FUE extractions should be done by who? The doctor or the techs?

[crowngarden]

What's more important in an FUE hair transplant? The technical skill and patience of the extraction process? Or the artistry of implanting the grafts at the correct angle? Who is more suitable for each? In the hair transplant profession is the doctor more of the "artist" while the techs have the skills? The reason that I ask is that I was always under the impression that the extraction process was the more surgical and delicate process of procedure where transection was a risk so that was normally the lead doctor's duty. I know that Dr. Diep in San Jose, CA has stated that only he (and not his techs) performs all extractions. I also believe Dr. Feller in NY told me that he does the extractions (it was long ago when I had my consult with him so I could be wrong but I'm pretty sure he told me this). But then today I have read that Dogonay, Lorenzo, Hasson and Wong all have techs doing the extractions at their clinics. I know Hasson and Wong are known to be ethical, cream of the crop surgeons in the hair transplant field. And Lorenzo's results speak for themselves. There doesn't appear to be a consensus among the top docs on where the responsibility lies when it comes to the extraction process.

 

[buckthorn]

In the ideal scenario, the surgeon will do all the extractions and create the recipient sites, while the techs are trained properly to do the placement. Some of the better clinics have become so popular, with such increased demand, that they are starting to micromanage too much responsibility to the techs. IF the techs have been properly trained to do the extractions, AND have a consistent track record of excellent graft survival, then I would feel fine if this was an option. I would walk right out of a clinic, however, if they had the techs creating the recipient sites. I think that is unacceptable bullsh*t. We pay for the surgeons artistry in creating natural hair lines and the illusion of density. I don't want to walk into a clinic the day of and realize that I put the fate of my hair line in a doctors previous work and he is not the one doing it.

 

[crowngarden]

I agree with you. But at that point, if you're in the chair, and the extractions have been made, and then the doctor walks out and the techs start to do the recipient area, what can you do? You're kind of stuck at that point. I guess this is very important information to get before agreeing to the surgery. I wish hair transplant surgeries were a one-professional procedure. That way you would know what you're getting for sure. Instead of a revolving staff of technicians which of course, like any profession, some are going to be more skilled than others so it's a crap shoot on wether or not you are going to get the best. It's like admiring the gallery of a great tattoo artist, then going to get a tattoo by said artist only to learn that he's only going to outline the design on you and some other guys are going to fill in the colors and shading.

 

[shookwun]

When I had my FUE done.


Rahal did the incisions. His lead hand, did the harvesting.

Techs did the implants.


His lead hand is fully registered, and has his doctorate degree.

 

[buckthorn]

When I had my FUE done.


Rahal did the incisions. His lead hand, did the harvesting.

Techs did the implants.


His lead hand is fully registered, and has his doctorate degree.

Hey Shookwun,
I didn't know you had a FUE with Rahal. He is top notch. Are you considering more work in the future?

- - - Updated - - -

When I had my FUE done.


Rahal did the incisions. His lead hand, did the harvesting.

Techs did the implants.


His lead hand is fully registered, and has his doctorate degree.

and yes, this would be totally acceptable to me. I would just trust that someone like Rahal, having such a strong reputation, wouldn't risk hiring half a*sed techs. Certain surgeons, like Rahal, H &W, the Shapiro's, erdogan, etc... are known, respected and trusted for their hair line work and proper placement behind to create an illusion of density. You would just have to put faith that they wouldn't want to jeopardize that. I think that once I am ready, I will make them fully aware that I will be documenting EVERYTHING on here, BTT and other forums. Perhaps that will help influence them to not put a shifty tech on my head.

 

[shookwun]

I'm done with transplants. the last one I had was to give me more angle closure, and construct temple points.

 

[Swoop]

I had the head tech doing my extractions solely and the doctor working on the implantation 100%.

Bottom line is that you want to have people work on you that are skilled. Can't have noobs working on your head.

 

[Deadman1]

There is a high turnover rates of assistants (I refuse to call them technicians) so chances are you will get someone in training doing the work. Also I am finding that the longer a doctor has been in the hair transplant business the worse their results are. I don't know if they stop caring, see the money they make and get greedy wanting more and more so do rush sloppy work to get more patients in, or get involved in using substances they shouldn't. Also some don't even do the work anymore and have their assistants do it. You do your research, pick a doctor with great results and then on the day of surgery find out he doesn't do any of the work.

If there was any real regulation of the industry 95% of hair transplant doctors wouldn't be allowed to practice and a lot would be arrested for mayhem.

 

[Pequod]

If they do a horrible job at extraction but place them perfectly it won't matter as the grafts will be dead on arrival.

 

[arfy]

I've never heard of techs making recipient sites. This would be completely unacceptable. In my opinion, it's also completely unacceptable to have techs doing extractions. They are not licensed to do surgery. In many states, I believe this is illegal (the practice of medicine by a non-physician) however the laws may vary by state. In a strip surgery, the doctor removes the strip of donor scalp and gives it to techs, who sit at workstations with microscopes* dissecting the grafts. But with FUE, some clinics have the techs harvesting the grafts directly from the patient's scalp, which is surgery, plain and simple. A medical tech certificate only requires 2 years of college, and they are not licensed to operate on patients. Techs aren't even legally licensed to inject anesthetics! Notice how the doctor is the only one administering your injections? Yet some doctors have techs making incisions into your scalp, and removing scalp tissue. This is very likely illegal.

Also, from a consumer's standpoint, there is simply no way to know how much experience a medical tech has, or how skilled they are at doing graft harvesting (experience doesn't always mean ability, but it probably helps). You choose a clinic based on the doctor's reputation, and then unskilled workers do a majority of your surgery -- it's a farce! When Dr Cole did my surgery, he had medical techs do most of the graft harvesting. Dr Cole would leave the room for 20-40 minutes at a time, leaving the techs working unsupervised. The techs did most of the harvesting and about half of the graft implantation. The only thing that Dr Cole did by himself was create the recipient sites (which he does extremely quickly, as do most doctors, from what I've seen and experienced). They don't stand there agonizing over where to put each graft, they jab your scalp rapidly with a needle, and that's how the recipient sites are made, in most cases. The only exception would be Dr Woods and Campbell, who only create a few recipient sites at a time, and only at the last moment, when they have harvested a small number of grafts (in order to avoid minimize having grafts sitting around outside the body as much as possible, and to have recipient sites as fresh as possible). As I documented in my thread here, my surgery with Dr Cole was virtually a total failure. But it was very cost-efficient for Dr Cole!

Also, the concept of "artistry" is IMO over-blown, when it comes to vast majority of doctors. They're not artists. They are following a template, coloring within the lines, so to speak. "Artistry" is marketing BS that they use to promote themselves.

*(not all clinics even use microscopes to dissect the strip! They use inferior magnifiers or jeweler's loupes instead. "Do you use microscopes?" used to be a key question to ask, and still is, in some clinics.)

 

[crowngarden]

I've never heard of techs making recipient sites. This would be completely unacceptable. In my opinion, it's also completely unacceptable to have techs doing extractions. They are not licensed to do surgery. In many states, I believe this is illegal (the practice of medicine by a non-physician) however the laws may vary by state. In a strip surgery, the doctor removes the strip of donor scalp and gives it to techs, who sit at workstations with microscopes* dissecting the grafts. But with FUE, some clinics have the techs harvesting the grafts directly from the patient's scalp, which is surgery, plain and simple. A medical tech certificate only requires 2 years of college, and they are not licensed to operate on patients. Techs aren't even legally licensed to inject anesthetics! Notice how the doctor is the only one administering your injections? Yet some doctors have techs making incisions into your scalp, and removing scalp tissue. This is very likely illegal.

Also, from a consumer's standpoint, there is simply no way to know how much experience a medical tech has, or how skilled they are at doing graft harvesting (experience doesn't always mean ability, but it probably helps). You choose a clinic based on the doctor's reputation, and then unskilled workers do a majority of your surgery -- it's a farce! When Dr Cole did my surgery, he had medical techs do most of the graft harvesting. Dr Cole would leave the room for 20-40 minutes at a time, leaving the techs working unsupervised. The techs did most of the harvesting and about half of the graft implantation. The only thing that Dr Cole did by himself was create the recipient sites (which he does extremely quickly, as do most doctors, from what I've seen and experienced). They don't stand there agonizing over where to put each graft, they jab your scalp rapidly with a needle, and that's how the recipient sites are made, in most cases. The only exception would be Dr Woods and Campbell, who only create a few recipient sites at a time, and only at the last moment, when they have harvested a small number of grafts (in order to avoid minimize having grafts sitting around outside the body as much as possible, and to have recipient sites as fresh as possible). As I documented in my thread here, my surgery with Dr Cole was virtually a total failure. But it was very cost-efficient for Dr Cole!

Also, the concept of "artistry" is IMO over-blown, when it comes to vast majority of doctors. They're not artists. They are following a template, coloring within the lines, so to speak. "Artistry" is marketing BS that they use to promote themselves.

*(not all clinics even use microscopes to dissect the strip! They use inferior magnifiers or jeweler's loupes instead. "Do you use microscopes?" used to be a key question to ask, and still is, in some clinics.)

I think that FUE extraction might not fall under "surgery" although I agree with you that it should. And I would definitely feel more comfortable having done research on the person who would be doing my extractions. But even the best doctors out there (Lorenzo, Hasson, Wong) are using technicians to do extractions. Since I am sure they use multiple technicians, there is really no way of knowing who it is that will be doing your extractions on your surgery day. No way of researching this person's work. You just have to have faith that a reputable doctor is employing very skilled and competent technicians. Dr. Diep is the only doctor I've spoken/consulted with that has stated that he does the extractions.

 

[Roberto_72]

This is why in the USA FUE can't be done because it's illegal to have technicians extract your donor since it counts as surgery?

I've seen a lot of USA surgeons bashing FUE just because they can't do it as they do it in Europe. Not to say that all this tech thing isn't troubling. But still I don't want to have a big scar on the back of my head.

Spencer Kobren was bashing it too.

Another reason (in both Italy and Spain) is that for a surgeon it has less added value (too time consuming).
However, were I to go back, I would do FUE rather than strip because it is my understanding you can still have a shaved look with FUE. With strip, I can feel the scar with my hands and it's not cool.

 

[arfy]

I think that FUE extraction might not fall under "surgery" although I agree with you that it should.

"Fall under surgery" how? Legally? I believe that it does. If medical techs can't legally apply an injection of anaesthetic, then they surely can't legally remove hundreds of living tissue grafts directly from a patient by using sharp tools. It depends on where you live though. In the US, questions like this are decided by the state medical boards. In other countries, they would have their own regulations. I wouldn't assume that because doctors are doing it, it's been decided that techs making extractions is legal... In many places, FUE is brand new, and it may have not come up as an issue yet.

 

[crowngarden]

"Fall under surgery" how? Legally? I believe that it does. If medical techs can't legally apply an injection of anaesthetic, then they surely can't legally remove hundreds of living tissue grafts directly from a patient by using sharp tools.

I'm not sure how. But I don't think reputable doctors like Hasson and Wong would be doing anything illegal, let alone advertising the illegal action on their website. Like you said. The laws probably differ from state to state.

 

[Piyush]

It should be done by experienced doctor or hair transplant surgeon only

Dear friend,

Graft Extraction and placement in hair transplant is very important and crucial part. Graft as you may know contains 2 or more hairs which is to be removed from the hairs rich area and implanted to the recipient area.

Graft wastage also should be avoided under expert guidance. The micro punches that used to extract the grafts should be of appropriate size and the process should be handled very carefully and precisely. Bleeding can also be the reason to worry during graft extraction so one should take care of this.

These all precautions can be taken care by an experienced hair transplant surgeon only. I would suggest to have a procedure under some expert guidance only.

 

[Rambo69]

Very interesting trhead.