1 euro per graft strip, 2 euro - fue

[linchpin]

donor density

 

you mentioned that the doc had a special device to measure your donor density. was it a densitometer or something else? and did you see anything showing up on screen? it would be great if you could elaborate on that also including your donor density. did the result also include eg. the average size of your grafts? or the percentage of miniaturisation?

 

 

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.

Edited August 25, 2010 by linchpin
Grammar correction

[linchpin]

choice of clinic

 

i understand that you did a lot of research before you made the decision to go exactly for this clinic. what was the particular reason why you didn't choose eg. the world renowned clinic by dr humanyan from pakistan and who offers much better rates in doing a strip procedure?

 

 

 

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..

Edited August 25, 2010 by linchpin
Grammar correction

[linchpin]

size of the implant sites

 

i understand that the doc is the only one who makes the implant sites. and you wrote that the doc uses different sizes of punches to accommodate the various sizes of the grafts. i had a look at their website including a video showing the making of the implant sites but could only see the doc using just one and the same tool throughout the entire procedure. did you notice that he changed the punch or not?

 

 

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.

[linchpin]

number of harvested grafts

 

i understand that your doc got more than 3300 grafts out of the strip and which is quite a lot. what was the size of the strip (length and width)? and did you get a breakdown how many single-, double-, triple- and quadruple grafts were harvested?

 

 

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.

Edited August 25, 2010 by linchpin
Extra detail given

[linchpin]

donor density

 

you wrote that the doc would be capable of planting 100 grafts per cm2 and which is great if, as a patient you have got this amount of donor capacity in the first place. anyway, i am wondering whether the doc also placed grafts between your thinning hair and what his new techniques look like in order to minimise shock loss. by the way, would it be possible if you took some pics so that people here can literally see what's been going on. it definitely would be appreciated in particular by other potential candidates who also might be considering taking the plunge and to try this clinic out.

 

 

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!

Edited August 25, 2010 by linchpin
Grammar correction

[TomA]

And there is the problem. Hairtransplants are relatively expensive. The staff and facilities are expensive. EVERY clinic that offers this type of "low cost" approach must cut corners. They have to. That can include the fast-food type service of doing 2-3-4 patients a day to make up the difference in cost.

 

 

I realize that I am responding to an old thread, but I have to strongly disagree with your statement. You are failing to acknowledge the lower wages and exchange rate differences in other countries. Dr. Madhu (who is recommended here) charges even less that ?1 per graft for strip and I was his only surgical patient on the day I visited (though he had lots of visitors for consults).

[TomA]

The cost of good staff certainly impacts what a clinic can charge per session.

 

However, even the cheapest clinics, with slave labor wages, still have to pay for a clinic, proper anesthetization, punches, blades/needles, microscopes, lighting, bandages, tape, garbage bags, etc.... still MUST cut corners to offer surgery at this price.

 

 

Clinic: lower real estate and construction costs abroad.

Anesthetization (heck, all meds): generally MUCH MUCH cheaper abroad. I buy the same meds in Thailand for less than my $15 deductible back home.

Punches, microscopes: might be the same price, but this is a SMALL part of the price

Blades/needles, bandages, tape, garbage bags, ALL cheaper abroad.

 

The fact is, for something labor intensive like hair surgery, the VAST, VAST majority of the cost comes from labor.

 

If we were talking about something like LASIK, which is not as labor intensive, I could agree more. A huge part of the cost of LASIK is the licensing of the LASIK machine software which costs the same everywhere.

[linchpin]

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.

Edited August 26, 2010 by linchpin
Extra detail

[Happy]

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.

 

 

 

excellent response as usual, linchchpin. the same goes with toma and your valid point! with g spot we shouldn't forget where he is coming from. with all due respect to his contributions, but after all as the shapiro coordinator he has a vested interest in directing candidates more towards his own, probably high priced clinic whereas you guys have the privilege to provide rather an unbiased view based on facts.

[Happy]

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.

 

 

 

many thanks first of all for providing so much invaluable details. this really does sound like a highly professional approach instead of just applying a ballpark figure. there is only one thing which i am not quite sure whether the doc also told you - how many miniaturised hairs your donor had:

 

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.

 

in another thread i raised the question about whether miniaturised hair will get transplanted or not - you know, this is all the thin, weak hair which is already in the process of becoming terminal.

 

so, when i was asking about the percentage of miniaturisation i meant the proportion between healthy and miniaturised hair in the donor area. eg.:

 

if your doc measured a density of 100 fu's per cm2 in your donor area but noticed that 20 fu's per cm2 were already miniaturised, then this would be a percentage of 20%.

[Happy]

 

 

 

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.

 

 

 

i was just wondering whether starting your ht with fue has also to do with the tricho closure. because somehow i remember slightly that with this special closure technique usually many hairs would be lost/damaged unnecessarliy if only the strip was applied. maybe i am wrong.

[Happy]

linchpin, when watching one of the clinic's videos about extracting follicles via fue, i had the feeling that they used an electric device and which is normally not recommended by other top notch fue surgeons who prefer the manual approach.

 

what was your experience on that?

[linchpin]

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..?

Edited September 6, 2010 by linchpin

[TomA]

I will say that I don't think the Western clinics are ripping people off--their costs are MUCH higher. (Especially their malpractice insurance!) I don't begrudge them one penny of whatever they make. And the vast majority of people are not going to leave their country to have surgery. That's fine, too. But some people, like me, don't mind having surgery at a good clinic in Asia (or Eastern Europe) for whatever reason. Some may need to save money. Others may prefer to spend their money on other things. To each his own. The Western clinics have furthered HT research and have graciously shared that information with others around the world. Dr. Path, I believe, trained with Blufford Stough at Stough Medical Associates in Hot Spring, Arkansas, one of the hair transplant pioneers. Everyone has a place at this table.

[EpilepticSceptic]

I once saw a dingy delapidated shack in Reynosa, Mexico advertising a HT for $2 per graft. This is NOT a joke! It was right when you get over the border from McAllen, TX. I think it was also a hair salon, but it's been so long that it's hard to remember.

 

I wish I would have taken a picture of that. The sign was pretty slick looking, but the place was truly a dingy shack. Since I've been on these boards I've often wondered how many poor butchered souls have walked thru those doors.

[Happy]

hello linchpin,

good stuff again - it all sounds very authentic and as such quite reassuring of the doc's and clinic's reputation! in particular i like that they seem to be very transparent in what they do, not just with the pre-op assessment, but also during the surgery.

 

you suggested to contact the clinic and ask for dr tsolani's advice so that he could clarify any outstanding issue.

 

since you know him personally, would it be possible for you to invite him to this forum to publicly clarify further questions that people here have? it's not just about his special fue approach and efforts about minimising trauma, but also about many other interesting things; eg. his experience with super mega sessions; or findings of his research work...

 

i am sure that his contributions would be highly appreciated by the whole ht community here.

 

ps: did you have at any stage any post-op pain or/and swelling of the head including the famous boxer look?

[Happy]

Some may need to save money. Others may prefer to spend their money on other things. To each his own.

 

this sums it all up nicely: people are different including different taste and preferences. we live in a world of variety as a natural result. and that's wonderful. at least i wouldn't want to change it.

[linchpin]

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.

[Happy]

hello linchpin,

 

your response sounds quite sensational: having had only very brief swelling plus no pain at all. i am sure that many strip patients will be very envious of you!

 

as for the doc's command of written english, i don't mind his level of expertise as long as it is possible to somehow communicate. in my experience this is almost always possible even with people who understand very little english if there is a will in the first place.

 

in terms of your suggestion to approach the doc privately - i am sure that the questions that i have could also be of public interest for other ht patients.

 

furthermore, he would be much more flexible compared to a potential telephone enquiry as he can respond whenever it is most convenient for him.

[Talizi]

Hello! Dr. Tsilosani had his vacations and came back today. He will be happy to answer to all your questions here.

Please post questions and I'll post his answers as the representative of the clinic.

 

linchpin gave good answers to all your questions mentioned above, and I'll give you more information on these subjects in a few days.

[Talizi]

Before operation doctor uses Folliscope (phototrichogram system for hair and scalp analyses). This system consists of 50X magnification digital camera and computer software, which allows us to count the quantity of follicular units and hair, grown per square centimeter, hair shaft diameter, telogen–anagen ratio and many other details.

 

 

 

 

In case of FUE, we never harvest miniaturized hair. In case of Strip method, every harvested follicle as a rule must be transplanted.

 

For creating recipient sites, we use different needles or Sharpoint micro blades. For example:

1 hair grafts – 21G needles (0.8 mm diameter) or 0.75 Sharpoint micro blade.

2 hair grafts – 20G needles (0.9 mm diameter) or 1 mm Sharpoint micro blades.

3–4 hair grafts – 19G needles (1.1 mm diameter) or Sharpoint 15 micro blade (1.5 mm).

 

 

 

Maximal density per sq. cm we have achieved in case of scientific research during our practice was 100 follicular units in 1 cm without decreasing survivability (92%). But in everyday practice we plant up to 70 follicular units in hairline and front sides, 30–35 f. u. in midscalp area and 20–25 f. u. in crown area.

 

45 double-hair grafts are placed in 1 sq cm and density of 89 hairs in was achieved:

 

100 grafts (70 double-hair and 30 single-hair FU) are placed in 1.0 sq cm and 156 hairs grew up:

 

We are getting detailed report about grafts quantity from assistants during each operation:

Edited September 5, 2010 by Talizi
Aditional details given

[Talizi]

Our clinic participates in all major workshops of International Society of Hair Restoration Surgery. Last one was on June 25-27, 2010 in Bangkok.

 

It was hosted by famous Thai surgeon – Damkerng Pathomvanich. Almost all famous Asian hair transplant surgeons participated in this meeting: Kenicharo Imagava – from Japan, Tommy Sungjoo Hwang – from Korea, Bertam NG – from Hong Kong, Sanjiv Vasa – from India and Akaki Tsilosani – from Georgia. Leading figures of hair transplantation also arrived in Bangkok from different continents: Mario Marzola – from Australia, Jerry Wong – from Canada and Dow Stough from the USA. They really adorned theoretical part of the annual meeting with their scientific reports and made some demonstrative sessions: Mario Marzola – initiator of wounds trixophitic closure presented a masterful technique of strip excision and plastic, Damkerng Pathomvanich – his open donor method, Jerry Wong – formation of coronal slits.

 

Akaki Tsilosani with Iranian colleagues:

 

Akaki Tsilosani and Jerry Wong (Hasson & Wong, Canada):

Edited February 26, 2011 by TakingThePlunge

[mattj]

Interesting stuff, Talizi, especially the density research.

[Surfarosa]

Taliz - I love the use of the high tech mathmatical approach and the demonstration of density via actual counts and awesome pics. It still shocks me at how the docs are still so "rule of thumb" and approximating this stuff.

 

HT is such a quantitative game yet all the discussion focusses mainly around the qualititive (and equally critical) dimension.

 

Thank you for such an interesting and progressive post.

[Surfarosa]

I have always thought that a telogen–anagen ratio or some other metric pertaining "rate of hair-loss" or "stability" is absolutely critical for this science to have any real credibility.

 

This should be an absolute in what Coalition doctors should be doing without exception. Stability is such a critical component (even though it can change for various reasons) even if it's a snapshot in time. If the technology is there it should be part of the gold standard for sure. Doctors could then say that you have become less stable than 3 years ago - we need to change your medications up etc etc ....

 

I also think full "standardized" reports should be given to patients before surgery and after 12 months.

 

i.e. you had this many FUs harvested successfully. They were placed in these regions at these densities. The survival rate was estimated at x %. You have xxx of FUs left in your donor area that could be used with a further xx via FUE.

 

Then you can take your report to another doctor if you decide to have further work done elsewhere (or you current doctor disappears) or to seek a second opinion. This would eliminate so much of the conjecture and subjective b/s that plagues this field of surgery. As you history is a critical indicator of you destination with this condition, how can we not demand this ?

 

I think this step forward as a standard would be awesome for us patients & would elevate this community. It would really make doctors have scientifically comparative results and elevate the bar beyond what really is just opinions about photos for most patients and potential patients.

 

What do others think ?