choi technique

[marc4170]

Hi, i had a strip surgery transplant done (1800 grafts) 8 Jan 2007 in Athens Greece using the choi procedure which basically is a type of hyperdermic needle that injects the hairs into your scalp rather than making small incisions and harvesting. apparently they claim to get the hairs closer together (more density) Im still waiting for the results but im feeling quite positive. I need to have at least 1 more procedure maybe in about 10 months time. I was wondering if anybody else has had the same procedure using the choi technique?

[HK500]

I am not familiar with it. Please give us more details as to your surgeon, clinic, weblink, etc ...

[marc4170]

The surgeon that did my HT is Dr. Alex Santo, i was recommended by Andy Hunt who has had 3 HT's by Alex Santo and i saw the results for myself on a one on one consultation these results were so impressive that i made my mind up there and then and booked in for the procedure. Andy Hunt is now the UK contact for the Asanto clinic in Athens Greece and here is his website for anybody that is interested to see. www.headofhair.co.uk

http://www.headofhair.co.uk/

[NervousNelly]

I did check out the site. That guy is certainly interesting isn't he. That was about the best I've ever seen someone post their progress. Many of the pics weren't the best but you could get the idea of the changes. Interesting. Thanks for the post.

[hairroot]

I have read that the results from choi cause pitting. There were a couple of guys on another forum who had very unsatisfactory results from that particular surgeon.

 

Choi

[the B spot]

I am still trying to find out some more information on the Choi Implanter and why it is being sold as device that can place grafts closer together.

 

Just to add a bit of info before I find addition info, it is virtually impossible to make incisions closer than .4-.5mm, even with the highest magnification and incision making device.

 

I am not discounting the Choi implanter, because I don't quite know enough about it, but it is a delivery system that creates the recipient site and places the graft at the same time.

 

I will discover its nomenclature shortly, but I want to know if they are only using it on 1-2 hair grafts and have to sub-divide everything else.

This is just speculation, so I will report back when I have more info or someone beats me to it!!!

[Bill - Seemiller]

It's an interesting concept. I admit, I haven't had any time to research this but it's definitely the first time I'm hearing about it. B Spot will most likely beat me to the punch because I probably won't have any time to research this method more until tomorrow or Wed. But I'll be following this post to see what others have found out.

 

Marc...in the meantime...good luck with your progress.

 

Bill

[hairbank]

I've seen Andy's results before but wasn't aware of this choi technique. I'm interested to learn more.

 

I'm with ya, Bill..........I'll give B spot until Wednesday then expect to see a full, detailed "pinpoint" report of choi including full disclosure of all sources and reference material .

 

B spot............"nomenclature"..........have to admit, I had to look that one up in Webster's Online Dictionary, very appropriate use of the word by the way. I plan to use it in at least one sentence this week.

[the B spot]

Thanks Bank!!!! Gotta love the chance to insert a 5 dollar word every now and again!

 

Anyway, I am putting together all of the information I have gathered into a tidy post of all of the points I would like to hone in on.

 

I hope to have this completed by tonight or tomorrow....

 

Later Guys!

J

[Pat - Community Publisher]

Marc4170,

 

Welcome to our community and thanks for sharing. Dr. Santos at one time was the lead physician for DHI based in Greece. At that time Dr. Santos appeared to be providing quality follicular unit grafting using the Choi implanter pen (as it was called at that time) to both create the needle incision and inject the graft. He believed that the Choi implanter minimized the potential mishandling/damage of the grafts and made graft placement easier and more efficient for the staff.

 

At that time Dr. Santos of DHI was recommended on the Hair Transplant Network. However, Dr. Santos had a falling out with DHI and left them. I no longer had confidence in DHI and I removed them from the Hair Transplant Network.

 

I would like to learn more about Dr. Santos and the success he has in using the Choi implanter, which has not been adopted by North American surgeons. I have seen the Choi Implanter demonstrated at various surgical meetings. When I've asked physicians their opinion about this device they generally feel that it offers little advantage to a clinic that already has mastered the skill needed to successfully place grafts without injury.

 

I would like to get reacquainted with Dr. Santos and his clinic, which has been open in Athens now for just over a year. This clinic could potentially provide quality service to patients throughout Europe and the UK.

 

I'm strongly considering visiting leading/promising clinics in Europe this coming Spring and if his results are compelling I may visit to observe his surgery and patients.

 

It would be great if you could share your photos with us.

 

Best wishes for great growth. Pat

[chucky]

when i had my ht with dhi they used the choi on me.out of 1043 fue i had at the most 200 grafts survive,very poor yield.this may have been down to the individual surgeon.

i recently met a top surgeon from ny and he told me the choi damages the follicle on extraction as it pulls it out quite vigourously

again other surgeons may be better at using it than others and get top results.

2 hts dr norton strip,graft count no idea

1ht dhi 1043 fue poor yield

5mg proscar cut into 5th 2years now

minoxidil foam 5% twice a day on crown for 18 days now

[HK500]

Hi Chucky,

How do you get Proscar cut into 5ths?

[marc4170]

Hi Chucky,

i read your post about your results with the choi and that you were told that the choi implanter can damage the folicle on extraction as it pulls it out quite vigorously.

 

As far as i am aware the choi only implants the folicle and has nothing whatsoever to do with the removal process.

 

For those of you that are interested i will post some before and after pictures when a bit more time has lapsed and i can see some results.

 

1800 grafts

4800 hairs

(a little more info)

[chucky]

hi marc

i thought it was the same tool dhi use for extraction and implanting.correct me if i am wrong but my result speaks for itself,very poor.

hi hk500

i have a small sharp knife,put pill onto a teatowel,cut the top off and then cut into quarters.it cuts easy when the cloth is absorbing the pressure

[Janna]

I don't know if there's an instrument out there we haven't looked at or tried. Our experience with the Choi implanter lasted about 2 minutes. One of the reasons we did not like it was due to the fact that you couldn't get the incisions very close to each other. Once one graft was inserted, the next incision would make the last one pop out. I'm sure there's a learning curve with it. IMO, since we already had a superior technique, we didn't see a need to continue learning a technique with inferior results. I think the instrument does benefit those clinics with less experienced staff or for those who are used to planting in larger size incisions with incisions spread apart more.

[the B spot]

This is a response offered by Dr. Rassman on the Choi Implanter Feb 3rd 2006:

The Choi implanter is just a surgical tool. It makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills with the more traditional transplant tools used throughout the world. An instrument is only as good as the person using it, so I can not package the tool with the technique. The Choi generally requires ??skinny' grafts, which tend to dry out more easily, therefore, this instrument requires special skills, different than those that do not have to make the grafts skinny. Some people believe that skinny grafts do not grow as well. I believe that in the right hands, with the years of experience, skinny grafts should grow as well as chubby grafts. The grafts we make are half way between skinny and chubby, just my preference.

The Choi implanter did not develop a following in the United States. In Asia and other parts of the world, it is very popular. I do not believe that it is any better than anything else that the surgeons have perfected in their native countries.

http://www.baldingblog.com/2006/02/03/what-is-the-choi-implanter/

 

In speaking to two people who have seen the results of the Choi Implanter, they stated the work was OK at best. Poor yield and a "bristle" like appearance seem to be the most common issues with the work.

 

The strip is removed and dissected like any strip surgery, but then the grafts are inserted into the Choi "pen" and then implanted. (The pen itself uses an 18 gauge needle)

The recipient site is made when the needle is inserted into the scalp and then the plunger is pressed to insert the graft.

Obviously, depth control and proper seating could be a problem, in addition to the grafts drying out during this process.

 

It is my opinion that this instrument only benefits the Doctor, not the patient.

Using the pen, a Doctor could reduce his staff by 2-3 technicians that normally would be placing grafts, due to the fact that the Doc is creating the incisions and implanting in the same motion.

 

There is no empirical evidence that this method allows grafts to be placed closer.

In fact, I would have to say that the pen forces grafts to be spaced out wider, due to the fact that the needle acts like an "expander" in order to force the graft into the site.

 

One of 2 problems would seem to occur---- either the incision is too large, or the incision is too small (for 3-4 hair grafts)

This would explain cases of poor yield or improper angulations because the graft may "pop up" and then die out, or move around in the recipient site, and if it survives, grow at whatever angle it settles into.

 

In summation--- the Choi Implanter is an attempt to "automate" the incision making/implantation portion of transplantation. In my opinion, the slight variations in graft sizes in relation to the size of recipient sites, is a process that must continually be checked and double checked throughout the transplantation process (i.e. The techs doing the placing state that the recipient sites are too large or too small) The Choi Implanter does not allow for this. In addition, trying to create a standardized recipient site most likely results in: A. All Sub- Follicular Division (in order to make all the grafts the same size) or B. Causes irreplaceable damage to individual grafts by forcing them into smaller instrumentation and smaller recipient sites.

 

Of course, this is all my opinion, based on the conversations and reading I have done.

I believe that the current slitting methods, high magnification, large technician staff, and dissection methods still produce the highest quality results. It is my belief that the work of our Coalition Docs, on a patient in the same room as the result of a patient using the Choi method, would allow us to see the drawbacks of this method.

 

Take Care,

J

[HK500]

Thanks Chucky, I'll try it on my next Proscar pill.

Thanks Bspot for great research on the Choi instrument, I think I now understand the technique much better. I would never choose it over an all manual and consequently more customized approach.

I was looking at the DHI video again, they use 2 instruments one for extraction and one for implantation, the latter seems very similar to the Choi implanter. I now can see why it would be more difficult to achieve better survivability of the FU and good density with such a tool.

[Bill - Seemiller]

B Spot,

 

Great post and very educational. I agree with your assessment. I don't know if automation is the way to go with something as complicated as hair transplantation. And since the results don't support the hype, it most likely is not superior. BUT, I do agree that any instrument in the right hands can be used to high benefit. Choosing the right doctor, therefore becomes of high value (as we all know).

 

Bill

[hairbank]

B spot-

 

Thanks for the information you provided on Choi. It's always nice to get the facts about the different methods in the HT industry. It sounds like an expert surgeon could make use of the technique but in no way does it appear to offer anything close to what is being produced in the way of density, graft angulation, survival percentages..............seems a bit risky to me.

[Guest 20yearold]

Hi Marc, hope everything goes really well for you. I also read Andys story and was very close to gettin the surgery done, however these forums have slightly put me off. Have you got any pictures of your before and after results?

[MrJobi]

I'm sure everyone on here wishes him luck as well.

 

However, the forum is here to provide objective feedback for people seeking the best options available. It seems obvious this method provides little benefit as opposed to current technologies. Why go with a doc who uses a method that none of the tops docs use? As much as we dispute on who's the best in the coalition, they all use relatively the same procedures..

 

I'd prefer to go with proven techniques for my head!

[battler]

Hi,

I've had 2 choi procedures done at the Asanto clinic. Does anyhone know if there is somewhere I can go to in the UK to verify roughy how many hairs/grafts there actually are on my head? I am not getting much satisfaction from the clinic themselves as they just seem interested in me getting another procedure done.

 

I thought there would be more hairs on my head at this stage. How does one know how many hairs/grafts you actually have on your head or have you no choice but to believe what they tell you?

[danny_m]

battler,

 

I have been looking into the choi procedure extensively after seeing the head of hair website, have you got anymore feedback on your HT's?

 

The more i read the less likely i am to go ahead with this procedure as most people seem to be slating it...

 

any thought would be appreciated!!

 

Cheers

[Dr. Alan Feller]

I recommend staying away from implanter pens. The amount of extra handling required to load the "pen" and then push the graft through it will reduce the overall yield. Grafts don't like to be handled, which is why FUE procedure tend to produce lower yields as well.

 

The device may have some application in the hands of novice clinics, but it could never seriously be given credit as a device that could INCREASE dense packing. On the contrary, the large size of the needle itself limits any valid claim of dense packing. Furthermore, as Janna already noted, the increased popping of nearby grafts is virtually unavoidable causing yet more graft handling.

 

One final objection I have to such devices is that they are relatively expensive compared to slit blades or disposable needles. Because of this the device is reusable and I personally have a problem with any reusable surgical instrument that has a lumen as the choi implanter pen does.

 

No matter how well sterilized this tool might be, I would never want it used on me or my family.

[danny_m]

Dr Feller,

 

Thank you for the information, as i mentioned the more people i speak to and the more i read about it, it seems as if the Choi implanter method is nowhere near as successful as the more capable hands of an experienced and respected surgeon.

 

what is the fundamental difference between FUE and FUT? Is FUT also known as "strip" surgery?

 

It seems after my research that the strep method without an automated implanter of some sort is the best way to move forwards?