09 · 22

Thailand Medical Tourism - Top Hospital Review

by Charles Runckel

Thailand is the world leader for medical tourism, but which hospital within Thailand is best for you?  This article, part three of a series on Medical Tourism, explores the top two choices.  While there are many hospitals in Thailand that cater to medical tourists, these are two full-service facilities that have strong reputations for quality and experience with foreigners.  The aspiring medical tourist should consider these two before any other Thai hospitals, even ones with a slightly lower cost, as they are the gold standard for medical tourism not only in Thailand but worldwide.

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Pictures (top) Bumrungrad Hospital's main building and entrance
Pictures (below) Bangkok Hospital's Buildings and one of their entrance

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Background and Location

Bumrungrad Hospital treats over 400,000 foreign patients every year and has made medical tourism its major focus.  The monolithic hospital consists of a large tower and several associated buildings adjoining, all conveniently located in downtown Bangkok.  The hospital is within walking distance of Bangkok’s Skytrain (light rail system) but only barely, and given the heat usual in Thailand most patients are strongly advised to take a taxi.  International patients are so much a part of Bumrungrad’s focus that they recently broke from their single tower architecture and built a separate International Tower that caters specially to foreigners with a brand new Physical Exam wing and upgraded VIP rooms.

Bangkok Hospital Group is a network of Thai hospitals focused on Bangkok and sprawling into the provinces and even Cambodia, though the portion of this that is most important to foreigners is their Bangkok Hospital Medical Center (BMC) complex.  This campus consists of their International Hospital as well as their main General Hospital and a collection of specialty hospitals, including their Heart Hospital, Rehabilitation Center and Dental Clinic.  The BMC is a series of adjacent buildings connected by skywalks and, apart from the main General Hospital building, are new having been built in the past five years.  The BMC is located near, but not walking distance from, several Skytrain and subways stations, so a taxi is in order in this case as well.  While BMC and Bumrungrad treat about the same number of total patients each, a lower proportion of BMC’s patients are from overseas and total only 150,000 annually, though these are often for more serious treatments.

These top hospitals charge more for their services than most other Thai hospitals, but also offer services that cannot be found elsewhere.  Fortunately for a direct comparison, their costs are very similar across the board and the focus can be on their service and capabilities.

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Pictures: Patient room and waiting area (top) at Bumrungrad Hospital
and (below) at the Bangkok Hospital

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Layout and Impressions

Bumrungrad Hospital is, as previously mentioned, monolithic.  Visitors enter into the lobby of the main tower at the ground floor, but this and the next floor contain mostly restaurants, coffee shops and the cafeteria.  The Hospital portion does not begin until the third floor, where the patient is greeted with a larger lobby and registration area.  Elegantly uniformed staff register new patients with digital cameras – both Bumrungrad and BMC are very tech savvy hospitals with test results updated and delivered electronically and pictures of each patient checked at every stage to avoid foul-ups.  This registration area is both the point of entry and exit, and next to registration are desks for checkout and a pharmacy.

On every floor of Bumrungrad runs a long, wide hallway with specialty clinics and divisions branching off, generally four to six per floor.  Each has its own lobby, which looks out onto the hall.  The older main tower and new international tower are quite different, with the older tower very much feeling like a mature hospital, with traditional waiting areas and layout, while the new wing is decidedly more modern and up-to-date, from the lobbies and hallways to furnishings in patient rooms.

Upon walking into BMC’s main building, one is immediately greeted with the registration staff.  They are far more eager to register you than those at Bumrungrad, though this has a strong basis in necessity.  Upon registration, a patient’s schedule will likely initially take them to another building, or several buildings if they have multiple appointments.  The BMC staff then ensure that you are taken to the right building or floor of the main structure.  There are enclosed walkways between the buildings, however most patients are initially led to the shuttles, which are over-sized gold carts or minivans that scoot patients around the campus. 

Each division, clinic or specialty hospital at BMC has its own modular area with it’s own independent registration and cashier services (so you don’t have to go through the main lobby at all, if you know where you’re going).  These lobbies, especially in the newer buildings, are considerably more aesthetically appealing and pleasant to wait in than many of Bumrungrad’s specialty clinic lobbies, mostly due to their smaller size, more updated furnishings and clever architectural design.  Like Bumrungrad, there is a clear difference in ambiance between their older General Hospital building and the new, adjoining specialty centers.

One major difference between these hospitals is their monolithic vs. modular nature.  In Thailand’s heat, having all clinics in the same building would tend to be an advantage, though BMC would counter that almost all of their modules are actually linked by skybridges, so their campus is mostly connected by air-conditioned walkways.  One bonus of BMC’s (and the Bangkok Hospital Group’s) modular design with different specialty hospitals is that one hospital happens to be located in Phuket.  The famed, or infamous, Bangkok Hospital Phuket is renowned as a world leader in sex-change operations, but is also a state-of-the-art hospital for more mundane purposes and nothing beats Phuket’s beaches for physical therapy and recuperation after a surgery in Bangkok, which the Phuket Hospital supervises and coordinates.

Pictures at Bumrungrad Hospital (below)

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Pictures of one of many MRI scanners at Bangkok Hospital (below)

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Staff and Technical Capabilities

It’s certainly very difficult to compare the level of skill in physicians and nurses for two world-class hospitals like Bumrungrad and BMC.  They boast similar proportions of foreign-trained doctors, especially those trained in the US and EU.  Nursing staff are professional and abundant in both and interpreters are available in a large number of languages.  BMC goes a step beyond this by hiring a physician and nurse from their major patient nationalities (ie a Saudi doctor and nurse for Saudi patients) and having significant staff and facilities specially devoted to Japanese and Middle-Eastern patients, who represent a large proportion of their patient base and are generally very appreciative of services in their native language.

Unlike many other aspects of a hospital experience, the sheer technical capabilities of a hospital are somewhat easily quantified, and it is in this aspect that Bangkok Hospital most outshines its competitor.  BMC has focused a tremendous amount of resources to being on the cutting edge of medical technology, and while Bumrungrad is certainly not unsophisticated, there is general agreement that Bumrungrad is a solid step behind BMC technologically.  BMC’s hi-tech drive falls into two general areas: advanced imaging and non-invasive surgery.  Their advanced imaging options include at least seven MRI scanners in their main campus alone.  Each department receives its own specialized diagnostic equipment, unlike many hospitals which must pool resources, including Digital Mammography and a brand new 128-slice CT scanner currently being installed.  It is peerless in South-East Asia, and BMC boasts one of Thailand’s only two clinical PET-CT scanners.  The non-invasive offerings include state-of-the-art radiation systems such as the Novalis device for brain tumors and robotic laparoscopic surgery for both heart and joint operations (with different robots, of course).  Bumrungrad simply does not compete in this field, which gives BMC a decisive advantage in the specific operations these advanced machines enable; reducing risk, discomfort and hospital stay time.

The overall level of service in each hospital is remarkably similar.  Both rely heavily on an integrated and ubiquitous IT system that shepherds patients from area to area and relays patient information, including test results, digitally between doctor and technician.  Their systems are extraordinarily efficient by American standards.  This also makes bill payment very simple and straightforward in both.  Between the two, BMC has stepped ahead of Bumrungrad in terms of arrangements with insurers, both of the international and regional variety, which makes it easier to automatically claim insurance (they take care of it for you completely in most cases).  Bumrungrad also offers help with paperwork, but their connections are significantly less extensive and it shows in that for many people there is a good deal more work to do with their insurers.

Reputation and Marketing

Bumrungrad is probably the best-marketed hospital in the world.  Their fame is well deserved, but their marketing staff and management have put a tremendous effort in being “The” medical tourist hospital that potential patients in the Western world have heard of, specifically through news reports on ABC and CBS as well as multiple appearances in Newsweek.  BMC, in contrast, is more famous within Thailand and elsewhere in Asia and the Middle East.  Both hospitals treat approximately the same total number of patients – about 1 million a year – however Bumrungrad began courting foreign patients much earlier than BMC and now draws 400,000 foreign patients a year to BMC’s 150,000-250,000.  It is worth noting that different hospitals use different metrics to calculate these numbers (visits vs. patients) so these comparisons must be taken with a grain of salt, however it is commonly accepted that Bumrungrad’s proportion is higher than BMC’s, though not by as much as the disclosed numbers suggest.  While BMC’s focus for the future includes increasing the proportion of foreign patients, the target countries of both hospitals will likely remain the same with Bumrungrad focusing on the US and BMC focusing on the Middle-East and Asia, affecting the level of marketing in each area.

Part of Bumrungrad’s early marketing included aggressive pursuit of international certification, and as a result Bumrungrad correctly claims a number of regional “Firsts” with various international credentialing organizations.  In many ways, Bumrungrad was a trendsetter and these certifications were necessary when no one had even heard the term  “medical tourism” and there were serious doubts about the quality of a Thai hospital.  Today, the first and second tier of Thai hospitals are firmly within international standards and rising acceptance of medical tourism make this less necessary.  BMC has, itself, a slew of acronyms attesting to its quality, many of which overlap Bumrungrad’s, and comparing certifications should be less important to the potential medical tourist than other aspects of reputation, but for a nervous first time medical tourist Bumrungrad’s list of “firsts” can be welcome reassurance.

Conclusion

A medical tourist would be well taken care of in either of these world-class hospitals.  Both boast new wings dedicated to foreign medical tourists and sophisticated computer registration and billing systems that make the entire experience very smooth.  For lower-level care they are remarkably similar, however for high-tech treatments BMC’s massive technological lead is significant.  Simply put, if a patient is seeking complicated heart, brain or joint surgery, there is no question which hospital to go with.  While they are neck and neck on most categories , this technological edge and a number of areas where BMC is just a little bit ahead of the curve in service set it apart as the top medical tourism and Thailand plastic surgery  destination.

07 · 01

How to find doctor who is a specialist - http://www.facelift-pedia.com/specialty-assessment-engine/

(download)

02 · 04

Board Certified Botox Doctor - Funny Cartoon

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02 · 02

King Crab Served at the Norwegian Buffet Lunch at World Economic Forum 2011

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01 · 14

Facelift Through Teeth: What an innovation!

(download)

01 · 01

Vampire Facelift

Definition of the Vampire Facelift: Use of blood-derived growth factors in an artistic and specific way (in multiple places on the face) to create a younger and more beautiful appearance.

The fascination with vampires being rejuvenated by blood has made its way into marketing a new face lift cosmetic procedure, known as the "Vampire Facelift™."

vampire facelift
vampire facelift

The process starts with drawing a vial of blood from patients, similar to a regular blood test blood drawing.  Plastic surgeons then use a special kit: SELPHYL®, marketed by a Pennsylvania-based company called UBS Aesthetics.

 

Other companies such as Cascade and CryoSeal Systems also provide similar kits to process and separate blood from a patient and inject the key blood components back to the patient.

The SELPHYL device spins and separates blood into white, red, and plasma cells. The plasma cell platelets are pivotal in this entire process to the rejuvenation. The plasma cells are rich in a platelet material called Platelet Rich Fibrin Matrix – PRFM, which, when injected into the dermis and immediate subdermis releases growth factors into the skin through a sustained mechanism that encourages the growth of collagen and face lifting.

Patients thus receive the Platelet Rich Fibrin Matrix component (or sometimes just Platelet-rich Plasma or PRP) in the form of one's own natural filler injection. The process claims to correct skin lumpiness, depressions, wrinkles, and acne scars and promotes skin smoothness and face lifts.

Obviously, it is not a surgical facelift, but is more similar to liquid facelifts with synthetic fillers such as Juvederm and Restylane. Claimed benefits of Vampire facelift over the traditional use of synthetic fillers include a lower chance of an allergic reaction to foreign chemical, and possibly longer-lasting effects due to the growth factor and collagen stimulation. But definitely does not yield permanent results.

Vampire facelift is an especially close variant of stem cell face lifts, which utilize your body’s own fat, harvested via liposuction. But in stem cell facelifts, after fat is spun and separated from stem cell tissues, plastic surgeons may need to add Platelet Rich Fibrin Matrix (PRFM) to the stem cell component before injecting it into your face.

With the Vampire facelift, you may NOT see immediate volumizing results as you would with stem cell facelifts, and definitely not as you would with liquid facelift. For Vampire facelift, it may take up to 5 weeks to see volume gain. You might experience minor side effects such as mild irritation, edema, bruising, swelling, or itching. The upside appears to be that there is less downtime due to bruising etc. with Vampire lift than with the stem cell facelift.

Skin depressions, acne scars, wrinkles and folds can all be treated by Vampire facelift in what experts say takes no longer than 20 minutes. Results take three weeks to develop and last for up to 18 months, costing around $1,500.

Selphyl, according to the company’s website:

The patented SELPHYL® System enables the safe and rapid preparation of an activated Platelet-rich Fibrin Matrix (PRFM).  A small volume of the patient’s blood is collected and the platelets and fibrin are concentrated during a simple centrifuge process.  The resulting product (liquid, gel or membrane) can be applied to a treatment area of the face or body to stimulate natural, new tissue growth.  SELPHYL® prepared PRFM has been shown to increase skin volume and rejuvenation.

SELPHYL® ensures a preparation of fibrin and platelets, with virtually no red or white blood cells. Studies have shown these platelets to be viable and intact.  Platelets will release proteins, which have been reported to trigger cell migration, proliferation and differentiation over time.

With over 45,000 procedures performed world-wide, this technology has been extensively used for soft tissue regeneration in plastic surgery, orthopedics and maxillofacial surgery.

Dr. Charles Runels MD, darkly handsome no less than Bill Compton (the vampire in True Blood) mentions in an official Website for the Vampire Facelift™ about the facts of Vampire Facelift™ as following:

The Down Sides

  • I must draw blood from you to create the product.
  • The first week after the injections, you may see a fading of the improvements seen in the office as the fluid goes away but before the fibroblasts have time to do their work.
  • It cost more than a bottle of your favorite cosmetic.
  • This product is new to my practice so I have no before and after's of my own patients to show you.
  • It's called the Vampire Face Lift because someone takes your blood but then you have "eternal youth" like a vampire with the treatment. i think that perhaps the name is a downside. I promise to not wear a cape when we do the procedure.

The Up Sides

  • The amount injected is equivalent to 4 syringes of Juvederm (which would cost over $2,000 and start fading at the end of a year).
  • This looks better at the end of a year than at the end of a month because it actually de-ages the skin.
  • As a 12-year veteran of the ER, drawing blood is something I'm very skilled at doing.
  • Your skin becomes healthier in multiple ways--fewer wrinkles, better complexion, improvement in scars, lessens skin folds
  • I can use it in the upper forehead and between the brows (which should not be done with the fillers like Juvederm and Restylane).
  • I have much experience with cosmetic injections-- having injected thousands of patients. The technique of injecting is similar to the other products, it's just that the product is new and better in many ways.
  • Since I'm injecting a distillate of growth factors from your own blood, there should be NO side effects from the material injected.

For more information, watch the following video: Vampire Facelift

12 · 24

24K Gold Facial for Chirstmas? Worth it for your wife?

12 · 21

Cosmetic Gone Wrong

Cosmetic_surgery_gone_wrong

According to the Medical Defense Union, a not for profit UK organization whose one of its role is to help mediate between surgeons and patients in medical negligence incidents, the clear communication between both patients and surgeons is the key to avoid cosmetic surgery claims being brought against surgeons.

MDU has settled a total of 250 cosmetic surgery claims, an average of 25 per year between 1996 and 2005. However, there is no clear sign of the number of claims increasing, despite the fact of increasing cosmetic procedures.

The main reasons for patients making claims were categorized by the MDU as follows:

  • Dissatisfaction with the aesthetic results (42%)
  • Unaccepted Scarring (24%)
  • Infection (12%)
  • Nerve damage (3%)
  • Wrong Operation (3%)
  • Other (16%)

This represents the importance of communication between both patients and surgeons, to effectively present both the desired and expected results from the surgery. The MDU have highlighted poor communication of side effects and absence of consent on behalf of the surgeon as probable reasons of why dissatisfaction and subsequently claims may result.

Below are examples of real life claims made by patients against the surgeons in response to results of facelift procedures. These cases have all been taken directly from the Medical defence union’s publication of December 2006.

Case 1

A middle aged man who had a face lift and blepharoplasty made a claim against his surgeon alleging that he was not warned that any scars would be visible after the facelift. He also complained of a scar near his mouth, which it was later discovered was due to a burn from a diathermy instrument used during the operation to seal blood vessels and which had accidentally touched the patient’s face. The claim was settled for £25,000.

Case 2

A young man sued a cosmetic surgeon because he was unhappy with the results of a rhinoplasty. He complained that he had suffered breathing problems since the operation and that he had asked the surgeon to make his nose smaller but that this hadn’t been achieved. He needed two further operations to get the effect he wanted and to correct the breathing problems. The doctor had kept careful notes of the pre-operative discussion and was able to show that he had counseled the patient about the aesthetic effect which could be achieved. The claim was settled for £10,000 in recognition of the patient’s breathing problems.

What can we do?

At Facelift-pedia, we believe that it is in the public interest for transparency information such as cosmetic medical negligence incidents to be readily available. Because of the Data Protection Laws, patients in the UK have limited access to objective, systematic information about mal-practice lawsuits and medical negligence incidents - unlike patients in the US.

Furthermore, plastic surgery is often a hush-hush topic among both patients who undergo plastic surgery and among those who are considering it. It is also one of the least regulated medical areas, and one where a majority of patients pay out of pocket for treatments in private establishments. When some thing had gone wrong, most patients did not voice the dangers and failures publically. These factors result in a highly divergent standard of care. We hope to be your voice. Please contact us if you have a real story to tell. Blow the whistle, and we will help fighting cosmetic medical negligent surgeons with you.

Or contact AvMA, Action against Medical Accidents, an independent charity which promotes better patient safety and justice for people who have been affected by a medical accident.

Source: MDU Journal Volume 22 Issue 2 December 2006

12 · 15

Gold Thread Lift

Throughout ancient times, gold has been recognized for its luxurious and beautifying properties for the skin: a daily part of Egyptian skin care and anti-aging. It has been said that Cleopatra slept in a gold mask almost every night. In ancient Rome, gold products were applied for treatment for a wide variety of skin problems. In ancient Chinese medicine, gold products were a key to youthfulness and smooth skin tone, the queen of the Chiang dynasty used a gold massager everyday. Recent western super-luxury anti-wrinkle cosmetics contain gold dust claiming its rejuvenation property worth $500 a jar.  And there is a Malibu, California opulent spa pampering you with 24K facial for $500. No doubt, gold thread lift is alluring because of the precious properties of the metal.



Gold Thread lift Procedure:

This technique involves implantation of a thin gold filament (i.e., 24 carat gold, less than 0.1 mm in diameter) into the sub dermal skin line by threading a web of gold filament into your skin and underlying soft tissues with real 24 karat gold threads.  It began with your surgeon covering your face in cream to numb it before injecting you with local anaesthetic. Then your doctor will weave a gold thread web to hold the facial tissues in place and prevent sagging of the skin. The procedure is completed in one single treatment that lasts approximately 60 to a few hours.

After the procedure, prepare to see that your face will be quite appallingly bruised, black eyes coming on and prick marks all over the face. It should be subside by the 2nd and 3rd weeks.

After that, gold thread will stimulate an increase of production of collagen and fibroblasts in response to the presence of a foreign substance. Collagen is formed around the implanted threads. In the theory, new tissue formation is stimulated and increased metabolism and blood flow occurs in the treated areas, which results in skin rejuvenation. This gold thread facelift takes a few months to show the results, as the gold mesh stimulates the body’s own production of collagen, which in turn plumps up the skin naturally. Over five to ten years, the fine gold sutures gradually become fragmented as they are broken down naturally. The effect of rejuvenation can last to 8 to 12 years depending on the individual body type, age, initial state of the skin and patient’s way of life.

Gold Thread Lift History:

The gold thread lift procedure was first commercialized in Europe in the late 1970s. Many brand-names for the gold thread lift procedure are: Gold Filament, Gold Lift – UK & USA, UK; Remaillage – France; Gold Reinforcement – Russia; Happylift – Korea, and Gold Silk – China, each of which has its specific procedure based on years of development from practice & trial and error. The differences in each procedure can be based on the additional use of other suture barbed-thread thread such as APTOS®-Threads (tiny spikes threads made from a special bio-compatible material) along with pure gold thread from different suppliers. Each brand-name also offers a different pattern of threading a web of gold filament and other substance into the face.

Keys to Consider:

There are a few gold thread suppliers in the world. You need to make sure the clinics you plan to undergo the gold thread lift use the thread that is FDA approved and fully compliant with US FDA Quality Systems Regulations. Contact us, if any questions.

More importantly, you need to make sure the doctors who will perform the procedures for you are board certified, well-trained, and have performed the gold thread lift procedures for a period of time. This is because even this procedure is promoted and marketed as minimally invasive, non-incision, or non-surgical procedure, it is a complex procedure to interwoven threads under the skin with the use of a special needle. Surgeons must be skilful not to pierce the tissues apart and not to damage to large vessels and nerves. A surgeon commented, ‘If you are stitching a surface wound you can see what you are doing, but when you are stitching beneath the skin, you are virtually doing it “blind” which, if you are in the wrong hands, could be hazardous.’

Top doctors in this method are scattered in worldwide but for the most part they are in Europe (where the thread lift is originated) and Asia (where its culture esteems and obsesses with gold). Please contact Facelift-pedia for info about top doctors in this procedure.

Gold Thread Lift can be performed on cheeks, forehead, eyes, mouth and neck, and other areas including hands, cleavage, arms, stomach and hips.

Price:

Prices vary from a start of around US$3,000 in Thailand, Hong Kong and Singapore to a few thousands Euros in Voronezh, Russia to a few thousands pounds in South-East London.

Risk and Complications:

One patient reported that a couple of days after the procedure, she was shocked to look in the mirror and see two gold threads popping out of her forehead.  A quick visit to her facelift doctor was able to remedy this, as the doctor clipped a centimeter off the end of each thread and the rest of the threads did stay inside.

This is something that can occur pretty commonly with a gold thread lift, but if the facelift was done properly it should only happen during the first week or so after the procedure and is easily rectifiable.  It is simply the result of the body rejecting the gold threads, which it sees as a foreign object, but as gold is something that is not harmful to the body, it shouldn’t keep on happening.

Also, a medical journal paper published in Aesthetic Plastic Surgery:  The ‘‘Golden Thread Lift’’: Radiologic Findings cites a case study of patient 48-year-old patient reported intense pain in her face.

“Within 10 years she had undergone three ‘‘golden thread lift’’ suspension procedures, the last one 2 years previously. Skull radiographs showed complete fragmentation of all the implants into small pieces, and a total loss in their vector orientation. None of these fragments were oriented straight, as would be expected for them to function as a suspension vector for facial lift. They are

unevenly distributed and oriented within the facial and cervical soft tissue. A complete surgical removal of all these foreign bodies was also impossible, although a later attempt might be made to remove some of them in open face-lift.

Although adverse chemical or immunologic tissue reactions are very unlikely with an inert implant material such as gold, such foreign bodies may become infected. In the reported case, just the fragmentation and migration of the implant material resulted in very disturbing pain. Because these procedures are administered commonly for relatively young patients and complete surgical removal is virtually impossible, these residuals may remain for decades, with symptoms worsening through time.”

cosmetic surgery gone wrong

cosmetic surgery gone wrong

Further Read:

11 · 16

Silhouette Lift

Silhouette Lift is one of the thread lift technique that is performed with local anaesthetic in less than 45 minutes and without any hospitalisation. The expected recovery time is within 2 days when the patient can go back to normal activities, and after 2 weeks any sign of the cosmetic procedure should be disappeared.

The article will brief you about the procedure, the suture compound & structure, and potentially fit nad non-fit candidates.

Silhoulette_thread_lift
Read the full article on Silhouette Lift

 

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