Doctors who do everything themselves

[StaggerLee123]

After reading through some posts I've noticed that some docs, including Umar and Konior, do all of the work in their procedures themselves. They take the donor hair, close the wound, make all the recipient sites and then do all the planting of grafts.

 

While this seems to be very laudible as they can absolutely control the quality of their patients procedure, does anyone think that this approach is too much for one person to take on? The thought of one person doing that very detail oriented work for hours upon hours seems like it would take its toll in the form of fatigue, and when fatigue is a factor mistakes can be made more easily. This is in no way a criticism of their method.

 

Any thoughts on this way of working?

[aaron1234]

Good question. I wouldn't say these docs do all of the work themselves. They don't do the graft trimming - that would be insane. Also, Konior does SOME of the planting himself but not all of it. Techs still play a big role for these docs - probably more than we all realize.

 

I remember Dr. Paul placing some of the grafts during my procedure as well. It is very much a team effort, though I'm not trying to diminish the role of the surgeon.

[StaggerLee123]

Hey Aaron I'm fairly sure that I remember some posts where Dr. Konior stated that he did all of the planting and didn't leave his patients side for the entire procedure. I'll find out for sure as I am going to do a consult with him. Lol I get tired after 15 minutes of doing scalp laxity exercises, I can imagine how tough it would be to do a whole day of this very technical procedure.

[orlhair1]

Most docs do use techs for planting the grafts. When I had my HT done, Dr. Shapiro was in the room the majority of the time. I was very comfortable and confident with the approach used at SMG. Each clinic probably has some variance in their approach. I think you just have to evaluate the clinic as a whole. As an aside, I think Dr. Konior has amazing results, so whatever approach he uses, it works well.

[NEWHAIRPLEASE]

Dr Konior is in the room most of the time with a patient, if not all of it..however, Im sure he does take breaks..Needless to say, his work ethic is amazing!!

[Dr. Michael Beehner]

With the size of cases we routinely do today, it is impossible for the physician to do everything, even apart from the dissecting of the grafts under the microscope. Once a fair number of grafts have been cut and prepared, it is absolutely necessary for two pair of hands to get busy placing grafts. One of them can, and often is, the physician. If only one person is placing grafts, the grafts will be out of the body too long, and past research shows that after being out of the body over 8 hours, the percentage that survive starts to decrease. The issue brought up by one of the commentators about fatigue is an important one. It's important for everyone on the team, including the doctor, to take periodic breaks to rest the hands, arms and shoulders, and also your psychological state. On a few occasions I have cut grafts for a couple hours straight, and that is too long. You need a break away from your task every 30-40 minutes in order to keep the quality of your work top-notch. If I see the girls on the scopes too long, I will encourage them to all take five minutes to rest or walk around the block.

In our own clinic, I do all of the planning, the nerve block and local anesthesia, the harvesting of the donor area and suturing it up, and then the placing of all the incision sites where the grafts are going to go. This last task, if done conscientiously, can sometimes take 1 1/2 to 2 hours to do, making sure the size of each site matches the different size grafts (1-hair, 2-hair, and 3-hair grafts) and that the angle is just right and that native hairs are not damaged. My routine is then to start placing grafts along with one of my experienced assistants until all the grafts are prepared. I then let one of the girls take my place after they have had a break between those two tasks. I always save out around 50 grafts, usually half 1 and 2-hair FU's, which I then at the end of the case will put in where needed in the hairline area, using the "stick-and-place" method. This gives me a final chance to "fine tune" the hairline and get it exactly the way I want it.

So don't look for a clinic where the poor doctor takes on all of the tasks. If it's a 300 graft case, which doesn't exist anymore, then it might be ok Rather, look for a clinic where the doctor carefully supervises the quality of the work of the technicians and in which the whole team cares as much about the grafts surviving as the doctor does. Gentle handling, care to keep the grafts moist at all times, and proper rotation of the graft within the site as relates to the curve of the hair are all crucial and you want a staff that takes pride in doing each of these things right, not an assembly-line operation, where the goal is to get the case done as fast as possible.

Mike Beehner, M.D.

[NEWHAIRPLEASE]

Thanks for the input Dr Beehner!!

[StaggerLee123]

Thank you for the detailed post Dr. Beehmer. You give a very good account of the overall tasks that are shared by the physician and techs. Your approach seems to make the most sense and fatigue monitoring in everyone involved in the procedure must be paramount. The whole day really needs to be choreographed well as there are so many moving parts...

 

Thanks again.

[wylie]

After reading through some posts I've noticed that some docs, including Umar and Konior, do all of the work in their procedures themselves. They take the donor hair, close the wound, make all the recipient sites and then do all the planting of grafts.

 

While this seems to be very laudible as they can absolutely control the quality of their patients procedure, does anyone think that this approach is too much for one person to take on? The thought of one person doing that very detail oriented work for hours upon hours seems like it would take its toll in the form of fatigue, and when fatigue is a factor mistakes can be made more easily. This is in no way a criticism of their method.

 

Any thoughts on this way of working?

 

Both doctors do all the work themselves in the hairline, they won't let anyone else touch the hairline, however, they do have techs work south of the hairline, as it takes hours to plant all these grafts.

[StaggerLee123]

Ty Wylie.

[MrJobi]

From what I have researched, once the incision is made the graft can only be inserted one way. Does the size of the incision match the graft size ( single, double , etc.)?

[StaggerLee123]

Mr Jobi I think you answered the wrong post here but yes the docs have custom cut blades to match the size of the grafts they are inserting.