How to tell the quality of Hair Technicinans??

[Romeono1]

Hi Guys,

 

I have spoke to a lot of Dr Humayuns (Pakistan) patients about his hair transplant surgery and a lot of them say the hair his technicians implant take longer to grow and the hair he implants does not look dense enough.

 

 

I am sure the Dr is a very good surgeon but I am not sure how qualified or skilled the technicians are.

 

How can you verify that the technicians used during the HT surgery are qualified and experienced? Often in third world countries they can make up forged documents etc.

[Forrest Gump]

Romeone1, actually we CANNOT verify about the credentials/quality of the technicians since we do NOT have much data about them. However, the assumption is that if the doctor is reputed, they'll properly screen the technicians for quality work.

 

I don't know about doctors in other countries, but I believe most of the reputed doctors in North America have a permanent team of technicians, instead of relying on temporary rotating ones.

[Bill - Seemiller]

Romeono1,

 

This is actually the first time I'm hearing about patients who are disappointed with their results from Dr. Mohmand. Why haven't these patients come forward themselves?

 

Honestly, unless these patients are willing to come forward to discuss their dissatisfaction themselves, I don't think it's fair to discuss what you've obtained in private. Without any specifics, such partial information is damaging to Dr. Mohmand's reputation.

 

Generally speaking, whether or not a patient is satisfied with their results depends not only on the successful growth from a procedure, but on their expectations of the procedure. Ultimately, we will be happy to consider the feedback from these patients, but it is up to them to come forward individually to discuss their concerns. Most importantly, I hope these patients you are referring to have discussed their concerns with Dr. Mohmand.

 

Dr. Mohmand has an excellent reputation on this community for producing excellent results. In the event of less than stellar results due to less than optimal growth, I know he stands behind his patients.

 

It's ultimately the responsibility of the physician to train and supervise their staff. While technicians are crucial to the success of the hair transplant, any problems immediately go back to and reflect on the physician. However, as a prospective hair transplant patients, you are certainly entitled to ask about the level of each technician's experience. In my opinion, Dr. Mohmand is very open, transparent, and honest and will provide you with anything you need.

 

Best wishes,

 

Bill

[Romeono1]

Bill, yes some of his patients don't think their hair transplant surgery by this doctor has led to the results they expected. Though they have all said that Dr Humayun is a very good surgeon and is very supportive.

 

No a few have not contacted him directly but I have recommended they contact him. (Please note some of them haven't reached the 12 months post op stage yet, so their results may improve)

 

If you want I can let you know who they are in private?

 

 

Do you know if this Dr uses Ultra Refined Follicular Unit Hair Transplantation? His website claims that he does but some of his patients don't seem to think this is accurate? If he does use this technique then why is he not a coalition member?

 

Do you know if he has applied to become a coalition member?

[Bill - Seemiller]

Romeono1,

 

I appreciate the additional information regarding the patients you spoke to. However, unless they come forward themselves, let's not discuss or speculate why they may or may not be satisfied with their results - especially since some are still in the process of waiting for more growth. Deal?

 

Dr. Mohmand is recommended on the Hair Transplant Network because he provides quality follicular unit hair transplants. While he does perform larger sessions when appropriate for the patient, I'm not sure that I would classify his technique as ultra refined, especially since he has a tendency to trim chubbier grafts. That is, unless he's refined his technique.

 

Leaving extra tissue surrounding the graft does provide some additional benefit. Studies conducted by a few leading physicians show that chubby grafts are more likely to survive than skinny or "skeleton" grafts, thus producing higher yield. That said, a handful of leading physicians have been producing excellent results with high yield with densely packed ultra refined follicular unit grafting. Others however, have not been able to achieve such high yield cutting grafts too skinny.

 

The advantages of cutting skinny grafts include the ability to densely pack grafts closer together in a single session and less trauma to the scalp. Assuming the physician has the skill and an experienced staff to handle larger sessions and a patient has optimal donor characteristics, cutting skinnier grafts also allows physicians to perform larger sessions in a single procedure.

 

That said, If Dr. Mohmand has now refined his technique and provides ultra refined follicular unit hair transplant and can demonstrate evidence of this, we'd be happy to consider him for the Coalition.

 

Best wishes,

 

Bill

[Romeono1]

Bill thanks very much for the information, I won't mention the patients that are having concerns with his hair transplant surgery until they have been through the 12 month post op period again.

 

The information you have provided is very useful, I spoke to his consultant and you are right he does say he trims chubbier grafts.

 

Please see below for a response I just got from his consultant:

 

Thank you very much for your message. We are pleased to inform Dr. Humayun also carry out extra refined follicular Units. The meaning of extra refined follicular units grafts is to remove excess fat from grafts. But some people in the world separate naturally paired follicles of 2's, 3's and 4's in to singles to make more grafts and call it extra refined follicular units. He is against that and keep the follicles in to natural pairs. Off course the single ones are used on the front hair line and then 2,s and others later on.

 

I do not know about the technical details of member or coalition member. You'd better ask to management of network forum."

 

Is this accurate?

[Bill - Seemiller]

Romeono1,

 

Trimming the excess tissue around the follicular unit to create "skinny" grafts is entirely different than splitting apart follicular units to make smaller grafts.

 

For instance, there's a 2 haired follicular unit "chubby" graft and a 2 haired follicular unit "skinny" graft. The difference between the two is that the skinny graft is trimmed of excess tissue and can fit into a tinier incision. Tiny incisions reduce the amount of trauma to the scalp and allows a quality physician to densely pack more follicular units per square centimeter when appropriate for the patient.

 

Splitting naturally paired follicular units would be to take a 2 haired follicular unit (which can be skinny or chubby) and cutting it to make 2 single haired follicular units (which can be chubby or skinny). There are extra risks involved in doing this however, this is a practice regularly done by all physicians in some cases to create extra single haired grafts for the hairline. But other than creating single haired grafts for the hairline, most physicians leave the follicular unit fully intact.

 

Those who do divide follicular units aren't necessarily doing anything wrong as long as they're disclosing this to the patient. Some physicians believe that smaller grafts (1, 2, and a select few 3 haired follicular units) will produce a more natural looking result than using too many bigs (3 and 4 haired follicular units). On the other hand, there are those physicians who will cut and transplant some double follicular units (a graft containing 2 follicular units between 2 to 8 hairs) because they believe it will help aid the illusion of density in some patients.

 

Regarding cost, if there are physicians out there who split follicular units into sub-units just to charge more are less than ethical. On the other hand, there are no physicians recommended by this community who practices this.

 

Best wishes,

 

Bill

[Dr. Michael Meshkin]

I am so glad this issue is being discussed on this thread. Ultra Refined Microscopic follicular unit grafting raises the bar for physicians and their staff. This delicate and demanding hair transplant procedure requires more skill and careful attention to be performed properly. The smaller and more tightly packed incisions require more closely dissected follicular unit grafts that are carefully trimmed under microscopes. These Follicular units are cut under the microscope into their natural state of one two or three hairs, and then placed into very small incisions using the lateral slit technique.

 

Another very important transformation is the size and the angulations of the incisions in the recipient area. These small and densely packed incisions are more difficult to place the grafts into. For these reasons, this procedure requires more careful selection of the doctor and the staff. the clinics surgical staff should have been with the doctor for a long time and have highly developed surgical skills and qualifications to perform hair transplants.

 

A prospective client needs to ask about the doctors staff, and their qualifications regarding hair transplant experience. These are the questions you may want to ask the doctor or his technicians:

1.The number of years the technicians have been working as hair transplant assistants.

2. How many technicians work on each client.

3. Are they full time or per diem.

4. How many surgeries per day and how long does it take for an average surgery.

5. Ask if they use microscopes for cutting the grafts.

6. Ask to observe a surgery and the technicians in action or get a tour of the clinic.

7. Talk to the technicians and ask specific questions to test their knowledge on hair transplant.

 

If a doctor doesnot perform hair transplant procedures on regular basis or doesnot have enough clients to keep full time staff, they use one or two assistants or in some cases hire per diem contractors for the procedure. In these cases the quality of the work is absolutely questionable.

For today's Refined Follicular Unit HT, which is the standard of care, it takes a team of at least 4 to 6 experienced well trained team working together for hours, so the procedure is done effeciently in a timely manner.

Always question the doctor about the staff and remember "a chain is only as strong as its weakest link".

[Dr. Mohammad Humayun Mohma]

Dear Romeono1

 

I have total of 18 techs

 

3 of them started with me in 2001

1 started in 2002

4 started in 2005

6 started in 2007

3 started in 2008

1 in 2009

 

one of them have just left.

 

so this is the experience of my tech,

 

I divide them in 4 theaters with 1 team leader of more than 8 years, one each with 5 years and then mix.

 

The rest of extra fine was answered to you by my consultant Shahid jamil.

 

Please feel free to ask what ever you want.

[Romeono1]

Dr Humayun thanks for providing us with this information. It is good to know that your patients are in the hands of experienced technicians.

 

I have seen some the results of some of your hair transplants and most of them look like you have done an excellent job.

[the B spot]

A prospective client needs to ask about the doctors staff, and their qualifications regarding hair transplant experience. These are the questions you may want to ask the doctor or his technicians:

1.The number of years the technicians have been working as hair transplant assistants.

2. How many technicians work on each client.

3. Are they full time or per diem.

4. How many surgeries per day and how long does it take for an average surgery.

5. Ask if they use microscopes for cutting the grafts.

6. Ask to observe a surgery and the technicians in action or get a tour of the clinic.

7. Talk to the technicians and ask specific questions to test their knowledge on hair transplant.

 

To try and add to the great response by Dr. Meshkin...if you ask these questions and you are made to feel uncomfortable or uneasy for asking them, walk away.

 

I will ask Janna, whom many of you know as SMG's super-awesome wonder woman =), to respond with the process our technicians go through just to train to be a cutter/placer and how much experience our staff has.

 

Excellent thread.

Jason

[mmhce]

Great post with lots of information!

[Janna]

Gee, super awesome, no less!! Well, I may be referred to as wonder woman because I 'wonder' where the heck my head is most of the time but thanks Jason.

 

We are fortunate at SMG to employ a core group of techs who have been with SMG for 7 - 14+ years. We have a training protocol for each phase of ht surgery. With ample number of microscopes, the cutting phases can get started right away. Quality is always stressed over quantity or speed. Once the skill is learned, we know the speed will follow. Since there is a limit with the number of techs who can plant around a patient's head, this phase normally takes the longest to master. We also have a system for going over the work to double check the work...even for seasoned tech's work. I agree wholeheartedly the skills of the technicians matter in the outcome.

[Forrest Gump]

Very informative thread (Romeono1, thanks for starting it) and very good information provided by Bill, Dr Meshkin, Jason, and Janna.

 

Dr Mohmand, you mentioned that you divide your team into 4 theaters. Does this mean that you have 4 parallel surgeries going on every day? (Btw, I have asked you a similar question on another thread also.) I am curious to know if HT surgery practice is different in other parts of the world... since to the best of my knowledge, reputed doctors in North America do only 1 or at the most 2 surgeries in a day (of course, the "non-reputed" HT mills in North America do more than that in a day).

[Dr. Mohammad Humayun Mohma]

Dear FG

 

I believe that if you manage the time well, and I am hopefully if accepted will present my paper on time management in Hair transplant.

 

The time taken by a physician in a surgery is not more than 1.30 hrs, so if the time is managed well one can do two surgeries by adding only 25 more minutes to 1.30 hrs, in other words if you are well versed with the technique and have a good and sound surgical back ground, one can easily do 3 to 4 surgeries in 4 hours of physician time.

 

You have a fresh team for each theatre so the techs are 4 per theatre

you only have to spend 4 hours to do 3 to 4 surgeries. So in this way one can reduce the over heads and hence the price for the patient so every one wins

Mind you the quality is the main issue so no compromise on the quality. Keeping the quality at top priority, i am sure if one can manage why not.

 

Mills of North American are also in every part of world but not all mills are of poor quality. Some can do good job with reproducible results.

[Forrest Gump]

Dr Mohmand, thanks for your response.

 

You make a very interesting comment: "Mills of North American are also in every part of world but not all mills are of poor quality. Some can do good job with reproducible results."

 

I used to always believe that HT mills almost always produce low quality results... but your comment makes me pause and think about this. Perhaps you are correct in that not all HT mills are of poor quality and some can do a good job.

 

This definitely influences my outlook about HT mills, and in a positive way. Thanks for the comments!

[Romeono1]

Dr Humayuns quote:

 

"Dear Romeono1

 

I have total of 18 techs

 

3 of them started with me in 2001

1 started in 2002

4 started in 2005

6 started in 2007

3 started in 2008

1 in 2009

 

one of them have just left.

 

so this is the experience of my tech,"

 

 

As you are aware just because a technician is experienced doesn't mean they are good. How do you ensure the quality of the technicians you use in Pakistan? Do you carryout an audit on the results of your technicians work? An ongoing review maybe?

 

Have you ever tried to find out which technicians have been working on patients that have had poor hair growth results and tried to find out if there is a pattern?

[Bill - Seemiller]

Romeono1,

 

I'll let Dr. Mohmand address the question of how he specifically trains and supervises his staff. However, in general, the ultimate test of any technician's skill is the patient's final results.

 

Every physician has cases of poor growth for various reasons, some of which, cannot be explained. This is what's referred to as the "X" factor.

 

Poor growth due to issues that may have occurred during surgery is referred to as the "H" or human factor. The most likely "H" factor cause is mishandling of the grafts either due to transection, desiccation, or simply crushing them.

 

That said, if a patient does experience less than optimal growth, it's up to the physician to rule out the possibility of the "H" factor. However, if there are any H factor related issues, patterns of less than optimal growth will develop and will become quite evident.

 

The physicians recommended by this community (including Dr. Mohmand) have an outstanding record of producing excellent results. To date, I haven't seen evidence of an ongoing problem at Dr. Mohmand's clinic. However, it is a good to ask physicians how they monitor quality assurance of their staff.

 

Best wishes,

 

Bill

[Romeono1]

Bill thanks for the above post it is very informative. I wasn't aware of the H Factor.

 

I agree it would be good to know how physcians monitor the quality assurance of their staff.

 

Dr Humayun can please shed some light on how you monitor the quality assurance of your staff?

 

Thanks

[MikeyJ]

Romeone1 -- you definitely have legitimate concerns. When I decided to get my HT, I didn't think to ask a ton of questions but rather did a ton of research and then picked a very reputable hair surgeon.

 

Although when I was getting my HT done, I spoke with the hair techs (while they were doing the implantation) about their work experiences. Perhaps I did the process backwards.. haha.. but I understand your concerns.

[CaptainO]

I had my procedure done on Jan 19th with dr meshkin. I had consulted with him 3 times over a 1.5 year span. I am now 2 months post op and can't beleive I am already starting to see signs of growth. It is very encouraging.

 

In this day and age, time is money. And for a dr to consult with a patient 3 times and answer all of my questions was great.

 

I think all of the points these dr's make are excellent. I have two cousins that are brothers. One is a dentist who is 33 and was very disappointed by his ht in 2002. I have highly recommended dr meshkin to him and he is giving it heavy thought. The other is 25 and is considering it.

 

Hope this helps.

[Mr.Nk]

Romeono1 i have to say a Great post !!

 

i came on this forum after a month i think and i was really surprised to read this post ! This is something which was always there in the back of my mind but i dont know sometimes u never ask these questions loud !!

 

I developed a necrotic area .. and its been 3.5 months now since my surgery and im still waiting for the wound to heal !!

 

ive been told by other doctors that this mite have occurred due to the anesthetic solution .. and all i remember is my doctor was Not supervising the technicians when they were injecting it (not even in the room)

 

Even at that time i was wondering what sort of qualifications and degrees they have to do all the procedure !!?? which hospital do they go to for training ? which test they pass ?? or is it just watch.. learn and do later qualification !

NO matter how experienced u are but u need to know the human anatomy atleast about the area ur dealing with ! the arterial and venous system .. the nerve supply .. pharmacology of the drug in ur hand ..cross infections and so so on ...

 

i have suffered a lot in the last 3-4 months .. still am .. and i guess ill never know what really caused this ...

 

i hope and wish you with the best of results and health !!

 

take care and thanks ...

[EpilepticSceptic]

A few more questions:

 

1) do the techs employed at what most here consider the "top 5" clinics have medical degrees from accredited medical schools ? Or can they still become techs with no prior official medical training/education ?

 

2) some of these clinics look like they have 20 or more techs on staff. Are they ALL full time, or do they work part time ?

 

3) it seems that for the clinics that have 20 or more techs, they cannot ALL possibly be as good as each other or have as many years experience. So how does a patient know IN ADVANCE (hopefully 1 month) WHO the most experienced techs are, and that he/she will be getting THESE techs on that day ? Is there a way to know in advance (or request) that the clinic's most experienced techs will be performing your surgery ? Can you select a date specifiaclly when THESE techs will be available, or is it all just a crap shoot WHO you will get ?

[MikeTheDane]

Rome

 

We discussed this in private, but I believe that one reason may be because of Mohmands '2 surgeries' philosophy. For this reason, it's possible that he doesn't densepack as much as others, but rather goes for coverage on #1, and density on #2.

 

Just a theory.

[Dr. Mohammad Humayun Mohma]

there are two types of tech in the world

1) those who have a medical nursing background

2) those who are what we call OT technitians and they do not hold any nursing diploma.

 

they are trained on site and in job.

 

generally when we hire a tech, they only observe for about 3 to 6 months what to do and how to do. In their 3 to 6 months they start cutting and assisting the surgeon to take a strip etc,

it is not till the end of first year when they start doing the planing and they gradually start from the crown and finally end up in the hair line.

 

with respect to the skin necrosis, its not that uncommon but its a sequale of dense packing or reduced blood supply to the most vulnarable area in frontal aspect.

 

Its just one of the things and just to let you know that

in this area we really do not have any very important nerves or arteries or veins that we should be really worried about. the arterial supply vary from person to person and this necrosis was the one amoung two that I have seen after 2 years and well over 1400 cases.

so its pretty rare.

 

with respect to the Dr NK, I saw him middle of March and the healing was well on its way.

 

I am not a dense pack man anyway, so most if not all of my clients are told about two sessions.

 

at the end of the day Romeono1 you need to understand that you are young and you want all the area frontal and crown to be covered with medium mobility and density.

2500 grafts can only do what 2500 will do, so trying to cover every thing with 2500 is asking for a bit too much.

 

I have told you that all you have to do is wait and if there are any problem, I would always stand beside you. I am always there for you.

 

unless I do not make you happy, I wont be happy either.