Jump to content
LaserCap

What happens with "extras" at the end of the day?

Recommended Posts

One of the most recent posts dealt with this issue and I feel it merits discussing for the sake of all patients......

This can be taken a number of ways, so it is up to you to choose the road......

We are dealing with human interaction....and there is no "hairometer."  Yes, there are instruments out there that help, but - as everyone knows - there are no "exacts" in science.  Thus, it is likely, at the end of the day, there will be extra grafts harvested, or the count is short.  If short, no issues, you just pay for what you get.  But, was there a discussion during the consultation if this does happen?  Discussing goals and priorities is important. 

But, what if there are a lot more grafts?  Will they be on the house or do you have to pay for them?  And, where will they be placed? 

There are clinics out there that will just place the grafts and charge nothing.  I applaud them.  Grafts are like gold and should be treated as such.  Where to place them?  If not discussed with the patient during the consultation at the beginning of the day, it is the responsibility of the Doctor, (or at least I feel it is),  to decide where they'll benefit the patient the most.  At the end of the day how exciting and humbling it is for patients to hear....."the doctor gave you $2000 worth of free work."  Just created lots of intrinsic value and good will when phrased this way.....Some will say, you got 300 extra grafts.  Can you equate this to value?  I think people understand money.  What do you think?

Once the procedure starts, and the patient is under local....How can you go to the patient and tell him that he'll be charged for extra grafts?  This may be even against the law.......It would be nice to find out........And yet it happens all the time.  If you are planning on charging for everything that's harvested, discuss it with the patient beforehand.  You could even seem helpful by , perhaps, charging a lesser amount for extra grafts.  

Opinions?

 

 

  • Like 1

Share this post


Link to post
Share on other sites
Posted (edited)

I think you are referring to my most recent comments on another thread.

I underwent an operation where I was told in pre-op the operation would be 1800-2000 grafts max (confirmed in the consultation sheet), and yet the surgery was expanded to 15 hours while i was unconscious to 2600 grafts. I only took the valium during the operation because i started panicking when I realised another doctor in the clinic (not the one I had chosen) was operating on me. At the end of day I awoke to find out the operation was a "success", but it was only the next morning I realised I had to pay an extra $3000 euros for everything. As there was never any conversation about where the extra grafts were to be placed the doctor chose to place them randomly in the crown, messing up my hairline, with those extra grafts harvested exhausting the core of my donor. I only realised what was done to me when I returned home, and have since spent $12K with another doctor on a repair job.

What the other doctor did is probably against the law (I would be curious to know?), but given I am currently in debt it's not like I can afford a lawyer, and even if I could I'd have to find another doctor to attest to the bad work which is impossible to do given doctors always protect their own. Sad truth is the industry is unregulated and patients are essentially at the mercy of doctors, so I guess all patients can do is try and be aware of their rights. This is the wild west.

I'd do anything to go back and simply walk out of surgery rather than take that valium. I still think about it everyday.. The majority of the advice I've gotten here has been to "move on", "get over it" or "your repair work will be great" as if any of those answers are satisfying. It's why the more awareness patients might have about their rights and the more we can support each other is so important (and why I find it hard to stop obsessively logging in here).

I'd be curious to know if this is happened to anyone else and what they did?

Edited by transplantedphil

Share this post


Link to post
Share on other sites

We need to keep in mind that the patient is a vulnerable state, and should not be asked to make decisions once the procedure has begun. On the morning of the procedure I explain that if we are short grafts, then the patient is refunded the difference, and we have extra grafts, they are placed without charge.

  • Like 1

Share this post


Link to post
Share on other sites
2 hours ago, Michael Vories, MD said:

We need to keep in mind that the patient is a vulnerable state, and should not be asked to make decisions once the procedure has begun. On the morning of the procedure I explain that if we are short grafts, then the patient is refunded the difference, and we have extra grafts, they are placed without charge.

Awesome! And, thinking out loud, a "positive" remains when you consider - more grafts- more density.  

Share this post


Link to post
Share on other sites
24 minutes ago, LaserCap said:

Awesome! And, thinking out loud, a "positive" remains when you consider - more grafts- more density.  

I somewhat disagree but only on a technicality ... the placement of a graft can be more important than an arbitrary number of grafts. There is an art to this industry after all :) 

Share this post


Link to post
Share on other sites
25 minutes ago, transplantedphil said:

I somewhat disagree but only on a technicality ... the placement of a graft can be more important than an arbitrary number of grafts. There is an art to this industry after all :) 

With everything being equal.....and we are talking about experienced, talented surgeons....You have 1 graft and you place it "perfectly" in the forelock area.....That's more important than placing 100 grafts in the same area?  Explain.

Share this post


Link to post
Share on other sites
Posted (edited)
16 minutes ago, LaserCap said:

With everything being equal.....and we are talking about experienced, talented surgeons....You have 1 graft and you place it "perfectly" in the forelock area.....That's more important than placing 100 grafts in the same area?  Explain.

It's more about discussions ive had with a well acclaimed doctor on this site about the importance of placement of grafts and "artistry" over some arbitrary graft count. Some "experienced talented surgeons" can achieve more with 5000 well placed grafts than the same 5000 grafts placed by others. That would be my only argument. 

Simply arguing more grafts= more density isnt always meaningful. 

for example look at this result posted yesterday https://www.hairrestorationnetwork.com/topic/54976-drdamkerng-pathomvanich-dht-clinic-fue-2518-grafts-post-op-10-months/?tab=comments#comment-518500

the doctor achieved amazing coverage for a mere 2500 grafts, whereas another clinic could have used almost double the grafts, had less of a yield, and the results could have been similar. 

but back to the original topic though, i am curious as to what most doctors do concerning excess grafts

 

Edited by transplantedphil

Share this post


Link to post
Share on other sites
3 hours ago, LaserCap said:

With everything being equal.....and we are talking about experienced, talented surgeons....You have 1 graft and you place it "perfectly" in the forelock area.....That's more important than placing 100 grafts in the same area?  Explain.

 

What he is saying is if you end up with a few hundred extra grafts it makes more sense to place them in areas that will create a noticeable cosmetic difference rather than just placing them anywhere simply because we have some extras. I agree with him on that.

 

Share this post


Link to post
Share on other sites

I agree with that as well.  If you read my initial post.......discuss all of this beforehand so there is no resentment at the end of the day.

Share this post


Link to post
Share on other sites
11 minutes ago, LaserCap said:

I agree with that as well.  If you read my initial post.......discuss all of this beforehand so there is no resentment at the end of the day.

That's the ideal ... but if we are going to be blunt surgeons dont always have the time, sometimes deal with multiple patients at the same time, are not always upfront about everything and in my specific case clearly decided to take advantage.

It's why this thread is important and I decided to contribute to it because (for the sake of the patients) it would be nice to know what each surgeon's stance is publicly. So I applaud @Michael Vories, MD for commenting on this thread and clearly taking an ethical stance towards his patients :) 

Share this post


Link to post
Share on other sites

I don't think this is decided on the day of the procedure.  An established practice has discussed this ad nauseam.  "Don't have the time?"  They better make time!  If they don't, why schedule so many in one day?  This business is getting very competitive in a number of levels.  

Not being up front....I have a huge issue with that.  Everyone, not only doctors, need to be honest, ethical and up front.  At the end of the day it's the only thing we have.  

Have you ever heard "what a web we weave when we try to deceive?"

You are representing yourself and the company you work for.....

 

Share this post


Link to post
Share on other sites

Some docs might have large overheads so might be motivated to extract every graft possible once a patient walks through the door. While I agree with EVERYTHING you've said I just haven't experienced it personally. 

I was surprised that Dr Vories actually refunds the difference in grafts which seems amazingly decent (I haven't heard of that before). Is this common? Curious what other patients have experienced.

Share this post


Link to post
Share on other sites

If you're short at the end of the day, the right thing to do is to only pay for what you get.  Most, if not all clinics, will ask for money up front.  This is understandable when you consider the patient is under local once the procedure starts. So the right thing to do, clinic wise, is to give the money back for grafts not transplanted.

Share this post


Link to post
Share on other sites

I got a contract from the clinic month before surgery which says

a) If I need more grafts than initially considered, they cost x/€ per graft (approx. 2/3 or 1/2 of the standard price)

b) If I need less my money get refunded

Fun fact:

- I required almost 150 FU more than planned (which for me was almost 40 % more!) and I never had to pay it. 

Share this post


Link to post
Share on other sites
23 hours ago, Gasthoerer said:

I got a contract from the clinic month before surgery which says

a) If I need more grafts than initially considered, they cost x/€ per graft (approx. 2/3 or 1/2 of the standard price)

b) If I need less my money get refunded

Fun fact:

- I required almost 150 FU more than planned (which for me was almost 40 % more!) and I never had to pay it. 

Wow....

It's NOT.......that you will need more grafts....If that was the case, why not incorporate it into the plan before the procedure starts? This is, of course, conveniently written that way to camouflage the reality....more grafts were harvested inadvertently.  Moreover, and on the other side of the coin, if less, it's not that you need less. it's the fact that it is all they were able to harvest.

Share this post


Link to post
Share on other sites
3 minutes ago, LaserCap said:

If that was the case, why not incorporate it into the plan before the procedure starts?

Cause HT is not an excact science.

Sometimes in real life (if only online consultation before) or after shaving (if F2F consullation before) it looks different than thought. Or your loss was not stabelized (and consultation was several month before). Or  ratio of singles/multies was different than expected. Also, hairline fine tuning before procedures adds a lot of uncertainity in both directions (more/less grafts required).  

Summary: No one can give the exact # of grafts for an optimal result before. Nothing shady in that. Not everyone is  case like Phil.

7 minutes ago, LaserCap said:

 Moreover, and on the other side of the coin, if less, it's not that you need less. it's the fact that it is all they were able to harvest.

Only for a very small # cases this is the reasons. Much more often the prediction just did not match the final outcome. Another example: You started with FIN and reacted better than expected.

 

10 minutes ago, LaserCap said:

 This is, of course, conveniently written that way to camouflage the reality....more grafts were harvested inadvertently. 

Sorry, that is nonsense. See all reasons above.

Share this post


Link to post
Share on other sites

100% agree with @Gasthoerer comments about HT not being an exact science and thus suggesting any predetermined graft count given is only ever a guide and never a certainty. There is an artistry and design to this field after all.

Ideally when you choose a surgeon or clinic you are effectively choosing them based on their approach to your specifics needs as a patient, which then ultimately reveals itself to be a relationship of trust.

While it might be possible to read something negative into that contract (it's Feriduni so the suggestion is somewhat laughable), at least everything was clearly written out.

Given Gasthoerer's surgery was unique the contract itself might be similarly designed for his case. Repair cases similarly might be designed more around a flat fee structure given there's no way to predict an outcome. In the end it's all about communication and trust. 

Edited by transplantedphil

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

×