Urgent Consumer Alert by ISHRS

[ej]

Busted big time !

[PupDaddy]

I posted this in the other threads where Bill has called out GraveD11gger/MikroFUE/Fisher4man/etc. for sharing IP addresses and likely being one and the same person or at least in league -- but I think it bears repeating:

 

If it turns out that GraveD11gger and MikroFUE are one and the same, or are in cahoots, I would not be at all surprised. (In fact, I seem to recall somewhere that GraveD11gger let slip once that he works or worked directly for The Maral Klnic.) From the outset of this blatant promotional campaign for The Maral Klinic, its representatives and shills have engaged in deception and misrepresentation. It began with the initial posts of "MikroFUE," who assured us that Dr. Maral was totally hands-on and personally performed every stage of the FUE ht surgeries at the clinic, with assistance of his technicians. To further convince us that it was Dr. Maral, and not his technicians, that performed the transplant surgeries, "MikroFUE" even went so far as to note that it would violate Turkey's medical-legal laws for anyone other than a licensed aesthetic surgeon such as Dr. Maral to perform ht surgery on patients. As we now know, Maral's supposed hands-on involvement was a total fabrication. When it was exposed that Dr. Maral took no hands-on part in the clinic's FUE transplants, "MikroFUE" changed course and asserted that Dr. Maral "supervised" the clinic's transplants. This supervision supposedly consisted of Dr. Maral briefly checking in on the multiple ht's being performed by his technicians each day, but then we learned from a patient that Dr. Maral wasn't even on the premises while that patient was still being operated on.

 

Don't be fooled. Technician-performed hair transplantation has nothing to do with the patient and everything to do with a clinic's owner maximizing profits by leveraging cheap labor to perform hair transplants. The discounted pricing he is able to charge for hair transplantation relative to expert ht surgeon-performed hair transplantation reflects a willingness to make money by flaunting rules and regulations, not altruism. The business model is low fixed cost (technician salaries) + volume: Run as many patients a day through the technician transplant mill as possible, give technicians motorized punches and motorized recipient incision tools to enable them to keep up the pace, and thus pocket healthy profits without having to get your hands dirty actually performing hair transplants. Brilliant! For the clinic's owner-physician, anyway, who can devote his time to other profitable pursuits while his technicians are drilling away on patients' scalps.

 

Bill, thank you for catching this apparent further deception by this clinic and its "advocates." We await GraveD11gger's explanation.

[Ali Emre Karadeniz]

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.

 

 

These are clever words, but add nothing to the topic.

However I have noticed that you are able to type Erdoğan correctly with a 'ğ'.

It is surprising that you are using a Turkish keyboard!!

 

Have a good day!

[1966kph]

I use my phone 90% of the time when posting so it just comes Erdoğan in predictive text are you trying to say I'm Turkish?

There not clever words and are relevant to the thread topic.

What am I saying thats not on topic? You high light tech involvement and I point out that the states would if at all possible use the same business model as that employed by Erdoğan and Lorenzo and I asked two US drs if they would stick to the rules they currently have to abide by or use techs more if they could.

I was hoping blake or dr vories would reply.

I also asked you about the tech you mentioned do you know what became of him?

Did he stay within the industry.What amount of training was he receiving? How long was his training ect ect. It would be interesting if you elaborate on training techniques for techs and I'm sure there's more than myself that is interested.

Have a good day

[Blake Bloxham]

Another few things ...

 

Swooping - I think you may be expanding my statement a bit. I think, in theory, a tech can be trained and develop good technique and dexterity. I don't think this translates to me saying: "a technician can become just as good, if not better, than a doctor;" which is closer to what you're saying. This misses a fundamental point; FUE is more than being technically proficient at extractions. Just because a tech can develop technical skill with route repetition and focus, it does not mean they are as "good" as a doctor. Like I said above, being a good surgeon is more than being technically proficient. There really isn't any substitute for going to medical school and learning the entire symphony.

 

Bill - You bring up an excellent point; I hope it doesn't sound like I'm belittling or insulting technicians. They are a crucial part of surgery and it could not happen without them. Period. Hair transplantation is a team effort, and technicians are an undeniable part of that team.

[fortune11]

I think Dr Karadeniz made very balanced arguments . Not sure why this thread had to get so heated.

 

I have the highest degree of respect for the techs who performed my hair transplants and I still thank them when I can for their meticulous attention and focus on my procedure.

 

But interestingly, someone else mentioned that FUE is getting commoditized -- I think that is the real reason behind people defending techs as being fully equivalent to surgeons -- it all comes down to $$$ involved. Some day you could have "botox-like" HT sessions performed by techs, with just the surgeons name and face on the (chain) clinics .

 

That is why I am actually thankful for the laws we have in this country that still maintain some semblance of respect for patient rights and dignity. Not the case across the world.

[1966kph]

The ht industry has always been about money and always will be and your probably right about the chain of clinics point. As long as standards stay high I have absolutely no problem with this and its just as dr Karadeniz says if drs have to adpt or sink they will adapt even though he conceded that the results would suffer.

Now the only reason I mention maral in this scenario is I only know of him and one other clinic with the same set up but the name escapes me.

I have seen it a couple of times resently were people have gone to him after multiple surgeries elsewhere and and have stated hands down that marals was by far the best results.Their previous surgery's were all carried out by drs the ones with maral were techs and this coupled with the photographs tell me techs can get very good results.

Bill said it himself before that maral was doing good work and up until very resently was going through the potential recommendation process so thats how much he thought of the results

 

Were this argument loses real ground is when I read that drs have dexterity or a golden eye or a drs veiws is nonsense.

If as is claimed a dr is better than a tech because of the training and this is the thing that sets them apart how does one explain the differing skill set of drs when they have had the same amount training and education? Is dexterity or the eye of a dr something that is something bestowed to only drs by god its ridiculous.

If you blake go through say 3 years of training in all aspects of ht but during that same time a tech is doing just one part the extractions day in day out who do you think would be the better at extractions? You because you've got the title of dr ? I very much doubt it unless you are naturally gifted at the task.

 

The title of dr does not automatically mean your going to be a excellent ht dr its the years of experience that determine whether you can cut it as a ht dr.

Blake your a qaulfied dr now do you think just because you have title and with your training thus far you could extract grafts better than marals head tech who has been doing it day in day out for over 10 years ?

 

I fully appreciate that your going to stand your ground and fight tooth and nail to justify all the hard work that must go in to qualify as a dr.

Marals techs have proven to me to such a degree that not only can they do the extractions but the incisions as well they are doing the same thing every day and have been for years with no dr participation.

Its clear unrefutable evidence that you dont need to be a dr to do fue.

I always have and still do say that a dr should be immediately available in case of any complications but it would be interesting to know how many times maral has been called to the op room because of a complication has arisen.

Answer this please - were are the majority of the members from that make up the ishrs ?

What is the directive dr Karadeniz mentioned hoping to achieve?

Will members who use techs for extractions leave or comply?

Is this directive the US trying to dictate because of the restrictions imposed by US law?

How many US ishrs members would use techs for extractions if the law permitted?

I think you know what my assumptions to these answers would be so could you please try and answer them rather than ignore them?

Have a nice day

[Swooping]

Another few things ...

 

Swooping - I think you may be expanding my statement a bit. I think, in theory, a tech can be trained and develop good technique and dexterity. I don't think this translates to me saying: "a technician can become just as good, if not better, than a doctor;" which is closer to what you're saying. This misses a fundamental point; FUE is more than being technically proficient at extractions. Just because a tech can develop technical skill with route repetition and focus, it does not mean they are as "good" as a doctor. Like I said above, being a good surgeon is more than being technically proficient. There really isn't any substitute for going to medical school and learning the entire symphony.

 

Bill - You bring up an excellent point; I hope it doesn't sound like I'm belittling or insulting technicians. They are a crucial part of surgery and it could not happen without them. Period. Hair transplantation is a team effort, and technicians are an undeniable part of that team.

 

Blake I know it's hard maybe to comprehend in your position. But it's the reality. Well not than a doctor in the pure sense.

 

Let's rephrase is then; A technician can be just as good and can surpass any doctor in any aspect of the hair transplant process. And this is totally true you do agree with me on this one right, at least Bill does. And it's not in theory Blake, it's already happening. The world's best regarded practitioners in the hair transplant industry use technicians for (big) parts of he process. There is 0 reasoning to believe otherwise really. Unless you can come up with a specific example. But you can't. Not every doctor can become the best. Doing a great hair transplant requires to have an extremely important aspect; artistry. Not everyone can be a Bisanga, as nobody will ever be like Picasso. So I welcome technicians because a Picasso under them may be present. And again, it's a reality already. It's happening.

 

Then a clown like Dr. Karadeniz has a big mouth to run but he is far from being considered a world class practitioner. By the way, I want to thank you personally Dr. Karadeniz that you gave me a valid reason now to definitely recommend you on all hair related forums. I hope you understand huge sarcasm in this one you "intellectual" :rolleyes:.

Edited February 13, 2015 by Swooping

[1966kph]

Dr Karadeniz is obviously a very clever individual but I think he suffers as we all do to some degree of a inflated opinion of our own self worth and a dr has probably more reason to suffer from this condition to the subject matter under discussion and due to the knowledge he pogesses being a professional within the subject matter.Its quite understandable.

Its just the same if a taxi driver was to preach about poor driving standards as its their profession.

Have a good day

thank you for the edit swooping as it was uncalled for and unhelpful to the debate staying civil

Edited February 13, 2015 by 1966kph

[Blake Bloxham]

Swooping,

 

I don't think I was clear before: I do not think a tech can surpass a doctor in every/any aspect of hair transplant surgery. Why would this be true? This makes no sense to me. Techs are better than surgeons at every aspect of surgery? Who are these techs? Who trained them? Why are we to believe that these people have innate artistry akin to Picasso, but doctors can't? You want one example where a doctor was better than a tech? I think you can open almost FUE thread from one of our recommended doctors and find a result that is better than a result than from a tech somewhere? Are you saying techs are always going to be superior?

 

Again, I don't know why we keep coming to this very theoretical argument where techs are all savant artists and doctors are all incompetent boobs with decades of medical and surgical training that apparently means nothing?

 

Just to clarify again: I don't believe techs can surpass doctors in every aspect of surgery like you said above. I think they can practice extraction over and over and become proficient like any other person with two hands could. However, being good at extraction is only one aspect of surgery. It's takes a lot more to pull off a solid result, and this is where a surgeon comes in. Techs are a crucial part of this team, but a solo tech team is not superior to a model with a doctor and techs working together. Bill feels the same way. I promise that.

 

If you'd like to see some of my problems with this model, see the recent Maral controversy.

[Blake Bloxham]

Swoop,

 

I hope the above doesn't sound too harsh. I know you're very informed on this subject, and I've actually enjoyed reading a lot of your online content. Just had this discussion a number of times and it still puzzles me a bit.

[Swooping]

Swooping,

 

I don't think I was clear before: I do not think a tech can surpass a doctor in every/any aspect of hair transplant surgery. Why would this be true? This makes no sense to me. Techs are better than surgeons at every aspect of surgery? Who are these techs? Who trained them? Why are we to believe that these people have innate artistry akin to Picasso, but doctors can't? You want one example where a doctor was better than a tech? I think you can open almost FUE thread from one of our recommended doctors and find a result that is better than a result than from a tech somewhere? Are you saying techs are always going to be superior?

 

Again, I don't know why we keep coming to this very theoretical argument where techs are all savant artists and doctors are all incompetent boobs with decades of medical and surgical training that apparently means nothing?

 

Just to clarify again: I don't believe techs can surpass doctors in every aspect of surgery like you said above. I think they can practice extraction over and over and become proficient like any other person with two hands could. However, being good at extraction is only one aspect of surgery. It's takes a lot more to pull off a solid result, and this is where a surgeon comes in. Techs are a crucial part of this team, but a solo tech team is not superior to a model with a doctor and techs working together. Bill feels the same way. I promise that.

 

If you'd like to see some of my problems with this model, see the recent Maral controversy.

 

No I am saying that what Dr. Karadeniz was stating is absolute nonsense. I'll quote again;

 

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.

 

You know what he says with this statement? He basically says that all active technicians currently or in the future will always be subpar to an expert surgeon. I never said however that a technician will always be better than a random surgeon. However a technician may very well be sometimes get better than a random surgeon. I provided you enough examples. I'll give you one; Dr. Lorenzo achieves one of the highest consistent yields worldwide, yet his technicians do most or a huge part of the extractions. So this technician must be world class and is better than most of the recommended surgeons, on this site in the extraction process. What is there so hard for you to grasp on this concept?

 

Also a solo technician team can perfectly fine be on par with a model of a technician + a doctor. There is 0 reasoning why they could not. Give me specific example why they could not? Specific examples please. I'm talking about a well trained eligible legal team. That's right blake you can't give them. You have nothing to stand on, totally nothing. Apart from the argument that surgeons may have better overall medical training to react on rare complications. But again if they are legally able to solely operate in a hair transplant in a jurisdiction, they have the right too.

 

I don't know about Maral or the controversy. Are they a technician only clinic? If they have had adequate good training,they are legally able to do so and they produce good results they should be applauded. It's a development Blake, something you might be scared of or surgeons might be scared of. Why? Because it threatens their job, it creates a more competitive market. Only the best will survive, it may create more niches. Perhaps they will produce average results, not top notch but average for a very low price. Not everyone has that much money to spend and needs to chose for price quality. It may even spark innovation. It's always easy to pick apart one side of the story. Furthermore I wouldn't be surprised if their results from now could be better than some of the recommended surgeons on here. Obviously I didn't research them but it's completely plausible.

 

That's the real world Blake. Good excellent results that is what I want to see, whether that is from a skilled legally able technician only clinic or from a team of 20 doctors. I don't care.

 

So to return to Dr. Karadeniz statement, do you agree with that statement? If you do, I don't care but I'll tell you straight in your face you are speaking from an bias subjective opinion which doesn't hold any truth.

 

I would appreciate if I can at least give my honest view on these forums without any disgusting slandering like Dr. Karadeniz gave me when I point him on having an biased opinion. Cheers.

 

Edit; By the way I enjoy your posts too, no hard feelings either obviously ! By the way some of this is obviously my personal view, but you can't generalize like Dr. Karadeniz did.

[Michael Vories, MD]

Every year at the annual ISHRS conference we (the ABHRS) sponsor a Morbidity and Mortality (M&M) night session. During this session we hear from doctors around the world who practice daily hair transplantation. During these sessions we have encountered various complications, including cardiac, infections, asthma attacks, vasovagal attacks, and many others.

 

No doubt hair transplant surgery is low risk when compared to more invasive procedures, but it is still surgery. Not having a physician present (who is also up to date with ACLS), should be a minimum requirement. Your life is worth it.

[Swooping]

Every year at the annual ISHRS conference we (the ABHRS) sponsor a Morbidity and Mortality (M&M) night session. During this session we hear from doctors around the world who practice daily hair transplantation. During these sessions we have encountered various complications, including cardiac, infections, asthma attacks, vasovagal attacks, and many others.

 

No doubt hair transplant surgery is low risk when compared to more invasive procedures, but it is still surgery. Not having a physician present (who is also up to date with ACLS), should be a minimum requirement. Your life is worth it.

 

New information to me.This is indeed an extremely valid and important point. I would rather be in someone his hands who knows what to do when unexpected (rare) complications happen than someone who doesn't know how to handle.

[1966kph]

So blake and dr vorie are you pleading the fifth on the questions I ask in the quote below?

Blake when has anyone said that a tech is ever going to always be more artistic or better skilled than a dr?

On the reverse though you are of the opinion that a dr will always be better than a tech and you've said it many times and its perfectly understandable your a doctor.

I have said it before that artistry and skill is not a god given talent just bestowed to drs and its ridiculous if this is your stance.

To think that a dr should not be on hand in case of complications is a veiw I have never endorsed nor will i.

Blake did you notice any difference,a turning point with the results being anything less than excellent with Lorenzo or Erdoğans work? If not then there goes your theory of a doc being superior in this crucial part of the procedure because you cannot see any difference.

 

Please can you respond to this quote if you choose not it will just reinforce my suspicion and probably those reading this that what I say here is accurate.

Have a nice day

 

The ht industry has always been about money and always will be and your probably right about the chain of clinics point. As long as standards stay high I have absolutely no problem with this and its just as dr Karadeniz says if drs have to adpt or sink they will adapt even though he conceded that the results would suffer.

Now the only reason I mention maral in this scenario is I only know of him and one other clinic with the same set up but the name escapes me.

I have seen it a couple of times resently were people have gone to him after multiple surgeries elsewhere and and have stated hands down that marals was by far the best results.Their previous surgery's were all carried out by drs the ones with maral were techs and this coupled with the photographs tell me techs can get very good results.

Bill said it himself before that maral was doing good work and up until very resently was going through the potential recommendation process so thats how much he thought of the results

 

Were this argument loses real ground is when I read that drs have dexterity or a golden eye or a drs veiws is nonsense.

If as is claimed a dr is better than a tech because of the training and this is the thing that sets them apart how does one explain the differing skill set of drs when they have had the same amount training and education? Is dexterity or the eye of a dr something that is something bestowed to only drs by god its ridiculous.

If you blake go through say 3 years of training in all aspects of ht but during that same time a tech is doing just one part the extractions day in day out who do you think would be the better at extractions? You because you've got the title of dr ? I very much doubt it unless you are naturally gifted at the task.

 

The title of dr does not automatically mean your going to be a excellent ht dr its the years of experience that determine whether you can cut it as a ht dr.

Blake your a qaulfied dr now do you think just because you have title and with your training thus far you could extract grafts better than marals head tech who has been doing it day in day out for over 10 years ?

 

I fully appreciate that your going to stand your ground and fight tooth and nail to justify all the hard work that must go in to qualify as a dr.

Marals techs have proven to me to such a degree that not only can they do the extractions but the incisions as well they are doing the same thing every day and have been for years with no dr participation.

Its clear unrefutable evidence that you dont need to be a dr to do fue.

I always have and still do say that a dr should be immediately available in case of any complications but it would be interesting to know how many times maral has been called to the op room because of a complication has arisen.

Answer this please - were are the majority of the members from that make up the ishrs ?

What is the directive dr Karadeniz mentioned hoping to achieve?

Will members who use techs for extractions leave or comply?

Is this directive the US trying to dictate because of the restrictions imposed by US law?

How many US ishrs members would use techs for extractions if the law permitted?

I think you know what my assumptions to these answers would be so could you please try and answer them rather than ignore them?

Have a nice day

[KO]

Lorenzo uses techs for extraction, not implantation. Lorenzo's techs could never operate independently as they do not have that skill set. Finally, they have been highly trained and experienced, and no one, including Dr K denies that the can achieve great skill, and Lorenzo checks graft quality. However his clinic continues to be a surgeon-driven operation, and he continues to have significant control. It's not about whether techs can be good, they can, but that doesn't translate into a technician clinic being a good idea.

[1966kph]

Some people concede techs can do extractions some do not.

Some said fue was never going to be of any worth.

Then we have the idea of techs doing incisions its being done and people are

showing the results now is up to us to judge the results as we have with fue right from

its infancy

All marals patients that have posted have been convinced or so it would seem.

I think the idea has been shot down in flames as with the ishrs directive it is down to in fighting because competition is seen to have a unfair advantage.

In the uk there even talking about trailing driverless cars were will it all end.

Have a good day

[KO]

May I ask what is the point of this rambling? You want a technician driven procedure, go for it, why do you care that dr Karadeniz does not approve?

[PupDaddy]

May I ask what is the point of this rambling? You want a technician driven procedure, go for it, why do you care that dr Karadeniz does not approve?

 

Maybe he's trying to convince himself? It would be understandable in light of Bill's exposure yesterday of the apparent massive fraud perpetrated on this forum on behalf of The Maral Klinic. If I were in 1966kph's shoes and had booked my transplant procedure there, I might be seeking approval and reassurance about technician-only transplant surgeries too.

[1966kph]

Of course you can ask ko

What was the point of the thread there in you have your answer.

I don't care that dr Karadeniz or anyone else aproves of were i go just as you will

not care if everyone approves of your choice.

Its more the stance that the ishrs has taken and I look forward to what will transpire.

I think there's many good points that have been raised and many that have been ignored.

I think it strange how some questions get ignored and read into it what you will just as I will.

Have a good day