Techs Qualifications and Experience Disclosed

[whispy]

Thia is my first post here, so please be gentle!

 

I am currently considering an FUE procedure and have noticed that some non US surgeons are not performing the scoring and harvesting of grafts or new site incisions but are being performed by technicians.

 

Whilst I believe this practice is legal outside the US I am concerned for the following reasons.

1. Do you think the names,qualifications,period of experience in this procedure,number of procedures carried out,length of time employed at that clinic should be made clear on the clinics website ?

 

2. Do you think a reduction in price should be offered if technicians are effectively carrying out the whole procedure(possibly training on you!).

 

3. How are members supposed to compare results when the actual person/s(technician/s) carrying out the procedure may not be known.

 

 

Some surgeons appear to be leaning more and more towards merely administering the anesthetic,possibly making the donor incision sites(but sometimes not even that) and of course popping their head in now and again to see how its going.

 

I can see some advantages and disadvantages of the surgeon not carrying out all the work,but there needs to be more transparency upfront so that patients can make an informed decision.

 

Personally, if point 1. was fully disclosed and I was happy with the techs backgrounds I think the possible larger quality graft numbers achievable(due to rotation of techs and lack of fatigue) and limited time the grafts would be out of the body could be an advantage.

 

On the downside I would be concerned to think that a tech might be in training with my precious grafts and I think I might feel cheated if the surgeon was just popping in now and again,

 

After all we are could be talking about a circa 10,000euro one day procedure.

The surgeons currently in my scope are Dr Christian Bisanga (BHR Clinic) and

Dr Bijan Feriduni (Dr Feriduni Hair Clinic) both in Belgium.

 

I welcome your comments.

[Modenese]

Hi Whispy,

 

You are mistaken, at least in the case of Bisanga.

 

I'm just back from a 2nd HT. Bisanga did 100% of the punch operations, and 100% of the incisions, just like at the first procedure, in line with normal practice.

 

The technicians insert the hairs into the incisions, and prep them under a microscope. and administer the (painful) anesthetic.

 

I've never heard of anything else there to be honest. Feriduni may be different.

 

Modenese.

[whispy]

Hi Modenese

 

I did not say that Dr Bisanga or Dr Feriduni use any particular procedure.

 

I am just asking the questions in general in the industry.

 

I am,however aware that Dr Bisanga does what you say.

 

Regards

 

Whispy

[JohnnyDrama]

Whispy, I'm a Dr Bisanga patient as of 2 months ago (FUE), and like Modenese said, Dr Bisanga punches every single donor graft himself, and makes every single incision in the recipient area himself.

 

There are then specifically trained techs that (1)remove the grafts from the donor (2)dissect/clean/prepare grafts for placement and (3)place the grafts (the placement technician working on me had 11 years experience in this). Dr Bisanga will come in and overlook these procedures at certains points through the process to monitor that everything is in order.

 

I believe in Dr Feridunis clinic, that the techs do play an even bigger role in the process in that Dr Feriduni makes the incisions in the recipient areas, but the techs do all of the extractions.

[whispy]

Hi JohnnyDrama

 

Did you know your technicians details and experience before you traveled to your procedure?

and do you know the details of the other technicians that worked directly on you?

 

Happy Healing to both of you!

 

Whispy

 

 

[Levrais]

Whispy,

 

You raise some good points. When I was researching clinics, I had the same questions like who are these techs and how much will my result will depend on them. I think these are fair questions to ask the doc prior to deciding. Most of the clinics I consulted with assured me that the techs they use had been with them for a long time and had implanted millions of grafts. One doc even took me into his clinic, introduced me to the techs and allowed me to watch them work for a few minutes.

 

You are also correct that techs are utilized more in some clinics than in others. I would imagine though that the various doctors have already factored that in when setting their prices.

 

Levrais

Edited October 24, 2013 by Levrais

[JohnnyDrama]

Hi JohnnyDrama

 

Did you know your technicians details and experience before you traveled to your procedure?

and do you know the details of the other technicians that worked directly on you?

 

Happy Healing to both of you!

 

Whispy

 

 

 

I was in touch with my rep beforehand on what to expect re how experienced my techs would be, but didn't really ask for the level of detail you are referring to. To be honest, at that point, I had done so much research, I had put my full faith in the clinic and their practices so I was relatively at ease from that point of view. I don't see a problem in you asking those questions to individual clinics though!

 

I recall asking two other techs (one taking out grafts, the other who was cleaning them) during op day #1, but I was pretty out of it at the time due to a combination of drugs and lack of sleep the night before, so can't quite remember what they had said.

[GreatPelo]

Techs should be limited on separating grafts and placing. A licensed doctor should be the only one allowed to cut into skin...whether harvesting or creating slits where grafts are placed. Tech's doing complete surgeries is against the law in many, if not all, States in the US. State medical boards are becoming aware of this...I'm sure we'll see many licenses pulled in the future.

 

Patient safety should be #1.....period!

[whispy]

Whispy,

 

"You raise some good points. When I was researching clinics, I had the same questions like who are these techs and how much will my result will depend on them. I think these are fair questions to ask the doc prior to deciding. Most of the clinics I consulted with assured me that the techs they use had been with them for a long time and had implanted millions of grafts. One doc even took me into his clinic, introduced me to the techs and allowed me to watch them work for a few minutes.

 

You are also correct that techs are utilized more in some clinics than in others. I would imagine though that the various doctors have already factored that in when setting their prices."

 

Levrais

 

Thanks for your reply it seems you have had a long journey but a successful one well done.Do you wish you had done anything differently?

 

Purely with regard to pricing relevant to the involvement of a surgeon the information below is a breakdown of costs from Dr Bisanga`s website when a surgeon is fully involved as he is in all the `cutting` of the skin.

 

ALL FUE

First 1000 Grafts 5 euro, Additional grafts 3 euros,

 

Grafts COST

1000 = 5000 euro

2000 = 8000 euro

3000 = 11000 euro

3500 = 12500 euro

 

Terms 50% Non refundable deposit with a few exceptions.

 

Does anyone have examples of pricing for surgeons that do not perform the scoring/extraction as it appears nearly all surgeons do the new site incisions ?

 

I would expect it to be much cheaper as they can be carrying out other work at that time, but we shall see from the replies.

[whispy]

Whispy,

 

"You raise some good points. When I was researching clinics, I had the same questions like who are these techs and how much will my result will depend on them. I think these are fair questions to ask the doc prior to deciding. Most of the clinics I consulted with assured me that the techs they use had been with them for a long time and had implanted millions of grafts. One doc even took me into his clinic, introduced me to the techs and allowed me to watch them work for a few minutes.

 

You are also correct that techs are utilized more in some clinics than in others. I would imagine though that the various doctors have already factored that in when setting their prices."

 

Levrais

 

Thanks for your reply it seems you have had a long journey but a successful one well done.Do you wish you had done anything differently?

 

Purely with regard to pricing relevant to the involvement of a surgeon the information below is a breakdown of costs from Dr Bisanga`s website when a surgeon is fully involved as he is in all the `cutting` of the skin.

 

ALL FUE

First 1000 Grafts 5 euro, Additional grafts 3 euros,

 

Grafts COST

1000 = 5000 euro

2000 = 8000 euro

3000 = 11000 euro

3500 = 12500 euro

 

Terms 50% Non refundable deposit with a few exceptions.

 

Does anyone have examples of pricing for surgeons that do not perform the scoring/extraction as it appears nearly all surgeons do the new site incisions ?

 

I would expect it to be much cheaper as they can be carrying out other work at that time, but we shall see from the replies.

[MAGNUMpi]

1. Do you think the names,qualifications,period of experience in this procedure,number of procedures carried out,length of time employed at that clinic should be made clear on the clinics website ?

That's a good idea. This info should be more available. Techs are an important part of the procedure I think this is a fair request.

 

2. Do you think a reduction in price should be offered if technicians are effectively carrying out the whole procedure(possibly training on you!).

Most doctors do the incisions and oversee the procedure. There are some doctors that do more of the work themselves. I'm thinking of Dr. Lorenzo for FUE and Dr. Konior for FUT. They have techs, but do most of the work/placement themselves if I am not mistaken.

 

3. How are members supposed to compare results when the actual person/s(technician/s) carrying out the procedure may not be known.

Well, results are all that really matter but yes I agree with your sentiment here. I think it this info is important and, right, if a tech is training (and they all do) then it very well can effect a procedure in terms of quality I would think.

 

If you are really concerned with this tech issue I would suggest contacting Dr. Lorenzo for FUE or Dr. Konior for FUT. One might be a perfect fit for you.

[whispy]

Thanks for your input MAGNUMpi I will certainly investigate the surgeons you mention.

 

This is the I.S.H.R.S`s position.

 

This leaves no room for ambiguity but is not what is happening in some clinics.

 

"The following is the position of the ISHRS: ISHRS Position Statement on Qualifications for Scalp Surgery

The position of the International Society of Hair Restoration Surgery is that any procedure that involves tissue removal from the scalp or body, by any means, must be performed by a licensed physician in the field of medicine. Physicians who perform hair restoration surgery must possess the education, training, and current competency in the field of hair restoration surgery. It is beyond the scope of practice for non-licensed personnel to perform surgery. 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."

Edited October 24, 2013 by Future_HT_Doc

[GreatPelo]

Spot On Whispy....pretty much sums it up!!!

[Blake Bloxham]

Whispy,

 

I feel similarly. Frankly, I think most state medical boards have similar guidelines. I know in my state, (essentially) any cutting or cauterizing of the skin (including the scalp) must be performed by a physician. In a hair transplant procedure, this means strip removal, direct FUG removal via FUE, and incision site creation would need to be completed by the physician.

 

Having said that, technicians are a crucial part of the surgical hair restoration process, and a hair transplant procedure would not be possible without them. It's absolutely a team effort, and the technicians are key members of this team. As many know, a team is only as strong as its weakest member. Because of this, a strong captain of the team - the physician - is going to surround himself with technicians of equal experience and talent, because it takes the total package to achieve a quality result.

 

Quality physicians will select, train, and retain quality technicians; so those who chose quality physicians should feel confident with the competence of their technicians (in my opinion).

[whispy]

I think that would be fair enough if patients could easily research their technicians as they can with their surgeon and also write into the contract for their procedure who is going to be working on them on the day of their transplant.

.

It is apparent that a large number of patients are leaving the clinics not knowing anything about the techs that have worked on them!Scary.

 

A lack of research on the patients part or an easy situation to find ones self in due to the non transparency of some clinics.maybe both.

 

We are after all talking about techs carrying out procedures which are ILLEGAL outside most of the US.

[Blake Bloxham]

Whispy,

 

This phenomenon of using technicians otherwise unknown to the patient is not exclusive to hair transplant surgery. Most hospitals/surgery centers employ technicians who work regular shifts and assist whichever surgeon is operating that day. During my time on surgical rotations, I (and the surgeon) would be unaware of which technicians were working until we actually got to the operating room and saw who was preparing the suite. Obviously, this means the patients never had the opportunity to meet and approve of the technicians either.

 

In a private hair restoration clinic, the model is a bit different and physicians are able to select, train, and utilize the same technicians each day. This actually provides a much greater level of quality control. What's more, many physicians do post information about their technicians on their websites.

[whispy]

Future HT Doc

 

I would be very interested if someone would post examples of which clinics websites provide the background information of their technicians so that I could see what level of detail they provide.

 

 

Whispy

[Blake Bloxham]

Here is an example from Shapiro Medical: Meet the Surgical Team

 

Each technician's background, number of years spent assisting with hair transplant procedures, and role at the clinic is clearly outlined.

[whispy]

Thanks that is a very good example,lacking in qualification information and procedures involved in but very good.

 

What do you think of Dr Feriduni`s medical team information I was recently looking at?

 

Seems a bit vague to me and provides little meaningful information.

[scar5]

How do tattoo and body piercing practices flourish in a country where it is illegal for a non-medically qualified and certified people to puncture the skin?

 

I have asked myself that for years, but one thing I am sure of, is that the legal ramifications awaiting a clinic caught in the glare of trigger happy would be law suitors have given pause for docs and clinics in the US to push FUE into the mainstream because it is not a desirable for a doc to be performing it day in , day out. This helps explain why places like Turkey and India have outgrown the states in FUE. They can have multiple techs performing the extractions, rotating in teams. Whether it is legal or not? No idea? they are or have been getting away with it.

 

I've had two tech extracted FUEs. One famous doc later told me, I had about a 50% successful harvest rate on the first. The second, well to be honest, I was astounded. I expected the doc to do the extractions. It was in a very developed country. Two techs did the extractions. Amazing to me. I sat in the chair shocked. I hadn't bother to check, as I assumed in this day and age, in that country, there would be no other way. And where was my doc? Doing a strip in the other room! The techs' were quite different in technique.

 

My first FUE doc, with his band of of techs and drills, seems to have abandoned FUE, save for BHT. Interesting in this day and age, when FUE has bloomed. Could it be he got wind of something legal whiffing about in the breeze? Or was his FUE so lousy, and would it have been uneconomic for changing to a doc driven harvest protocol? Ill never know. Perhaps he is preparing to go FUE as I speak, or perhaps he never really stopped, just stopped producing results on forums.

 

One thing Ill say. My tech driven FUEs were cheap, and there I should have guessed.

[jfables]

Jose Lorenzo does everything, including implanting. All his techs do are organize & prepare the grafts for him. I think considering how much these procedures cost the doctor should do as much as possible. Some of them just appear in their suit in the middle of the day to punch holes in your head ('create recipient sites' as they say) and disappear again until the whole thing is over... this after paying them $20,000 or more.

The hospital comparison is silly and a lame attempt to protect this shameful industry. Sure, a heart surgeon has help, but his hands are doing the real work.

[whispy]

Thank you Scar5 and fables for your replies, my sentiments exactly.

 

Your posts have confirmed my concerns and from first hand experience.

 

DO YOUR RESEARCH AND ASK THE RIGHT QUESTIONS.EVEN IF THEY SEEM OBVIOUS AS YOU MIGHT BE SURPRISED BY THE ANSWERS YOU GET.

 

ps. When I read the post raising the hospital analogy I thought here comes the surgeon biased pressure of the forums!

[MAGNUMpi]

Having said that, technicians are a crucial part of the surgical hair restoration process, and a hair transplant procedure would not be possible without them. It's absolutely a team effort, and the technicians are key members of this team. As many know, a team is only as strong as its weakest member. Because of this, a strong captain of the team - the physician - is going to surround himself with technicians of equal experience and talent, because it takes the total package to achieve a quality result.

 

Quality physicians will select, train, and retain quality technicians; so those who chose quality physicians should feel confident with the competence of their technicians (in my opinion).

Good point Blake. Good doctors will want the best team possible. Results will effect any doctors success and in this day and age with so much info sharing they know that they must try to continually produce great results, so the whole team is very important.

Having said that, I also agree with this:

 

I think considering how much these procedures cost the doctor should do as much as possible.

[Blake Bloxham]

Guys,

 

I was simply trying to clarify that technicians playing a part in the surgical process is not exclusive to hair transplant surgery. My comments were based upon my first-hand experience. My comments were not driven by the desire to protect any medical field or push an agenda on the forums. If anyone else has experience and feels differently, I welcome them to share their opinion as well.

 

I hope this clarifies my prior comments.

[MAGNUMpi]

ps. When I read the post raising the hospital analogy I thought here comes the surgeon biased pressure of the forums!

Ive been on this forum for a few years now and have never seen one post from Blake that has tried to pressure anyone into anything. He is always fair, balanced, knowledgable and a great part of this site.