Questions related to hair surgery

It is very important that the patient is in good condition, both physically and mentally. If the patient has had or has a chronic or serious illness, it is advisable to request authorization for surgery from the specialist who has treated the illness. It is also essential that the patient provides as much information as possible about his or her condition and medical history.

Tobacco is one of the most common addictions, but it is also one of the worst in terms of health. The effect of tobacco on the skin tissue means a clear reduction in the supply of oxygen, so the healing will be different and recovery will be slower. Similarly, there is a greater risk of complications in procedures performed on patients addicted to tobacco. Although smoking is not in itself a contraindication for surgery, if you are thinking of having a surgery of this type, it would be ideal to stop smoking at least two weeks before the procedure.

Ideally, the following guidelines should be followed before undergoing surgery:

  • It is advisable to stop taking, two weeks before the intervention, medications such as aspirin, omega 3, vitamins, Minoxidil, garlic herbal preparations, Ginkgo Biloba, and, in general, any type of medication that has not been prescribed by your doctor. Pain medication should also be avoided for three days prior to transplant.
  • If the patient is diabetic, suffers from high blood pressure, or has any other important medical problem, he must be well controlled before the procedure. If you suffer from psychiatric problems, it is advisable to talk to your family doctor so that he or she can authorize the procedure.
  • If the patient is a smoker, it is best to stop smoking as much as possible about two weeks before the procedure.

No es necesario tomar ningún medicamente para el pelo trasplantado, aunque puede ser una buena alternativa para evitar la caída del pelo original.

Ideally, you should wait an average of 6 weeks after surgery.

A maximum of 50% of the follicles in the donor area can be removed, although only 20% of the follicles are used in a single session.

Depending on the degree of baldness, one or more sessions can be performed. The higher the level of alopecia, the greater the number of follicular units needed to correct the problem, and therefore the lesser the possibility of the receiving area being completely covered in a single session.

No. The body can only accept follicles from the same person. The procedure works just like any organ transplant, but the hair itself does not receive immune rejection.

Anyone who has a donor area with any of these characteristics will not be considered a valid candidate:

  • A very small donor area.
  • Very low capillary density.
  • Very thin and fragile hair.
  • Uncontrolled active diseases in the scalp.
  • Alopecia areata.
  • Tendency to keloid scarring (i.e. a very thick and painful scar).
  • Having an active infection in the donor or recipient area.
  • Hypertension, diabetes or uncontrolled psychiatric diseases.

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Common questions and answers about hair grafting

It is very important for the patient to report any significant and/or recent medical history and tests, especially if he or she has a blood condition such as hepatitis C or HIV. Our medical team’s priority is always to ensure the patient’s health, so having as much information as possible about their medical and hair condition is essential. We will do a blood test before the intervention to check the following aspects: complete emochrome (CBC), glucose, sodium, potassium, creatinine, ALT AST, bleeding time (PTT, TTPA, INR), hepatitis and AIDS tests (HBs Ag, anti-HBs Ag, BHC and HIV). These tests are carried out by the hospital’s own medical staff, and the patient is always required to inform the surgeon, before leaving his or her country and through the staff in charge of clinical communications, if he or she has any diseases or allergies related to the regular use of certain medications. All medications that could induce bleeding, such as aspirin or Coumadin, should be notified to the physician and should be removed if ordered by the physician. It should also be borne in mind that if the patient tests positive for any of the above-mentioned diseases, the procedure cannot be performed, based on the obvious risk it would entail for both the patient and the medical team. If you are not sure whether you suffer from any of these diseases, we recommend that you have a prior test in your country of origin.

The guarantee includes a commitment to the success of the transplant, as well as to the quality and naturalness of the transplant. If these results are not obtained, the patient can be operated on again without any cost, except for the return trip to Turkey.

We are asking for an advance payment for the sole purpose of ensuring that your decision is firm and that it has been thought through with maturity. If the operation cannot be carried out due to major causes (accident, hospitalisation, death of a close relative), the advance will be reimbursed. In order to be able to reorganize the surgery sessions in case of cancellation, we ask you to give us a minimum of three weeks notice so that we can reimburse your advance. The payment of the remaining balance of the operation is made on the day of the surgery. A detailed invoice will be given to you after the surgery.

Self-transplantation is a matter of aesthetics, so the motives are always personal. Hair is one of the most important elements of a person’s physique, but we must also bear in mind psychological factors: sometimes hair loss can lead to self-esteem problems or something more serious. Recovering hair means recovering confidence and increasing self-esteem, so there is no precise period to determine when to do the transplant: it is the patient’s decision.

Generally, the patient does not feel any pain during the procedure, and neither after the intervention is finished, since the area where the graft is going to be done is anesthetized. Slight discomfort is rare and disappears with the use of common painkillers, but it is generally a painless practice.

The duration depends on the number of grafts to be transplanted, but usually lasts on average between 6 and 8 hours. During this period of time, the patient will be able to watch TV, read or listen to music, since only the scalp is anesthetized.

The most common surgical instruments used in these operations are the following:

  • Trillix. It is a small drill with a tip diameter of 0.6-08mm. It is used to accelerate the extraction time, allowing the removal of the bulb with a small part of the scalp.
  • Circular scalpel. It is a punch that is used to mark in the skin the follicular unit, since it surrounds it with a circle to establish the distance of 2mm between one unit and another.

The follicular units are transplanted into the scalp through micro-incisions in the skin, where the follicles are later grafted.

It depends on the situation and conditions of each patient. 70% of patients only need to travel once to Istanbul, as the surgeon and his medical staff do everything possible to ensure that the patient does not need to make a second trip. After the transplant, remote medical consultations can be made completely free of charge by sending images to the surgeon to check on the progress.

During the first two or three weeks you will notice the small scabs in the area that has been transplanted, as well as a reddening of the donor area. After these three weeks there will be no trace of the transplant, except for the natural growth of new hair.

As long as the direction of hair growth is correct, something that we take care of in detail because it is one of the most important factors in the success of this operation.

The hair transplant can be performed at any age, as long as the patient is not a minor, and as long as there is a good donor area. In our clinic we receive both young patients and older patients who wish to leave alopecia behind by taking advantage of technological innovations.

No specific care beyond the basics is required. From the first day of the procedure, the patient should not wash his or her head for three days. In the same way, you will also have to avoid direct exposure to the sun of the transplanted area during the two months following the transplant. After the operation, the implanted hair enters a rest phase and falls out approximately fifteen days after the transplant, pushed by the new growing hair. It is recommended not to use an aggressive shampoo.

The operation is quick and painless, and has no side effects, so the patient can leave the clinic immediately after the surgery.

Multiple types of alopecia can be treated through transplantation.

  • Male androgenic alopecia (90% of cases).
  • Scarring alopecia caused by different causes.
  • Female androgenic alopecia.
  • Aesthetic correction of other skin interventions.
  • Alopecia caused by diseases related to the scalp.

However, it must be taken into account that patients with incipient alopecia in which no preventive medical treatment has been attempted, or those with poor or scarce donor areas compared to the areas to be covered, will not be considered candidates for a hair transplant. In this sense, the intervention will never be proposed to a patient if it is not certain that the final result will be satisfactory.

The following factors must be taken into account when performing a micro transplant:

  • Sex of the patient.
  • Type of alopecia (a detailed medical history will be required to allow an etiological diagnosis).
  • Age of the patient and evolutionary history of his baldness.
  • Degree of alopecia (intensity and extension).
  • Extension, density and elasticity of the donor area.
  • Characteristics of the hair (density, diameter, color, texture, curl, etc.)
  • Extension of the receiving area.
  • Previous medical treatments and surgical procedures (oral treatments, laser, wigs, cosmetics, topical applications, artificial hair, other surgeries, etc.).
  • Diseases of the scalp (seborrheic eczema, alopecia areata, etc.).
  • Scarring disorders (keloids, hypertrophic scars, etc.).
  • Systematic diseases (diabetes, haemopathies, cardiopathies).
  • Pre-surgical studies of all interventions (analysis, Thorax RX, ECG).
  • Psychological profile and motivation of the patient, as well as his expectations.

Hair on the back and sides of the scalp is not affected by the effects of genetically caused baldness. This means that they are programmed to continue growing throughout life, since they do not weaken in the same way as the follicles in the areas that do lose hair. For androgenic alopecia to act and promote hair loss, two factors must be present:

  • The presence of androgen.
  • A genetic inheritance, both from the mother and the father, which causes the follicles in certain areas to be more sensitive to this hormone.

When these two conditions are met is when baldness occurs, but, as you can see, it is an alteration that only affects certain areas, so the hair in the back and side areas is not weakened.

The hair that is transplanted maintains its characteristics no matter how much it is grafted to another area. The fact that it maintains its characteristics is called “donor dominance”, and what it refers to is that hair not affected by androgen will maintain its immunity to this hormone when it is transplanted to an area that had previously been affected. The donor area is characterized by being genetically predisposed to growth, so these characteristics are transmitted to the alopecic area, so the implant is definitive.

The follicles need tissue around them in order to create stronger roots. After all, they need to attach themselves to something familiar in order to start developing in a new environment as if it were their own. To do this, what is extracted and implanted during a hair transplant are follicular units, sets of follicles that are born together. These units usually have between one and six follicles, so there is no tendency to graft isolated follicles. By transplanting complete follicular units, a greater density and acceleration of the process is achieved. In addition, much more natural results are achieved, mainly due to technological advances.

One of the most important aspects to take care of is the direction of the follicle to be transplanted, which has to follow the right direction according to the area. The angulation will be more open as we move away from the first hairline. It is also necessary to take into account the amount of follicular units that we can obtain, since, depending on the area that we have to transplant, we will be able to achieve more or less density. In view of the patient’s expectations, it is advisable to foresee the results of the transplant to a certain extent within one or two decades, since natural hair loses density and this will also affect the grafted hair.

Depending on the level of baldness that the patient presents in the frontal, middle and crown areas, more than one session will be assessed in order to cover the entire receiving area. The number of grafted follicles in each session may be very variable, and will depend on the alopecic area to be covered, the amount of hair that can be extracted from the donor area, the characteristics of the patient’s hair and the expectations of each one.

The first two days after the transplant it is advisable to lead a quiet life, without effort, although it is not necessary to do absolute rest. In about 24 hours a small crust forms on the surface of each graft, which falls after 7 or 10 days. Most of the follicles that are observed emerging from the grafts will fall during the first month. The root, on the other hand, will remain in the rest phase for an average of three months, and those that have not fallen will continue to grow. The transplanted hairs usually begin to grow about three months after the transplant, and then they will grow naturally throughout life. As women and men age, there may be a slight loss of hair density on the head, which could affect the transplanted hair as well.

Of course, as long as there is enough space between hairs to be able to place a new follicular unit: approximately 1mm. The disadvantage is that, due to the surgical trauma inherent to the transplanted area, a part of the native hair will enter the resting or telogen phase and will fall during the two months following the transplant, as happens with the grafted ones. After two or three months, both the transplanted hair and the hair that has fallen out during this phase will begin to grow.

The goal of a hair transplant goes through several stages. Clearly, the final objective for the patient is to recover the hair and eliminate the alopecic areas, but on the part of the surgeon the objectives are various. One of the surgeon’s priorities is to create a natural hairline, since this is the most difficult part of the procedure. The hairline is not really a line, but it is a smooth progression from the naked skin of the face to the hairline, so the most important thing to achieve an optimal result is to create an imperceptible hairline. On the other hand, the second objective of the surgeon is to achieve the highest possible density in the areas where the graft is being performed. To do this, the follicular units are grafted in a relatively strategic way, placing those that have more follicles in the central areas and thus providing a greater feeling of abundance in the hair.

On average, a person without alopecia has more than 100,000 hairs.

In a single day, an average of 100 hairs move. The hair has a continuous growth cycle of approximately 6 years, then it starts a resting phase, and after a few weeks a new cycle begins. Due to the male hormone dehydrotestosterone (DHT) in the sensitive areas, every time a hair falls out, another hair is born, but it is slightly weaker.

The most common cause of hair loss in men is androgenic alopecia (AGA), also known as male pattern alopecia or common baldness. It is related to the effect of testosterone on genetically susceptible follicles, usually those with previous and superior implantation, and causes progressive hair loss in certain areas. This process is called “miniaturization”.

The most common cause in the case of women is called “Chronic Telogen Effluvium”, which, unlike men, occurs in more localized areas. In the case of women, there is a diffuse pattern of long-term hair loss. There are situations in a woman’s life in which hormonal alterations can occur that cause hair loss, such as pregnancy, postpartum, pre-menopause and menopause, among others.

On average, human hair grows 1/3mm per day, and 10 to 15 centimeters per year. Hair can grow throughout life.

Shaving does not increase hair thickness or quality. When you shave your hair it looks thicker, but this is because the roots are the thickest part of the hair, so overall they give an appearance of increased density. However, when the hair finishes growing, it looks exactly the same as before.

No. Both gray and pigmented hair can be transplanted, and both grow naturally.

Androgens play a very important role in hair growth in both men and women. Testosterone is produced mainly in the testes, ovaries and the adrenal glands. Hair loss occurs when testosterone is transformed into another compound, dehydrotestosterone (DHT). At the level of the scalp, this derivative binds to the genetically sensitive hair follicles (normally the anterior and upper area of the head), significantly reducing the phases of hair development. The structure of the follicle receives less blood circulation and the new hairs are weaker and more brittle than normal. The resting stage is also increased which, extended in time, generates little growth, progressive hair loss and, finally, alopecia. Thyroid hormone levels can also affect hair growth.

Do you want more information about the treatment?

Contact FUEMEDICALCENTER and book your appointment with Dr. Cinik to start your hair implant treatment in Turkey