Swooping

Guys how do i upload pictures into this?? Ive got them saved in my profile but cant seem to add them to this

[iM]http://www.hairrestorationnetwork.com/uploads_user/194000/193756/23008.jpg[/img]

[iM]http://www.hairrestorationnetwork.com/uploads_user/194000/193756/23009.jpg[/img]

[iM]http://www.hairrestorationnetwork.com/uploads_user/194000/193756/23010.jpg[/img]

[iM]http://www.hairrestorationnetwork.com/uploads_user/194000/193756/23011.jpg[/img]

[iM]http://www.hairrestorationnetwork.com/uploads_user/194000/193756/23012.jpg[/img]

Copy this in your message but edit the [iM] at the front to

Very good result.

Every year at the annual ISHRS conference we (the ABHRS) sponsor a Morbidity and Mortality (M&M) night session. During this session we hear from doctors around the world who practice daily hair transplantation. During these sessions we have encountered various complications, including cardiac, infections, asthma attacks, vasovagal attacks, and many others.

 

No doubt hair transplant surgery is low risk when compared to more invasive procedures, but it is still surgery. Not having a physician present (who is also up to date with ACLS), should be a minimum requirement. Your life is worth it.

New information to me.This is indeed an extremely valid and important point. I would rather be in someone his hands who knows what to do when unexpected (rare) complications happen than someone who doesn't know how to handle.

Swooping,

 

I don't think I was clear before: I do not think a tech can surpass a doctor in every/any aspect of hair transplant surgery. Why would this be true? This makes no sense to me. Techs are better than surgeons at every aspect of surgery? Who are these techs? Who trained them? Why are we to believe that these people have innate artistry akin to Picasso, but doctors can't? You want one example where a doctor was better than a tech? I think you can open almost FUE thread from one of our recommended doctors and find a result that is better than a result than from a tech somewhere? Are you saying techs are always going to be superior?

 

Again, I don't know why we keep coming to this very theoretical argument where techs are all savant artists and doctors are all incompetent boobs with decades of medical and surgical training that apparently means nothing?

 

Just to clarify again: I don't believe techs can surpass doctors in every aspect of surgery like you said above. I think they can practice extraction over and over and become proficient like any other person with two hands could. However, being good at extraction is only one aspect of surgery. It's takes a lot more to pull off a solid result, and this is where a surgeon comes in. Techs are a crucial part of this team, but a solo tech team is not superior to a model with a doctor and techs working together. Bill feels the same way. I promise that.

 

If you'd like to see some of my problems with this model, see the recent Maral controversy.

No I am saying that what Dr. Karadeniz was stating is absolute nonsense. I'll quote again;

Originally Posted by drkaradeniz

It is an illusion that trained technicians can do the job with the same excellence as an expert surgeon and the only thing that matters is doing the incisions.

You know what he says with this statement? He basically says that all active technicians currently or in the future will always be subpar to an expert surgeon. I never said however that a technician will always be better than a random surgeon. However a technician may very well be sometimes get better than a random surgeon. I provided you enough examples. I'll give you one; Dr. Lorenzo achieves one of the highest consistent yields worldwide, yet his technicians do most or a huge part of the extractions. So this technician must be world class and is better than most of the recommended surgeons, on this site in the extraction process. What is there so hard for you to grasp on this concept?

Also a solo technician team can perfectly fine be on par with a model of a technician + a doctor. There is 0 reasoning why they could not. Give me specific example why they could not? Specific examples please. I'm talking about a well trained eligible legal team. That's right blake you can't give them. You have nothing to stand on, totally nothing. Apart from the argument that surgeons may have better overall medical training to react on rare complications. But again if they are legally able to solely operate in a hair transplant in a jurisdiction, they have the right too.

I don't know about Maral or the controversy. Are they a technician only clinic? If they have had adequate good training,they are legally able to do so and they produce good results they should be applauded. It's a development Blake, something you might be scared of or surgeons might be scared of. Why? Because it threatens their job, it creates a more competitive market. Only the best will survive, it may create more niches. Perhaps they will produce average results, not top notch but average for a very low price. Not everyone has that much money to spend and needs to chose for price quality. It may even spark innovation. It's always easy to pick apart one side of the story. Furthermore I wouldn't be surprised if their results from now could be better than some of the recommended surgeons on here. Obviously I didn't research them but it's completely plausible.

That's the real world Blake. Good excellent results that is what I want to see, whether that is from a skilled legally able technician only clinic or from a team of 20 doctors. I don't care.

So to return to Dr. Karadeniz statement, do you agree with that statement? If you do, I don't care but I'll tell you straight in your face you are speaking from an bias subjective opinion which doesn't hold any truth.

I would appreciate if I can at least give my honest view on these forums without any disgusting slandering like Dr. Karadeniz gave me when I point him on having an biased opinion. Cheers.

Edit; By the way I enjoy your posts too, no hard feelings either obviously ! By the way some of this is obviously my personal view, but you can't generalize like Dr. Karadeniz did.

I think a air pillow is the best personally (not inflated preferably). You need something around your neck from preventing you from turning in sleep. With this prone pillow you'll be still easily susceptible to turning in your sleep. I'm a huge stomach sleeper and when I had my HT I used a air pillow and that really prevented me from turning.

Another few things ...

 

Swooping - I think you may be expanding my statement a bit. I think, in theory, a tech can be trained and develop good technique and dexterity. I don't think this translates to me saying: "a technician can become just as good, if not better, than a doctor;" which is closer to what you're saying. This misses a fundamental point; FUE is more than being technically proficient at extractions. Just because a tech can develop technical skill with route repetition and focus, it does not mean they are as "good" as a doctor. Like I said above, being a good surgeon is more than being technically proficient. There really isn't any substitute for going to medical school and learning the entire symphony.

 

Bill - You bring up an excellent point; I hope it doesn't sound like I'm belittling or insulting technicians. They are a crucial part of surgery and it could not happen without them. Period. Hair transplantation is a team effort, and technicians are an undeniable part of that team.

Blake I know it's hard maybe to comprehend in your position. But it's the reality. Well not than a doctor in the pure sense.

Let's rephrase is then; A technician can be just as good and can surpass any doctor in any aspect of the hair transplant process. And this is totally true you do agree with me on this one right, at least Bill does. And it's not in theory Blake, it's already happening. The world's best regarded practitioners in the hair transplant industry use technicians for (big) parts of he process. There is 0 reasoning to believe otherwise really. Unless you can come up with a specific example. But you can't. Not every doctor can become the best. Doing a great hair transplant requires to have an extremely important aspect; artistry. Not everyone can be a Bisanga, as nobody will ever be like Picasso. So I welcome technicians because a Picasso under them may be present. And again, it's a reality already. It's happening.

Then a clown like Dr. Karadeniz has a big mouth to run but he is far from being considered a world class practitioner. By the way, I want to thank you personally Dr. Karadeniz that you gave me a valid reason now to definitely recommend you on all hair related forums. I hope you understand huge sarcasm in this one you "intellectual" :rolleyes:.

Thanks you all!

17 days post op right temple wet condition;

I'm not sure why you're using them as your examples, but I don't think Erdogan "I post wet before and dry after" or Doganay "I don't have many good results despite a decade of surgery" are really all that good.

That is your opinion. When I look across all forums I see them mentioned extremely much. Also they are very busy so they must be doing something right. Nonetheless that again isn't the point, you don't understand the context.

Furthermore look on the positive side of a technician, relieving fatigue of the doctor for example. Also when you are going to put a stamp on technicians and are going to generalize them as per definition worse you are literally hindering rivalry, development and innovation. Which is an extremely bad thing. Perhaps only a few can understand this.

I'm done on this discussion anyway, I made my point. The moderators agreed on my point which is a good thing. I do agree however with Blake and Bill that surgeons have a better understanding on how to anticipate on eventual (rare) complications during a hair transplant due to better medical training.

You are just talking about a theoretical situation where a technician magically becomes a great HT practitioner. Karadeniz on the other hand is generalizing and speaking to a realistic situation based on his experience working as a surgeon, Lorenzo and Feridnuni's techs are good as they have worked under his supervision for many years, and their doctors continue to be heavily involved in the operation. They did not magically sprout HT powers like X-men. Finally Lorenzo's techs would never be able to perform a hair transplant as they have no experience in implanting grafts.

"Theoretical"? Dr. Koray Erdogan and Dr. Hakan Doganay have technicians too, these guys should be based on their skill and you should be damn right that they have very skilled technicians in what they are doing. Else they wouldn't be regarded as world class in FUE. Furthermore they won't take the risk in letting these guys do the job if they are not on par with them self. They would be putting their reputation on risk which they worked hard for for for several years. If you want to generalize the word "technician" in this sense like Dr. Karadeniz does you are putting a stamp on technicians as if they are per definition in shortcoming in comparison to a doctor which is a fantasy story.

Hair transplant surgery may appear to be a simple process of harvesting and implanting hair however, what happens in the event of a serious complication? Technicians may be just as technically able to extract and implant follicular units, but are they knowledgeable about how to handle serious surgical complications that can occur during a surgical procedure?

 

Best wishes,

 

Bill

I'm glad that two moderators agree with my standpoint that a technician may be just as good as a doctor and in fact can surpass them in a aspect or a whole of the hair transplant process. They can also as easily adapt to transection and donor problems as a doctor. So in that sense Dr. Karadeniz is talking nonsense again from an biased subjective opinion.

DR. Yaman,

 

How long can skin grafts be stored in a refrigerator in normal saline solution and can still survive after transplantation??

He won't be able to answer this question I think. First of all because there is individual genetic variability in hair follicles. To explain this within a example;

A graft of myself might survive for example 24 hours in a normal saline solution while a graft of you might survive for 36 hours. Another patients graft could perhaps only survive for 18 hours.

Note how I say "graft" and not grafts because in a individual there will also be variability across grafts. For example when I take 2 grafts from your head a stronger one might survive 36 hours but another may succumb in 24 hours. I pull out random numbers here but it's just to provide an example.

One thing is for sure, it is in everyone's interest to opt for a good storage solution and not go with insane sessions (especially with FUE). Always better to play safe in this regard in my opinion. The less stress to the grafts, the better.

Also interested in Dr. Yaman opinion though!

Yes ,in our clinic and in Turkey, we operate lots of 3000 and more grafts hair transplatation .When we operate them with normal procedures the outside duration of grafts takes longer.As a solution, after taking and transplanting 1000-1500 hair follicles the operation moves on the other ones.We can do this three or four times a day.It might be a bit tiring for our patients but we prefer short sessions with breaks.This help us to protect the hair follicles.

Excellent results. Furthermore I want to applaud your methodology of breaking the grafts up. I requested the same to have only max.1500 grafts extracted from one session when I had my hair transplant. Time out body makes a huge sense in terms of yield.

First of all because when grafts are extracted they get cut off from the blood supply which causes ischaemia. Secondly hair follicles reside in a perfect low oxygen gradient, removing them from that environment causes reactive oxygen species (ROS) to set in, no doubt. Furthermore it has been proven by for instance Limmer;

Limmer performed an in vivo time out of body study using chilled normal saline with follicular unit grafts. The results were: 2 h, 95%; 4 h, 90%; 6 h, 86%; 8 h, 88%; 24 h, 79%; 48 h, 54%.

Now better storage solutions may be used as for example Hypothermosol mixed with ATP to cope with ischaemia and energy demand. PRP also.. But these storage solutions ain't perfect, simple as that.

So I totally agree with you that it is better to opt for lower out of body times of the grafts. It makes total sense.

Keep on doing great work and good luck!

Swooping - No, you're not wrong. Like I said before, there is nothing saying a technician can't be trained and develop effecient extraction skills. In my mind, however, the situation is much more complex than that. Not only do I make this point with my last post, but I've also explained previously why there is so much more to a surgical procedure than meets the eye; things can go wrong and humans are much more complicated than they appear. Despite what some may say, FUE isn't simply a process of pulling out follicular unit grafts and plugging them back into the scalp, and patient are not static, simple models. FUE is a surgical procedure. Granted, it is a minimally invasive procedure, but it's surgery. Patients are complex organisms with unique anatomy, underlying medical conditions, and unpredictable responses. Taking a trained physician/surgeon out of this situation is unwise. Frankly, it disrespects the nature of surgery and the patient themselves. I know most will probably roll their eyes and state that FUE is perfectly safe and you don't need a surgeon standing by for a "one-in-a-million" complication, but I really disagree with this position. Treating a living, breathing human with surgery requires a skillset that it obtained by going through serious medical training. Anything less just doesn't make a whole lot of sense.

For your part; I understand your personal reasoning and your concerns over this point. However when a technician can legally individually operate in a jurisdiction he has all rights too, simple as that. The government in this case has decided. They simply have decided that a technician can have full responsibility in operating in a hair transplant. Some jurisdictions probably have a good damn reason to allow technicians to perform a hair transplant. I do agree that these "only technician" clinics should be approached very cautiously. Nonetheless perhaps it will be a development. I'm from the Netherlands and not so long ago dentists were only allowed to perform fillings. Time has changed however and now trained assistants are allowed to perform this action by the government.

But that is a other discussion anyway. We seem to agree on this point that a technician can perfectly well attain the same skill as a hair surgeon and even surpass them. For example I wouldn't be surprised if the technician of Dr. Lorenzo is better than some of the recommended doctors here in the extraction part. It's completely plausible. Dr. Karadeniz was generalizing and talks from a bias and I pointed him on that, then he personally slanders me like a little kid. How unprofessional is that?

Well we all can see that Dr. Karadeniz speaks from personal subjective reasoning with a bias to protect his position. From a objective standpoint however we can see that what he speaks is totally nonsense. Always think through, research and educate yourself guys !

I am prepared for representatives and trolls attacking me here, so it is no surprise. I will not go into discussion with such people who are usually at a lower intellectual level and more importantly are vulgar. The fact that I am making a comment here doesn't mean that I am answering you personally as your motivations to promote a technicians clinic has no intellectual value.

I have explained this issue previously, so it needs no further comment.

None of my postings are personal, but are intended to share my knowledge and opinions with a large community. Everyone can draw their own conclusions.

Typical response from a cat who is cornered. He jumps away. Then he slanders me based on nothing. Furthermore I am chuckling here. As I'm perfectly sure I am on a way higher level than you in hair biology and Androgenetic Alopecia. Also I am aware of the all papers done related to hair transplants. You are free to meet me in November this year at the hair congress. Furthermore you are speaking here to someone who has been active for some years on several hair forums helping people, educating and engaging in interesting discussions. I can prove this immediately . Second time you make yourself look bad.

Originally Posted by drkaradeniz

It is an illusion that trained technicians can do the job with the same excellence as an expert surgeon and the only thing that matters is doing the incisions. This claim is the fruits of a doctor being able to cope with 3-4 patient incisions a day. When that clinic has 8-10 patients a day then they will claim just doing the markings is enough and the incisions can also be taught to technicians. Who can claim that a talented technician can't learn how to do good incisions? There is no end to this.

Moderators am I wrong here? I'm asking for a reasoning why a legally eligible trained technician in pure sense can't acquire the same skills as a surgeon in a hair transplant. I'm waiting for a explanation, yet I don't get one. Dr. Karadeniz preaches himself as telling the truth but he can't give reasoning. Then he slanders me on a personal level. Talk about "intellectual" here.

It is curious how in these debates the technician is always a phenomenon, and the doctor is incompetent, and this ideal scenario is used to defend techs doing surgery. No agenda though.

Unrelated to this discussion. That's not the point. You are talking about people preaching from a bias on the other side of the story, more-so a hidden agenda. I'm talking objectively here. If you think that a legally eligible well trained technician can't acquire the same skills as a surgeon in a hair transplant you are totally twisted in reality. We ain't talking about acquiring the mind of Einstein or Nikola Tesla here.

It is my patients who is going to tell if I have a golden hand or not.

There is nothing to be gained from such unfruitful comments. It is neither going to put me off in trying to support the truth, nor going to change the reality that supporting technicians has marketing purposes rather than quality and patient benefit.

Problem is you ain't objective and you are talking with a bias here. Seems you are saying that nonsense to protect your position. There is 0% reasoning to believe that a well trained technician can't live up to the standards of a surgeon in a hair transplant. In fact I'm sure that some trained technicians do a better job with the extraction process than some of the recommended surgeons on this site. It is perfectly plausible. So in that sense you ain't preaching the truth but are downwards lying here.

Can you come up with reasoning why a well trained legally eligible technician can't acquire the same skills as a surgeon in the extraction process? That is right, you can't. Sorry Dr. Karadeniz I am not on these forums to buy into fantasy stories.

It is an illusion that trained technicians can do the job with the same excellence as an expert surgeon and the only thing that matters is doing the incisions. This claim is the fruits of a doctor being able to cope with 3-4 patient incisions a day. When that clinic has 8-10 patients a day then they will claim just doing the markings is enough and the incisions can also be taught to technicians. Who can claim that a talented technician can't learn how to do good incisions? There is no end to this.

Absolute nonsense. Do you have a golden hand Dr Karadeniz for graft removal? Does your mind perform in vivo screening of the dermis in 3D so you have a better feel than a trained technician can have? It is an illusion in your world yes, in the real world it is an reality.

what topical anti androgen are you using?

ru-58841.

bmorelaxing , the technique you are referring to is called FIT farming : replace scalp hairs donor with body hairs in order to maintain donor appearance .We usually use Body hairs from beard , chest or leg .BHT will keep their own characteristics ( caliber , color ) .We observed a change in length .they have tendency to catch up with the length of your scalp hairs .

 

Now , the test about hair multiplication we did in India didn't bring to much outcome .We noticed no marks in the donor area after using a bigger punch.In recipient area , it was a failure ( no hairs are growing so far ) .The informations we gathered from that case report led us to apply others protocols we are still testing ( used of fresh DP cells , growth factors ( wnt , Prp, Acell,...) .I wish I could have my own lab to culture stem cells and conduct the study on more cases .

That is unfortunate. Can you describe your initial protocol Dr. Mwamba? What did you test? Transection of hair follicles in vitro and re implantation? Some more information would be great, appreciate it thank you.

Are we talking about a specific technician here? If we were, then anyone who had an experience, together with the results could contribute into a discussion about this person. In light of such testimonials and evidence I would be ready to admire a genius. However in the absence of a specific person we have to stick with our generalisations.

 

A question also arises: Why would someone posting his opinions here try to squeeze in a rare exception of a technician being much better at doing hair surgery than a properly trained surgeon? And why do I see this happening so frequently?

No, but people might perceive your opinion as that they should per definition think that technicians can't have the same qualities in terms of a hair transplant as a surgeon. Which just isn't true. Even these technicians "only" clinics should be reviewed from an objective standpoint without a bias. I don't have a good expertise of the results and market of these (nor am I interested) and I do believe you are being honest about the current state of these clinics in your country. However that doesn't exclude the point that one day such a clinic may arise with only technicians which will provide world stellar results. If that happens these results should be indeed admired and received in open hands without a bias.

A question also arises: Why would someone posting his opinions here try to squeeze in a rare exception of a technician being much better at doing hair surgery than a properly trained surgeon? And why do I see this happening so frequently?

This wasn't my point and you misinterpreted my context then, actually you stretched it way too far. Secondly are you implying that I have a hidden agenda ?

Thanks guys!

did he say how many grafts u have left from the donor zone?

Hey Busa,

1500 at least, but it's way too early to speak how much really perhaps it's more. Depends on the healing of my donor too..Unfortunately my mid and upper donor on the back isn't that suitable for extraction because the density isn't as good & there is more thinning, weak hairs! The punch diameter on my donor side was 0.7mm with a length of 4mm. Hope that answers your question!

Thanks for the detailed answer!! Are you on any medications?

I actually had a pretty big shed and loss of density & thickness because I dropped my medication 3-4 months before the surgery. I was on a topical anti-androgen + minoxidil. I restarted the topical anti-androgen now , won't restart minoxidil though. My hairloss is stable and because I restarted now I should expect some gain of quality of my hair as before (hopefully) !

The principle you are basing your opinion totally defeats the principle of 'Licensing in Medicine'.

 

If we accept what you are saying, then we could train a car mechanist to do heart surgery better than some heart surgeons, we could train a policeman to do better gastrointestinal surgery than some general surgeons and we could train a housewife to do a rhinoplasty better than some plastic surgeons and so on. There is no end to this.

 

If we are talking about public health and safety, of course we have to generalise.

We have to assume that in order to get the best average quality of hair transplants, with regards to safety, naturalness, donor and recipient area aesthetics, we should give a licence to physicians not technicians.

 

I have to add that the term 'technicians' does not refer to a specific specialty with training in hair procedures, but is a mixture of people from various fields, including nurses, ambulance technicians, paramedics, laboratory technicians, biologists. I have even heard car mechanists, secretaries and housewives doing this. So you can imagine how much we actually need to standardise this in Turkey.

Well I completely agree with you. It's absolutely needed that these rules exist for public health and safety. I wanted to create a nuance here though. People might perceive the generalizing as that per definition a technician always does a worse job than a surgeon , while it may be the other way around. I do agree that people should be especially cautious of these clinics, however that doesn't mean that they cannot provide stellar consistent work.

Hey John, what are your/Dr V's opinions on the advantages/disads of the Hans Lion Implanter? Has there been a visible impact on yield vs using blades?

 

 

It seems to be a regional thing as Dr Vories wrote, not too many Western surgeons use its relative the Choi pen, and early on it was derided by people like Feller and Rassman that it's maybe good for inexperienced practitioners.

What is the difference between a Hans Lion implanter and the Choi pen? Thanks in advance.

I don't think I need to say anything more about technician clinics as I have posted a lot about this. Me and my patients on this forum have been subjected to personal insults by them and their representatives lately. Meanwhile, I would like to add here that I am not against these clinics as long as they are transparent in what they do and the patients accept this. Anybody who feels they will never have a chance to have a proper hair transplant by one of the leading surgeons and are willing to risk their natural appearance to get some hair on top of their heads can and will continue to go to these clinics.

It's good that you raise awareness about this. I think you generalize a bit though. You talk about "technicians" and "surgeons", however what makes you think that a technician can't become more skilled than a surgeon? In fact, some technicians might do a better job as surgeons right? It's only a qualification we are talking about here.. Honestly no offense, but even a random person from the street who is unqualified could be the next worldwide superstar in hair transplants if he receives adequate training and is talented. While there is definitely some technical and medical knowledge needed for hair transplant, the artistry outweighs far more. You can only gain this through practice, effort & talent. At least this is my opinion.

@fc8uk, I just came back from Turkey and made a report of my hair transplant experience here; http://www.hairrestorationnetwork.com/eve/178374-hakan-doganay-2835-grafts.html. Perhaps interesting for you too read, good luck!