Techs doing FUE. What do you think?

[Jotronic]

In Florida I know for a fact that one need only have a degree as a PH (physician's assistant) to perform hair restoration procedures as long as a doctor is within the same facility in case something goes wrong. In Canada it varies by province like it varies by state in the US. In British Columbia, it is legal to have technicians perform extractions but I am not privy to the details of the exact conditions. I do not know the legality of this in other provinces.

[Hanzo]

Thanks for the reply Jotronic, I tried to find out the info myself but can't seem to find any details regarding this on the internet.

[Dr. Alan Feller]

In the end it’s both the law and ethics that dictates what technicians can do.

 

When I started performing FUEs in 2002 I spoke with a medical malpractice attorney about the legalities and liabilities of the FUE procedure. What I found out was that it was not legal for technicians to cut the skin in New York State. Period, end of story. It didn’t matter whether the doctor was in the building or the same room, if they did not have a medical license, they could not cut. And that makes a lot of sense to me for obvious reasons.

 

To confirm this I called the New York State Dept of Education, which contains the “Medical Board” of New York. I spoke with the director of the Medical Conduct division, a Dr. Marks, a retired physician himself, and he also made it clear that if someone reported to his office that a technician was making incisions of any kind he would hit the responsible doctor with a medical misconduct charge. That’s pretty heavy since that may result in suspension or revocation of a doctor’s license to practice medicine.

 

So I went through the procedure step by step with him to find out what was permissible, and what it came down to was that in the case of an FUT it was OK for techs to cut the follicles out of the strip already harvested by the doctor because it was out of the body. It was also ok for techs to re-implant the grafts because the slit would have already been made by the doctor. So the way most clinics perform hair transplants in New York State was fine.

 

With FUE, he made it clear (and so did the malpractice attorney) that techs may NOT punch the skin in any way because that is considered “cutting”. However, once the skin has been “scored” with the punch it was permissible for the techs to apply a forcepts and pluck the graft free. And it’s this aspect of extraction that seems to have been overlooked by, well, just about every poster who has ever written on the subject of FUE.

 

Extraction actually consists of two very difficult portions:

 

The first is the “scoring”. That is, the application of the punch at just the right angle, to just the right depth, with just the right amount of rotation/oscillation, and just the right pressure.

 

The second is what I call the “delivery” phase. That’s when the punch is put down and the forcepts (or some other such device) are picked up and used to grasp the PARTIALLY freed follicular unit to pull it free from the skin. This takes MASSIVE skill and patience and is a major step that has been way overlooked by posters.

 

In my office, I believe in dividing work among an OVERSTAFFED team. This way nobody gets too tired or frustrated. Our protocol includes me, the doctor, “scoring” around a number of grafts and then letting an experienced tech “deliver” them. Another tech will immediately take that graft and submerge it in ice cold saline solution and then deliver it to yet more techs who will inspect and trim it under stereoscopic microscopes.

 

This is not only the legal way to perform FUE, but the most ethical because the doctor is doing the scoring and the staff are doing the “delivering”. An even and LEGAL sharing of work.

 

Why don’t I do both? The simple answer is because I can’t without becoming exhausted. And exhaustion leads to corner- cutting and mistakes. By splitting the work with technicians the procedure has a much greater chance for success.

 

I also learned another thing while doing my investigation. Turns out that since FUT is considered the “standard of care” for hair transplantation and FUE is considered to be an “alternative” method, it is the responsibility of the doctor to explain the pros and cons of FUE to the patient AS COMPARED to FUT surgery. Not doing so is considered to be failure to give “informed consent”. A big no-no.

 

Also, if a clinic SOLELY performs FUE they are law bound not only to REFER a patient seeking FUE to an FUT doctor before accepting them, but to encourage them to seek the “standard of care” method instead of FUE. I had my attorney check out the law on lexus- nexus (a huge law database) in different fields of medicine and he was one hundred percent correct.

 

To me, with respect to FUE, if the doctor explains the pros and cons prior to surgery, gets confirmation of understanding IN WRITING in the informed consent document, scores ALL the grafts, makes all the slits for re-implantation, and allows the EXPERIENCED staff to do the rest, then not only are we acting legally, but ethically.

[lorenzo]

After spending a lot of time in the hospital was surprised how much the nurses do . They do all the blood tests, they gave me my chemo, blood transfusions all without a doctor even in the room. They also gave me my stem cells for my bone marrow transplant but in that case the doctor was in the room.

What the doctors did was all the biopsy that needed to get done. Which involved opening the skin. Who knows if its because the nurses cant do it or don't know how to do it.

[HARIRI]

With FUE, he made it clear (and so did the malpractice attorney) that techs may NOT punch the skin in any way because that is considered “cutting”. However, once the skin has been “scored” with the punch it was permissible for the techs to apply a forcepts and pluck the graft free. And it’s this aspect of extraction that seems to have been overlooked by, well, just about every poster who has ever written on the subject of FUE.

 

Extraction actually consists of two very difficult portions:

 

The first is the “scoring”. That is, the application of the punch at just the right angle, to just the right depth, with just the right amount of rotation/oscillation, and just the right pressure.

 

The second is what I call the “delivery” phase. That’s when the punch is put down and the forcepts (or some other such device) are picked up and used to grasp the PARTIALLY freed follicular unit to pull it free from the skin. This takes MASSIVE skill and patience and is a major step that has been way overlooked by posters.

 

In my office, I believe in dividing work among an OVERSTAFFED team. This way nobody gets too tired or frustrated. Our protocol includes me, the doctor, “scoring” around a number of grafts and then letting an experienced tech “deliver” them. Another tech will immediately take that graft and submerge it in ice cold saline solution and then deliver it to yet more techs who will inspect and trim it under stereoscopic microscopes.

 

Well said Dr. Feller, Unfortunately there are some recommended clinics in this network that allows their technician to do the punching (which is the most sensitive part of FUE procedure). That is why they have inconsistent results.

 

Top FUE docs like Bisanga does ALL the punchings himself and Incisions too while leaving the extractions and implanting only to the nurses and technicians. Thats why he has my respect because anything has to do with cutting is done by him ONLY. I hope other FUE surgeons learn from him.

[cousinr]

Dr Villnow did a four day operation on me with 4200 grafts. He worked with two teams of two and they rotated through the day to prevent fatigue.

 

All the scoring and incisions were done by the doctor but if he'd tried to do everything himself, I can see how he would have become exhausted. This way they were always fresh.

 

Splitting the operation over four days also reduced fatigue which gave my a great result (I was Norwood 6). Here's my journal:

 

http://www.hairrestorationnetwork.com/eve/170774-4200-fue-dr-villnow-800-body-hair.html