Techs Placing Grafts?

[Cant decide]

Is it common for a HT doctor to allow his techs to place all of the grafts after the doc makes the slits? I am finding that even the top docs on here let their techs place all of the grafts.

 

Thanks

[Cant decide]

Is it common for a HT doctor to allow his techs to place all of the grafts after the doc makes the slits? I am finding that even the top docs on here let their techs place all of the grafts.

 

Thanks

[Acrobaz]

That certainly happened in my case.

[balody]

these dr's are good,but theyre not superman.i think results would suffer if dr,s were expected to do the planting on top of everything else.

the techs are trained and take pride in what they do and the dr should be overseeing the work to make double sure.

i had the added bonus of having team farjo(mr and mrs)working on me,him;donor removal,tricho,slits and her(along with techs)graft placement.

dont worry,if the clinics decent,the techs will be too.

[Acrobaz]

Good point balody - my surgeon was certainly supervising the techs.

 

To put this in context ... I had two techs working on me at once to place the grafts, one on either side, with a third administering the solution, and they regularly swapped with another two techs throughout, working in shifts. I wasn't timing it, but my guess is that the graft-placing took something like 4 hours in my case. They work in shifts because it is skilled, repetitive and exhausting work. (And don't forget the other techs whose job is to harvest follicles from the donor strip.)

 

So, if my surgeon had been doing it all himself, even working at the same speed as the skilled techs and without any breaks, it might have taken him 8 hours - and that would have been on top of the pre-op discussion, administration of injections, strip removal, tricho closure, the highly refined placement of slits and the post-op stuff. As balody said, he would have had to be superman. He certainly was in attendance regularly throughout to supervise the process.

 

If you have not been through the process, it is understandable to think that the placement of the grafts is the most skilled part of the process. But that is a misconception. It is the placement of slits that is crucial - that is what creates the hairline, the hair direction, the hair density etc.

 

To put it another way: the surgeon is the sculptor and the techs provide the varnish. One can't do the job without the other, and both need to be highly skilled - but the sculptor is the true artist.

 

Hope that helps.

[AMR1]

in my case it was the same both in UK and in Pakistan, but they were skilled and knew what they were doing

[Eman]

That is fairly standard Can't decide. The doc spends the time removing the donor and closing it, making the incisions in the recipient site and monitoring the techs and going over the work. Most techs have been with the top docs for years and there is usually a head tech (no pun intended) that monitors all the others for quality control.

 

You will be in good hands with any top doc and their techs!

[Mr. GQ]

like once upon a time wise Dr. PGP once said:

"they cut the strip out and they go eat donuts."

what a job eh.

[Yogi's Dad]

I echo the sentiment of Eman.

 

Many top-notch Docs have top-notch (and very well schooled) techs who place most of the hairs. My Doc got the process started and suspect he made some of the more strategic placements. In my case, The Doc was in and out during the graft placements making sure everything was tip-top, and advising the techs.

 

And the head tech calls the shots too.

 

The top Docs probably take good care of the great techs - these are very important folks who are critical to a good practice; the practice really wants to retain these folks.

[Leeson]

I remember once a tech asked a new hiree if she'd like to try to place a couple, ON ME! Saw an ad a week later that Latham's was seeking a new HT tech in the news paper.

[mrkneed]

Dr. Keene makes all the slits and places all the grafts herself - I like this method best with the doctor performing both tasks.

[Dr. William Lindsey]

At our office, I always start placement and continue until the cutters start seeing that graft cutting will be done in a timely fashion. Then the techs join in.

 

As our patient from last Saturday saw, I placed about 700 across the front and down the right, then one of our techs replaced me on the right and I started down the left. As cutting was winding down another tech replaced me; then I came back for the last 20 minutes or so to check for empty slits, and finish up.

 

At least one of our techs is significantly faster than me in placing with a gentle touch.

 

The key is Doctor Supervision, not necessarily doctor placing. It takes a while for anyone, doctors included, to get good at placing. We almost always have a less experienced tech place beside me, for slits significantly away from the hairline itself. That way I can personally watch that tech, give constructive criticism and instruction, and allow them to grow in their skills.

 

Before I see alot of outcry from bloggers, remember, that is how med students, then residents, then fellows learn how to practice medicine and operate. The more supervision and experience gained under close guidance, the better--whether a tech, a doctor, or almost any career.

 

Dr. Lindsey McLean VA

[Bill - Seemiller]

Hair transplant surgery is a team effort. Whereas the surgeon is ultimately the one responsible for the result and their entire staff, the technicians play a vital role in the success of the hair transplant. After all, they are the ones who usually dissect follicular units and place them into recipient sites.

 

The scary thing is, one technician could siginificantly impact the result if they're off their game. In my opinion, that's why the surgeon needs to be attentive and oversee every single procedure in it's entirety.

 

Now that doesn't mean that the doctor has to be present in the room for the entire surgery. But it does mean they're obligated to check on every aspect of the procedure and ensure quality.

 

Best wishes,

 

Bill

[HairHope]

In my opinion, the approach you take is exactly what I think is best practice. Nice job.

 

Originally posted by dr. lindsey:

At our office, I always start placement and continue until the cutters start seeing that graft cutting will be done in a timely fashion. Then the techs join in.

 

As our patient from last Saturday saw, I placed about 700 across the front and down the right, then one of our techs replaced me on the right and I started down the left. As cutting was winding down another tech replaced me; then I came back for the last 20 minutes or so to check for empty slits, and finish up.

 

At least one of our techs is significantly faster than me in placing with a gentle touch.

 

The key is Doctor Supervision, not necessarily doctor placing. It takes a while for anyone, doctors included, to get good at placing. We almost always have a less experienced tech place beside me, for slits significantly away from the hairline itself. That way I can personally watch that tech, give constructive criticism and instruction, and allow them to grow in their skills.

 

Before I see alot of outcry from bloggers, remember, that is how med students, then residents, then fellows learn how to practice medicine and operate. The more supervision and experience gained under close guidance, the better--whether a tech, a doctor, or almost any career.

 

Dr. Lindsey McLean VA

[Dr. Mohammad Humayun Mohma]

When I started 8 years back

I use to plant/place about 70% of the grafts but over the period of time I saw my techs results were as good as mine. After all that is all they do day in an day out so they become proficient in that. So graually I started to do less and less. Now I do not Place unless I am training a tech. I do certainly see the front lines for the curl of the shaft of hairs are they in righht direction or not cause the placing might be perfect but the direction of growth might not be.

 

I have a team of 17 Tech of which 12 are trained planters and rest of five are only cutters.

Two of each team are the senior planters so they would start the front which is the visible work and unnaturalness can be detected if careless work is done.

 

I think the crucial part, if you do not worry about the curl of the hair shaft, is the making of slits by the doctor. The direction he has chosen will be the direction the grafts will grow.

 

But do not worry about the techs doing the placing, they are good and they are professional otherwise they would not be there in the first place.

 

The growth of hair is attributed to the placers and the naturalness and minimal visibility of scar is attributed to the Doctor.

 

So if you see a natural growth and full growth of grafts the whole team is good.

If the hair have growth but not looking natural then the techs are good but Doctor is not. and if the looks are natural and the growth is poor then there could be problem in the techs.

This is my personal honest openion.

[Dr. William Lindsey]

Bill is right again as usual. Thanks Hairhope.

 

Speaking of training placers, I'll try to put up a pic or 2 of us training a new placer today. We use pickle seeds and place them into the skin of either pickles (mimicks really soft scalp) or oranges (seems to be more like most scalps). We have a cutter who has been with us for a while and who rapidly progressed from a novice to becoming the second best cutter we have in a very short period of time. Its time for them to start thinking of placing, so today is training day.

 

Thinking back to when I taught Ear Nose and Throat residents to take out face and neck tumors, training hair is a breeze. Training someone to take a tumor off of the carotid artery going to the brain is "really" stressful.

 

 

Dr. Lindsey McLean VA

[Hairtechnician]

FYI, Dr. Keene does a lot of the graft placement, but she does indeed also have assistants help--she has never claimed otherwise. However, she participates throughout in placing the grafts, along with her most experienced placers, who have been placing grafts longer than some hair transplant doctors. She doesn't just leave it in the hands of her assistants, as is sometimes the case.

 

Yes, hair transplantation is a team effort, but Dr. Keene prefers to participate throughout. This topic comes up a lot and I have posted about it before, but again, this is Dr. Keene's preference and she has no criticism of other doctors who don't have this preference.

[latinlotus]

It is impossible for a doctor to all the work. However, I want my doctor to as much as possible, including grafts placement. It is unacceptable for me for a doctor to leave all the placement of grafts to the techs. That is one of the main reason why i went with dr. Cooley since he does maybe 40-50% of the grafts himself.

 

Do you go for HT with a certain doctor because of the doctor's reputation or for the tech's reputation? Staff comes and go, while the doctor stays.

[latinlotus]

Hairtechnician:

if i did not go with Dr. Cooley, i would have gone with dr. Keene, for that reason.

[mmhce]

So typically, what percentage of grafts are implanted by the technicians themselves?

[Dr. William Lindsey]

MMHCE

 

That answer has got to vary tremendously over the industry.

 

8 years ago when we did 1000 graft cases, I placed almost all of the grafts and had 3 cutters.

 

Now, when we are doing 1500, I probably place 500, and probably the same on a 3000 graft case. Maybe a few more.

 

I have 6 techs, and I want them to cut. I can't cut, but I can place, so they are to cut until we start seeing the end of donor material is approaching, then they can place.

 

The difference is that on a 1500, everyone is cutting. On a 3000, one tech and I start placing early on so we can get placement going.

 

But if I had a huge practice with 15 techs, I might not be placing 500, but I would be in and out of the procedure for quality assurance.

 

Dr. Lindsey McLean VA

[mmhce]

Thanks for the reply Dr. Lindsey!

[Dr. Glenn Charles]

The amount of technician involvement varies greatly among the many hair restoration physicians. There is a common denominator that probably has a significant impact on the actual results. This is the experience of the person who is doing the graft placement. Some technicians can learn this procedure quickly and others may take a long time to get the feel for it. It is up to the doctor to be able to recognize which staff members have this ability. It is common for some technicians to be better at cutting vs placing and visa versa. The key is to not have someone perform a task that they are not capable of. I personally think that the most critical area of graft placement is the hairline. This area should have direct doctor involvement. Also, every graft should be checked for proper depth and angulation by the doctor before any patient leaves the surgical suite.

[mmhce]

Also, every graft should be checked for proper depth and angulation by the doctor before any patient leaves the surgical suite.

 

Thank you for your contribution Dr. Charles!

 

This sounds time consuming. How is this checking done? Surely it has to be done instantly while the graft is being placed and not after all the grafts have been placed.

[Dr. Mohammad Humayun Mohma]

There is one point to remember

NO surgeon would ask a scrub nurse to do the appendix operation or do the closure of the abdomen wound on the other side as this is an important and Nurses Mostly are not trained and qualified.

Many doctors do allow tech, some of these tech are not from Nursing background either, to do the placing means its important but not necessary that the doctor has to do it. If the angle of site making is perfected which is done by the surgeon then the issue of growth in right direction is also solved and even in the tech try to place the graft in other direction it will grow in the same direction.

Any one whether Doctor or Tech while doing the graft placing have to be gentle to hold the grafs as that is a cause of graft crushing and hence poor growth.

 

With respect to ensure the proper depth of the grafts, not so difficult, use a holder which has a depth control with it and measure the length of the graft in the begining and adjust the depth control of the blade one use for slits and Voila the problem is solved mostly.

 

Th surgeon still needs to have a vigilant eye and should check the end session.

 

so I am not down playing the importance of placing the grafts but thats the most simple but time consuming portion of the procedure.

 

The real control of the direction of grafts growth is in making the slits.........in my openion at least.