A ruined fue operation

[Blake Bloxham]

Walky,

 

Great reply yourself! I hope you'll keep us updated. Again, let me know if there is anything I can do to help.

[scar5]

... this is a good example of why I take a lot of issue with this technician-run FUE model.

 

It indeed sounds like a poor protocol, but not one a technician would have arbitrarily made calls about in respect to parameters. Surely, it was the good doc's call about the .5mm slits? Furthermore, the choice to not use an implanter pen - a doctor's choice, not a technician's.

 

We need to be careful not to conflate the issues here. Using technicians makes sense, if the laws allow for it.

[Blake Bloxham]

Scar,

 

The problem is that we've seen instances where there is no physician input whatsoever. Technicians are in charge of everything from hairline design to post-op instructions. I fear this may have been the case here.

 

Technicians play an important role in the hair transplant procedure. No doubt about this. In fact, you can't do a procedure without them. However, I do not believe their role is unsupervised surgery. I think they should be part of a team that is led by a competent physician. I also believe the physician needs to take responsibility for hiring, training, and monitoring the performance of the technicians.

 

To me, this is ethical.

[Janna]

Walky,

 

The smaller the incisions the faster a patient heals, for sure! but the main goal in getting a hair transplant is to achieve the best yield/result. The size of the incisions should be the same or slightly bigger than the grafts. Injury to the grafts can result in wiry hairs or worse. Some injuries can be detrimental to the follicles so it goes without saying that proper handling and care of the grafts is paramount. The hooked grafts don't necessarily mean that the hairs won't grow just a longer time may be needed for the follicles to recover as long as all the other steps in handling of the grafts were carried out well. At this point there isn't anything you can do but wait. Bummer that you pulled some grafts out

 

Best of luck to you!

 

Zeoranger,

 

You can't cut your hair for 6 months after surgery? We inform our patients that 10 days after surgery they can buzz, cut, or put products in their hair.

[gillenator]

That's a good point of the possibility of the recipient sites being smaller than the peripheral size of the grafts that were placed in those sites.

[hairweare]

My point has always been that when you view the work of doctor's such as Vories or earlier examples of Lorenzo, you pretty much know whose hands will be on the case and at what skill level. Even in the most reputable clinics that have rotating techs doing part or all of the work, this adds layers of uncertainty that I as a patient with a limited bank of donor follicles would not wish to leave to chance. If you think that all humans doing the same task have equal abilities, why do baseball hitters in the lower half of the order have lower batting averages?

[walky]

since baseball is non existent in Turkey, i don't know the answer. Maybe thats why i choose the wrong clinic.

[hairweare]

For those who follow the American pastime closely, the game provides many metaphors for life!

[Blake Bloxham]

Weave,

 

Most of the reputable clinics I've encountered do not use rotating techs. In fact, most pride themselves on hiring, training, and retaining their technicians. Have you experienced something different?

 

However, I think we're on the same page when it comes to physician involvement. It's imperative!

[ZeoRanger]

 

Zeoranger,

 

You can't cut your hair for 6 months after surgery? We inform our patients that 10 days after surgery they can buzz, cut, or put products in their hair.

 

Yes. My clinic has a very strict post op rule book.

 

No products for 2 months; no shaving for 6 months. I know it contradicts what other clinics recommend.

[hairweare]

Blake, I can say with first hand knowledge that there is a turnover amongst all medical practices (my own included). People get married, have kids, move to another city, or just tire of the job and move on, etc. I also know that the results of my beard extractions from the the docs most experienced tech was not quite at the same level although perhaps that was a pretty high bar to set. Nonetheless there will always likely be new hires, trainees, or just the natural variance in skills that will have a variable impact on the outcome.

When down to you last out in baseball or follicles in this case, don't you want your clutch superstar hitter up at the plate going to bat for you? (Sorry for the analogy that for the ROW people who only know soccer might miss)

Edited May 2, 2015 by hairweare

[walky]

How many more follicies should soccer people sacrifice before you make analogies globally understood

[Blake Bloxham]

Weave,

 

This may be true for technicians at general medical practices who room patients, take vitals, etc, but I personally think it's a different story for hair transplant technicians at established hair transplant practices.

 

For example, we have probably around double the technicians we need currently employed at our practice. There are some who have decades of experience and others with much less. There are several who are in charge of training new techs and all are supervised and reviewed by physicians during each step of the procedure -- via direct supervision and a monitor in the procedure suite. All of their work is also broken down and identified so everyone knows exactly who did what.

 

What's more, we never hire a single technician at a time. We hire 3-4 for every 1 we really need. We tell each applicant that we are essentially going to pay them as employees during the training period. If all of them pick it up and do well during the training process, we would hire them all. However, it usually ends up that 2-3 do not and they aren't actually hired. These technicians don't ever really work on patients either. Between this practice and having at least 2 full teams ready to go at all times, we really never have an instance where the "bases are loaded" but the rookie who just came up from the minors is at bat -- if you get my analogy ; ).

 

Most reputable practices likely do something similar.

[hairweare]

While both FUSS and FUE procedures can be repetitive and tedious to a technician arguably it is much more so for the latter. I suspect burnout and turnover to be higher than you may think. For the extraction phase I seriously doubt that even among experienced operators transection rates like batting averages are all identical.

[FUE2014]

My doc, Dr Feriduni, has had his techs for years and they do all the extractions and implanting. He told me he has ongoing pain in his hands from years of surgery which is one of the reasons why he does not do all of the extractions himself. People perhaps underestimate the physical demands FUE places on the surgeons hands, and have unrealistic expectations that they should be doing absolutely everything where it is not feasible or necessary. I say not necessary because, in Dr Feriduni's case, his techs are exceptionally skilled and experienced, so it comes down to not just knowing your doc, but knowing your techs as well, because with FUE you are buying into the whole package. This means when researching, not just obsessing over the doctor, as everyone tends to do, but finding out information about the techs as well, and this is something I suspect most of us don't do in our research.

[Blake Bloxham]

Weave,

 

I don't doubt that tech turnover can be high at some practices. However, quality clinics retain techs long-term. It's, without a doubt, a very important piece of their success.

[scar5]

Such a brilliant thread guys.

 

The take-away for me is that techs need to be trained to use implanter pens.

Can they? Is it illegal, even in Turkey?

 

From the little I just read yesterday (or whenever it was) it was slit size that did the damage. Even clumsy handling of the grafts might have been accommodated for with wider slits - as bad as that sounds.

 

Slit size is a doctor's decision. It costs him/her nothing to make the decision surely. He/She thinks a) graft survival vs b) having nice 3 day post-op pics with clean heads, and goes from there. From what is being said here, the decision to use .5mm slits is a crazy.

 

The more sloppy the tech force and the protocol, the bigger the slits need to be.

 

So this is a case of doctor incompetence.

 

Or are you people suggesting that techs now decide what size to make the slits?

 

If that is happening now that IS a scarey scenario!

 

Added to the poor decision - and I'm sticking to my hunch that the doc decided that - I think it is a case of economics-laws strikes again yet again.

 

Can/do techs in Turkey now use implanter pens? Is that already happening?

 

Can you, as a consumer, stomach the idea of that?:confused:

[FUE2014]

You can't cut your hair for 6 months after surgery? We inform our patients that 10 days after surgery they can buzz, cut, or put products in their hair.

 

Blake any idea why there is a disparity between docs on when patients can buzz their hair after surgery? Ten days to six months is a huge disparity, what could be the medical basis for not buzzing your hair for up to six months post op?

[ZeoRanger]

There is this study that confirms the grafts are securely anchored after day 8:

 

Graft Anchoring in Hair Transplant Surgery (2006) | Bernstein Medical

 

A clipper should not be capable of pulling a graft out once the grafts are anchored.

 

So I think the no shave rule till month 6 exists because the recipient site may still be sensitive and a cut from a clipper could cause an infection in a worst case scenario. If you search this forum there were a few threads on this topic and apparently there are a few clinics that don't want you to shave before a few months are out.

[Blake Bloxham]

FUE,

 

Nope. I'm not sure why a clinic would ask you to wait 6 months before cutting your hair. I've always heard 7-10 days. The study Zeo linked confirms this.

 

If your clinic says wait 6 months, however, wait 6 months. It's always important to follow your clinic's specific post-operative instructions to a T. This removes a very important variable from the equation if the results don't mature as expected.

[rev333]

Wallet

Wise move,

Don't mention the docs name. It does you no good. People asking for the name of the doc or clinic don't care about you usually. You compromise yourself for no good reason.

Hopefully, only the bad grafts popped and you'll be fine. Your post is very valuable to us just as it is. No names is a smart policy.

 

And watch out for the PMs too.

 

^^^^^BUMP^^^^^

 

i love it (sarcastic) when people ask for help and the answering posts only want to find out who did the work!

[rev333]

Rahal uses a tech-run FUE-Model to much success

techs extracts follicles

doc makes slits

techs implant

 

Much like every clinic runs a FUT-Model

doc removes strips

techs cut the strip into separate follicles

techs implants

 

In each case the tech is responsible for the follicle used in implanting

 

TECHS are very much responsible for the viability of the grafts in both models

whether extracting in FUE or cutting them out of the strip in FUT, in many case making viable 1 and 2 follicle grafts out of the heavy filled 3 and 4 follicle grafts found in the average strip

 

The techs in the current FUT-Doc based model handle all aspects of getting that graft viable enough for transplant

the doc does not.

 

This is comparable to the so-called FUE-Tech based model

 

It's the same:

Techs play an the same important role in both models

 

Keeping a stable crew of techs will always be an important part of any successful clinic

 

God save the Techs

Edited May 19, 2015 by rev333

[KO]

Such a brilliant thread guys.

 

The take-away for me is that techs need to be trained to use implanter pens.

Can they? Is it illegal, even in Turkey?

 

....

Can/do techs in Turkey now use implanter pens? Is that already happening?

 

Can you, as a consumer, stomach the idea of that?:confused:

 

I think this is a mistake. Insertion of the grafts is probably the most important step and the core of the artistry in HT surgery...how to allocate grafts, angulation, constructing the different regions is not something for a team of techs to undertake IMO.

 

But to answer your question, everything is legal in Turkey. I believe Hakan has a tech use the implanter for portions as he has arthritis. Some videos in YouTube I think also show techs using implanters.

[Blake Bloxham]

KO,

 

Do you mean graft insertion or creating the incisions? I agree that creating the incisions is absolutely crucial. It's the most artistic part of the operation -- alongside design.

[KO]

Incisions, but in the context of the implanter, both steps are one, as you know.