Dr. Akaki Tsilosani’s authorized hair transplant method
With greatest pleasure welcome you at our web and would like to represent Dr. Akaki Tsilosani's method, our team and myself.
I’m working in Hair Transplant more than 20 years. During this period more than 10 000 hair transplant surgeries are performed in Georgia and also in different parts of the world: United Kingdom, UAE, Russia, Ukraine, Thailand, India, Malaysia, Singapore, Belarus, France, Mauritius, Armenia, Kazakhstan, Uzbekistan and other countries). The archive of my practice includes patients of all human races (Europeans, Asians, Africans) and all age groups (children with post burn and post trauma scars and middle and older age people - up to age of 75.
Quite hard to make an exact calculation, but taking in account that we always specialized in Mega and Giga Sessions, it means that during my practice as a hair transplant surgeon I have transplanted more than 20 million grafts! Over the years hair transplantation has not stood still, this field of plastic surgery is actively developed. The rapid changes that took place in hair transplant, can be compared with the changes that have occurred in the fields of mobile and computer technology over the last 15-20 years. During these years I have been an active member of the ISHRS (International Society of Hair Restoration Surgery), became a Faculty of AAAM (American Academy of Aesthetic Medicine), has taken part in dozens of congresses and workshops, conducted numerous master classes and attended master classes with leading hair transplant surgeons in the world.
Despite the enormous long-term experience, I always take into account the experience of my colleagues, always using and testing in practice everything new, all emerging methods and techniques and selecting the best. As a result of this synthesis I was able to develop my concept of hair transplantation, the most result-oriented.
What are the criteria’s for an "excellent" result of a hair transplant? The fact that hair transplantation is effective in the sense that the transplanted hairs grow and regrow substantially throughout the patient's life, was known even in the 50s of the last century. The question is, how they grow. In the past, there were cases when patients passed with unnatural growth of hair, especially unnatural hairline and "doll heads" effect (see. Photo #1, 2, 3, 4). Such cases patients sometimes preferred that the transplanted hairs even does not grow...
In 2008-2010, I completed the development of my concept of hair transplantation, complex – combination of methods, which provided opportunity to achieve these goals and allowed to reach excellent results even in cases of high degrees of androgenic alopecia (V-VII of the Norwood classes). The goal #1 in hair transplant (as well as in other fields of aesthetic surgery) is to achieve natural results. At the turn of XX-XXI centuries, when I first started doing hair transplant, some American surgeons (B. Limmer R. Bernstein, B. Rossman and etc.) were already using follicular unit transplant method and also used stereomicroscopes, however, other hair transplant surgeons continued using the method of micrografting, sometimes even "large" (4 mm) grafts. Hairline design was payed a little attention. It was formed in a way of lines, and the holes for the grafts implantation as "Row" or "Ranks", which does not correspond to the concept of the natural result.
Recipient sites for grafts implantation were performed with large micro blades, grafts after implanting were sank deep into the large holes. After healing and hairs changed the orientation of growth, grew like from a dimple (see. Photo #2, #3 and #4) and in the wrong direction (at best more vertically than in nature).
After years of observation and experimentation with sagital and coronal recipient sites performed by micro blades, I changed my opinion and started using needles of different caliber (21G, 20G and 19G) accordingly to the follicular units : 1, 2, 3 and 4 hair grafts (see photos #6).
As long as recipient site creation with needles less caused the damage of recipient zone, the needles were bend according to the length of the grafts and this allowed the grafts to be planted in correct depth (Photo #6). Depth limiting from one side decreased trauma of the scalp, risk of damaging scalp blood supply, increased grafts survival rate and from other side excluded unnatural growth and decreased the risk of developing folliculitis. However, a reduction of recipient sites required adequate reduce of grafts size, so that assistants could implant them easily and without any damage. We had to find a golden middle: dissecting the grafts to possible small size, but at the same time, without compromising the integrity of the follicular units (not devide them) and leaving enough subcutaneous tissue around the follicles as protection against dehydration and injury during implantation (see photo. #7).
Such a high-quality preparation of grafts required microscopic technique, the usual magnification with loops turned out not to be enough. This changes in United States in 1995-2005 occurred to be quite painful: for experienced assistant - cutters, used to cut grafts quickly without magnifiers or with a slight magnification, it was difficult to get used to the microscopes (See Photo #8).
There were many opponents. The difficulties appeared in previous clinic, which I then led. However, in 2003 we were the first in East Europe, who totally changed the technique of graft cutting and started using stereomicroscopes.
These innovations, plus the original design of the hairline allowed to improve dramatically the results of hair transplantation, reaching a high density and natural looking hairline (See. Photo #9, #10 and #11).
The natural density at occipital area is considered as 70-80 FUs at 1 cm2 (photo # 12). The cosmetically acceptable density in hair transplant was 20-25 FUs in 1 cm2. For achieving a high, visually close to the natural density result we had to increase the number of transplanted FUs up to 30-40 in 1 cm2 and more than 45 FUs in 1 cm2 at hairline area.
In small recipient areas (androgenic alopecias II-III classes by Norwood) it seemed to be really achievable, but at bigger areas, like alopecias classes IV-VII by Norwood, where the recipient area is more than 100 cm2 it seemed to be unreal. For covering this kind of area a large number of grafts were needed, not less than 4000 grafts with 100% survival rate.
The main method of hair transplantation at the dawn of the twenty-first century was FUT - strip method. Through much research and observation, I have developed my private technique of donor wound closure, providing healing with cosmetically acceptable scars even in cases of wide strip excisions. Later, after enriching the technique of donor wound closure by Trichophytic Closure, we achieved getting excellent looking postoperative scars even in case of giga sessions (See. Photo #13).
In cases of low scalp laxity and poor donor supplies at occipital area, which desn’t allow to harvest a sufficient number of grafts for covering a recipient area, we were one of the first in the world who started combining FUT method with FUE. This kind of combination allowed to reach not only the big number of donor grafts but also increased the laxity of scalp and after harvesting large strips the postoperative scars cosmetically looked better.
In cases of poor donor supply at the back of the head (occipital area) we started using body hairs: hairs from beard, chest, shoulders, pubic and etc. So, the problem of getting sufficient number of grafts was solved. Simultaneously a highly qualified staff of surgical assistants were collected. They were able to cut and implant thousands of grafts very fast. In 2003 I have established a reliable method of local anesthesia (Patent #1068, 12.09.2003, Republic of Georgia) providing a long time anesthesia, minimizing bleeding and avoiding postoperative swelling and anesthetic toxicity.
«If not everything, experience means much for the surgeon. What have a learned from the 10 000 surgeries performed by me? Probably the understanding that the follicles we work with are tiny, live, very fragile and vulnerable creatures. They need to be taken care, need to be loved and cherished. Besides perfectness and faultless of our surgical techniques, transplantation is still a stress and trauma for the follicles and for achieving a good survival rate its necessary to fully support them. »
Combination of non-surgical (conservative) treatments with advanced surgical techniques of hair transplantation significantly increased the PGI (Personal Growth Index) of transplanted hairs, improved survival rate of grafts and has allowed us to achieve excellent cosmetic results (See. photo #18, 19).
Quite hard to make an exact calculation, but taking in account that we always specialized in Mega and Giga Sessions, it means that during my practice as a hair transplant surgeon I have transplanted more than 20 million grafts! Over the years hair transplantation has not stood still, this field of plastic surgery is actively developed. The rapid changes that took place in hair transplant, can be compared with the changes that have occurred in the fields of mobile and computer technology over the last 15-20 years. During these years I have been an active member of the ISHRS (International Society of Hair Restoration Surgery), became a Faculty of AAAM (American Academy of Aesthetic Medicine), has taken part in dozens of congresses and workshops, conducted numerous master classes and attended master classes with leading hair transplant surgeons in the world.
Despite the enormous long-term experience, I always take into account the experience of my colleagues, always using and testing in practice everything new, all emerging methods and techniques and selecting the best. As a result of this synthesis I was able to develop my concept of hair transplantation, the most result-oriented.
What are the criteria’s for an "excellent" result of a hair transplant? The fact that hair transplantation is effective in the sense that the transplanted hairs grow and regrow substantially throughout the patient's life, was known even in the 50s of the last century. The question is, how they grow. In the past, there were cases when patients passed with unnatural growth of hair, especially unnatural hairline and "doll heads" effect (see. Photo #1, 2, 3, 4). Such cases patients sometimes preferred that the transplanted hairs even does not grow...
Photo #1
At the beginning of my career in the field of hair transplantation at the turn of XX-XXI centuries, I have designated four main goals according which we can speak about the “excellent results” of hair transplant. All my scientific and practical activities I directed at their realization:
- The first - natural result. The transplanted hair should look similar to natural and almost impossible to be distinguished.
- The second - an opportunity to achieve a high, preferably natural density of the transplanted hairs.
- The third - the ability to achieve these goals without the complications and side effects.
- The fourth - the possibility of achieving the above mentioned goals with minimal discomfort to the patient, preferably in a single sitting and minimally time-consuming for the patient.
In 2008-2010, I completed the development of my concept of hair transplantation, complex – combination of methods, which provided opportunity to achieve these goals and allowed to reach excellent results even in cases of high degrees of androgenic alopecia (V-VII of the Norwood classes). The goal #1 in hair transplant (as well as in other fields of aesthetic surgery) is to achieve natural results. At the turn of XX-XXI centuries, when I first started doing hair transplant, some American surgeons (B. Limmer R. Bernstein, B. Rossman and etc.) were already using follicular unit transplant method and also used stereomicroscopes, however, other hair transplant surgeons continued using the method of micrografting, sometimes even "large" (4 mm) grafts. Hairline design was payed a little attention. It was formed in a way of lines, and the holes for the grafts implantation as "Row" or "Ranks", which does not correspond to the concept of the natural result.
Recipient sites for grafts implantation were performed with large micro blades, grafts after implanting were sank deep into the large holes. After healing and hairs changed the orientation of growth, grew like from a dimple (see. Photo #2, #3 and #4) and in the wrong direction (at best more vertically than in nature).
Photo #2
Photo #3
Photo #4
To eliminate such effects and achieve natural results in 2002 I started to gradually reduce the size and depth of the recipient sites by using 1.5 mm, 1 mm and 0.74 mm Sharpoint micro blades (see. Photo #5) with depth limiters.
Photo #5
After years of observation and experimentation with sagital and coronal recipient sites performed by micro blades, I changed my opinion and started using needles of different caliber (21G, 20G and 19G) accordingly to the follicular units : 1, 2, 3 and 4 hair grafts (see photos #6).
Photo #6
As long as recipient site creation with needles less caused the damage of recipient zone, the needles were bend according to the length of the grafts and this allowed the grafts to be planted in correct depth (Photo #6). Depth limiting from one side decreased trauma of the scalp, risk of damaging scalp blood supply, increased grafts survival rate and from other side excluded unnatural growth and decreased the risk of developing folliculitis. However, a reduction of recipient sites required adequate reduce of grafts size, so that assistants could implant them easily and without any damage. We had to find a golden middle: dissecting the grafts to possible small size, but at the same time, without compromising the integrity of the follicular units (not devide them) and leaving enough subcutaneous tissue around the follicles as protection against dehydration and injury during implantation (see photo. #7).
Photo #7
Such a high-quality preparation of grafts required microscopic technique, the usual magnification with loops turned out not to be enough. This changes in United States in 1995-2005 occurred to be quite painful: for experienced assistant - cutters, used to cut grafts quickly without magnifiers or with a slight magnification, it was difficult to get used to the microscopes (See Photo #8).
Photo #8
There were many opponents. The difficulties appeared in previous clinic, which I then led. However, in 2003 we were the first in East Europe, who totally changed the technique of graft cutting and started using stereomicroscopes.
These innovations, plus the original design of the hairline allowed to improve dramatically the results of hair transplantation, reaching a high density and natural looking hairline (See. Photo #9, #10 and #11).
Photo #9
Photo #10
Photo #11
The natural density at occipital area is considered as 70-80 FUs at 1 cm2 (photo # 12). The cosmetically acceptable density in hair transplant was 20-25 FUs in 1 cm2. For achieving a high, visually close to the natural density result we had to increase the number of transplanted FUs up to 30-40 in 1 cm2 and more than 45 FUs in 1 cm2 at hairline area.
In small recipient areas (androgenic alopecias II-III classes by Norwood) it seemed to be really achievable, but at bigger areas, like alopecias classes IV-VII by Norwood, where the recipient area is more than 100 cm2 it seemed to be unreal. For covering this kind of area a large number of grafts were needed, not less than 4000 grafts with 100% survival rate.
Фото #12
To cope with this daunting task, I had to solve complex of technological problems, the main of which were:
- Problem of harvesting needed number of grafts 4000-6000 and even more from donor area.
- Creation of a highly qualified staff able to transplant this number of grafts in short time with a highest quality.
- Establishment of a reliable method of anesthesia, providing prolonged anesthesia at large areas of the scalp, minimizing bleeding and swelling, as well as having a low toxicity.
- Achieve 100% or survival rate in case of high density transplants (35-40 FUs in 1 cm 2).
The main method of hair transplantation at the dawn of the twenty-first century was FUT - strip method. Through much research and observation, I have developed my private technique of donor wound closure, providing healing with cosmetically acceptable scars even in cases of wide strip excisions. Later, after enriching the technique of donor wound closure by Trichophytic Closure, we achieved getting excellent looking postoperative scars even in case of giga sessions (See. Photo #13).
Photo #13
In cases of low scalp laxity and poor donor supplies at occipital area, which desn’t allow to harvest a sufficient number of grafts for covering a recipient area, we were one of the first in the world who started combining FUT method with FUE. This kind of combination allowed to reach not only the big number of donor grafts but also increased the laxity of scalp and after harvesting large strips the postoperative scars cosmetically looked better.
In cases of poor donor supply at the back of the head (occipital area) we started using body hairs: hairs from beard, chest, shoulders, pubic and etc. So, the problem of getting sufficient number of grafts was solved. Simultaneously a highly qualified staff of surgical assistants were collected. They were able to cut and implant thousands of grafts very fast. In 2003 I have established a reliable method of local anesthesia (Patent #1068, 12.09.2003, Republic of Georgia) providing a long time anesthesia, minimizing bleeding and avoiding postoperative swelling and anesthetic toxicity.
Years of hard work and numerous researches have ended with triumph: in April 2012, I and his team performed a unique, record breaking hair transplant surgery – during 11 hours 9688 grafts were transplanted to the patient in one sitting. Till now this still remains as a world record in Hair Transplant Surgery (See photo #14a, b, and c).
Photo #14 a
Photo #14 b
Photo #14 c
My basic professional achievement I still consider is the high survivability of transplanted grafts. Record breaking graft transplant is one thing, but achieve a high rate of survivability in case of such number of grafts is absolutely different and quite difficult.Nowadays in hair restoration surgery dominates the opinion, that density of transplanted grafts more than 25 FUs in 1 cm2 decreases the survival rate. With numerous researches done by us during many years we have proved that it’s not the truth. In 2003 we have showed that three times magnified density of transplanted hairs, from 15 follicular units to 45 follicular units in 1 cm2 doesn’t decrease the survival rate (see photo # 15). In 2004 we have achieved 96% survival rate of transplanted grafts with density 64 FUs in 1 cm2 (See photo #16).
Photo #15
Photo #16
In 2008 our team has achieved a record density of transplanted grafts without decreasing the survival ability (92%) – 100 grafts (170 hairs) in 1 cm2 (see photo #17).Yet no one else has reached to such results. The best indicators that the “King” of giga sessions – Dr. Wong from Canada with his co-authors have shown are – 72 Follicular Units in 1 cm2 with 96% of survival rate. Famous Spanish hair transplant surgeon, Dr. Lorenzo has achieved 80 FUs in 1 cm2. However, Dr. Lorenzo demonstrates photos of patient immediately after implantation and not after one year. So, the survival rate of grafts is impossible to be judged. All other messages, which are close to our indicators are not confirmed with photos.
Photo #17 a
Photo #17 b
Photo #17 c
«If not everything, experience means much for the surgeon. What have a learned from the 10 000 surgeries performed by me? Probably the understanding that the follicles we work with are tiny, live, very fragile and vulnerable creatures. They need to be taken care, need to be loved and cherished. Besides perfectness and faultless of our surgical techniques, transplantation is still a stress and trauma for the follicles and for achieving a good survival rate its necessary to fully support them. »
Because of all above mentioned reasons, I started using routinly conservative treatments with hair transplant in my practice. These are:
- Ancient Japanese alternative treatment technique – Reiki Ryoho, which restores damaged energetic levels of hair follicles.
- Medical treatment, which prevents follicles from damaging factor of Dehydrotestosterone.
- PRP and A cells, which improves blood circulation for hair follicles.
Photo #18
Photo #19
Combination of non-surgical (conservative) treatments with advanced surgical techniques of hair transplantation significantly increased the PGI (Personal Growth Index) of transplanted hairs, improved survival rate of grafts and has allowed us to achieve excellent cosmetic results (See. photo #18, 19).