Urgent Consumer Alert by ISHRS

[Michael Vories, MD]

In 2003 I underwent abdominal surgery. The surgeon I consulted with was the surgeon who performed my surgery. It never crossed my mind that someone else could of operated on me.

 

Why is hair transplant surgery any different?

 

During surgical consultations many things happen. The most important of which is the establishment of trust. When patients hire us they are putting their trust in us that we will be there. That we will be honest with them. That we have an expertise, not just in managing a team, but in performing the actual procedure. The least we can do is make sure that trust is not violated by hiding behind our MD degree.

 

At a recent ISHRS conference I had a physician accuse me of "just being a tech." Well, I am a

proud to be a tech as well as a surgeon, and I should do everything I can to make sure I am the best "tech" on my team. Because leading from within your office (and not in the OR) is as crazy as it sounds.

[hairweare]

Having finished med school more than several years ago followed by a career in which I worked extensively side by side with techs as well as being a veteran of 5 HT procedures, I have no dog in this fight but I will provide another common sense example that I think most lay people can relate to.

 

Let say you book a procedure at a well known clinic in Kazakhstan based on your extensive research were you have studied dozens of pictorial case reports and read first hand accounts from patients on various HT fora. You have met with Dr. B and were impressed with his demeanor and professionalism. The clinic is spotless, modern and everyone is wearing a cleanly pressed white lab coat. There are 3 other cases scheduled besides yours and two tech will be performing your extractions as Dr. B shuttles between the 4 OR suites. Of the 8 tech working that day who among them has had the most experience particularly with your caucasian curly hair? Which technician was a recent hire and still on their 6 month probation period? Were you aware that the head technician D. called in sick yesterday and was replaced by T.? Of the 8 technicians who has the lowest transection rate? who has the highest? Consider the batting line up of the World Champion SF Giants. All are professional major leaguers but hitters 1-8 all had different batting averages. Is it therefore logical to believe that all 8 technician working at Dr. B's clinic have identical transection rates and skills?

 

Dr. K was being totally honest that the reason doctors do multiple same day procedures and rely on techs is purely financial. There is no benefit whatsoever to the patient. A procedure with Dr. Reyes in Belgium who limits his extractions to 1500 a day or the work Dr. Lorenzo produced in Manchester is about as transparent as one can get in this industry. When looking at those results and consulting with those doctors or ones with similar practices, a patient has the best chance of getting precisely what he is paying for and having his expectations met. Yes, even a shortstop with a batting average of .230 can hit a game winning home run, but what are the odds?

[KO]

While overall I agree with you regarding the centrality of a surgeon. I do think that even in an ideal situation, there can be tech support, as we would not the doctor to be tired when handling the implanter pen. The question to me is how can the patient know the experience of that technician? Regarding Lorenzo, it seems he has been using technicians since opening his clinic, and the process in Manchester was a departure due to the absence of his team.

 

Of course in the above I'm only referring to surgeons who use the implanter. If they are using lateral slit and only making incisions, I do not agree with heavy tech involvement in extraction.

[hairweare]

I am not so clear as to when exactly Lorenzo began using techs at his clinic in Madrid. Certainly his practice and techniques have evolved since 2004. I suspect he started out performing all parts of the procedure himself and then added an associate (Dr. Villa) when the case load started to pick up. At some point he expanded sessions to more than 1500 grafts and began to utilize techs for extractions. Nuria is his most experienced tech but others are more recently trained. Personally, I would not want to be part of someones extraction learning curve regardless as to whether they were a technician or doctor. Donor supply is too limited and transection will affect yield. I was too drugged to see or ask if Dr. Lorenzo personally inspects the extracted grafts prior to being loaded into the implanter pen.

 

My point remains that a FUE is a personal service where quality is dependent on the summation of the parts. I don't believe that quality can be maintained if that service is expanded or franchised. Consider the great restaurant owned by a chef who then later becomes famous and franchises his name to multiple locations. Are any quite as good as the original?

[1966kph]

All of this points to the basic number one we as patients should do and that is research as much as possible and ask as many questions to get the answers before we commit to move forward with the procedure.

What I see developing here is a clear pattern were doctors are prepared to come to this thread and say this or that so are they prepared to stand up in front of the next ishrs meeting and state what they say here?

If you think that a drs practice is doing wrong by their patients would you be prepared to stand up and be counted?

We members of the forum see a lot of double standards that go unchallenged and no one held to account over their actions.

We had a case a while back were the thread starter asked for opinions on a dr who had let the patient know he would not be present during all the procedure.

It was a strip procedure and if I remember right the doc was going to suture the donor then leave the premises and as I understand it would not be returning that day.

This was in the US so I would like to know was any inquires made by moderators here to ascertain who this dr was so he could be warned of his conduct in the future?

We had a case were the donor was left open and the patient was not informed of the complications and sent home oblivious until five days post op so what happened to this doc?

A dr being in the same room during the whole procedure is being slowly consigned to the history books in just about all countries apart from the states.

Patients could not care less a lot of the time whether the dr spends 40 minutes as dr Erdogan does in two day procedures on the same patient as long as they are happy with the results.

Like I've said the fue ht industry is in decline because people go abroad and they do not care for the most part who is doing what.

The excellent results while saving thousands are what lure them there.

If the US is to compete it must adapt because one thing is for sure the world ht industry is not going to go in reverse to match what the US does and why should it.

Drs defending their amount of involvement is only coming from US drs and a dr Karadeniz who has his sales aimed at people who want total dr participation why do we think this is.

Do we think that the drs who do not comply with the ishrs directive will give a damn if they are exiled from its ranks?

The US ht industry needs to catch up with the current best exponents of fue nearly all of who have far more tech involvement.Argue all you want and I'm sure in country the size of the US with the size of its population and the limited number of ht drs you won't go short of customers.

The current state gives the consumer the opportunity if they are prepared to travel the chance of excellent work at a fraction of the cost.

It used to be patients would be going to the states now there coming from the states.

This business is not about what the drs want its what the customers want and its clear more and more are not wanting what the states have to offer.

Have a good day

[Ali Emre Karadeniz]

Just when I start loosing my faith in the forum a couple of wise members enter the thread making me feel that I am understood by some. But, could someone explain to me why the 'technicians lobby' is so strong and aggressive at this forum? It is tragicomic that I am put into a position as if I am trying to protect myself. Why is a doctor working on a single patient a day for at least 6 hours of hard work alone, has to defend his philosophy and representatives of technician clinics, stand up proudly and behave as if they are the kings of this field?

[KO]

Just when I start loosing my faith in the forum a couple of wise members enter the thread making me feel that I am understood by some. But, could someone explain to me why the 'technicians lobby' is so strong and aggressive at this forum? It is tragicomic that I am put into a position as if I am trying to protect myself. Why is a doctor working on a single patient a day for at least 6 hours of hard work alone, has to defend his philosophy and representatives of technician clinics, stand up proudly and behave as if they are the kings of this field?

1) Patients concerned with cost.

2) Promoters of technician clinics.

3) Some want to commoditize the FUE procedure. (This I get, while disagreeing with it).

[1966kph]

You dont work alone dr Karadeniz you are aided by techs.

Just because someone has a different opinion why do you insinuate they are a rep of a clinic or a troll? Its insulting and unnecessary.

This is a good civil debate let's try and keep it so.

Have a good day

[Ali Emre Karadeniz]

Another fact:

 

FUE does not work on everybody. In some patients we can tell that it is unlikely to work, however in some patients we only find out after we do an FUE test. What I mean by FUE test is actually starting the operation and doing 100-200 grafts to find out about the transection rate and the quality of grafts. If I find out that the results of the test are unfavourable, I stop the procedure. I recommend doing FUT or totally cancel the procedure.

 

Now, I think this should be a standard approach. How do we fit this in with technicians FUE? More importantly, how do we fit this in with FUE-only clinics. Without the chance of a doctor doing these evaluations and/or doing FUT, how do we think these clinics actually deal with these unlucky patients? Technician clinics will surely butcher these patients. I am not sure if FUE-only clinics , even if the doctor does the extractions, will stop these operations, give the patient his money back and recommend them to go to a FUT surgeon.

[Gram]

Interesting post dr. K. what characteristics make a patient more prone to FUE failure or success? I am a proponent of test patches as I have posted before.

[Ali Emre Karadeniz]

Interesting post dr. K. what characteristics make a patient more prone to FUE failure or success? I am a proponent of test patches as I have posted before.

 

This is a very complicated topic and deserves to be discussed in a separate thread.

However I can say that it is a combination of multiple subtle factors regarding tissue characteristics. As I mentioned, there are a group of patients which the donor area looks perfectly good before surgery, but the FUE test shows a very high transection rate. Let me list the factors that comes to my mind now:

 

1. Unfavourable tissue resistance to the rotation of the punch

2. Splayed follicles beneath the skin

3. Bulbs that are too deep

4. Bulbs that are too shallow

5. For unknown reasons: topping if the punch depth is shallow and total transection when the punch is inserted slightly deeper.

6. Diffuse idiopatic fibrosis

7. Diffuse fibrosis due to previous surgery (may be suspected before)

8. Diversity of directions (may be suspected before)

9. FU's with a very acute angle on the skin (may be suspected before)

10. Splayed follicles above the skin (may be suspected before)

 

And maybe more...

Lets not forget that god didn't create our scalp considering that we would try to do a very sophisticated procedure as FUE!

He didn't create us to have FUT, but strip removal is such an elementary surgical procedure that it can almost always be done despite various skin characteristics.

[1966kph]

Very good point and one I've heard raised before in regard to the test procedure.

One of marals patients has just done his second procedure with maral he is 9 months after his first with IMO very good results.

Now to the point when he went to maral he had been and consulted at least two drs both of whom said he was a poor candidate and turned him away as he had three previous fut surgery's

I would suggest that maral has helped this chap as he states he is very happy after first having started with fut in 1994.

This is all us sufferers look for a solution for our problem and he's got it at the hands of techs.

I do not contend that all tech clinics are going to give good results and from what you describe happens in your country probably 99% of the time its going to be a disaster going to these clinics.

How many of these clinics are capable of giving results like the example I gave I have not got a clue.

The clinics you describe dr Karadeniz are not technician clinics as technician means someone with skill and artistry if they are a technician its not within the ht industry and they have no place within it.

As I have said before your country's short comings in regulating the industry is the biggest crime.

Have a good day

 

Another fact:

FUE does not work on everybody. In some patients we can tell that it is unlikely to work, however in some patients we only find out after we do an FUE test. What I mean by FUE test is actually starting the operation and doing 100-200 grafts to find out about the transection rate and the quality of grafts. If I find out that the results of the test are unfavourable, I stop the procedure. I recommend doing FUT or totally cancel the procedure.

 

Now, I think this should be a standard approach. How do we fit this in with technicians FUE? More importantly, how do we fit this in with FUE-only clinics. Without the chance of a doctor doing these evaluations and/or doing FUT, how do we think these clinics actually deal with these unlucky patients? Technician clinics will surely butcher these patients. I am not sure if FUE-only clinics , even if the doctor does the extractions, will stop these operations, give the patient his money back and recommend them to go to a FUT surgeon.

[GraveD11gger]

Another fact:

 

FUE does not work on everybody. In some patients we can tell that it is unlikely to work, however in some patients we only find out after we do an FUE test. What I mean by FUE test is actually starting the operation and doing 100-200 grafts to find out about the transection rate and the quality of grafts. If I find out that the results of the test are unfavourable, I stop the procedure. I recommend doing FUT or totally cancel the procedure.

 

 

 

This is just the possibility in African descent men with curly hairs.

[Bill - Seemiller]

Dr. Karadeniz,

 

Firstly, I want to thank you for creating this topic. I think the topic concerning the role of technicians in hair transplant surgery is incredibly important and it's helpful to hear the ISHRS' position on the topic.

 

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.

 

Blake, I couldn't agree more. Ultimately, physicians/surgeons have more overall training when it comes to anatomy and how to handle complications. Hair transplant surgery may appear to be a simple process of harvesting and implanting hair however, what happens in the event of a serious complication? Technicians may be just as technically able to extract and implant follicular units, but are they knowledgeable about how to handle serious surgical complications that can occur during a surgical procedure?

 

Hair transplant surgery is no doubt a team effort and in my opinion, there is nothing wrong with hiring and using technicians to assist with the procedure. But in my opinion, removing a licensed and qualified physician/surgeon from the equation is dangerous.

 

Best wishes,

 

Bill

[waittosee]

Recently, I had a phone conversation with Dr. Koray's Office to schedule an operation day. I asked if I was able to choose the technician namely Mrs. Dilek since I read her name often on this forum and the answer was no. Mrs. Secil explained to me that thay have 4 surgeries a day and they decide the tech teams which all are very much experienced according to the patients hair characteristics, some have hard fu's some have smooth etc.

Now, how am I suposed to know what kind of result I will get If I don't know the tech's skills ?

We come to this forum and look the results of this clinic or others for that matter but we don't know WHO was the tech. Perhaps, X tech is much better than Y tech the unbelievable result I see is belong to X tech and I won't get that tech because my hair is too hard.

 

I think there should be 2 sets of recommended doctors here on this forum one with technicians assisted and the other with solely doctor operated. And clinics which use techs for extraction and inserition should name the tech for that operation on their showcases.

[1966kph]

Who said anything about removing him the dr from the equation?

I have always maintained that a doctor should always be on the premises in case of complications.

This is another point with regard to marals practice apart from not doing 20 minutes work doing incisions to match the amount of time Erdoğan does on each patient and a tech does it were are the differences in the actual process?

Whether maral is behind his desk or Erdoğan is doing incisions or sat behind his desk maybe doing a consultation they are both not in the op room and the same could be said for most multi patients per day practice's.

In the case I mentioned about the donor being left open the complication which is basically a foot long gaping wound and the patient is sent home unaware of it.What did the doc do there?

Two docs turn a patient away then marals techs does two fue sessions and takes 6000+ grafts that supposedly were there was not meant to be any,

9 months out a very good result is immerging.

I would never and have never said to someone that they should go here or there its their decision that should be based on as much research as possible.

Without a doubt most of these places in Turkey that dr Karadeniz talks of should not exist but you yourself bill were until very resently considering maral for potential recommendation knowing full well what the set up was there with maral not being hands on.

You also said a while back bill that he was doing some very good work but I think you thought at that time the work was being done by him so thats the standard we are talking about here.

I'm going to maral in just under a month thats how much faith I have in his set up and the possibility of getting a good result.

Have a good day all

[hairweare]

The case you cite is an extraordinary one and those who go to this clinic with the expectation of similar results are leaving themselves open to dashed dreams and disappointment. We are not informed who the two doctors were that turned him down, nor do we know whether they had any expertise in FUE. Certainly if a microscopic evaluation was performed the extremely thick density of the donor area as well as favorable hair shaft caliber would have been readily identified. You can't get water from a stone nor can you extract 6000 FUs from a zone previously exhausted from 3 previous FUTs so it is fair to assume that similar results could have been obtained from any doctor specializing in FUE. That it was achieved at such a bargain is the real story for that particular individual. Personally, I wouldn't have taken the chance myself but the outcome speaks louder than words and obviously the HT Gods were looking down on him during his procedure.

The important point is that YMWV where ever you decide to go and the old investment adage, "past results do not guarantee future performance" holds true in the HT business as well. The point that has been made repeatedly here is that many informed prospective patients attempt to control as many variables as possible even if one has to spend more to do so. Those that view FUE as a technician dispensed commodity are more likely to select a clinic based on price alone and hope that "what you get is what you pay for" will not necessarily apply to their particular outcome.

[1966kph]

Hello hairware.

You are right about not knowing who the two docs were and I asked him who they were but as yet he has not answered this.

I agree he must of had at least enough hair available to do the procedures but the result he has got are looking very promising at 9 months which I assume you are not disagreeing with given what you said.

From what I have seen this is not a one off and marals techs have at least 30 patients who have posted their results now I dont know how many you have seen but they have some good results especially on the higher norwood cases.

Obviously cost enters into the equation so look at it from this point if they had to go elsewhere how much would they be paying?

If they cannot afford to say pay anything more than 5k anything above this budget is taken out of the equation.Then say for the 5k they can only get 3000 grafts again they could see this as not meeting their needs of addressing the loss to the extent they desire.

But most importantly out of all this is that I see the results and this above all is what matters is it not? And how many of marals patients are unhappy with their results? And how many are happy again they've achieved happiness at the hands of techs under the planning and guidance and supervision of dr maral.I hope I end up in the same way but we all know there's no gauntee even going to the best and paying 20k.

 

Were are the most the most members of the ishrs based? I will hazard a guess the US were they are very limited in their capability to use techs by law now if as I guess the biggest number of members are in the US does it not stand to reason they would want to vote in favour of limiting tech involvement to take away the advantage foreign members have?

 

I agree with dr Karadeniz if they dont sign up to the directive they should leave the ishrs and if they do sign they should adhere to it.

 

We all choose were to go and I'm not going to dictate to someone were they should or should not go to and were ever they decide I wish them all the best and I hope they find happiness. So far there's about 30 people who got their happiness at hands of techs and that is the biggest plus I take from this not that it was achieved at ridiculously low cost.

 

I would never condone a clinic such as the ones dr Karadeniz talks of were any Muppet is let loose to savage someone's head and ruin theirs lives I think its appauling it is allowed to happen. I would argue that marals clinic is a million miles apart from such places in just about every regard.

I asked dr Karadeniz to elaborate on the tech he was helping with training but he hasn't yet so if you could please dr Karadeniz ?

I'm glad this has thread is managing to stay for the most part on track without the usual insults and insinuations that usually occur.

Have a good day

 

 

The case you cite is an extraordinary one and those who go to this clinic with the expectation of similar results are leaving themselves open to dashed dreams and disappointment. We are not informed who the two doctors were that turned him down, nor do we know whether they had any expertise in FUE. Certainly if a microscopic evaluation was performed the extremely thick density of the donor area as well as favorable hair shaft caliber would have been readily identified. You can't get water from a stone nor can you extract 6000 FUs from a zone previously exhausted from 3 previous FUTs so it is fair to assume that similar results could have been obtained from any doctor specializing in FUE. That it was achieved at such a bargain is the real story for that particular individual. Personally, I wouldn't have taken the chance myself but the outcome speaks louder than words and obviously the HT Gods were looking down on him during his procedure.

The important point is that YMWV where ever you decide to go and the old investment adage, "past results do not guarantee future performance" holds true in the HT business as well. The point that has been made repeatedly here is that many informed prospective patients attempt to control as many variables as possible even if one has to spend more to do so. Those that view FUE as a technician dispensed commodity are more likely to select a clinic based on price alone and hope that "what you get is what you pay for" will not necessarily apply to their particular outcome.

[Swooping]

Hair transplant surgery may appear to be a simple process of harvesting and implanting hair however, what happens in the event of a serious complication? Technicians may be just as technically able to extract and implant follicular units, but are they knowledgeable about how to handle serious surgical complications that can occur during a surgical procedure?

 

Best wishes,

 

Bill

 

I'm glad that two moderators agree with my standpoint that a technician may be just as good as a doctor and in fact can surpass them in a aspect or a whole of the hair transplant process. They can also as easily adapt to transection and donor problems as a doctor. So in that sense Dr. Karadeniz is talking nonsense again from an biased subjective opinion.

[KO]

I'm glad that two moderators agree with my standpoint that a technician may be just as good as a doctor and in fact can surpass them in a aspect or a whole of the hair transplant process. They can also as easily adapt to transection and donor problems as a doctor. So in that sense Dr. Karadeniz is talking nonsense again from an biased subjective opinion.

You are just talking about a theoretical, and ideal situation where a technician magically becomes a great HT practitioner. Karadeniz on the other hand is generalizing and speaking to a realistic situation based on his experience working as a surgeon, Lorenzo and Feridnuni's techs are good as they have worked under his supervision for many years, and their doctors continue to be heavily involved in the operation. They did not magically sprout HT powers like X-men. Finally Lorenzo's techs would never be able to perform a hair transplant as they have no experience in implanting grafts.

[Swooping]

You are just talking about a theoretical situation where a technician magically becomes a great HT practitioner. Karadeniz on the other hand is generalizing and speaking to a realistic situation based on his experience working as a surgeon, Lorenzo and Feridnuni's techs are good as they have worked under his supervision for many years, and their doctors continue to be heavily involved in the operation. They did not magically sprout HT powers like X-men. Finally Lorenzo's techs would never be able to perform a hair transplant as they have no experience in implanting grafts.

 

"Theoretical"? Dr. Koray Erdogan and Dr. Hakan Doganay have technicians too, these guys should be based on their skill and you should be damn right that they have very skilled technicians in what they are doing. Else they wouldn't be regarded as world class in FUE. Furthermore they won't take the risk in letting these guys do the job if they are not on par with them self. They would be putting their reputation on risk which they worked hard for for for several years. If you want to generalize the word "technician" in this sense like Dr. Karadeniz does you are putting a stamp on technicians as if they are per definition in shortcoming in comparison to a doctor which is a fantasy story.

[KO]

I'm not sure why you're using them as your examples, but I don't think Erdogan "I post wet before and dry after" or Doganay "I don't have many good results despite a decade of surgery" are really all that good.

[Swooping]

I'm not sure why you're using them as your examples, but I don't think Erdogan "I post wet before and dry after" or Doganay "I don't have many good results despite a decade of surgery" are really all that good.

 

That is your opinion. When I look across all forums I see them mentioned extremely much. Also they are very busy so they must be doing something right. Nonetheless that again isn't the point, you don't understand the context.

 

Furthermore look on the positive side of a technician, relieving fatigue of the doctor for example. Also when you are going to put a stamp on technicians and are going to generalize them as per definition worse you are literally hindering rivalry, development and innovation. Which is an extremely bad thing. Perhaps only a few can understand this.

 

I'm done on this discussion anyway, I made my point. The moderators agreed on my point which is a good thing. I do agree however with Blake and Bill that surgeons have a better understanding on how to anticipate on eventual (rare) complications during a hair transplant due to better medical training.

[1966kph]

Hello dr Karadeniz.

I'm a little confused as in the quote below you say that you would be prepared to follow the same business setup as Erdoğan, Lorenzo ect ect if the market dictated you had to. And I appreciate that you would not say it is for quality purposes.

The point is how many of us before being made aware of it actually noticed a decline in the quality of the work produced by Lorenzo or Erdoğan?

 

So you are prepared to follow the example set by others who you are somewhat berating even though you think your results will suffer and your patients will not get the best possible results. Your not going to do it now but when needs must.

 

This just goes to echoe my point that if in the US there was the same opportunity's to follow the very successful business model as Lorenzo and Erdogan how many of the US drs would stick with the old limitations ? Dr karadeniz a big advocate of non technician extractions says he would use them if needs be.

 

So just to some up you start a thread to high light something you are prepared to do your self but want other drs booted out of the ishrs for doing it ?

Blake and vories what about you two are you gonna say whether you would stick to your principles or would you yield to market forces if the shackles were removed off the US ht industry to allow techs to do extractions ?

 

Most importantly what I take from this dr Karadeniz is that its not the patients best interest you ultimately have at heart if you are prepared to do something you admit give them a inferior result. I am not trying to have a go at you for admitting as much as its being done by some of the best in the world and IMO they have managed to maintain a very high standard and that is the point I'm trying to make.

Have a nice day all.

 

 

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.

[Bill - Seemiller]

GraveD11ger,

 

I have received multiple complaints from various members about you and I have warned you multiple times. Moreover, you are heavily promoting Dr. Maral and are inappropriately bumping topics to discuss him.

 

Furthermore, while you seem to have a dynamic IP address, you share multiple IP addresses with the users "Fisher4man", "Longevita", "lifeisbeautiful", "Truthfu11" and my favorite of all "MikroFUE" - Dr. Maral's very own representative.

 

It seems obvious that you are posting under multiple aliases, which includes Dr. Maral's representative "MikroFUE".

 

This appears to be a covert promotional campaign for Dr. Maral initiated by one individual, most likely whomever actually goes by "MikroFUE".

 

You have now violated multiple rules and regulations of this community. Thus, unless you can provide me with excellent reasoning behind the above, I will be forced to terminate your and all your associated accounts.

 

Best wishes,

 

Bill