I have spoke with two offices in the past few days. I'm not going to say which I spoke to just yet.

One office says the Dr. does NOT do the actual placement of the FU's. That they have trained medical assistants placing them. The other says the Dr. does the placement and is there by your side throughout the ENTIRE process, and is a bit more expensive.

I'm wondering what is such a big fuss about who to go to, if they arent actually performing the work. I mean, I'm paying for the name/reputation of Dr._____ and he is nowhere to be seen?

I must say I have a great understaing about density now.I have read about it, but after speaking to someone and having it explained, I now get it.

Whoever chimes in, can you just kinda throw in whether or not the Dr. you chose actually hung in there the whole time?

TIA!

Nope.. The first Dr. was unavailable while I was bleeding to death and counting my money.
The second that repaired me was there and wouldn't take my money.
This is leagal crime.. Be careful.
The dif betwen a good and bad doc is profound.

Burt,

This issue has come up here many times and I feel the same way you do. It is the "skill and artistry" of the surgeon that is being promoted yet a paraprofessional (highly competent and experienced as they may be) is peforming one of the most crucial functions. However I don't think there is anything to prohibit this legally as the technician works under the supervision, authority, and license of the physician.

There also is a current running post on the background, qualifications, training, and credentials (if any) of those in the technician role.

In my case for my most recent proceedure a technician did assist although the Dr. was still present throughout.

Phil

Burt-

I think it's safe to say that many of the Coalition Surgeons here have qualified, experienced techs place the grafts. The artistry and "map", if you will, of the HT, is in the design and placing of the incisions. I don't mean to brush off the importance of the skill of the person placing grafts, however, many reputable clinics have techs do this.

At the same time, the techs who are placing this piece to the HT puzzle are very experienced. Otherwise you would see top Docs like Hasson, Wong, Shapiro, Feller, Cooley....(list goes on) producing poor quality work and this obviously is not the case.

Personally, Dr. Wong made all my incisions for HT #2 but the techs placed the grafts........all of them, I think?? Even for my first HT which was nowhere near the quality of the 2nd, same thing.

In reality, whether the tech or the Doc places them, I couldn't care less if they CONSISTENTLY deliver quality results which is what we are after.

Do you fire an architect because he doesn't place every brick himself?

This topic might be expended by the question of having the FUE extractions done by trained assistants. Please take into consideration that placing grafts by assitansts is a tedious work but it requires great skill to do it properly. These techs have to have VERY steady hands and excellent eye/hand coordination.

Would you accept trained assistants doing all of the extractions and planting them afterwards?
The doc would just do the anestetics, design and some checking during the procedure.

Originally posted by rp1979:
Obviously it's impossible for the doctor to place all the grafts. BUt after all the grafts from the pre-punched incisions have been placed, some patients prefer that the doctor do a final "stick and place" at the very end for refinement to areas such as the hairline for the last 100 grafts or so i.e. make an incision, place a graft, make an incision, place a graft... etc.

It's a personal thing, I think. For me I rather have all aspects of my expensive meal prepared by the head chef, eventhough his assitants could be just as qualified.

This topic has been quite thoroughly discussed in this thread. Let us know what you think:
http://hair-restoration-info.com/eve/forums/a/tpc/f/346...661007013#7661007013

quote:

Originally posted by rp1979:
Obviously it's impossible for the doctor to place all the grafts. BUT after all the grafts from the pre-punched incisions have been made, some patients prefer that the doctor do a final "stick and place" at the very end for refinement to areas such as the hairline for the last 100 grafts or so i.e. make an incision, place a graft, make an incision, place a graft... etc.

It's a personal thing, I think. For me I rather have all aspects of my expensive meal prepared by the head chef, eventhough his assitants could be just as qualified.

This topic has been quite thoroughly discussed in this thread. Let us know what you think:
http://hair-restoration-info.com/eve/forums/a/tpc/f/346...661007013#7661007013

Well, lets take an AVERAGE strip surgery 2000-2500 grafts.
Doc comes in ... aneastetic ... takes out strip ... closing up the wound.
Takes about an hour ? Maybe a bit more ?

Techs start disecting grafts and preparing them for implanting. Usually it a team of multiple techs doing this job.

A good tech does 500 grafts implanting or more per hour. If a doc would take the time to get up to his techs skills it would take him about 4 or 5 hours to plant everything.
In total it would take him about 7 or 8 hours of work to do the entire job. Thatis a normal working day in terms of hours.

Again, I think it is very possible to have placement done by the doc in a lot of cases performing strip surgery, I see little excuses.

Obviously it takes more implanters if things are going giga size sessions.

Hello everyone,

Yes, this debate has come about before, and there are different perspectives on this.

I will say, however, that it is pretty much the norm that the techs place the majority if not ALL the grafts into the recipient areas. Of course, it is highly important therefore, that the techs be highly experienced and trained since it is delicate and tedious work.

Clearly then a clinic is measured by both the doctor AND the techs, though IMO, ultimately comes back to the doctor. Even one bad apple can spoil the bunch...in other words: many times results will be poor, which is why it's important to look for the consistency of the results.

Because this is the NORM, I have grown comfortable with the techs placing the grafts...

However, it is much less common for techs to extract the follicles (whether by Strip or FUE) and to make recipient sites. Because it is less common, I still have some reservations about this. But ultimately for me, it comes down to the results of the clinic.

Falc

Thanks for the replies. I will check the links posted above a little later ( long day at work today).

OKAY, riddle me this...

What happens when the 12 year tech leaves Dr.(insert coalition Dr. here) and goes to work for Bosley? Would we still say Bosley would be sub-par clinic to go to? If you are getting the work done by the same tech, just in a different invironment wouldn't you get the same results?

Discalimer: I have no interest in Bosely just using them as an example. They seem to be the Bose (over-rated lack of quality) of this site

Burt,

First of all, I doubt it would happen...that a quality tech would leave a highly respected elite physican and go work for Bosley...but...

Try to remember that all the pieces must fit together in order for the result to come out optimal.

Just as one bad apples can spoil a bunch, one good apple isn't good enough to change the outcome of a result.

Plus, it's not just a matter of placing the grafts that make for a good transplant, it's the number of grafts, placement of incisions, tool used to make incisions, harvesting of the donor, cutting of the FU grafts by all the techs, care of the FU grafts once harvested and cut, etc. There is a LOT to an HT and all pieces must be done not only adequately, but optimally.

Falc

There is a lot that goes into the placement of grafts and a lot that can go wrong. One must be well-trained and meticulous in order to be a great placer.

That being said, modern follicular unit transplantation involves moving THOUSANDS of grafts into balding or thinning areas. These units need to be removed (excised or extracted), slivered (during strip sx), dissected under the microscope, and placed into tiny sites.

There is only so much the doctor can do in a given period of time. He or she is still the quarterback for the entire procedure though! The doctor must be involved in the patient consult(s) to fully understand the patient’s needs, expectations, and physical characteristics. The doctor can then plan the procedure, taking all the patient variables into account. Excising the strip and suturing the wound (or extracting the follicles) is the sole job of the doc. So is making the recipient incisions. These tasks, respectively, determine the (un)delectability of the donor scarring and the aesthetic design of the recipient area.

Having techs or an assisting physician help in the silvering, dissecting, and graft placement is ok. The staff must be well-trained and take the patient’s precious donor supply seriously. They must be experienced and work well with the surgeon. Similarly, the doctor must able to deftly conduct his team to ensure a seamlessly executed procedure.

When you research a clinic, ask about the doctor’s involvement in your case. It IS important. Also ask about the staff too. How long have they worked in the field? How long under that physician's direction? Etc.

Consistent results are the bottom line.

quote:

Originally posted by Burt1973:
Thanks for the replies. I will check the links posted above a little later ( long day at work today).

OKAY, riddle me this...

What happens when the 12 year tech leaves Dr.(insert coalition Dr. here) and goes to work for Bosley? Would we still say Bosley would be sub-par clinic to go to? If you are getting the work done by the same tech, just in a different invironment wouldn't you get the same results?

Discalimer: I have no interest in Bosely just using them as an example. They seem to be the Bose (over-rated lack of quality) of this site

LOL !

Riddler: Riddle me this cape crusader- What is about the size of a mellon with little prickly hairs sticking out of it?

Robin: Holy critters, Batman, a porcupine??

Batman: No Robin, a post-op HT patient!! Your leotards must be a wee bit tight today!

Sorry.........couldn't resist throwing that in.......at least it was free !

I don't think you can fit this square peg in a round hole !!

My point is.................the tech, no matter how skilled, is placing grafts in incisions. The Dr. is "making" the incisions which requires skill in and of itself, along with the art of "where" to place them.........ultra-important in the hairline.

Also, the Dr. is harvesting the grafts and closing donor. So, if it is a poor quality doc and he transects many follicles during harvest, or sucks at donor closure, you can still get a bad HT with poor yield or poor-looking results.

Make sense? It's more of a both/and situation with Docs and Techs..........team effort from the clinic.