Dr. vs Nurse placing the grafts after extraction

[Welcome]

I'm planning a FUE procedure (1200 grafts) and was told that the surgeon would do the FUE but placement of grafts will be done by the nurse. Is this usual? Please help.

 

Thanks,

Wel

[JohnnyDrama]

Yes, this is actually very common among even the best clinics. Like you, when I first heard this I was very surprised, but the more I understood the whole procedure, the more I saw why it happens like this.

 

The number 1 most important aspect (in my opinion) of the HT is the incision / slit making. This is where the doc makes all of the little holes in your recipient area, and is essentially where the grafts are placed. This is the most important aspect from a design point of view. Placing is regularly done by the technicians, and the doc will typically oversee this part anyway. I was informed by my own clinic that the placements will mostly be done by the techs. The doc will oversee this. He may make some placements himself but it is not to be expected.

[tacolinowest]

I'd be nice for the doc to at least stay in the room while they place grafts

[Midwest00]

Also I have experienced times where the Dr does the incisions and placed a good majority of the hairline. Sometimes it can be difficult to tell who is doing what and where they are placing due to the numing of the area....and Valium Unless the surgeon or techs are telling you what they are doing which is rare during what can be a lengthy procedure.

[Welcome]

So long as it's not out of the ordinary, I'm OK with a medical assistant placing the grafts. Thanks Again, Welcome.

[Mickey85]

I'd be nice for the doc to at least stay in the room while they place grafts

 

My doc was having consultations whilst the techs placed grafts... was absolutely bewildered at that....

[GNX1]

I dont see it as an issue. the artistic holes are already made and the grafts are already extracted.

Edited April 25, 2013 by GNX1

[Shampoo]

It's not at all unusual for techs to place grafts, but don't assume all techs are created equal.

 

The elite doctors usually have a deep highly skilled staff of very experienced technicians.

 

I visited some clinics that use "part time" techs or techs that fly in on surgery day.

 

Personally I believe choosing a clinic that has a deep staff of skilled full-time technicians can be very important as to the overall success of your surgery.

 

A deep staff of techs allows for some to be off on vacation, out sick ect...without the quality falling off.

 

Also a deep staff of techs allows for doing large sessions easier on a regular basis.

In other words large sessions are "no big deal".

 

If a doctor is booked and only has 2-3 techs....and one calls in sick the day of your surgery you could be getting an exhausted over-worked tech placing your grafts towards the latter part of your operation.

 

The doctor is important but not the only thing to think about when choosing a clinic. Patients should inquire about whether the techs are full-time employees, how many techs are full-time, what the tech's years of experience are, how long have the techs been working with this doctor that builds chemisty, ect....

 

Look below at the Hasson/Wong staff of surgery technicians.

That kind of depth does not happen by accident or by doing hair transplants part-time.

 

Edited April 26, 2013 by Shampoo

[Mickey85]

Dr De Reys and his wife(qualified nurse) take turns implanting the grafts. There are no others involved.

[Shampoo]

The issue with this limited number of staff is fatigue.

 

It appears to me the way clinics with a small staff compensate for the fatigue is to steer patients towards smaller sessions. I am sure there are exceptions but as a general rule....smaller staff of techs = offer smaller sessions. The doctor realizes neither him nor his one tech are able to make it through long 10-12 hour mega-sesssions day after day. So they do the 1200-2200 graft sessions. Where when you have a deep staff you can bring in "fresh horses" half way through a surgery and routinely pull off the mega-sessions with no drop-off in quality.

[PupDaddy]

I'm planning a FUE procedure (1200 grafts) and was told that the surgeon would do the FUE but placement of grafts will be done by the nurse. Is this usual? Please help.

 

Thanks,

Wel

 

A proviso: Make sure that your chosen clinic does not use implanter pens, such as the Hans Implanter Pen or the Choi Implanter Pen. Why? Because if, as your surgeon advised, the tech or nurse is doing the "placement" of the grafts in the recipient sites, and the clinic uses implanter pens for FUE, then the nurse or tech is also necessarily creating the recipient sites -- because that is how these implanter pens work: the recipient hole is made with the implanter pen, which is loaded up with previously extracted grafts, and a graft is placed from the pen simultaneously with the cutting of the recipient hole. You will want to confirm that the clinic does not use implanter pens for FUE and that your surgeon will be creating/making all the recipient sites.

 

I personally think that the transplant physician should at least place all of the frontal hairline grafts (as Dr. Konior and some other top docs do), but as others have said, it is not uncommon or unusual for reputable clinics to have their techs or nurses do all the graft placements.

Edited April 26, 2013 by PupDaddy
typo

[SamSpade]

For what it's worth, I only wanted my Dr. doing all of the graft work, particularly in the hairline. So if it were me, i wouldn't advise that clinic. When i recieved my HT the techs were there for assisting and hair slicing but Dr. Konior performed the artistry, this is a lot of money we're talking here.

[Shampoo]

Plus if you are having a large session that last 10-12 hours do you really think one guy can hold up and do quality work towards the latter part of a 10-12 hour marathon?....day after day? I doubt doctors that place every graft are doing sessions in the 4500-6000 graft range very often. During my 10 plus hour session at Hasson/Wong several very skilled technicians worked together on placing my grafts as Dr. Wong kept a watchful eye throughout the day. The skill level of top notch technicians is under-estimated. In my mind a doctor that places every graft himself is not necessarily a plus.

[Sparky]

huh, techs place way more grafts than the dr over their career, so they are better at it most of the time.

[MAGNUMpi]

the artistry, this is a lot of money we're talking here.

I would have to agree with that.

 

huh, techs place way more grafts than the dr over their career, so they are better at it most of the time.

That's a risky way to look at it. A patient wont know if they are being worked on by long-term experienced techs who have been there for years or someone new who is still learning (and making mistakes).

I think the high cost of FUE should include at least the doctor there watching the placement. This is seriously expensive and can effect a person for the rest of his/her life.

The doctor should at least be there to oversee the whole procedure. Seriously.

[Sparky]

All good points, I wouldn't want an unexperienced tech working on me, I probably have had bad techs working on me in the past, I know I have had bad Dr's working on me.

[Blake Bloxham]

Technicians are fantastic at placing grafts. However, the real questions (in FUE procedures especially) come into play when clinics allow technicians to extract grafts and, in some instances, make the recipient incisions. What's more, I think having physicians supervise the graft placement is reasonable.

[KO]

I don't understand the issue in allowing techs to do it. Doctors are not "trained" to do FUE, there is no internship or residency or formal pathway to becoming an FUE surgeon, they learn the exact same way as techs. Doctors are trained to be knowledgeable about many things, but techs can specialize in one very specific aspect.

[Blake Bloxham]

I don't understand the issue in allowing techs to do it. Doctors are not "trained" to do FUE, there is no internship or residency or formal pathway to becoming an FUE surgeon, they learn the exact same way as techs. Doctors are trained to be knowledgeable about many things, but techs can specialize in one very specific aspect.

 

Nothing wrong with techs placing grafts or extracting grafts and creating incision sites? Frankly, I completely think techs should be handling and placing grafts, but I really don't see the need to take the delicate extraction or slit making out of the hands of the physician. What is the advantage of taking decades of medical training and experience, and throwing this out the window? What is the advantage of placing a surgical procedure in the hands of someone without a medical license? Technicians may be very well trained, like you said, in one very specific aspect, but surgery is far more complicated than one specific task, and when something changes, something is different, or something goes wrong, I don't think I'd want anyone else in the room besides a physician who - as you stated - is knowledgeable about these many things.

 

I've said this many times before, but I truly believe hair transplantation is a highly collaborative process and it absolutely does not work without technicians. However, there are a lot of fine, technical details to the surgical aspect of hair transplantation, and I think results suffer and patients get hurt when people assume that "anyone can do it" and dismiss the medical/surgical art and science of hair restoration.

[HARIRI]

Mickey85, According to your experience in the FUE industry. Can you list us names of FUE surgeons that extract the grafts by themselves only and also names of FUE surgeons that extracts and places or strongly supervise placing the grafts? Enlighten us Buddy.

[alix]

I'll be honest,if I hear techs will be doing the incisions and extracting grafts I will walk away from that clinic.

you are paying for the skills and expertise of an individual.therefore that doctor SHOULD do the incisions and extract the grafts.otherwise you are just paying for some technicians doing the job under "franchise" name of the doctor,much better if you go to the cheaper clinics were techs do all the job at least you wont waste you money on a name.

but properly trained and experienced techs placing the grafts under doctor supervision is acceptable and it's the norm for both FUT and FUE.although there are some famous FUE surgeons that do the incision,extraction and placing the grafts themselves (Lorenzo),and he has the best FUE results.also DeReyes (and his Wife).

[Blake Bloxham]

I'll be honest,if I hear techs will be doing the incisions and extracting grafts I will walk away from that clinic.

you are paying for the skills and expertise of an individual.therefore that doctor SHOULD do the incisions and extract the grafts.otherwise you are just paying for some technicians doing the job under "franchise" name of the doctor,much better if you go to the cheaper clinics were techs do all the job at least you wont waste you money on a name.

but properly trained and experienced techs placing the grafts under doctor supervision is acceptable and it's the norm for both FUT and FUE.although there are some famous FUE surgeons that do the incision,extraction and placing the grafts themselves (Lorenzo),and he has the best FUE results.also DeReyes (and his Wife).

 

Nicely stated.

[rev3]

handling and placement of grafts are just as important as extractions and incisions

 

since most docs do not do the former emphasis is placed on the importance of the latter

 

it is an industry-wide practice, so all we can do is go by clinic results and hope that there isn't high-turnover of tech staff

[SamSpade]

Just to followup regarding Dr. Konior since I mentioned him earlier, his words in regards to this topic after I contacted him:

 

 

My placment strategy varies depending on pre-made openings or stick and place. I do all placement with stick and place. I have one assistant, who places with me for large (3000 plus graft) pre-made opening cases. She has been with me for about 15 years and is the only person I trust for handling grafts. She never places alone as we are always working side-by-side so that I know what is going on. She assists me with the stick and place method. It's fairly technical in how I approach this, but the bottom line comes down to quality control which I'm fairly obsessed with. -Dr. Konior

[MAGNUMpi]

 

My placment strategy varies depending on pre-made openings or stick and place. I do all placement with stick and place. I have one assistant, who places with me for large (3000 plus graft) pre-made opening cases. She has been with me for about 15 years and is the only person I trust for handling grafts. She never places alone as we are always working side-by-side so that I know what is going on. She assists me with the stick and place method. It's fairly technical in how I approach this, but the bottom line comes down to quality control which I'm fairly obsessed with. -Dr. Konior

That's nice to hear. If the assistants are going to be doing parts of the operation that could potentially matter we should know about them. How long they have been working there etc. If not we are driving partially blind it seems.