FUE: Follicle Extraction not done by Dr himself? Transection risk?

[ZeoRanger]

Based on reading reviews in this forum, it seems like the follicle extraction is commonly done by nurses or assistants - not the actual doctor.

 

This concerns me because I think this is the process that would require most skill as there's the danger of transection, which would would render the transplant a failure in the end.

 

Are there doctors that do both, the extraction and the grafting? How high is the risk of transection in general during FUR?

[gillenator]

IMHO, this is a controversial issue that needs to be addressed. And you are correct, depending on the clinic, some use techs to perform the extraction process.

 

In most states within the USA, only a licensed physician can legally make incisions or perform "surgery" in its truest sense.

 

Yet we continue to see the trend of using techs in the extraction process of the FUE procedure...:rolleyes:

 

And yes, some docs see it this way and they make all of the extractions and also make 100% of the recipient incisions.

[gillenator]

Forgot to add that I have even heard of surgeons learning the extraction process from techs, not another surgeon...:rolleyes:

[fisher4man]

Transection risk is higher from donor areas with curly hairs by FUE technique, regardless of manual or motorized.

 

Those transected grafts should be discarded. Then we should talk about the discard rates.

 

Anyway, during cutting process of FUT strip, many hairs are eliminated/discarded from the usable grafts. Discard rates of hairs in FUT depend on the experience, talent and training of FUT nurses team who cut the strip.

 

Men of African origin are generally better candidates for FUT in this respect. But the risk for bad, hypertrophic scar development is also higher for them by FUT. And curliness gives one advantage; less hairs can cover more. So, FUE still might be applicable to hair loss sufferers with curly hairs.

 

And, curliness may be at outside of the skin, after haircut the hairs may be seen more straight, and FUE may be done easily.

 

Of course we must be sure that the extraction process is being done by a skilled, well-trained, talented and experienced technicians or physicians. Technicians might have much more experience and labor than the physicians (especially more than the non-surgeon HT physicians) in this respect and may train the physicians who want to start in a HT business.

[PupDaddy]

Transection of donor grafts isn't the only concern when letting techs do the FUE extractions rather than the hair transplant physician. There are critical judgments that come into play with the selection and extraction of donor grafts during FUE. Dr. Karadeniz noted some of these in another thread:

 

"There are a few important things that the person who extracts the grafts needs to consider, and you really need the physicians eye to take care about them. Please note that this eye has to be open throughout the procedure to readjust during the course of the operation; a supervising eye can not provide this. These are;

 

1. Extracting mainly from the permanent zone and entering the transition zone just for feathering purposes.

2. Not extracting from areas that might look depleted like temporal areas and neck.

3. Choosing proper instruments including the punch size depending on tissue character.

4. Doing a proper FUE test and if transection rates appear high offer FUT or cancel operation and give money back!: I believe this is very important.

5. Controlling penetrations per area and keeping equal distance between punches to avoid moth-eaten appearances.

6. Controlling angle and depth of punch and rotation speed to keep transection rate low.

7. Choosing the optimal graft number for both the patients recipient needs and the donor capacity."

[gillenator]

Good points by both PupDaddy and fisher4man...

[lifeisbeautiful]

great thread with great points! I would say that as long as techs are licensed and experienced, you should be fine.

[gillenator]

great thread with great points! I would say that as long as techs are licensed and experienced, you should be fine.

 

The industry is unregulated and so techs are not required to be licensed or regulated. Only nurses are regulated by licensure.

[Blake Bloxham]

Call me a traditionalist, but I believe graft extraction - be it strip or FUE - and recipient site creation should be done by a trained hair restoration physician. Frankly, it's illegal in most US states to do it otherwise. I think this issue will eventually be addressed in a courtroom - which is unfortunate because it will probably involve patients as well. In the meantime, I highly recommend all patients seeking FUE procedures at clinics that use traveling technicians or technician-only procedures make sure they know exactly who is performing their procedure AND make sure they are okay with a non-physician provider doing the work.

[KO]

In all seriousness then, if that is the case, then why does this site recommend surgeons who have techs or non physicians do extractions? Erdogan for example.

[JustJax]

In all seriousness then, if that is the case, then why does this site recommend surgeons who have techs or non physicians do extractions? Erdogan for example.

That was my first thought. Erdogan's clinic looks like it produces great work but on the site it does say that extractions are done by the technicians under his guidance... which is fine if they are very experienced but clincs don't seem to share info on the assistants so who's to say who does it on the day and how much experience they have.

[Blake Bloxham]

KO and Jax,

 

Again, my opinion isn't the "end all" for what is said and done on the community. What's more, there is something to be said for different laws and practices occurring in different countries, and being sensitive to this fact. Furthermore, I do believe there is a big distinction between an experienced physician training his own techs to assist in the procedure in a supervised manner (in an area where this is legal) versus a non- hair transplant exclusive clinic buying an automated FUE machine and bringing in alternating, unknown techs to perform the procedure in a clinic that is unfamiliar with surgical hair restoration.

 

Do I still think this should be performed by a physician? Yes, I do. However, I understand the above distinction and think that there is something to be said for a clinic that is open about this practice, trains and retains its own staff, produces solid results, and ensures patients know exactly who will be touching their head.

[gillenator]

Roughly ten years ago, an experienced tech opened his own FUE clinic in the Jacksonville, FL area where he is from. I can't remember the name of the clinic but his first name is Larry. He was an independent tech and contracted with one of the clinics that I used to work for, and that's how I became acquainted with him. He decided to open and operate his own HT clinic, yet he has no formal education or training in the medical field. He held no license as far as I know because he told me this himself when I first met him.

 

I then heard about him starting his own clinic and discovered that he shared office space with a licensed physician who was not a HT surgeon. This physician practiced in a completely different field of medicine that had no relation to the hair restoration field whatsoever. In other words, Larry was able to use the doctor's shingle (license) so-to-speak in order to meet the state's regulatory requirements to operate a medical facility.

 

Yet Larry himself was performing the procedures...:rolleyes: And they put up some examples of their work and some of it looked good. The best work? Not in my opinion yet at the time, there were only a handful of North American surgeons performing FUE with very few examples to showcase.

 

Some of you long term hair junkies may remember some of the controversy that occurred with this clinic in several of the online forums back then with the debate that if the work is good, "Who cares?" Others, like myself are of the opinion that an experienced licensed physician needs to be present in the OR whenever "surgery" is being performed no matter which individual is doing it. How in the world can anyone allow surgery to occur without an experienced licensed physician present?..:eek:

 

Why am I of this opinion? Because people forget that various complications can arise during any surgical procedure. Individuals health conditions vary. They can be on medications or have sensitive medical issues/concerns that must be addressed before the procedure even takes place. Does the clinic take a complete medical history of every patient and have each and every one of them "cleared" for surgery? Things can change on a dime without notice. Things like a sudden drop in blood pressure, cardiac arrest, diabetic seizures, etc, etc...:eek:

 

And I am not speaking exclusively about hair restoration surgery, it applies to any type of surgery including oral surgery and/or whenever anesthesia is applied.

 

And how many of us also know that anesthesia (local or otherwise) should only be administered by someone who is legally licensed and experienced to administer it? That's the law in most states. And I could go on and on with numerous other violations but the real issue, "Is the patient at risk?" Are the patents' vitals being competently monitored throughout the procedure and by whom?

 

Yes there are some very talented techs out there. But it's not just about the bottom line results or even the price. First and foremost, we cannot forget that the safety and the well being of every human being is imperative!

 

Things like this can and do occur in an unregulated industry.