Urgent Consumer Alert by ISHRS

[Ali Emre Karadeniz]

Seeking Hair Restoration Surgery?

Be sure that a properly trained licensed physician* is responsible for your treatment.

 

 

The International Society of Hair Restoration Surgery (ISHRS) is concerned about the growing risk to patients of unlicensed technicians performing substantial aspects of hair restoration surgery. The use of unlicensed technicians to perform aspects of hair restoration surgery, which should only be performed by a properly trained and licensed physician*, places patients at risk of: (i) misdiagnosis; (ii) failure to diagnose hair disorders and related systemic diseases; and (iii) performance of unnecessary or ill advised surgery all of which jeopardizes patient safety and outcomes. There may also be a risk that unlicensed technicians may not be covered by malpractice insurance.

 

The ISHRS believes the following aspects of hair restoration surgery should only be performed by a licensed physician*:

Preoperative diagnostic evaluation and consultation

Surgery planning

Surgery execution including:

Donor hair harvesting

Hairline design

Recipient site creation

Management of other patient medical issues and possible adverse reactions

Post-operative care

To help insure patients have information needed to make informed decisions about who performs their hair restoration surgery, the ISHRS urges potential patients to ask the following questions as well as questions regarding costs, risks, and short and long-term benefits and planning:

 

Patients Should Ask These Questions:

Who will evaluate my hair loss and recommend a course of treatment? What is their education, training, licensure, and experience in treating hair loss?

 

Who will be involved in performing my surgery, what role will they play, and what is their education, training, licensure, and experience performing hair restoration surgery?

 

Will anyone not licensed by the state be making incisions or harvesting grafts during my surgery? If so, please identify this person, explain their specific role and why they are legally permitted to perform it.

 

Is everyone involved in my surgery covered by malpractice insurance?

 

Consumer Alert | International Society of Hair Restoration Surgery

[GraveD11gger]

Are medical practitioners who just completed medical faculty licenced HT physicians?

[1966kph]

Yes all relevant in the USA .

So dr Karadeniz what do you suggest that the ishrs do to members who do not comply? Banish them from the ishrs ?

If so wave good bye to the top drs on the planet,Erdoğan, Lorenzo, Donagay ect ect I do not think you are going to reverse this growing trend dr Karadeniz but you carry on but I think your urinating in the wind.

You your self have undertaken ht procedure were these recommendations were not adhered to.

If the top drs deem it appropriate to operate this way I trust their judgement.Expertise. And many many years of experience over your rather limited experience in comparison ( no offence intended ) as I'm sure you agree experience counts for a lot ?

This is why the fue procedures in the US is dying a death compared to Europe and Turkey were people are flocking to.

If I remember rightly in a resent ishrs report about 60% of drs in the USA said they had convinced the patients to go for fut when they had their heart set on fue when they came in the door so make of that what you will.

If your on a crusade dr Karadeniz I think you would do better talking to your country's government to implement the laws of your land as many many people are having their lives ruined because of it.

Have a good day

 

Seeking Hair Restoration Surgery?

Be sure that a properly trained licensed physician* is responsible for your treatment.

 

 

The International Society of Hair Restoration Surgery (ISHRS) is concerned about the growing risk to patients of unlicensed technicians performing substantial aspects of hair restoration surgery. The use of unlicensed technicians to perform aspects of hair restoration surgery, which should only be performed by a properly trained and licensed physician*, places patients at risk of: (i) misdiagnosis; (ii) failure to diagnose hair disorders and related systemic diseases; and (iii) performance of unnecessary or ill advised surgery all of which jeopardizes patient safety and outcomes. There may also be a risk that unlicensed technicians may not be covered by malpractice insurance.

 

The ISHRS believes the following aspects of hair restoration surgery should only be performed by a licensed physician*:

Preoperative diagnostic evaluation and consultation

Surgery planning

Surgery execution including:

Donor hair harvesting

Hairline design

Recipient site creation

Management of other patient medical issues and possible adverse reactions

Post-operative care

To help insure patients have information needed to make informed decisions about who performs their hair restoration surgery, the ISHRS urges potential patients to ask the following questions as well as questions regarding costs, risks, and short and long-term benefits and planning:

 

Patients Should Ask These Questions:

Who will evaluate my hair loss and recommend a course of treatment? What is their education, training, licensure, and experience in treating hair loss?

 

Who will be involved in performing my surgery, what role will they play, and what is their education, training, licensure, and experience performing hair restoration surgery?

 

Will anyone not licensed by the state be making incisions or harvesting grafts during my surgery? If so, please identify this person, explain their specific role and why they are legally permitted to perform it.

 

Is everyone involved in my surgery covered by malpractice insurance?

 

Consumer Alert | International Society of Hair Restoration Surgery

Edited February 11, 2015 by 1966kph

[GraveD11gger]

The ISHRS believes the following aspects of hair restoration surgery should only be performed by a licensed physician*:

Preoperative diagnostic evaluation and consultation

Surgery planning

Surgery execution including:

Donor hair harvesting

Hairline design

Recipient site creation

Management of other patient medical issues and possible adverse reactions

Post-operative care

 

 

Dr Karadeniz,

 

Bill - Administrator says something different in another thread, what is your comments about his opinions?

 

POSTED BY BILL -ADMINISTARATOR, In my opinion, whose actual hands are on the tools is less important than the actual result. While some physicians may play more of a supervisory role, others are very hands-on.

Ultimately, hair transplantation is a team effort. So we respect that something sessions may step back and allow their team to perform certain functions. However, as long as the physician is actively overseeing the procedure and providing engaged quality assurance that results are optimal, then whose hand is on the tool is less important than the result.

 

 

[Blake Bloxham]

I read this statement after the 2014 ISHRS conference. It seems perfectly logical to me. I'm sure my motives will be questioned here, but I've never understood the argument behind taking the surgeon out of the surgery. If I was going to court, I would hire a lawyer, not a paralegal; if I were chartering a jet, I would hire a pilot to fly, not a flight attendant; If my loved ones were undergoing surgery, I would insist a surgeon performed the procedure, not a technician. In the end, it's just ethical and best for patients.

[PupDaddy]

Well said, Blake. Well said.

[hairweare]

Take it also from a non-medical perspective. If you were doing business with a company at this level of expenditure, would you prefer dealing directly with the owner of the business or with his employees?

[HARIRI]

ISHRS is purely commercial. Any HT surgeon can apply for it, my ex-butcher is a member there. I would only trust HTN and IAHRS when it comes to HT surgeon selection, they are the only 2 trusted organizations.

[1966kph]

Hello blake.

You have made the comparison before but for me and this is in regard to fue not fut your comparisons are not good ones.

With respect you are fresh out of med school and have only resently come to the conclusion that fut is better than fue.A lot of the most respected fue drs on the planet have taken the decision to have techs do extractions why do you think they do this is?

Is it that they are being self serving in regard to monetary gain?

Have they got lazy and cannot be bothered with this arduous task?

Do you think that they have started caring less about the results and the patients?

Blake why not ask Erdoğan, Lorenzo and all the other drs that have techs doing extractions the above questions.

I think the answer you will get is that they believe the tech is as capable as they are in doing this crucial part of the op because of their training and experience,

Anything other than a answer similar to this will make it obvious they do not have the patients best interest at heart so which answer do you think your going to get? Will you believe the answer they give? Will you change your opinion based on the answer?

As a American dr blake are entering into the American ht industry were more and more people are wanting fue but because of the way the industry is regulated in the states the associated costs to the customers are so high its forcing them to go abroad as is clearly evident.

Dr karadeniz works as many others do within a ever declining niche market that they do all the extractions but who has the more patients going their way dr Karadeniz or drs Erdoğan, Lorenzo, maral,donagay ?

We will always have people going for both fut and fue just as we will have people going to dr Karadeniz or dr erdoğan.

Pup, ko or anyone else for that matter were would you go given the chance even if it were free? Would it be Lorenzo and have techs do the extractions or dr Karadeniz who will do all the extractions? You don't need to bother answering you and I know the answer and if its Lorenzo that makes your arguments a bit weaker does it not?

Very few people who have researched thoroughly would go to dr Karadeniz given the above scenario and its based purely on the results we have seen from both drs its that simple,We would not on the principle that we hold go to the place were we thought we were going to get a inferior result would we?

The US needs to relax its hands tieing restrictions if it is to have a fighting chance with the competion from abroad and Turkey needs to regulate the industry more stringently to protect people from the unethical practice's that litter its country.

Dr karadeniz needs to concentrate IMO on acheiveing better results to show case his talents than try and undermine his very successful peers within his own country as I said above its results we are looking for plain and simple.

Have a nice day

 

I read this statement after the 2014 ISHRS conference. It seems perfectly logical to me. I'm sure my motives will be questioned here, but I've never understood the argument behind taking the surgeon out of the surgery. If I was going to court, I would hire a lawyer, not a paralegal; if I were chartering a jet, I would hire a pilot to fly, not a flight attendant; If my loved ones were undergoing surgery, I would insist a surgeon performed the procedure, not a technician. In the end, it's just ethical and best for patients.

Edited February 11, 2015 by 1966kph

[Ali Emre Karadeniz]

Yes all relevant in the USA .

So dr Karadeniz what do you suggest that the ishrs do to members who do not comply? Banish them from the ishrs ?

If so wave good bye to the top drs on the planet,Erdoğan, Lorenzo, Donagay ect ect I do not think you are going to reverse this growing trend dr Karadeniz but you carry on but I think your urinating in the wind.

You your self have undertaken ht procedure were these recommendations were not adhered to.

If the top drs deem it appropriate to operate this way I trust their judgement.Expertise. And many many years of experience over your rather limited experience in comparison ( no offence intended ) as I'm sure you agree experience counts for a lot ?

This is why the fue procedures in the US is dying a death compared to Europe and Turkey were people are flocking to.

If I remember rightly in a resent ishrs report about 60% of drs in the USA said they had convinced the patients to go for fut when they had their heart set on fue when they came in the door so make of that what you will.

If your on a crusade dr Karadeniz I think you would do better talking to your country's government to implement the laws of your land as many many people are having their lives ruined because of it.

Have a good day

 

It is very simple; ISHRS either has to remove the consumer alert or members who don't comply with their principles. If I am not mistaken, it is now obligatory for members to sign a consent that they will not use technicians for graft extractions.

 

I may not reverse the blowing wind, but I certainly can share my opinion. The reason why 'top doctors' use technicians is very simple: their growing business dictates that they must do multiple procedures a day. It is not possible to increase the price per patient more after a certain limit, however it is easy to increase the number of patients when using technicians. It is much more profitable to do multiple procedures a day even if the price is reduced.

 

You are right. The blowing wind may end up all 'top doctors' using technicians one day. If this is what the market dictates then I may end up in the same way. However I will never claim that this is for quality; it will be the results of my growing business and the blowing wind that I were unable to withstand. I will do my best to keep the quality high, but I will know that it is impossible to clone my abilities by training a technician; just as it is impossible to clone the abilities of the other doctors you mentioned.

 

It is an illusion that trained technicians can do the job with the same excellence as an expert surgeon and the only thing that matters is doing the incisions. This claim is the fruits of a doctor being able to cope with 3-4 patient incisions a day. When that clinic has 8-10 patients a day then they will claim just doing the markings is enough and the incisions can also be taught to technicians. Who can claim that a talented technician can't learn how to do good incisions? There is no end to this.

[Swooping]

It is an illusion that trained technicians can do the job with the same excellence as an expert surgeon and the only thing that matters is doing the incisions. This claim is the fruits of a doctor being able to cope with 3-4 patient incisions a day. When that clinic has 8-10 patients a day then they will claim just doing the markings is enough and the incisions can also be taught to technicians. Who can claim that a talented technician can't learn how to do good incisions? There is no end to this.

 

Absolute nonsense. Do you have a golden hand Dr Karadeniz for graft removal? Does your mind perform in vivo screening of the dermis in 3D so you have a better feel than a trained technician can have? It is an illusion in your world yes, in the real world it is an reality.

[Ali Emre Karadeniz]

Absolute nonsense. Do you have a golden hand Dr Karadeniz for graft removal? Does your mind perform in vivo screening of the dermis in 3D so you have a better feel than a trained technician can have? It is an illusion in your world yes, in the real world it is an reality.

 

It is my patients who is going to tell if I have a golden hand or not.

There is nothing to be gained from such unfruitful comments. It is neither going to put me off in trying to support the truth, nor going to change the reality that supporting technicians has marketing purposes rather than quality and patient benefit.

[Swooping]

It is my patients who is going to tell if I have a golden hand or not.

There is nothing to be gained from such unfruitful comments. It is neither going to put me off in trying to support the truth, nor going to change the reality that supporting technicians has marketing purposes rather than quality and patient benefit.

 

Problem is you ain't objective and you are talking with a bias here. Seems you are saying that nonsense to protect your position. There is 0% reasoning to believe that a well trained technician can't live up to the standards of a surgeon in a hair transplant. In fact I'm sure that some trained technicians do a better job with the extraction process than some of the recommended surgeons on this site. It is perfectly plausible. So in that sense you ain't preaching the truth but are downwards lying here.

 

Can you come up with reasoning why a well trained legally eligible technician can't acquire the same skills as a surgeon in the extraction process? That is right, you can't. Sorry Dr. Karadeniz I am not on these forums to buy into fantasy stories.

[KO]

It is curious how in these debates the technician is always a phenomenon, and the doctor is incompetent, and this ideal scenario is used to defend techs doing surgery. No agenda though.

 

Dr Feriduni and Lorenzo have a set of skilled techs, therefore techs doing surgery in general is OK. Maral has experienced techs, and since techs can do surgery, they can also make incisions and insert grafts, and therefore Maral = Feriduni = Lorenzo. #winning.

[Swooping]

It is curious how in these debates the technician is always a phenomenon, and the doctor is incompetent, and this ideal scenario is used to defend techs doing surgery. No agenda though.

 

Unrelated to this discussion. That's not the point. You are talking about people preaching from a bias on the other side of the story, more-so a hidden agenda. I'm talking objectively here. If you think that a legally eligible well trained technician can't acquire the same skills as a surgeon in a hair transplant you are totally twisted in reality. We ain't talking about acquiring the mind of Einstein or Nikola Tesla here.

[Blake Bloxham]

1966,

 

No, I think the analogies make perfect sense. You just don't agree with my argument.

 

This brings me to another point with this whole tech issue. It's far more complicated than simply saying "Techs can be as good as a doctor when it comes to extraction." I mean sure, I'm not going to say a tech couldn't develop good dexterity and become sufficient. But here's the question you must ask: who are these people?

 

We always talk about these techs who are fantastic, but aside from a few random comments about "X tech who works with Y doctor" or a first name of a tech with no further info, we have no information with respect to training, what aspect of the surgery they perform, how long they have been with the clinic, etc, etc. When we see a result from a recommended clinic, the doctor's name is on the result and we know who did what. Until we have further information about who these techs are and what they did, this is all just conjecture that we can't validate. This is a problem. It is difficult for us to refer patients to these clinics when all we have is the assurance that some tech somewhere who may perform some aspect of the procedure possess the ability to become efficient if they were trained by somebody. Does this make sense? Haha.

[Ali Emre Karadeniz]

Problem is you ain't objective and you are talking with a bias here. Seems you are saying that nonsense to protect your position. There is 0% reasoning to believe that a well trained technician can't live up to the standards of a surgeon in a hair transplant. In fact I'm sure that some trained technicians do a better job with the extraction process than some of the recommended surgeons on this site. It is perfectly plausible. So in that sense you ain't preaching the truth but are downwards lying here.

 

Can you come up with reasoning why a well trained legally eligible technician can't acquire the same skills as a surgeon in the extraction process? That is right, you can't. Sorry Dr. Karadeniz I am not on these forums to buy into fantasy stories.

 

I am prepared for representatives and trolls attacking me here, so it is no surprise. I will not go into discussion with such people who are usually at a lower intellectual level and more importantly are vulgar. The fact that I am making a comment here doesn't mean that I am answering you personally as your motivations to promote a technicians clinic has no intellectual value.

I have explained this issue previously, so it needs no further comment.

None of my postings are personal, but are intended to share my knowledge and opinions with a large community. Everyone can draw their own conclusions.

[KO]

1966,

 

No, I think the analogies make perfect sense. You just don't agree with my argument.

 

This brings me to another point with this whole tech issue. It's far more complicated than simply saying "Techs can be as good as a doctor when it comes to extraction." I mean sure, I'm not going to say a tech couldn't develop good dexterity and become sufficient. But here's the question you must ask: who are these people?

 

We always talk about these techs who are fantastic, but aside from a few random comments about "X tech who works with Y doctor" or a first name of a tech with no further info, we have no information with respect to training, what aspect of the surgery they perform, how long they have been with the clinic, etc, etc. When we see a result from a recommended clinic, the doctor's name is on the result and we know who did what. Until we have further information about who these techs are and what they did, this is all just conjecture that we can't validate. This is a problem. It is difficult for us to refer patients to these clinics when all we have is the assurance that some tech somewhere who may perform some aspect of the procedure possess the ability to become efficient if they were trained by somebody. Does this make sense? Haha.

 

This is the key issue, in theory and practice, a tech could become very good and exceed the skill of a doctor by specializing in one key task. How do you know which tech is what though? In some cases we know, Erdogan has Dilek, Lorenzo has Nuria. What about others, as a patient you are in the dark.

 

Techs doing surgery isn't a new development, this has been happening for a long time, the problems are the same but those with agendas do not seem to have an answer to this question.

[Swooping]

I am prepared for representatives and trolls attacking me here, so it is no surprise. I will not go into discussion with such people who are usually at a lower intellectual level and more importantly are vulgar. The fact that I am making a comment here doesn't mean that I am answering you personally as your motivations to promote a technicians clinic has no intellectual value.

I have explained this issue previously, so it needs no further comment.

None of my postings are personal, but are intended to share my knowledge and opinions with a large community. Everyone can draw their own conclusions.

 

Typical response from a cat who is cornered. He jumps away. Then he slanders me based on nothing. Furthermore I am chuckling here. As I'm perfectly sure I am on a way higher level than you in hair biology and Androgenetic Alopecia. Also I am aware of the all papers done related to hair transplants. You are free to meet me in November this year at the hair congress. Furthermore you are speaking here to someone who has been active for some years on several hair forums helping people, educating and engaging in interesting discussions. I can prove this immediately . Second time you make yourself look bad.

 

Originally Posted by drkaradeniz

It is an illusion that trained technicians can do the job with the same excellence as an expert surgeon and the only thing that matters is doing the incisions. This claim is the fruits of a doctor being able to cope with 3-4 patient incisions a day. When that clinic has 8-10 patients a day then they will claim just doing the markings is enough and the incisions can also be taught to technicians. Who can claim that a talented technician can't learn how to do good incisions? There is no end to this.

 

Moderators am I wrong here? I'm asking for a reasoning why a legally eligible trained technician in pure sense can't acquire the same skills as a surgeon in a hair transplant. I'm waiting for a explanation, yet I don't get one. Dr. Karadeniz preaches himself as telling the truth but he can't give reasoning. Then he slanders me on a personal level. Talk about "intellectual" here.

Edited February 11, 2015 by Swooping

[Ali Emre Karadeniz]

This is the key issue, in theory and practice, a tech could become very good and exceed the skill of a doctor by specializing in one key task. How do you know which tech is what though? In some cases we know, Erdogan has Dilek, Lorenzo has Nuria. What about others, as a patient you are in the dark.

 

Techs doing surgery isn't a new development, this has been happening for a long time, the problems are the same but those with agendas do not seem to have an answer to this question.

 

I agree and would like to add;

 

Once I was asked to train a tech to do FUE extraction where I worked for previously and I did so. He was extremely talented and soon started getting excellent grafts with a low transection rate. He would run to me showing his excellent rates and we would celebrate. However, occasionally we would run into some problems. Sometimes he would over harvest from close to the neck region causing visible moth-eaten appearances. Sometimes he would make a slight mistake in angles. These were rare and the company was very happy with having this tech.

 

What I am trying to say is that even if a tech is talented and trained well, he doesn't get the eye of a medical doctor. He doesn't have the responsibility and concerns that a doctor has, that enables the doctor to spot every danger in time and make the necessary adjustment. There are some rare parameters that you just can not remind the tech of for every patient. When that situation comes, he might be carried away with the standard thing he is used to do and make a mistake.

 

Patients being operated by a tech actually pay a price even if the tech is very good. That is they miss the chance to have the doctors eye on them, constantly trying to keep them out of trouble. It is like Russian roulette when mostly nothing happens, but rarely it is a disaster. Clinics may afford the risk, but do patients?

[1966kph]

Some very good points raised and to start with I agree dr Karadeniz if the drs have to sign up and in so doing giving their word that they will adhere to the ishrs directive they should keep their word or don't sign and walk away.

The case with the tech you were training dr if you could elaborate a little further, How long was he training for before starting to yeild descent results from extractions ? Hour many hours on average a week do you think he was doing extractions as I'm presuming he wasn't doing them all the time. Did he have any kind of prior medical training or did he come from a different profession? Do you know what became of him after you left transmed? I presume this was when you were at transmed ?

The times are changing there's no doubt about it and to be honest I have not seen any decline in the outstanding results produced by the clinics that have chosen to use technicians for extractions.

One other benefit to their business model is that more suffers are getting help and for me the easing of peoples suffering is the number one priority.

Thank you for being respectful in your previous response dr Karadeniz as I'm sure some of my comments cut you to the bone as at times I am brutally honest.

Have a nice day

[Swooping]

Well we all can see that Dr. Karadeniz speaks from personal subjective reasoning with a bias to protect his position. From a objective standpoint however we can see that what he speaks is totally nonsense. Always think through, research and educate yourself guys !

[Blake Bloxham]

A few things ...

 

First, let's all remain civil. There is no reason to make insulting remarks or personal attacks. This won't be tolerated; from physicians, moderators, or other members.

 

Second - KO, I've made this same point before. I've never understood why these "technicians versus doctor" arguments always result in such extremes. It seems to always unravel into an inane comparsion where we are comparing a phenom, wunderkind technician to an incompetent doctor. Like I said before, this isn't the argument nor is it realistic or fair.

 

Swooping - No, you're not wrong. Like I said before, there is nothing saying a technician can't be trained and develop effecient extraction skills. In my mind, however, the situation is much more complex than that. Not only do I make this point with my last post, but I've also explained previously why there is so much more to a surgical procedure than meets the eye; things can go wrong and humans are much more complicated than they appear. Despite what some may say, FUE isn't simply a process of pulling out follicular unit grafts and plugging them back into the scalp, and patient are not static, simple models. FUE is a surgical procedure. Granted, it is a minimally invasive procedure, but it's surgery. Patients are complex organisms with unique anatomy, underlying medical conditions, and unpredictable responses. Taking a trained physician/surgeon out of this situation is unwise. Frankly, it disrespects the nature of surgery and the patient themselves. I know most will probably roll their eyes and state that FUE is perfectly safe and you don't need a surgeon standing by for a "one-in-a-million" complication, but I really disagree with this position. Treating a living, breathing human with surgery requires a skillset that it obtained by going through serious medical training. Anything less just doesn't make a whole lot of sense.

[Swooping]

Swooping - No, you're not wrong. Like I said before, there is nothing saying a technician can't be trained and develop effecient extraction skills. In my mind, however, the situation is much more complex than that. Not only do I make this point with my last post, but I've also explained previously why there is so much more to a surgical procedure than meets the eye; things can go wrong and humans are much more complicated than they appear. Despite what some may say, FUE isn't simply a process of pulling out follicular unit grafts and plugging them back into the scalp, and patient are not static, simple models. FUE is a surgical procedure. Granted, it is a minimally invasive procedure, but it's surgery. Patients are complex organisms with unique anatomy, underlying medical conditions, and unpredictable responses. Taking a trained physician/surgeon out of this situation is unwise. Frankly, it disrespects the nature of surgery and the patient themselves. I know most will probably roll their eyes and state that FUE is perfectly safe and you don't need a surgeon standing by for a "one-in-a-million" complication, but I really disagree with this position. Treating a living, breathing human with surgery requires a skillset that it obtained by going through serious medical training. Anything less just doesn't make a whole lot of sense.

 

For your part; I understand your personal reasoning and your concerns over this point. However when a technician can legally individually operate in a jurisdiction he has all rights too, simple as that. The government in this case has decided. They simply have decided that a technician can have full responsibility in operating in a hair transplant. Some jurisdictions probably have a good damn reason to allow technicians to perform a hair transplant. I do agree that these "only technician" clinics should be approached very cautiously. Nonetheless perhaps it will be a development. I'm from the Netherlands and not so long ago dentists were only allowed to perform fillings. Time has changed however and now trained assistants are allowed to perform this action by the government.

 

But that is a other discussion anyway. We seem to agree on this point that a technician can perfectly well attain the same skill as a hair surgeon and even surpass them. For example I wouldn't be surprised if the technician of Dr. Lorenzo is better than some of the recommended doctors here in the extraction part. It's completely plausible. Dr. Karadeniz was generalizing and talks from a bias and I pointed him on that, then he personally slanders me like a little kid. How unprofessional is that?

[1966kph]

Blake I have had a post pulled about a hour ago could you please check it out