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Hair Surgery

The success of the operation is largely dependent on the experience and expertise of the doctor, the choices of technical equipment and a well-organized team. We are well aware of the fact that there are certain disadvantages of some new techniques and applications which have been scientifically tested and approved. That is why we offer only the tested and the least risky solutions to our patients.

What is a follicular unit? A follicular unit is a naturally occurring grouping of one, two, or three (and sometimes, four) hair follicles found in the skin. It is distinguishable only under a three-dimensional microscope.Where is the source of transplanted hair units and how are they obtained?In FUT method, the follicular units to be transplanted are extracted from the hairy scalp between the two ears in the shape of a thin strip. This method is called follicular unit transplantation. At Bosphorus , each follicular unit to be transplanted is dissected under the microscope with great care and is prepared for hair restoration. Each unit is a graft which is gets transplanted to its new place.In FUE technique, on the other hand, hair follicles are obtained one by one using special equipment. In principle, this technique is based on obtaining the hair follicles one by one which allows the extraction of body hairs to be transplanted to the scalp. The advantage of this technique is that it does not leave any scars where hairs are extracted from. The disadvantage is that it requires much more time than FUT technique to obtain the same number of grafts.In both FUT and FUE, grafts are placed on the scalp using the same technique. Where and how are grafts used and what is the maximum hair density that is supposed to be or that can be reached?In the preparation of the transfer channels, needles varying between 19-23 calibres and 0.016 mm width slit blades are used for lateral incisions, which all vary according to the area where the grafts are placed and the structure of the hair. Density is one of the most important topics in hair restoration and it has a relation with the highest growth rate. A successful hair restoration operation is possible only with a specialist doctor that can combine both of them. For the time being, we are able to transplant 40-90 follicular units (which make 150 hairs) per square centimeter depending on the donor area density. What are the medicines suggested for use after the operation in order to prevent hair shedding?Androgenetic hair loss is a constant process going on throughout people’s lifetimes. After a successful hair restoration operation, hair loss can be seen in the old ages only in the areas where there are the previously existing hairs of the patients, not the transplanted hair. We strongly recommend that our patients take Finasteride and / or Minoxidil in order to prevent hair loss.Reasons of hair lossWhile there are several reasons for hair shedding in men and women such as insufficient nutrition, burns, trauma, etc but the most frequent seen reason for hair shedding is shedding due to hormones called 'androgenic'.
Long term exposure to androgenic hormones (testosterones) as well as hereditary susceptibility causes similar hair shedding
Androgenic Hormones
Both men and women possess testosterones called androgenic hormones. Some of them are testosterones, androstenodion and dehidroepitestosterones. (DTH) These hormones are excreted by testis and supra-renal glands in men and by ovary and supra-renal glands in women.
As certain hair follicles are exposed to DHT for a long time, slimming, weakening and then shedding in hair roots is detected.
How DHT affects in these follicles?
Certain hair follicles with hereditary susceptibility are rich in an enzyme called 5 alpha reductas and this enzyme is responsible for turning testosterone into DHT. DHT is connected to a receptor and causes the natural cycle of the hair to stop by affecting the metabolism of cells.
In early phases of hair shedding, hair roots weaken (miniaturization) and they lose color due to lack of pigment. Rogain (minocidil) and Propecia (finasterid), recommended to be used in this period, absorb 5 alpha reductas and prevent DHT to rise in roots.
Hair on nape and ear do not shed, as they do not contain 5 alpha reductas activators. As hair is taken from DHT-insensitive napes, even though testosterone exists in hair-transplanted area, hair does not shed. When hair shedding will start and stop and the degree of shedding cannot be anticipated beforehand. The important point here is hereditary susceptibility. Whether hair will shed or not in the future has been programmed in the genes coming from the mother and the father.
ANDROGENIC ALLOPECIA Emergence of androgenic alopecia, hair shedding seen in men, is related to the structure of hormones and the human genetics. The loss of hair related to androgenic allopecia is completely related to the function of our hormones. Hair roots are organs which function separately and free from each other. Generally men suffer hair loss, either hair shedding or thinning, on top of their heads and on their foreheads but they do not lose hair between their two ears and on their forehead, as there are dense hair roots in these zones. This situation is called KING'S CROWN and the reason that men do not lose hair in these zones is that human genetics have two kinds of hair roots.

The first kind of hair root is prone to shedding and they are places on the forehead and on top of the head. This kind of hair starts shedding with the augmentation of testosterone (male hormone) in blood and the hair lost is not replaced again by the body as this kind of shedding results in eradication of hair roots. As hair roots are damaged trying to grow hair in these zones will not yield positive results. Thus, all medicines and lotions prepared to grow hair in these zones are attempts in vain. Each hair is also a hair root. In cases where hair roots are damaged, hair is not expected to grow. As this kind of hair shedding is related to hormones and genetics, intervention to grow hair may result in several risks. Contemporary medicine does not recommend any kind of medicine for growing hair in cases related to androgenic alopecia as it may cause deterioration in the genetic balance of the human body. This situation is valid for the first kind of hair root. The second kind of hair root is not affected by the augmentation of testosterone in blood and thus is not prone to shedding. Thanks to its favorable structure, we do not face any cases of hair shedding after hair transplant operations. The success of the hair transplant operation is related to the genetic structure of hair roots. Hair transplant operations are based on hair transplantation transactions on the zones with hair roots that tend to shed. Hair excreted from napes and from the zones between ears is transplanted on the zones where hair has either thinned or shed. A long tissue is excreted from the nape or from the zone between ears where second kind of hair roots is placed and the excreted tissue is closed with an aesthetic stitch. The scar that is left in this zone due to the excretion operation is closed when hair starts re-growing in the zone. The tissue that has been excreted is divided into one, two or three roots, depending on the vivacity of hair roots. The tissue with one root is called micro graft and the tissue with two and three roots is called mini graft. The most important issue in this phase of the operation is the fact that hair root grafts (particles) must be kept alive. Because the operation is based on live hair root transplant. Any kind of artificial material is not used. This operation might be summarized as replacement of the persons own hair root. Thus, as the tissue transplantation is realized with the persons own tissue, the body does not reject any tissue transplantation. The hair transplant operation does not have any adverse effects. The operation is based on the expertise of the hair transplant team and on the success of the micro graft system. It covers the placement of micro tissues into micro hair channels. As we mentioned before, the transaction must be realized under sterile and hygienic conditions. This is the principle of our hair transplant team.
Age
A direct relationship between age and hair shedding has not been detected. The ones with hereditary susceptibility, in other words those who have family members with apparent hair shedding, may tend to lose their hair even in 20s. Hair shedding is most apparent between 25 and 35. In most cases hair shedding slows down after 45 but we face some cases where one starts rapidly to lose his hair after 40. Other Reasons for Shedding

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Alopeci Areata (AA)

This is a recursive disease, which is caused by hair shedding in any zone of the hairy skin in elliptical or circular movement. It is generally seen in the hairy skin or eyebrows but it may also be detected in other zones of the human body.
Its certain reason has not been revealed yet but it could be called an autoimmune disease. Stress could be the main reason of hair shedding related to this disease. Sometimes whole body hairs may shed. (Alopecia Totalis) Hair is regained in several cases in 6 months - 1 year.
Steroids in form of topics or injections are used during therapies. Surgical treatment, in other words hair transplant, is not recommended.
Traction Alopecia
This is kind of hair shedding due to distention of long cycle of hair roots. Giving tight styles to hair, plaiting hair tightly and using tight turbans cause hair in the forehead line to shed. In cases where men use wigs for a long time, traction alopecia may be seen in zones where adhesives and clips are applied.
'Trichotilomania', a psychological ailment such as eating nails seen generally in women, may cause this kind of hair shedding. Hair transplant together with psychotherapy brings successful results in traction alopecia cases.
Scarring Alopecia
Scars and burns caused by face-lifting operations and operations conducted on the head may cause this kind of hair shedding.
A pre-examination is obligatory in order to detect whether hair transplant will be successful in hair shedding cases due to scarring alopecia cases. Thickness of scars and blood scream of the body must be analyzed during the examination.
It is possible to get positive results in various cases of hair transplant operations conducted on the scar tissue. An extension operation for the head skin to be realized by a plastic surgeon might be necessary for very large scars.

Telojen Efluvium
While 85 % of hair of a healthy person is in the anagene phase, 15 % is in the repose phase. That is, while we lose some hair, other ones begin to grow. As a result of this hair cycle, it is normal to lose around 100 hairs in a day. But hair may pass rapidly to the repose phase due to some factors caused by outer sources and this ratio may reverse. Telogen effluvium is thinning and shedding of hair, which may take a long period. The reason for this kind of shedding may generally be a factor caused by an outer source a few months ago. In our daily life, we all face such factors that cause this kind of hair shedding. Sometimes flu or even distress may cause hair shedding. Factors that may cause Telogen Effluviuma are as follows:
In babies after birth:
  • Chronic disease,
  • After pregnancy,
  • Chemotherapy,
  • Serious infections,
  • Serious psychological distress,
  • Serious operations,
  • Hipo and hipertroidism,
  • Anemia,
  • Certain medicines,
  • Long journeys that may cause jetlags,
  • Heavy metals (selenium, arsenic thallium)
Such factors damage the hair cycle. While the hair is in the anagene phase (at the beginning of the growth phase) its growing period suffers and it passes to the retrogression phase, called telogene phase. Hair starts to shed in a few months.
Hair stays for a longer period in the anagene phase during pregnancy due to hormones. Hair is in its best form during pregnancy. Hair passes rapidly to the repose phase after birth and this situation causes rapid shedding of hairs. The same situation is seen when birth control pills are quit.

When the factor caused by the outer source is eliminated, hair shedding due to telojen effluvium stops. If the outer source affected the hair roots for a long time, then permanent hair shedding cases may be faced and the treatment may not yield positive results.
If the reason of hair shedding may be detected during treatment such as hipo-hipertroidi, anemia, and diets lacking proteins) the therapy may be shaped in accordance with the problem. Supply of vitamin B and other vitamins such as zinc and application of mesotherapy may be necessary.


Trichotilomania
Trichotilomania is due to physiological reasons in which the person tends to pick his own hair. This kind of hair shedding is on the increase especially when the person feels himself under distress. Generally the person picks his hair but there are cases where he picks eyebrows and lashes. It is seen more frequently in women. In cases where the person picks hair from the same zone, the zone may suffer permanent hair loss after some time. This kind of hair shedding bears positive results thanks to hair transplant operations. The person also needs psychological therapy. Otherwise, the person may continue to pick his hair.Androgenetic Alopecia- Male-Type Hair Genetic Hair LossAndrogenetic Alopecia is the most common type of hair loss seen both in men and women. In this type of hair loss, a gradual thinning is observed on the forehead or crown. The cause for this hair loss is the genetically coded sensitivity of hair follicles to DHT.Hair first get thinner, their colors fade, their numbers decrease and finally the hair follicles perish completely. A father’s suffering from hair loss does not guarantee that the child will go bald, too. Hair loss follows a pattern determined by a random combination of both parents’ genes. This new pattern may as well prepare a future for the son totally independent of the genes he inherited from his father.Genetic androgen sensitivity is most effective in certain areas on the head. The hair ring that takes place between the two ears is defined as “permanent hair”. Hair follicles in this area are not genetically sensitive to DHT and they are alive during one’s lifetime. Thanks to the permanent hair follicules in the hair ring, it is always possible to restore hair with a hair transplantation operation. Follicular Unit Extraction (FUE) Unlike the previsously defined FUT technique, in this technique hair follicles are extracted directly from the level of follicles on the skin. This technique is known as “non-invasive”. In FUE, no scalpels or stiches are used in the donor region and thus no visible scars are left. While extraction techniques are different in FUE and FUT, restoration techniques are identical.This method is based on extracting hair follicular units without using surgical knives. Upper layer of the skin is cut with the help of special needles of 1 mm and the follicular unit is excreted from the bottom tissues without damage with special devices. Each follicular unit contains 2-4 hair and hair roots. Hair where follicles will be excreted is cropped to leave 1-2 mm before the operation. Each follicular unit is transplanted to the hairless zone after application of local anesthesia both to the donor and receiver zone.The advantage of the technique: Small holes where follicles have been excreted become extinct in one week without traces. Sessions may be applied every day and 600-800 hair follicles may be excreted in each session. Totally 3000 hair follicles are excreted, that is 6000-9000 hair roots may be transplanted. Intervals are not necessary between sessions as is the case for classical methods. The donor zone does not suffer apathy, bleeding and scar. As hairy skin band is not taken away from the nape, the recovery takes less time than expected. In cases where there are not enough follicles in the head, follicle units may be transferred from various zones of the body such as chest, back, belly and legs). The number of hair in the head skin of a person does not determine the fact whether the person may be candidate for this operation. Follicular Unit Transplantation (FUT)At the moment the most frequently applied and the most advanced technique is transplanting physiological hair groups called follicular units after extracting them from a strip of hair in the hair ring. This technique has long replaced the technique of traditional mini-micro graft hair transfer.A small tissue containing live hair roots is taken from the upper zone of your nape between two ears. The hair roots in the tissue are divided into single, double and triple micro grafts. Then small and thin channels in the size of a pinhead are formed on the zone where hair transplant operation will be realized and hair roots are injected into these channels. As hair roots are alive, they grow on your head in the same way that they do on the nape. The operation, which is conducted with expert surgeons and nurses, lasts 3-3, 5 hours. It is realized totally without pain with local anesthesia. It does not have any adverse effects. No scars are left in the zones where hair roots are taken from and injected into. You cannot differentiate the transplanted hair from the original ones. As it is your own hair, the colors are the same. They grow together with the rest of your hair. It grows 1-1,5 cm a month. You may have your hair cut by any hairdresser you wish. You may use any shampoo you like. It does not necessitate a special care. As we conduct a dense-hair operation, hairless zones are covered with hair in a single session but if you have a wide hairless zone, you may need two sessions. Points to pay attention prior to hair transplant operations
2 days prior to the hair transplant operation:
  • Do not use alcohol, aspirin and medicine for flu.
  • Do not use lotions that may influence the hair and the hairy skin before the operation.
  • Inform your surgeon of your chronic diseases such as hearth problems, blood pressure instability, diabetes, and gut-rots and of the names of medicine that you regularly use.
Sleep for at least 8 hours before the operation. Wash your hair on the day of operation before coming to the clinic. Come to the clinic with a dressing that is easy to put on and off. Do not have the hair cut on your nape. Have breakfast. Bring a hat with you.What to Pay Attention after the OperationComplying with the below mentioned medical directives will shorten the recovery period:
  • Use regularly the medicines prescribed by the medical staff,
  • Do not drive within 12 hours after the operation,
  • Avoid doing the following within 3 days after the operation
    • Heavy works,
    • Distress,
    • Too much excitement,
    • Sport,
    • Sexual relationship.
  • Do not use alcohol when taking pills.
Hair Care after the Operation Hair care is being applied for:
  • Elimination of possible problems in the hair and the hairy skin,
  • Provision of active substances that the hair and the hairy skin needs,
  • Clearance of natural wastes and gaining live and bright hair,
  • Protection of the natural balance of hair and the hairy skin,
  • Prevention of hair shedding.
This method can be applied to anybody who whishes to have healthy hair. When applied before and after hair transplant, hair transplant and hair care affect each other positively and the results reach excellence. You may wash your hair 3 days after the operation. You should wash your hair with Bephantol lotion and a special shampoo once or twice a day for 15 days and should not make normal massage movements on the hair transplant zone. Bepanthol lotion should be applied on the hair transplant zone and you need to wait for one hour. The Bepanthol lotion is sucked by the skin in one hour and it softens. The nape zone including the stitch zone is carefully washed with the recommended shampoo in normal movements. The hair transplant zone is shampooed. The skin is rinses well after washing with shampoo. After ten days when scars disappear you may wash your hair with your own shampoo. Comb your hair carefully after drying. If you need to use a hair dryer you may use it 5 days after the operation. If you need to work in a dirty atmosphere in the first three days after the operation you must wear a hat. Do not expose your hair to sprays and hair shapers for the first 15 days. Hair may shed in the transplanted zone within 3 weeks but do not panic. Hair will re-grow in 8 weeks. SPORTS ACTIVITIES You may do any sports you like after the general examination of the medical staff and after stitches have been taken. Avoid any kind of exposure to strong sunlight and incidents that may cause traumas and retard the recovery process for 4-6 weeks. Do not swim for one week after the operation. REMOVAL OF STITCHESYou should have the stitches on your nape removed after 15 days. If you consider having your stitches removed in Bosphorus , please ask for an appointment. RECOVERY PROCESS
    • 3 days after the operation: You may wash your hair for the first time and the small bubbles will disappear.
    • 5 days after the operation: Due date of medicines will prescribe.
    • 10 days after the operation: The recovery process of the hair-transplanted zone will be completed.
    • 15 days after the operation: The recovery process after removal of stitches will completely be terminated.
    • 3 weeks after the operation: 60 % of the transplanted hair will shed.
    • 8-12 weeks after the operation: The hair that shed in the 3rd week and the other transplanted hair will grow.
    • 6 months after the operation: The transplanted hair will have grown long enough and you will have it cut at least twice.
Hair Care after the Operation Hair care is being applied for:
  • Elimination of possible problems in the hair and the hairy skin,
  • Provision of active substances that the hair and the hairy skin needs,
  • Clearance of natural wastes and gaining live and bright hair,
  • Protection of the natural balance of hair and the hairy skin,
  • Prevention of hair shedding.
This method can be applied to anybody who whishes to have healthy hair. When applied before and after hair transplant, hair transplant and hair care affect each other positively and the results reach excellence. You may wash your hair 3 days after the operation. You should wash your hair with Bephantol lotion and a special shampoo once or twice a day for 15 days and should not make normal massage movements on the hair transplant zone. Bepanthol lotion should be applied on the hair transplant zone and you need to wait for one hour. The Bepanthol lotion is sucked by the skin in one hour and it softens. The nape zone including the stitch zone is carefully washed with the recommended shampoo in normal movements. The hair transplant zone is shampooed. The skin is rinses well after washing with shampoo. After ten days when scars disappear you may wash your hair with your own shampoo. Comb your hair carefully after drying. If you need to use a hair dryer you may use it 5 days after the operation. If you need to work in a dirty atmosphere in the first three days after the operation you must wear a hat. Do not expose your hair to sprays and hair shapers for the first 15 days. Hair may shed in the transplanted zone within 3 weeks but do not panic. Hair will re-grow in 8 weeks. SPORTS ACTIVITIES You may do any sports you like after the general examination of the medical staff and after stitches have been taken. Avoid any kind of exposure to strong sunlight and incidents that may cause traumas and retard the recovery process for 4-6 weeks. Do not swim for one week after the operation. REMOVAL OF STITCHESYou should have the stitches on your nape removed after 15 days. If you consider having your stitches removed in Bosphorus , please ask for an appointment. RECOVERY PROCESS
  • 3 days after the operation: You may wash your hair for the first time and the small bubbles will disappear.
  • 5 days after the operation: Due date of medicines will prescribe.
  • 10 days after the operation: The recovery process of the hair-transplanted zone will be completed.
  • 15 days after the operation: The recovery process after removal of stitches will completely be terminated.
  • 3 weeks after the operation: 60 % of the transplanted hair will shed.
  • 8-12 weeks after the operation: The hair that shed in the 3rd week and the other transplanted hair will grow.
  • 6 months after the operation: The transplanted hair will have grown long enough and you will have it cut at least twice.
Hair transplant operations have been conducted for how long in Turkey and in the world? Hair transplant operations have been conducted for 20 years worldwide. This is a sector that has constantly been growing for the last 10-15 years. Hair transplant is one of the sectors that plastic surgery is supporting. Does hair transplant operation cause any health problems? Does it have any adverse effects? If the hair transplant operation is conducted by an experienced staff, it does not have any adverse effects. When the necessary applications after the operation are applied completely, hair transplant operations do not cause any health problems. Our hair transplant staff can conduct hair transplant operations with no scars thanks to its latest technique. - How many hair transplant techniques are there? There are two kinds of live hair root transplant techniques. Hair roots are transplanted as tissue particles called follicles. The first technique is follicular unit transplantation (FUT) and the second technique is follicular unit extraction (FUE). Both techniques provide hair root transplantation. The techniques may be applied together. The purpose is to transplant as may hair roots as possible in a single session. - Hair transplant operations are applied to whom? What are the qualifications to have a hair transplant operation? If your hair has thinned or weakened or if it has started to shed, if healthy hair exists on your nape and if you do not have a serious disease, then you may have a hair transplant operation. - How long does the operation take? How many applications are possible?Hair transplant operation takes nearly 5-6 hours. In the FUT technique 2 or 3 sessions may be applied with an interval of 6 months. 5-8 thousand hair roots may be transplanted in one session.In the FUE technique 7 or 8 sessions may be applied with an interval of 3 days. The number of sessions depends on the number of hair roots to be transplanted. 500-100 hair roots are transplanted in one session. When FUE technique is preferred for clients who wish to have a hair transplant operation, it is an expensive technique that takes too much time. - Do people who have hair transplant operations suffer hair loss? The transplanted hair has the character of not shedding and it does not shed as long as the person does not suffer cancer or a hormonal disease. - Does it require special care after the operation?The client is advised to wash his hair with a special lotion and shampoo after the operation. He needs to use lotion that prevents shedding for hair, which tends to shed. We recommend the clients who are prone to suffer too much hair shedding to receive medical treatment. - Can you describe your client portfolio? Our clients are mainly educated and modern men and women who give importance to quality.- What are your recommendations for those who wish to have hair transplant operations? When hair shedding is detected in the early phase, it yields more positive results as is the case for all other health problems. We recommend that those whose hair has started to shed or whose hair has already shed had better have hair analysis in our clinic.

 


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