Turkish Hairlines
Every day in Istanbul, thousands of men from all over the world try to preserve their youthfulness with a hair transplant. According to statistics there were over one million in 2022. Who are the young men who want to save their hair in Istanbul?
"Get ready for space!" jokes the anaesthetist as he administers the anaesthetic ketamine to 26-year-old Felix Hofmann by infusion. After a few seconds, the shaven-headed young man on the couch is no longer responsive. The surgical team begins its work immediately and injects a mixture of saline solution and local anaesthetic into his head. The skin bulges like bubble wrap, with each injection creating a small, bulging bubble. This facilitates the removal of around 4,500 hair follicles from the back of the head, which are reimplanted in the bald areas at the front of the head. Felix will not be able to remember the first two of the eight hours of the procedure.
A younger friend finally provided the initial spark: "He also suffered from receding hairlines and decided to have a hair transplant." Felix was impressed by the quality - and the price: a weekend in Istanbul with surgery, hotel stay and taxi costs around 2500 euros, only the flight has to be booked by the patient. "In a world driven by social media, in which youth and vitality are seen as the ideal, hair loss symbolises the loss of this apparent youthfulness," says Felix. Unlike a beer belly, it can't simply be trained away. Hair loss is a natural thing: up to a third of all white men show signs of baldness by the age of 30. "Despite this, I've never seen a young man with hair loss in a Netflix series or advert," says Felix. "Our society often automatically associates hair loss with being old, which I find problematic." Felix knows men in his circle of friends who have been hit hard by their hair loss. "Some of them only wear a cap, avoid social life and become totally obsessed. It was never that extreme for me. I tended to ask myself: what can I do to change it?"
After a half-hour taxi journey, Felix arrives at the clinic in the north of Istanbul. An ultra-modern skyline of luxurious buildings sprawls along unfinished streets - the urban landscape gives the impression of being stuck in concept. In the entrance area, Felix is greeted by two uniformed receptionists. One of them no longer has a natural larynx; when she speaks, she presses the small button on her neck to produce a robot-like voice. The artificial sound blends seamlessly with the futuristic atmosphere of the foyer, where a huge bust stands in the centre, illuminated by a projector with wacky sequences. Men with head bandages sit scattered on sofas and at tables; many look as if they have just woken up from a dream. Crockery is rattled in the canteen and the smell of freshly brewed Starbucks coffee can be smelled. On one wall hangs a work of art made of clocks running backwards. "The biological clock is being turned back here," says a doctor proudly later.
Elithair, which describes itself as the world's largest hair clinic, carries out around 15,000 hair transplants a year on an area the size of 2,521 football pitches. Around 80% of all patients come from Germany. The company operates six branches in Germany and its advertising is aimed almost exclusively at the German market. There are 68 hotel rooms within the clinic where patients can stay overnight after their operation. Istanbul is known as the world's Mecca for hair transplants. There are estimated to be several hundred clinics in the city. A meme circulating on the internet shows an aeroplane cabin full of men with head bandages - instead of the well-known "Turkish Airlines" logo, it jokingly reads "Turkish Hairlines". Dr Abdulaziz Balwi, head physician at Elithair, sees social media as a decisive factor in the hype surrounding hair transplants. Twelve years ago, most of his patients came from the Middle East. "They often stayed in Istanbul after the procedure until their hair had completely grown back - to make sure that nobody in their home country found out about the operation." Nowadays, well-known personalities such as football legend Francesco Totti make their hair transplants public. Dr Balwi has already undergone two operations himself and is planning another one in around ten years' time. "Every time I look in the mirror and see my hair, it makes me very happy."
For thousands of years, the fight against hair loss has united men from all over the world.
For thousands of years, the fight against hair loss has united men from all over the world. Buddhist monks regard baldness as a sign of wisdom and spiritual development. But in most other parts of the world, luxuriant hair symbolises strength and virility in men. To preserve it, the ancient Egyptians massaged their heads with hedgehog spines soaked in oil or brewed obscure potions from dates, dog paws and donkey hooves. On the other side of the Mediterranean, Socrates provided philosophical advice on hair loss: grass does not grow on busy streets. In the 1930s, the Japanese dermatologist Dr Shoji Okuda revolutionised the treatment of hair loss. He removed small pieces of skin with healthy hair follicles from the back of the head and transplanted them into bald areas. Originally developed to treat burn scars, his procedure laid the foundation for today's hair transplant techniques. In the 1980s, the hair loss-inhibiting effect of minoxidil, once a high blood pressure medication, was discovered. This was followed in the 1990s by finasteride, which also treats prostate problems. Both drugs have side effects and require long-term use.
For Felix, medication was not an option: "A hair transplant is the least risky and most effective remedy for hair loss." He takes a seat in front of a large mirror. The Turkish doctor begins to measure his head and pulls on Felix's hair several times to check its strength. "We manage to put in about 75 hairs per square centimetre. Only God can do more - with 100 hairs," the interpreter remarks proudly. The doctor draws the lines with a felt-tip pen, which represent the future hair growth. "The line seems very high to me," remarks Felix sceptically as he looks at the first draft. After each adjustment, the translator turns to Felix: "What do you think now?" Finally, Felix is satisfied with the result. Now the final number of grafts to be implanted is determined - there are about a thousand more than initially assumed. Grafts are small pieces of skin that contain hair follicles and are harvested individually. The difference is paid directly by credit card at reception. Finally, Felix's head is completely shaved. It is already evening and the employee tries to cheer Felix up: "Oh, Germany!" he shouts, proudly naming a few Bundesliga football teams. Instead of more hair, Felix now has none at all. This will only change again in a few months' time.
Felix is sitting in the hospital canteen early in the morning on the day of his operation. In front of him is an empty table - he hasn't been allowed to eat or drink since midnight. "I was super nervous when I went to sleep and was terrified that I wouldn't wake up in time. Now, strangely enough, I'm super relaxed". As the interpreter is not yet there, the blood results are analysed with the Turkish doctor using Google Translate and hand gestures. Felix is then transported to the operating theatre with two other shaven-headed patients. In the mirror image of the lift, the three men observe each other as if they were newly created androids in a sci-fi film meeting for the first time, and Felix is asked to change. The corridor to the changing rooms, illuminated by dazzling LED lights, looks like a passageway to another dimension In a sterile surgical gown, he makes his way into the operating theatre accompanied by an assistant.
After Felix is put into the "deep sleep" advertised by Elithair using a ketamine infusion, the medical team immediately begins the procedure. "I didn't notice anything, which was very pleasant". The doctor injects a combination of saline solution and local anaesthetic into his head, after which the assistants start removing the 4,500 grafts from the back of his head. Using a specialised hollow needle equipped with a micromotor, the grafts are loosened before being removed individually with forceps. This is the bloodiest and potentially most painful part of the procedure, especially in the days that follow. When Felix regains consciousness around two hours later, the doctors are already in the middle of implanting the grafts. They use a special pin to insert the grafts individually into the scalp. This procedure avoids incisions in the scalp and is painless. "It feels like a strange head massage," comments Felix as he listens to a podcast on his airpods. At 12 o'clock, Felix is allowed to eat a schnitzel and some vegetables. "I'm still pretty trippy. Everything is moving!"
It is already evening and the operation is drawing to a close. Felix is relieved: "After so many hours, I'm really glad to finally be able to get up again." After the last grafts have been inserted, the doctor's assistant takes a few pictures with his phone for documentation purposes. He also takes a selfie with Felix. Finally, a so-called PRP treatment is carried out, whereby the patient's own blood is taken, centrifuged to extract the platelet-rich plasma and then injected into the scalp. This is intended to strengthen the newly transplanted hair follicles and stimulate hair growth. The area at the back of the head from which the hair was taken is carefully bandaged. "The donor area looks really tough," says Felix as he looks at the photos he has just taken. "The next hurdle will be the night. I'm only allowed to sleep on my back to prevent the grafts from falling out." After a half-hour recovery period under supervision in the lounge, Felix makes his way somewhat unsteadily to his room. He spends the rest of the day recovering and writing to his parents and friends about the operation.
Despite a lack of sleep for fear of toppling over into his favourite sleeping position, Felix feels no pain the next morning and does not need any painkillers in addition to the antibiotics. During the final examination, the doctor praises the exceptional density of the hair in his donor area, which is why he is honoured as the patient of the day with the most transplanted hair. His bandage is exchanged for a headband and shortly afterwards he is ready to leave. At 16.15 he is already on the plane to Berlin. To protect him from the sun and dust, he is given a hat from Elithair, in blue of course and with the appropriate branding.
Seven months later, Felix is sitting in his living room while the rain pours against the windows outside. It is early December and he is working from home. His hair has grown back and his former receding hairline is a thing of the past. With a proud smile, Felix reports: "I hardly think about it any more." He is happy with the result: "Of course I feel a bit more confident now." However, these months were not entirely free of challenges: "After a while, I noticed that a lot of my hair was greying." Concerned, he sought advice from the hair clinic, who said that this was not possible. On Reddit, he came across similar experiences from other patients after a hair transplant: "It seems as if the hair turns grey for a short time in a kind of shock state." In the meantime, however, everything is back to normal. He does not use the many chemical aftercare products recommended by the clinic. "I rub rosemary oil into my scalp every two days to stimulate blood circulation. I think everything else is a money-making exercise." Felix would have the operation in Turkey again, but admits that he felt a little let down afterwards. "I'll never know whether the current result even corresponds to the norm or how much hair has actually grown." The battle against hair loss seems to have been won - at least for the time being.
