How big a team for 4,000 grafts + list of questions

[yourcoach]

I have been doing my due diligence, reading thread after thread that seem relevant to me and are talking to the five practices that are still on my radar. Those doctors are Cooley, Charles, Hasson, Shapiro and Epstein. To paraphrase on one of the people from one of the practices, you need a team of at least 7 or 8 to do a large session of 3,500 grafts and up in order for fatigue not to be an issue. He said rotating around a smaller team, even if they are very good, fatigue will come into play. Obviously this is coming from one of a couple of practices that have a larger team. Is this a widely accepted point of view? If not, what might the counter argument be?

 

Has anyone put together a list of good questions that you should ask any practice that you are considering using? I think I have generated a fairly good list base on reading so many in the great threads on this forum, but I thought I would check if anyone has but together a list in case I might be missing something.

[yourcoach]

I have been doing my due diligence, reading thread after thread that seem relevant to me and are talking to the five practices that are still on my radar. Those doctors are Cooley, Charles, Hasson, Shapiro and Epstein. To paraphrase on one of the people from one of the practices, you need a team of at least 7 or 8 to do a large session of 3,500 grafts and up in order for fatigue not to be an issue. He said rotating around a smaller team, even if they are very good, fatigue will come into play. Obviously this is coming from one of a couple of practices that have a larger team. Is this a widely accepted point of view? If not, what might the counter argument be?

 

Has anyone put together a list of good questions that you should ask any practice that you are considering using? I think I have generated a fairly good list base on reading so many in the great threads on this forum, but I thought I would check if anyone has but together a list in case I might be missing something.

[Dewayne]

yourcoach,

 

There are some great debates buried in the threads here on this forum, including leading surgeons for and against 'mega' sessions.

 

Here's a good post by Pat on the subject. http://www.regrowhair.com/hair-transplant-surgery/is-bi...-transplant-session/

[Smoothy]

I think the key is not how many people are working on mega sessions, its how many people will be disecting grafts from the strips. I think 3 people disecting FUs for MegaSessions is enough as long as the FUs stay moist and are not exposed too long. The only thing that has concerned me with M.S. is the surgeon most of the time has to have another assitant working opposite side of the head implanting the FU at the same time do to time contraints (not always but a lot of times this is the set up).

I have been one that wants my surgeon to do all the graft incisions and graft placements because angle/direction/depth are critical with final outcome and I do not want a nurse (or even a LPN) doing the critical stages of HT.

Just my personal feelings.

 

Best of luck. And do your research.

 

SMOOTHY

Dr. Shapiro

Propecia/Rogaine xtra

MSM/Saw Palmetto

Nioxin Shampoo line

Zrii 3oz daily

[yourcoach]

Thanks for your reply Dewayne. I am not asking about the validity of doing "mega" sessions. My first question is about team size and fatigue issues. Some practices are doing large sessions with fairly small teams, some have large teams.

[Smoothy]

I think the TEAMS for MS and efficency comes down to how many MS they conduct-- the more then the TEAM probably have more synergy and require less people than lets say a TEAM that only does half the number of MS cases.

Lots of factors. I can think of about 2-3 doctors that most cases are MS thus have perfected the sessions with their TEAMS over the years. H/W being 2 of them.

 

SMOOTHY

Dr. Shapiro

Propecia/Rogaine xtra

MSM/Saw Palmetto

Nioxin Shampoo line

Zrii 3oz daily

[thanatopsis_awry]

Certaintly, you need a larger(*competent*) team for the very large sessions you are interested in. H&W decidedly have the largest staff out of the docs you've mentioned -- in fact, they may very well have the largest team period.

 

As for questions....try to get as specific as possible on what the prognosis is that yer receiving, and seek good cases to compare this to; be sure to compare/contrast any differences between clinics and don't be shy to inquire as to *why* X is being recommended over Y.

[Guest wanthairs]

Can Joetronic chime in?

[the B spot]

We have a very large team of techs and we could handle 6000 grafts if we desired.

 

However, regardless of how large your staff is, when it comes to placing 2-3 techs is all that can "fit" around a patients head and still work comfortably and maintain graft integrity.

 

The reason you need the larger # staff is to cut the grafts b/c you do not want them out of the body any longer than they have to be AND if you continually over-tax your staff quality will suffer.

 

Working at a measured pace serves our techs very well--they are VERY important to wonderful patient experiences and success Dr. Shapiro has established over many years.

 

Janna (the Surgical Manager at SMG)can explain this better than I, but our staff is large enough to handle any size transplant and has years of experience.

 

Take Care,

Jason

[Janna]

There are many factors that are involved when deciding what exactly is optimal number of staff to have on hand for Mega Sessions.

 

Having impressive number of staff isn't saying much if all your techs are newbie's. I know first hand a clinic that has 12 techs but will take 10-12 hours for 1500-2000 graft case on a regular basis. Even techs with years of experience don't necessarily mean they are more efficient cutters or planters than those with less experience. What it comes down to is how experienced and efficient (skilled) are the techs. Are they capable of delivering quality work on a consistent basis? The duties/tasks of ht technicians are meticulous and tedious, and pronounced even more for Mega Session cases. It's not something you can do without rest breaks. Because of fatigue factor, you need to have trained techs to rotate in and out. Years ago, 3-5 techs may have been the standard, however; even then Dr. Shapiro had the foresight to overstaff with 5-7 techs to minimize "burnout". Today, we have 9-12 techs. There are key components that are essential in dissecting and planting: a sufficient number of techs (7-10) to prevent taxing the staff, with fatigue come sloppy work, each tech works behind their own microscope where every aspect of the cutting is done (good, efficient techs can cut 200-250 grafts per hour if uninterrupted), every experienced techs' strong hand - eye coordination is required for planting. Our core technicians who do both cutting and planting have been with us 5-12+ years. This is all essential to achieve patient goals and expectations while minimizing staff turnover.

[Bill - Seemiller]

Yourcoach,

 

Size of the surgical staff is definitely relevant as is their experience and level of skill. Jason and Janna expanded on this concept very well for you.

 

I believe that there are a few threads in this forum devoted to a good list of preoperative questions to ask surgeons before a hair transplant. I'll do some digging later this evening, but if anyone finds them before me, they'll win a free dinner in Montreal at our 10 Year Anniversary Party if you come

 

Best wishes,

 

Bill

[Marko Ramius]

The only team you need...

 

[Dr. Ricardo Mejia]

For 4000 grafts we use a team of 7-8 people to cut and place simultaneously.

[Jeffrey Epstein MD, FACS]

A lot of very good points were raised in this thread, and I wanted to provide my perspective.

 

I am quite proud of the team I have assembled- a total of 18 full time assistants- who have been working with me a minimum of 14 months, and the maximum 14 years. The majority of my assistants have been with me for 6 years. Each assistant has certain talents: 5 of them are my designated assistants who do the slivering -these assistants have been with me on average 7 years; 7 of them specialize in graft placement - these have on average 9 years experience in hair transplantation, the majority spent working with me; several of my assistants are such outstanding graft dissectors that I make sure that this is what they spend the majority of the time doing; I even have certain assistants who specialize in assisting with FUE procedures, a few others who are my "eyebrow" team; and a few who assist me with most of the donor strip removals.

By having such a large team, I can be confident that: there will be no fatigue; that cases can proceed expeditiously but not harried nor rushed; and that if one or two assistants are out, I can proceed with a full team irregardless; and that each assistant has the opportunity to subspecialize and take advantage of her /his own talents, thus enhancing personal satisfaction (as well as the experience as well as final results for the patient, which is the most important element).

 

That all being said, this large team doesn't necessarily mean that our cases get done extremely quickly. For example, just yesterday, on a case of 4370 grafts, we started at 8:15 am and finished at almost 4 pm. During that case, I had two assistants placing at all times, the patient took a 25 minute lunch break, and a total of 4 assistants worked on him placing the grafts. The recipient sites were all 0.6 to 0.8 mm in size. The donor strip was removed in two separate pieces- the first strip removed at 8:30 that provided approximately 3500 grafts which got placed in around 6 hours, while the second strip providing an additional 850 grafts that got placed in around 2 hours- those last 800 or so grafts always seem to take the longest to get placed because we are working within already planted areas and seeking out any remaining recipient sites. By dividing the donor strip into two separate sections, even though the case took almost 7 1/2 hours, at no time were grafts out of the body longer than 5 1/2 hours.

 

Jeffrey Epstein, MD, FACS

Miami and NYC

Foundation for Hair Restoration

www.foundhair.com

[yourcoach]

Thanks for all the thoughtful replies.