linchpin

Thanks again Talizi. This is something I mentioned earlier, that it's nice to have a surgeon who will tell you the truth and not try to make claims that aren't supported by the evidence. It's important to have an honest relationship with your surgeon so that you can trust his advice and guidance in what could otherwise be a very stressful situation, and that's something I found to be very helpful when I had my procedure with you. There was never any attempt to evade any of the questions I asked, and the answers I received were always straightforward and explained properly to me. I have seen material from some clinics where they claim to have virtually 100% success rates with FUE follicles but common sense dictates that with this kind of procedure there will always have to be a certain amount of transection, so I think I would take it with a very large pinch of salt if my surgeon told me he could achieve a loss of only 1%. As a final note, I have been thinking about the FUE procedure I just had. There's no way I can claim to be any sort of expert, but I would have to say the FUE extraction method used seemed very precise and involved the minimum amount of disturbance to my scalp. It strikes me that a surgeon using a well-designed powered instrument should be able to make incisions that are at least as delicate and precise as someone who has to manually force the punch into the scalp at the same time as aiming it properly at the target follicle!

Also a question for you Doc: I think Surfarosa has an interesting point above. As your methods are clearly more precise than most other clinics and as your assessments are based on actual data (instead of guesswork), in combination with lengthy discusions with the patient, do you think your clinic might consider leading the way in presenting each patient with a short report on your findings? It would only have to be a small one-page assessment of the pre-op and post-op condition of the patient's scalp, and your recommendations for the future, based on current observations. As Surfarosa has said, this could be used by the patient as the basis for any further treatments needed. I know you like to stay at least one step ahead of other clinics and I'm sure you already keep a file for each patient, so do you think this sort of thing would be possible, or indeed useful?

Hello again Doc, nice to hear from you and thanks for those great photos. As I mentioned, everything has been super since I had my procedure with you 3 weeks ago (except that I'm still waiting for my shaven donor area to cover over fully with hair again, so I still have to wear a hat for a few more days!) And in response to your post Happy, it's true that there really wasn't any pain to speak of, and the very next day after the operation I was more than comfortable with the idea of going on a sightseeing tour. And the swelling from the op really did vanish overnight. Thanks again Doc. If I ever need any more transplanting done (and let's hope I don't), I wouldn't think twice about going anywhere else - I'll be straight on the plane to Georgia to see you again! I might just have to visit anyway, to partake of some more of that lovely Georgian wine...

Thanks Happy. It's true what you pointed out - the procedure I had was a very open and transparent affair. I was encouraged to ask as many questions as I liked and to take an active part in the pre-op calculations etc., and I felt that the doctor was happy to explain every stage to me because he knows his techniques are some of the best around. In answer to your question about post-op swelling: On the evening of the operation my head did indeed look quite swollen. Dr Tsilosani had mentioned to me several times during the day that this would happen, but he said not to worry, because it was just the immediate effect of all the anaesthetic solution that had been pumped into my scalp and it would all be gone by morning. Sure enough, next morning the swelling had completely gone. I was taken back to the clinic for a quick checkover and to have my hair washed very gently by one of the assistants, and after that I was quite ready to go out on my free tour of the local region (with a hat on, of course). There was never any pain, just a little discomfort from the donor area for the first night or two, when trying to sleep and needing to rest my head on something. The doc gave me some aspirin/paracetamol to take for the first 2 nights to make it easier to sleep with the discomfort. I would be happy to email the doc to ask him if he would like to take part in the forum; I was planning to email him anyway to let him know how I've been getting along since the procedure. One thing to bear in mind though - although Dr Tsilosani's English is perfectly good enough for conversation, his writing comes across much less clearly so you will have to bear this in mind when reading posts or emails from him. But if you have very specific questions of your own I would still recommend that you get in touch directly, by emailing the clinic or even calling them to speak directly with the doc (assuming he's not in surgery when you call). As I said, he comes across as a genuinely nice man and is very easy to talk to.

Hello Happy, I'll do my best to answer those questions for you. First of all, the miniaturisation: I understand now what you mean about the fading hairs that are on their way out. When the camera views of the donor area were brought up on screen it was easy to see that a few of the hairs showing were not very vigorous. But these were ignored when the donor density count was done, so there was no need to make an adjustment afterwards. Only the strong, thick hair follicles were part of the actual count and the weak ones were dismissed. Regarding the decision to do the FUE first, you may be right about it helping with the closure. It did seem as though the FUE extractions were done using a motorised device; it sounded a little bit like a dentist's drill. But the extractions were instantaneous, just like using a punch - one quick jab and the follicle was extracted; no pain or anything. It's possible the motorisation was a cutting device, or it could have been some kind of suction tool, I just don't know. Dr Tsilosani seemed to be very keen the whole time on minimising any kind of trauma to the scalp, and his technique is meticulous, so I would think his method for FUE is just as good as his strip procedure. My FUE donor area has been absolutely fine since the operation, and there is no evidence of any bumpiness/cobblestoning or scarring here at all (in fact, I can't even feel the FUE extraction sites any more as they have nearly healed up already. There are just a number of faint 'pink spots' still remaining like little freckles, and if I run my finger over them the area is perfectly smooth). But if you have any doubts then it might be worth contacting the clinic to ask for more detail, as my expertise in this is limited to what I observed during the procedure. I'm sure Dr Tsilosani would be happy to answer any questions - he's a genuinely nice man and I found he will give you a straight answer to a straight question. BTW, I just had a look at the 10-minute video on the Talizi website and everything shown there is exactly as it was during my own procedure, from start to finish. I even recognised some of the nurses! There are also some photos of the clinic hosting training sessions for some Indian nurses - I wonder if some of Dr Madhu's staff in Hyderabad did their training at Talizi..?

Tom is absolutely right. While I was at Talizi having my procedure I did a quick mental calculation of all the costs involved. As far as I could tell, once you have the clinic up and running your only costs in performing an operation (apart from labour) are for a few swabs, syringes, bandages and anaesthetic. What do these add up to for one transplant? Maybe fifty Euros or so? A hundred? Then after you include the overheads and wages for a team of 12 people, the total cost would probably still be much less than 1,000 Euros per session, so the vast majority is profit. That's why I think the British clinics are ripping us off by charging 3 or 4 times as much. By the way Tom, that's an excellent price you got in India, I hope it's working out for you. I didn't come across any reviews for that clinic when I was researching and decided upon Talizi. I'm very glad I went to Georgia and the results have been great so far, but I would also have been interested in comparing Georgia with India if I had known it was another good option.

Yes, of course an implant density of this level would require a very good donor capacity and I don't know whether this applies to me or not. I'm not sure if you read my post above, but basically the implants in the hairline region were planted very densely (I can't give you a figure on the density as I have no idea, but they look pretty thick to me!). And most of the 2-hair and 3-hair grafts were placed further back, mixed amongst my existing hair and in the crown. In the pre-op we'd had a full discussion of what I wanted from the operation and how each of us thought it would be best to distribute the grafts. This was a frank and open discussion, where the doctor learned about my expectations and I learned a little about how best to obtain optimal results. Akaki is clearly very skilled, and has performed hundreds of operations so I was happy to listen to his advice, and I think we were definitely on the same page here. He did mention 'shock loss' and said that I could expect to see some over the first few weeks. But he said the minimally-invasive techniques and speed of operation should help to mitigate this as far as possible. I guess I'll just have to wait and find out!

OK, here goes... It's lucky that I ask as many questions as you do, because some of this information was covered in our pre-op. I'm only going from memory here, but I believe the strip was 29cm across (basically from above one ear to above the other ear). The depth was (I think) around 27mm at its maximum. Note that not all of the extracts were taken by strip method - only 2,860 were done this way, and the remainder were FUE. In our pre-op discussion the doc reckoned he could guarantee that 2,800 could be obtained by strip, and the extra 500 FUE were offered as an option to supplement the total if I wanted it. Well, I was never going to get a better opportunity, so I went along with this plan and we agreed that the target was to be 3,300 grafts altogether for a total price of 3,800 Euros. This result was guaranteed by the doc before we started the operation, and he said that if we got any more than this out of the strip then I would get the extras for free (and I did get 60 free in the end). As for the breakdown, again you're in luck because I did request those numbers from Akaki before we finished (actually, I saw them for myself all laid out in groups of ten on the petri dishes). Out of the 3,360 total there were 500 single-hair, 685 triples, and the remaining 2,175 were all doubles. That gave an average of about 2.1 hairs per graft.

We were chatting about this while the holes were being made. As I mentioned, Akaki has an electronic system for displaying the number of implant sites created (please don't ask me how it works!), and so the procedure went like this: First of all he started at the hairline and punched out all the single-hair sites there. The electronic display reported back the number of sites instantaneously, so he was able to go at high speed with this, and it enabled him to match the number of sites with the actual numbers of grafts of that type that were being harvested. Then he changed to the 3-hair punch and did the crown region. Finally, the 2-hair punch came out and all the remaining sites across the top of my head were done. I think he said the punch sizes were something like 0.5, 0.7 and 0.9mm, but don't take my word for it. Akaki actually showed me the different punches, and I'm quite sure the punch was changed for each stage.

This is a good question, and one that is particularly difficult to answer. I first came across the Talizi clinic when I was researching for my first procedure 3-4 years ago, but at the time I was new to HT. So even though the Talizi clinic looked appealing then, the whole concept of HT was scary enough in itself without having to think of going overseas to a non-EU country as well! I think that for my first procedure I just felt a whole lot safer staying in my own country and getting the procedure done in London, even if it cost me three times as much. But this time around, things were different. I now know that HT works, so all of the technical questions I don't need to worry about. The only question this time was which clinic is offering the best value and the best possible outcome? Once again I came across the Talizi clinic and to be fair, the more I checked them out, the more satisfied I became that they would be able to do a good job (try this for yourself - email them a bunch of questions: The answers that come back will be written in terrible pigeon English, yet clearly they know what they're talking about). As for Dr Humayun's clinic, it never really crossed my radar very much. He may be well-known in the HT community, but I found his website difficult to navigate and his prices weren't immediately obvious. (Don't get me wrong: I'm sure this is an excellent clinic, it's just one that skipped passed my radar a little). Also, I was concentrating more on getting the procedure done either in the UK (for about GBP 8,000) or not too far away for a much lower price (GBP 3,000) - and Georgia is probably the closest place that has a clinic with such good prices. And once I started emailing them, I was happy with the responses I got and I suppose it all just carried on from there..

The computer system used to measure the donor density involved a kind of camera that was placed directly onto the shaven skin in the donor area. This was connected directly to a computer, which produced an image of a fixed-size area on the screen, and from there it was possible to see and have the computer count all the donor follicles in that given area, and what type they were (1, 2 or 3-hair follicles). He showed me all of this on the screen as we went along, and I was welcome to ask as many questions as I wanted about the process, and to take part in making the calculations if I wanted to. This test was done in different parts of the donor area to get an average result, so this produced a figure for the average donor density. This, combined with an assessment of the 'laxity' of the skin in that region, formed the basis for the doctor's calculations regarding the depth of strip that could be obtained, and therefore the expected donor quantity. At the end of this process he also had to make an adjustment for the old scar area - because this was to be cut out as part of the new strip, it was necessary to adjust the final total downwards slightly as not all of the strip area would be producing the same kind of density as the main average. I'm not sure what you mean by the 'percentage of miniaturisation' - but the screen images were obviously scaled so that the density was calculated per square centimetre.

Yes, the pre-op consultation was entirely by email. The clinic did provide me with their telephone number but I figured that it would probably cost quite a bit to put calls through to Georgia. Dr Tsilosani asked me to email him some photos of both the donor and recipient areas so that he could make his own judgement in addition to my suggestions of what I thought was needed. At this point there was no discussion of how many grafts he thought he might be able to harvest; we only discussed the number that we thought might be needed to return my head to a reasonably natural-looking state. This number was 3,000 - 3,500 grafts. I was advised to do some massage exercises on the donor area to improve 'laxity,' which I understand to mean flexibility of the donor area skin tissue, and I did the exercises daily before my trip.

Wow! That's a lot of questions! I'll do my best to answer them, but bear in mind I'm just a patient so I might not know all the technical details you're asking for...

Happy, I just noticed I forgot to answer your question about 'greater density.' Well, it seems the good doctor has not stood still over the years, and his clinic is also involved in ongoing research into new methods. Apparently he visits other clinics around the world to learn and also gives lectures on the techniques he develops. Anyhow, this leads me on to the density thing. He showed me some pictures of research he's done over the years into methods of achieving high densities of implants, almost up to natural density. He said he can comfortably achieve over 100 grafts per square centimetre for the average patient. If I look at the hairline he's just implanted for me I can see that the density is really thick - it's almost scary how natural it looks, when only a week or so ago there was nothing there at all. The follicles at the front were all implants of single-hair follicles (this avoids the 'dolls-hair' look that you might get if you implant 3-hair follicles there) which makes it even harder for the surgeon to do, yet the result has been outstanding. Further back the implants are a bit more spread-out, and this is the region where the 2-hair and 3-hair follicles are planted (most of the 3-hair ones went in my crown). But in this area the hairs will be allowed to grow out longer, according to my hairstyle, so there is less need for such dense implanting here.

Hi Happy, thanks for your kind comment, I appreciate it. I'll do my best to answer although I'm no expert in this area so I'm not totally clear about which particular things may have helped. I can tell you that the results seem to be excellent, my hairline is back to where it was ten years ago and everything behind it looks as though it will grow out to be dense and natural-looking again. What I can do is talk about the difference between this procedure and the first one I had in London, but that's about as far as my expertise goes. First of all, the faster healing and less trauma: Dr Tsilosani (I'm going to call him Akaki, as we were on first-name terms during my visit anyway) seems to do a number of things that make the procedure easier on the patient. The anaesthesia was swift and painless (he managed to numb my entire head with just two injections in the eyebrows) and the implant sites are punched in varying sizes to fit each follicle depending on whether it contained 1, 2 or 3 hairs, so that a very tight fit was made around each implanted follicle. (Back in London the implant sites were created using a scalpel rather than a punch. The scalpel slits were clearly much less accurate and had much more bleeding than Akaki's method). But the decisive factor seems to be that with a dozen people all working on me at once they were able to get the grafts separated and implanted again within a very short time (back in London there were only 4 people including the doctor, and it took all day to do just 1300 grafts). A key factor in the survivability of grafts is the length of time they spend outside the body, so by operating with such a large and efficient team at the clinic they were able to reduce this time to a minimum. Also, the healing of the implant sites was helped by the short time it took from punching each hole to filling it again with a transplanted follicle. From the little bit of medicine I know, it's obvious that this is a good thing and it helps with healing if you can minimise the time it takes to complete the operation. I think all of the above might account for some of what he means by 'less trauma.' Basically, I can't imagine any way the process could have been done any more accurately or efficiently than it was. As for results, in my case I experienced much less bleeding than I had after my first procedure (I was pretty much clear by the second day) and the implant sites have been less sensitive. Now a week or so later my head feels almost like normal. Also, a major difference was the way the strip at the back of my head was closed up. Back in London, it was just a quick stitch-up job with little thought given to how it might heal. I remember I had a bumpy ridge around the back of my head that lasted for a couple of months afterwards, and the closure was not particularly straight or tidy. Akaki used a different technique, and it was a trychophytic closure. I couldn't see what he was doing (as it was at the back of my head!) but he explained the technique to me on a bit of paper afterwards. He also used some excellent clamping devices that he said he had developed himself, and these helped make the closure a quick and easy process. He also cut out the old scar when taking the strip, even though this meant the number of grafts available would not be so high (The hair density in scar tissue is lower than that in normal scalp tissue, so, by opting to extract a strip containing scar tissue he actually reduced the average donor density and also the amount that he was able to charge me for the procedure, in order that I would have a neater result at the back of my head). Certainly the result here was much better than last time. At the end of the procedure I had a chance to look more closely in the mirror, and I could see the closure was perfectly straight and very tidy, with almost no sign of blood. Apart from some tension at the back of my neck (due to having the remaining skin stretched over the strip) it has been absolutely fine, and there's no bump this time - the back of my head feels smooth. You also asked why the doctor started with FUE. I asked the same question and he explained that, as the FUE extractions are made in the area above the strip, it helps with elasticity to take them out first. That is to say, by making holes in the skin above the strip it will make it easier for him to pull the two sides closed again afterwards because there is more flexibility in the skin above if it has a few holes in it. As I said, I wrote the first post because I thought it might help other people who are considering this clinic. When I made my decision to go there I had very little information to go on, so I would have welcomed any review by someone who had been there before me. Now if just one other person on this forum decides to go there too, then they can come home and write another review and we might start to build up a picture about this clinic and how good it is. Given that their prices are about a third of the prices in the UK and their techniques are at least as good (or probably much better), if the British clinics start losing patients to places like Georgia and Pakistan it might make them reconsider the outrageous prices they charge, and that would be better for everyone! Cheers.