I have to remain as close to my time zone as possible, and as I'm in the US, I will go with Dr. Paley. My deposit has been made and a surgery date already reserved.
That said, were I not constrained by time zone restrictions, it would be Dr. Birkholtz and it's not even a close decision. World-renowned clinician, very ethical, state of the art hospital and five star accommodations minutes from the hospital. All for a price of close to two thirds less than what I will spend with Dr. Paley (I anticipate spending about $130K total).
What really seals this: the 7 day step-down program, where you gently get eased out of the hospital into your guest house or secondary accommodations. No other Dr. does this and I have to believe this makes the transition to "assisted living", so to speak, so much easier for the patient during the most trying part of the procedure.
I have a multi-country business to run, and our base of operations is the US, so I have no choice. Dr. Paley is the gold standard for this procedure so I cannot really complain. Were my circumstances different, however, I wouldn't even blink before choosing Dr. Birkholtz.
I do not share the same concerns as many about safety in SA. I know people who live there, and gated, guarded communities are quite safe.