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olmert

Why do some people think doctors do FUE better than tech's?

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I still say if your don't like what your country is doing......Go somewhere else. I prefer a Dr. working on me. I prefer to stay warm in the winter with Natural gas. I'm not going to complain a Dr. is ripping me off for a job I agreed to have done. What's with the hostility with professionals. Most have sacrificed in life to get where they are at now. Do you guys think a so called "monkey" or some other derogatory name can do what you do better in your own profession? I bet we could give an example of one that could. Why can't the Dr. and the tech just be a well oiled machine/team?

 

I agree with about bitchin on professionals. They have made sacrifices and they desrve our respect. Ultimately, I look younger because of th ht industry.

 

I'm not so sure about the rest. We get what we pay for, rigjt? I think you will complain. I think you will get a lawyer to help you take care of problems and I think you will stay warm as long as you can payfor it.

 

Going to another country? That is precisely what is happening as we speak. How many patients on a plane to Turkey? More than five years ago, for sure. Strip is going down, and the HT industry in the states is doing its best to adapt.

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Lol. We all live in the real world. We are all human just some people have a high opinion of themselves.

Everything you have said is theoretical.

You have a nice day god.

 

It sounds very logical to stipulate that the doctor sign that he will not start the surgery in the event he is fully drunk. But just actually try to get any doctor in the world to sign such a statement, even a third world doctor that just graduated.

 

Pure naivety.Pure inexperience with the real world. A most uninformed and theoretical perspective. It reminds me of those who theorize that a doctor should be presumed to be better than a tech, with no empirical evidence.

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Also congrats Blake, what residency are you off to now?

 

Thanks! I actually graduated a while ago, just finally updated everything. Spending some time building a solid foundation in general internal medicine before transitioning into hair loss and hair restoration!


"Doc" Blake Bloxham - formerly "Future_HT_Doc"

 

Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

 

All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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an opinion piece published in the NYT isn't peer reviewed or possess a high level of evidence.

The article cited is not an “an opinion piece.” Click through the link. You will have to register free with the NY Times. The piece is labeled under the banner “science watch” and appears in the section of the paper labeled “Science,” which only comes out every Tuesday. The Tuesday “Science” section of the NY Times is not peer reviewed, but is intended to represent mostly peer reviewed studies. The NY Times does not publish opinion pieces on medicine or science.

 

The study's conclusion: circumcision is a surgical procedure that should be performed under sterile conditions in an appropriate medical setting.

The study actually says:

 

Circumcision is a surgical procedure that should be performed under sterile conditions.

Blake may not even realize the part he added about “in an appropriate medical setting” was not implied by the article. Bias may confuse him.

The article recommends against Mohel’s who use orogenital suction, but certainly does not purport to analyze the vast majority of Mohel’s who do not use orogenital suction. Nor does the article suggest a refutation of the prior studies finding that Mohel’s do it better than doctors.

This is not a controversy of Jewish tradition versus modern science. In this case modern science sides with Jewish tradition, and the controversy is modern science vs. one doctor ostensibly misrepresenting a study.

You can ask ahead of time if a Mohel uses his mouth. There is a tiny group of Mohelim belonging to a specific sect that practice the ritual of, tearing off the foreskin with their mouths, after it has been cut off with a knife. This is minority practice of a statistically insignificant number of Mohels. One old lady successfully sued McDonald’s for being burned by its hot coffee, despite McDonalds’ defense that only a statistically insignificant number of customers were burned by the heat. Liebeck v. McDonald's Restaurants - Wikipedia, the free encyclopedia

If you subscribe to Blake’s reasoning, you might avoid McDonald’s as dangerous.

It is unscientific to paint all Mohels with one brush. It would attribute the herpes caused by the sectarian Mohels to the majority of Mohels. It is like pointing out that most terrorists are Muslims, and therefore Muslim must be bad, never mind that there are 1 billion Muslims, most of whom are not terrorists.

 

Your argument has to be: mohel with 10,000 circumcisions to pediatrician with 10,000 circs; and hair transplant technician who's removed 10,000 grafts versus hair transplant surgeon who's removed 10,000 grafts - and likely trained the tech how to do so.

And sometimes it is the old timer tech who trained the newbie doctor. But to compare apples to apples, we compare a doctor who removed say 100,000 grafts to a tech who did so.

Manual dexterity is a large factor in who does it better, yet we have no objective way to predict manual dexterity, aside from recognizing that there is no evidence doctors start out with more manual dexterity than tech’s, and that practice builds dexterity. In medical school and residency, doctors extract zero or almost zero grafts, and whatever doctors extract is minute compared with that of an experienced career tech.

 

The subjective argument that the doc is better is premised upon the doctor’s training before he finished residency, or his smartness. But Blake has not cited anything in medical school or residency or smartness that gives the doctors a leg up on the tech.

In law school, you learn essentially nothing practical about any specialty. A 3rd year paralegal will know more for a job than any second year lawyer. What happens in law is that the paralegal writes the first draft of your papers, and then a lawyer rubberstamps it. In hair transplants, you actually get to watch who is doing the work, so you don’t get to maintain the illusion that you paid for a smartie who went to a selective school.

 

Now even Blake agrees that a phlebotomist draws blood better than a doctor, owing to practice. (And mind you, I doubt any doctor will prefer a doctor draw his blood.) Blake’s reasoning is premised upon practice being paramount in the physical exercise of drawing blood, with the smartness and academic training of doctors not helping much. And with hair transplants, it much the same. It is easier to find a tech who has extensive practice at FUE extraction than it is to find a doctor who has it. And 10,000 grafts of practice is nothing. You get better well beyond 10,000 grafts. There are just so many other things a hair transplant doctor has to do that you will rarely find one with the extraction experience of a career tech. A doctor could never specialize the way a tech can. And doctors do not really want to specialize in it when outside the US they can hire an experienced lower paid tech. So I am sure the top FUE doc's have as much practice as the experienced tech's, but outside the US they will necessarily migrate to more supervisory roles. Inside the US, they will push to the point where they lose manual dexterity. They will perhaps be forced to simplify their technique so they don't twist, as scar says. You would be better off with a tech who has extensive experience, but not to the point of a forced simplified technique. So it is funny. You want someone with a lot of experience, yet not too much.

Now, you will always have a doctor in the background to opine on the horror scenarios. The issue is who should generally do the extractions. Should it be a lower paid experienced tech, who can retire once he gets so much experience that he lost manual dexterity? If it will be a doctor, will you possibly get one with not enough experience, or one with too much experience so he lost manual dexterity yet has too much invested in his career to stop extracting FUE?

Edited by olmert

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The subjective argument...doctor’s training ...., ...his smartness.

 

...outside the US.....(docs).....migrate to more supervisory roles. Inside.... they...push to the point where they lose manual dexterity.

 

Docs will use hand held machines, feller machines, harris machines etc.

 

They won't persist with manual.

 

I think Blake having a bit of fun.

But even so, he is about to embark on a career as a doc in the states, where techs are banned from extraction, and where people are flying to Turkey instead. So any fun he is having has to be at the expense of the tech. (Politely avoiding the docs that employ them)

 

If you are going on about dexterity, there is the curious case of SMP at NHI, where docs actually do the SMP instead of SMP employees or proprietors.

 

Are they better? How would we know? They know the physiology of the skin better..Again, I think it is the stakes.

 

Docs can tell you information that techs can't mid-procedure. Docs have the power to control their speed where as employees are more likely to cover their asses and do their 'quota' regardless. Docs can act independently with confidence. Techs have the team/partner to worry about.

 

Docs are smart, and docs have patients lol.. patience..(good one scar) but will their brains be working 100% in such a mind numbing and boring pursuit as drilling thousands of tiny holes.

 

It comes back to the law and economics pretty quickly. If I were a doc based in the states, I'd trash FUE for as long as possible, then gradually concede yard-by-yard to small FUE procedures which I would do with hand held mechanical devices. I would consider ARTAS but consult carefully with an HT marketing company to see if patient ignorance was still strong enough or that the stigma of machines wasn't.

 

Just remember guys, no techs can drill in the states legally. Where does that leave an HT doc in a market that is flying itself overseas?

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Just remember guys, no techs can drill in the states legally. Where does that leave an HT doc in a market that is flying itself overseas?

 

Techs can't legally cut or drill into patients' scalps in Turkey either (according to Dr. K and MikroFUE) yet many docs and clinics there have chosen simply to flaunt the law -- including, apparently, the doc and clinic that MikroFUE represents, which has techs not only doing the FUE excisions and extractions but also the cutting/drilling of the graft recipient incisions.

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The status quo of doctors doing manual FUE in the United States will not continue. It is too physically draining on the doc, and there is not enough evidence doc’s do it any better than tech’s to justify the higher price. Scar cites doctor’s great knowledge of physiology as one reason they might do it better, but that is like saying a law professor’s knowledge of constitutional law will help him argue a traffic ticket. The discretion to pace oneself might help a doctor over a tech, but presumably that discretion could move over to the tech, the same way a phlebotomist has all the discretion how big a needle to use, with no doctor disillusioned enough to intervene in the phlebotomist’s field. There are three possible scenarios that will ultimately replace the American practice of manual FUE by doctors.

 

1) FUE results end up no better in the US but much more money, and too many American doc’s get carpal tunnel. In the end, American doc’s abandon FUE, and patients go to Europe.

2) The US begins to permit techs to do FUE extraction.

3) ARTAS or similar technology improves enough such that it works as well as doctors and tech’s.

 

But the status quo of American doctors doing manual FUE will not last until the distant day when cloning replaces FUE/FUT.

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Apart from dr Karadeniz who proclaims he does all extractions and the incision sites the other two recommended clinics here also flout the law as both have techs doing extractions but it is a world wide practice now as we are becoming more aware of.

In the usa is it the same laws regarding techs in every state or just some or most.

I just dont understand the need for state law when their all within one country it would only lead to confusion and possibly a criminal record or even prison.

Pup the point you make goes back to the original question who would be better a dr like dr k with 4 years experience or a tech with 12 years doing extractions? I know which I would choose but that does not mean everyone else should.

At least this debate is happening away from patients threads in a more appropriate thread.

Have a good day

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This is not true. In at least one case, one of Lorenzo's patients was told that technician X, and the doctor would be doing his extractions, however as it turned out, none of them did, it was a brand new tech with little experience.

 

Sounds like a mix up, and I would hope the exception not the norm among top tier doctors. It's pretty unethical (and just messed up) for a doctor to assure you a certain technician will be assisting then intentionally bring in someone else. So again I'm assuming your example was a mix up and a rare occurance.

 

Maybe if I was that concerned about which techs would be assisting though I would request to be introduced to each one personally the day of surgery and ask each one to break down what they would be doing and how long they had been doing it.

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Sounds like a mix up, and I would hope the exception not the norm among top tier doctors. It's pretty unethical (and just messed up) for a doctor to assure you a certain technician will be assisting then intentionally bring in someone else. So again I'm assuming your example was a mix up and a rare occurance.

 

Maybe if I was that concerned about which techs would be assisting though I would request to be introduced to each one personally the day of surgery and ask each one to break down what they would be doing and how long they had been doing it.

But how do you know it is a rare occurrence? Another patient on this forum was told that Lorenzo and one tech would be doing the extractions, and it turned out it was mostly technician driven with a carousel of techs. Then there's the matter that his website says the exact opposite, "no auxiliary staff is involved".

 

This too, at one of the best, if not the best HT surgeons around. That's my point, the people who are demanding disclosure, and clinics naming techs, and forcing doctors to sign papers as a way to ensure who works on you are living in dreamland. All these ideas are ok, but the simplest way is to find clinics where surgeons do most of the work.

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Techs can't legally cut or drill into patients' scalps in Turkey either (according to Dr. K and MikroFUE) yet many docs and clinics there have chosen simply to flaunt the law -- including, apparently, the doc and clinic that MikroFUE represents, which has techs not only doing the FUE excisions and extractions but also the cutting/drilling of the graft recipient incisions.

 

This includes recommended surgeons here like Koray Erdogan and Hakan Doganay, where techs extract grafts. Not that I have anything against these surgeons as they are clear to patients about their process, but if it is a question of legality, Maral is not the only one.

 

Wow, it sounds like I'm defending Maral Klinik.

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Ko as your a big fan of Lorenzo and rightly so do you know how long he has been doing fue?

Or roughly how many ops he's done roughly as I've heard him discribed as a machine.

Just wondering whether the amount of work he has done is now catching up with him and thus the use of techs.

Have a good day

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He began around 2002 IIRC at one of those larger HT places before branching out on his own.He has said that he believe the graft insertion step is more difficult, and important for graft survival, and it is easy to check quality of extracted grafts. But yes, I believe it is both fatigue, and for financial reasons he would do this process. That said, we cannot dismiss the possibility that he believes this process is also capable of delivering good results, and he does have them apparently.

 

 

In fact, here is his bio:

Dr. Lorenzo WikiBiopedia

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This includes recommended surgeons here like Koray Erdogan and Hakan Doganay, where techs extract grafts. Not that I have anything against these surgeons as they are clear to patients about their process, but if it is a question of legality, Maral is not the only one.

 

Wow, it sounds like I'm defending Maral Klinik.

 

Good for you, and, considering Dr. Maral is an Aesthetic Plastic Surgeon, Maral Klinik is more legal than the others.

 

I do not know but for the clinics if sponsored membership to this forum entitles more legality and anomoulos pricing?

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Good for you, and, considering Dr. Maral is an Aesthetic Plastic Surgeon, Maral Klinik is more legal than the others.

 

I do not know but for the clinics if sponsored membership to this forum entitles more legality and anomoulos pricing?

 

No, it is not more legal than others, because Maral does not do the surgery.

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No, it is not more legal than others, because Maral does not do the surgery.

 

The others also do not do the surgery, you know (Lorenzo said) implantation (always done by technicians) is the most important part for graft survival, then the graft extraction (mostly done by technicians).

 

For the legality, responsibility is more important than whose hands-on. So Maral is more legal in his country. (Not in USA but he has no branch there)

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The others also do not do the surgery, you know (Lorenzo said) implantation (always done by technicians) is the most important part for graft survival, then the graft extraction (mostly done by technicians).

 

For the legality, responsibility is more important than whose hands-on. So Maral is more legal in his country. (Not in USA but he has no branch there)

 

Serious question - are you illiterate or deliberately trying to confuse extraction and implantation?

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Serious question - are you illiterate or deliberately trying to confuse extraction and implantation?

 

To clarify; I exclude pen implantation which is done by doctors also (generally but may be also done by technicians now). Here, I am only talking about channel opening (including FUT), and then graft implantation using microforceps.

 

( Lorenzo said graft implantation is the moct critical part of HT for graft survival)

 

FUT doctors and FUE doctors who open channels and and then implant grafts always use technicians for graft implantation - HT basic fact from the beginning.

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The others also do not do the surgery, you know (Lorenzo said) implantation (always done by technicians) is the most important part for graft survival, then the graft extraction (mostly done by technicians).

 

For the legality, responsibility is more important than whose hands-on. So Maral is more legal in his country. (Not in USA but he has no branch there)

 

Where do you get your information, GraveD11ger? Are you seriously contending that Dr. Lorenzo's technicians make the graft recipient incisions on his patients? Do you not know that Dr. Lorenzo makes each and every graft recipient incision and does all the graft implantations himself? Do you not know that he does this using implanter pens (hollow needles with an injector mechanism)? His technicians load these pens with the grafts that were previously excised and extracted from the donor. Dr. Lorenzo then meticulously makes each and every graft recipient incision with these injector pens and simultaneously inserts the graft into the hole he just made.

 

Dr. Lorenzo used to even do all the donor graft excisions himself, but he has lately had his technicians assist with this task. But he continues to make all the graft recipient incisions himself, AS DOES EVERY HAIR RESTORATION SURGEON RECOMMENDED BY HRN. As Dr. Bhatti stated just yesterday: “Where harvesting is a skill, slit making is an art.”

 

I CHALLENGE YOU TO NAME A SINGE HAIR RESTORATION SURGEON RECOMMENDED HERE WHO ALLOWS HIS OR HER TECHNICIANS TO CUT THE GRAFT RECIPIENT SLITS OR HOLES INTO THEIR PATIENT'S SCALPS. Go ahead. Waiting . . . .

 

Contrast this with Dr. Maral, who performs NO PART of the surgery whatsoever. The hair transplants are performed entirely by non-physician technicians, from start to finish, including the cutting of all the graft recipient incisions (using a motorized drill, no less). Dr. Maral's "supervision" is limited to stopping by the operating room every now and again to ask how things are going, although as one patient told us, Dr. Maral is not adverse to leaving the premises to go home early while the patient is still in the chair being operated on by his technicians.

 

Your understanding of Turkish medical law is contradicted by Dr. K and even by The Maral Klinic's online representative, both of whom state that technicians are NOT permitted to cut into patients' scalps or otherwise perform surgical tasks or procedures.

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Lorenzo was referring to the pen implanter.

 

Pen implantation or channel-forceps implantation. He referred implantation is the most crucial part for graft survival.

 

Do we all agree that, implantation (excluding pen implantation) always done by technicians in every countries? (And less number of doctors use pen implantation, most of them use channel implantation)

 

FUT surgeons almost never use pen implantation. Do you know why?

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The laws themselves are one thing, the relative exposure to risk of prosecution is another. The states are so libel friendly, tech, extraction is too much of a risk, no?

 

But just to clarify - In States (correct me if I'm wrong)

 

For non-medically certified people (i.e. all non-doctors, or docs off the register)

 

1) Piercing the skin is legal> tattoos, injections, piercings, creating incision sites.

2) Chopping up living tissue is legal> slithering the strip on the bench

3) Putting chunks of living tissue back into the body is legal>implanting

4) Taking detached chunks of living tissue out of the body is legal>plucking out follicles once they have been cut

5) Carving out pieces of tissue whilst still in the body is illegal> cutting the extraction

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But how do you know it is a rare occurrence? Another patient on this forum was told that Lorenzo and one tech would be doing the extractions, and it turned out it was mostly technician driven with a carousel of techs. Then there's the matter that his website says the exact opposite, "no auxiliary staff is involved".

 

This too, at one of the best, if not the best HT surgeons around. That's my point, the people who are demanding disclosure, and clinics naming techs, and forcing doctors to sign papers as a way to ensure who works on you are living in dreamland. All these ideas are ok, but the simplest way is to find clinics where surgeons do most of the work.

 

We can only hope top tier doctors don't regularly lie. If the day of surgery Lorenzo told me so and so would be helping to do X and Y, and no one else, I would probably trust him. Maybe that's a mistake? By the way who actually told the patient you mentioned about the extraction information, was it Lorenzo himself? I'm sure the patient brought this point up to Lorenzo either during or right after the surgery, right?... I wonder what Lorenzo had to say. The "no auxiiliary staff is involved" thing may be a translation issue. It's an ambiguous statement as is, you could interpret it to also mean he has staff but not supplementary/backup staff (silly thing to say).

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