The live video surgery workshop took place during a conference in Rome organized by the International Society of Hair Restoration Surgery (ISHRS). The program was varied and interesting, with guests representing countries from all across the globe.
Before the 20 surgeries streamed live across the world there was a set of lively discussions.
And here is what captured our attention. Groups of assistants (including a number of Russians and Ukrainians) prepared the grafts using the state-of-the-art Mantis magnification tools which have a magnification of 3–4x. The basic feature of the enlargers is an LCD screen, as you seen in modern computer monitors or TVs; I could tell they definitely help – especially in preventing eye fatigue. Our assistants in Talizi prepare grafts under MEJI microscopes, they have a magnification of 10–20x, which many surgeons consider excessive, but we don't think so and as people who worked with microscopes, we wouldn’t change over to any other device, even if it helps stop the eyes from getting tired. Our microscopes could be one of the reasons why graft preparation occurs so much faster in our clinic, and how we manage to maintain quality at such high speeds! We had the opportunity to compare our techniques to others and to be once again proud of our successes.
We would like to take the opportunity to explain the benefits of large scale surgeries over smaller ones. Firstly, it’s important to note that every patient is different, and that one size doesn’t fit all. The fact that we can do large transplants (4,000–5,000 grafts), doesn't mean that we have to do it with all our patients.
Conversations with other professionals once again confirmed that besides the rapid results seen after large scale surgeries – the results can be clearly seen in 9–12 months, something that can take twice as long with two consecutive smaller operations – large scale operations also see the best hair growth as well.
During a procedure there is always a risk of losing existing hair; two stage operations are invariably more troublesome in this regard. Damage to existing hair during the first stage of a two stage surgery is not so catastrophic – we are usually dealing with already weakened and frequently doomed hair, but in the second stage it is essential to be particularly careful as we are dealing with donor hair, which is absolutely healthy and viable. Any damage done to donor hair in a second procedure undoes the good work done in the first.
Our second argument regarding the superiority of large-scale surgery over two smaller surgeries notes that that hair transplant surgery inevitably leaves tiny hems in the recipient zone. Survival rates in hem tissue are much lower than in intact tissue. Any practicing surgeon-transplantologist will confirm that the results of the first surgery always surpass the second.
Scarring of the donor zone is a problem visible with the naked eye. Sometimes even following the removal of unsuccessful wide hem during the first operation the tension of the scalp is so great that it is possible to predict in advance that the hem will scar. Only a small quantity of grafts could be extracted during this procedure – sometimes no more than 500.
Why then are some still against larger surgeries? The answer is compression, during large scale surgery, grafts are planted so densely many ague that survival rates decrease considerably. In response, we can say that we have made tests using small areas of hair (1 sq. cm) checking the growth and survival rates of implanted grafts. We tested our procedures up to a density of 70–100 grafts per cm² (much greater than performed in day-to-day operations), and found that it had very little influence on survival rates.
Let's count, even if we transplant 5,000 grafts to the forward third of the scalp (on average 80–100 cm²), it is rare to exceed a density of 50 grafts per cm². Thus, compression is more of a theoretical question than a practical one.
Once again we repeat that the argument that two small operations are superior to one large procedure is flawed. We see a problem only in cases where there is weak mobility of the scalp, here a major operation (3,000–5000 grafts) may risk scarring in the donor zone. Again, with poor mobility of the skin on the scalp can lead to scarring even at low densities.
Jennifer Martinick (Australia), Kenichiro Imagava (Japan), Ali Abbasi (Iran), Melike Kulahci (Turkey), Akaki Tsilosani (Georgia)
Akaki Tsilosani and Martin Unger
Robert Leonard and Akaki Tsilosani
I met Sergey Fedorov, an outstanding professional and wonderful person in June, 2008 at the International Society of Hair Restoration Surgery (ISHRS) conference in Rome. To say that we had many questions for each other is something of an understatement. At a time when borders between countries and continents are rapidly disappearing, when dozens of hair surgeons-transplantologists can come together several times a year to discuss their work, it is surprising to see that many countries of the former USSR fail to take part in such international events. There are no joint activities between Russian and Georgian clinics, and Russian transplantologists, with rare exceptions, rarely participate in forums like the ISHRS. Moreover, it is awfully unpleasant for me when I read letters from patients citing the impartial and sometimes simply slanderous words regarding Talizi from representatives from many Russian clinics.
Today it is almost impossible to talk about any absolute knowledge in the field of hair transplantology. There are two methods by which grafts can be extracted from a donor zone before implantation. Yes, there are nuances in the methods for closing seams, processing grafts, and placing notches. But there aren’t any new, unique, confidential methodologies and the chances of any materializing are slim. There is a limit to the amount of hair which can be transplanted to any one area. The main thing is how well the grafts are processed, the quality of rag cutting and how carefully follicles are extracted.
Having talked about these technical issues, our chat with doctor Fedorov turned to the need for a society of hair transplantologists for Russia and the CIS countries. After all, it is a real shame that even up to this day, Russian clinics rarely cooperate with each other, let alone with other countries, making surgeons in the country some of the most isolated in the world. And cooperation is necessary – the communication of experience, the training of new professionals – all these things are much more effective when you know what is going on in the next clinic, in the next city, in a neighboring state.
Fear of competition it not serious issue. Yet, we haven’t had an incident where a patient has been frightened of a competitor’s slander. On the contrary, when a clinic tries to paint their colleagues in a bad light, whether them be in other clinic, or other country, it in fact turns the patient against them. Hearing such negative charges causes a potential patient to reflect on what has actually happened and look into the facts themselves.
The lack of unity between hair transplantologists in the post-Soviet space is especially surprising because to any professional it should be abundantly clear that the market is large, rich and growing every day. The promotion of hair transplantation can't have a negative affect on any clinic, on the contrary, it will alert more and more potential patients to the fact that their problem can be solved.
Sergey Fedorov and Akaki Tsilosani