Who should be doing FUE removal and placement?

[BlondeDude]

My question here is pretty straight forward. Who should be doing the punching out of the grafts and who should be doing the implanting? I've read differing philosophies on this. Getting the grafts out is the hardest part of this procedure, yet when speaking with one of the top FUE recommended doctors on this site, I was told they only do the placement of the grafts, leaving the removal up to their tech. This is done because of fatigue, if they did both it wouldn't be as high quality as if their highly trained tech did the removal. I have also heard that the doctor should be the one doing the removal, especially because it is a highly skilled job where FUE is successful or fails. I just wanted to hear some opinions on this.

 

Cheers!

Edited September 21, 2010 by BlondeDude

[pablo]

I went to a dcotor and he did all the punching and removing of grafts from the donor, then made all the recipient sites. The techs placed all the grafts. From what I've read in the past I believe this is the correct way FUE should be performed.

Edited February 26, 2011 by TakingThePlunge

[mattj]

I went to a doctor and he did all the punching and removing of grafts from the donor, then made all the recipient sites. The techs placed all the grafts. From what I've read in the past I believe this is the correct way FUE should be performed.

 

I believe this is the most common way of doing things.

Edited February 26, 2011 by TakingThePlunge

[BlondeDude]

I believe Dr. Shapiro has a tech do the punching which kinda threw me for a loop because this is very different than how other doctors are doing this method. The reasoning was "fatigue". Thoughts?

[Janna]

There are many components to strip and fue techniques and achieving the most natural results. The major difference between fue and strip is the way donor is harvested. At SMG, we want to harvest the best donor possible via strip or fue method because we all know donor supply is limited. For years our doctors have lectured and demonstrated their strip techniques and garnered respect from their colleagues and the ht industry. With SMG’s reputation in mind, we certainly did not want to offer FUE until we were certain we were performing the same or better technique as other clinics offering FUE. We feel extracting the individual grafts are an acquired skill you achieve from experience and perhaps have innate intuition for it too. We hired a technician who had years of experience working for other fue doctors and he demonstrated that a low and reasonable transection rate was achievable. So when we saw that you can get low transections by a skilled person, it was difficult for our doctors to “practice”, which meant higher transections than if our skilled technician did the extracting. The donor harvesting make up approximately 60% of the day with FUE, which means creating recipient sites and planting may become 2nd priority. If the doctors can zero in on the design and creating the incisions, we feel our patients receive the highest possible work from each individual at SMG. Our doctors do the evaluating, designing, planning and implementing all the major aspect of ht surgery with our patients. Attention to detail is key to creating and achieving the most natural work at SMG. During our consultations, each prospective fue patients are made aware of who is performing each task.

I recently went to Europe to view some of the top FUE clinics. We wanted to be sure that our FUE protocol was in line with others. We’re grateful for the opportunity to see firsthand. Almost all clinics had at least a part of the extractions taken out by a well trained tech or multiple techs with an exception of one physician who extracted and planted all the grafts himself. His routine is to work 4 days a week but work the hours of 7:30am to 9-10pm. He finished at midnight the night before I arrived.

There’s an evolution to strip and fue techniques. When the session sizes were much smaller, the doctors could perform majority of the work but as session sizes got larger for fue and strip sessions, it becomes more acceptable for techs to be trained and perform them. Just as with “planting”, it used to be an issue that majority of the planting (if not all) are done by the technicians but it’s less of a concern now.

It all comes down to a trust issue and reputation. Do you trust the physician to make certain all aspect of surgery is performed in the best possible manner? I believe our physicians do this very well.

[scar5]

Agreed.

Janna makes a great point. FUE extraction takes too long and sucks up too much of a doctor's time and powers of concentration. So docs don't like doing it and so this is has helped FUE garner a reputation that it is 'Good for small jobs' simply because no normal doctor wants to spend that much time hunched over your noggin.

 

So I recommend people get many 'small jobs' spread over years BUT

Finally a quality clinic makes a statement about it - so kudos to Blondedude for getting this going.

 

I see no reason that techs can't do it. The problem is knowing the techs themselves, and how much confidence can we have in them? I've had both teams of techs as well as 1-1 with the doc. In respect to the teams, I didn't notice anything to make me panic, (I was more concerned with the extraction device) but I was quite surprised with the variation between them (the teams). An example would be the number of extractions holes , say team member 1 made, before stopping to re-asses. Now this maybe to do with a number of things unrelated to the tech, such as the position of that part of the scalp, degree of bleeding, stage of the surgery, relative ease in which the extractions are proceeding..but still I noticed quite a variation.

 

So how can we know if a tech is experienced? We could give him or her a 'face badge' and put him on a board like this - thus recognizing that person. But that obviously has problems too. (Maybe still, better than nothing) We don't know the pilot who takes us and 300 others up in a jumbo jet, but we don't sign disclaimers either. It's a tricky one. BUt as more clinics adopt FUE, and as FUE 'breaks out' of the shackles and the limitations are revealed to be more about clinic and doctor economics rather than patient characteristics, there is bound to be a need for us to have a way to see how techs get 'qualified'.

[RCWest]

Techs like Janna are as skilled and efficient if not moreso than the doctor they are working for when it comes to grafts. If I had someone like her working on my head I wouldn't worry a bit. They are highly skilled!

[Dr. William Lindsey]

Janna as usual has a good post. We do it similarly. I know that my 2 extractors are simply better at it than me. Therefore they do it. But in my opinion, the doctor needs to make the punch and the recipient slits. Its conceivable someone could do real harm with the punch device....and of course the slit creation ultimately determines the resultant hair direction.

 

Dr. Lindsey McLean VA

[RCWest]

Janna as usual has a good post. We do it similarly. I know that my 2 extractors are simply better at it than me. Therefore they do it. But in my opinion, the doctor needs to make the punch and the recipient slits. Its conceivable someone could do real harm with the punch device....and of course the slit creation ultimately determines the resultant hair direction.

 

Dr. Lindsey McLean VA

 

I agree. Any incision or punch should be done by a physician.

[BlondeDude]

So there are differing philosophies in regards to who should be using the FUE tool. I guess as long as transection rates are low and the results are good there is no difference?

[scar5]

Footnote from the beloved ISHRS (International Society for Hair Restoration Surgeons*) recent FUE vs Strip article on whether or not docs should perform extractions,

"Surgical removal of tissue by non-licensed medical personnel may be considered practicing medicine without a license by state, federal or local governing boards of medicine. The Society supports the scope of practice of medicine as defined by a physician's state, country or local legally governing board of medicine."

 

This is their disclaimer, after they totally trash the idea of techs doing extractions.

The society, is having their conference in Boston pretty soon. I hope someone form our community takes it in. I don't write them off as a source of information and as a window into the mindset that informs the 'shop window' they present to consumers in the HT market.

 

Back to the topic at hand

I am not confident, at the present time in techs or the system they are compelled to work within. I just think, in theory, they should and could be trained to do extractions. As for incision/recipient sites, I have personally been a victim of poor, very poor tech work, and I am even less confident of giving them the blade (or needle). NO disrespect to the techs, but the system

 

PPS. Note in their article, no mention of loss of dormant hair in strip.

 

 

[BlondeDude]

Thank you scar5 for this information.