course they didn't extract directly adjunct to the balding areas - still hard to believe that these hairs will ever miniaturise) 

Edited September 1 by Matthias

[Lengsson]

I had my surgery around the same time as you in late March with Dr Yaman. How many grafts did you get? Without seeing photos of the extractions immediately after the procedure it is hard to guess. 

How is it looking now? I'm not an expert by any means but I don't think your donor looked strong enough to withstand the 4000+ grafts I'm assuming they extracted from you in one session. It might take a little while longer for the donor to heal assuming you weren't overharvested. I would also advise you not to go to Smile or any Turkish hair mill for a second procedure. I think Yaman was a bad choice to start with, and then going one step lower to Smile would be very risky. Realistically you only have one more shot to get it right so you need to not be limited by time and budget. 

If you need a full head of hair by May 2025 your only option would be to let this surgery take its course and then use dermmatch or toppik until you schedule in a repair / second surgery with a good surgeon. Another option would be looking into SMP instead of a second surgery.