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Hello Everyone, 

I am two weeks post op from my second procedure here in Toronto, Canada and was just curious about the way things are done in the Hair Transplant industry. 

We all know FUT is considered relatively less labor intensive and hence is cheaper than FUE but my question is why is FUE priced higher since the bulk of the work seems to be done by the technicians. Are there any doctors out there who still do all the extractions and implantation themselves because it seems a norm that apart from hairline design, incisions and anesthetic most of the work is done by the techs. Also, aren't there any regulatory requirements pertaining to who can break into your skin since the techs are not doctors? 

In contrast, a doctor does more work during a FUT procedure since they have to excise the strip and do the sutures as opposed to techs. 

I am blessed to have had wonderful technicians for both my procedures and always wondered why they don't get credited as much as the doctors. Just some thoughts that I felt like sharing :). Happy growing everyone!

Edited by king100791

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In September 2019 the California Medical Board issued a position statement that unlicensed medial assistants cannot perform FUE extractions. This most likely will be adopted by different medical boards in the US, and slowly this scourge of non-physicians performing surgery will be eradicated. Because FUE grafts are fragile compared to FUT grafts, we use hair implanters to place grafts in a "stick and place" method, which also requires the physician to perform the graft placement as well. My hope is that more physicians will go back to realizing their place is in the surgery suite.

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2 hours ago, Michael Vories, MD said:

In September 2019 the California Medical Board issued a position statement that unlicensed medial assistants cannot perform FUE extractions. This most likely will be adopted by different medical boards in the US, and slowly this scourge of non-physicians performing surgery will be eradicated. Because FUE grafts are fragile compared to FUT grafts, we use hair implanters to place grafts in a "stick and place" method, which also requires the physician to perform the graft placement as well. My hope is that more physicians will go back to realizing their place is in the surgery suite.

What falls under “unlicensed medical assistants?”

 

cant PAs still perform surgery? Are RNs allowed as well?

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My understanding is that a licensed Physician Assistants (PA), can perform extractions if they are operating under a physician's oversight, but not a Registered Nurse (RN). I believe this goes back to the Scope of Practice guidelines for dermatology, where a PA can perform a punch biopsy under a physician's supervision.

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10 hours ago, Michael Vories, MD said:

My understanding is that a licensed Physician Assistants (PA), can perform extractions if they are operating under a physician's oversight, but not a Registered Nurse (RN). I believe this goes back to the Scope of Practice guidelines for dermatology, where a PA can perform a punch biopsy under a physician's supervision.

Dr Vories, some docs have been doing this from the start and its wrong.  I admire your efforts to do actually what you went to medical school for- that is what is known as surgery.  You sit down and dedicate time to a patient during their entire surgery and do the surgical aspects of surgery -  as i’ve heard you do one patient at a time .  There have been what seems fictitious concerns presented by some parties regarding tech extractions and what not in the beginning, only for those same parties to kind of defend it later by comparing things that happen outside the western world as an excuse to somehow validate the tech extraction protocol etc.....  

You’ve stood your ground.

Sometimes, a patient wonders if your paying a surgeon when you book a surgery or paying a tech a premium based on the name if the clinic.  Thats because extraction is considered surgery, so is slit or recipient zone creation which deals with scoring of the skin.

Ive heard your prices remain low ad the same, you don't jack them up, and you do the work manually.  At least, this should be recognized by forums you are a member of.  It is a distinct characteristic that should be praised and not argued against.  
 

There are reasons why med boards are picking up this issue  :) - and your medical statements  matter in helping keeping this regulated.  I hope you continue to emphasize this amongst peers and organizations.  Ive made a lot of friends that are doctors (from different specialties) but they agreed on regs/standards after seeing my issues that greatly affected me.   
 

 

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As Dr. Vories pointed out, there are laws put in place that requires surgeons to be the ones extracting the grafts during an FUE procedure - although it's my understanding that the top surgeons, particularly in North America, do this anyway. Extracting grafts via FUE requires a higher level of skill, as the grafts are being extracted "blindly" so to speak, as opposed to strip where they have a much clearer view of the angles of the hair, etc. 

I imagine from a business perspective, there's also a higher demand for FUE, and so I suppose the market plays a role in determining a higher price.


I am a patient advocate for Dr. Parsa Mohebi in Los Angeles, CA. My views/opinions are my own and don't necessarily reflect the opinions of Dr. Mohebi and his staff.

Check out my hair loss website for photos

FUE surgery by Dr. Mohebi on 7/31/14
2,001 grafts - Ones: 607; Twos: 925; Threes: 413; Fours: 56

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My understanding is that the skin must be scored by a physician, however, the removal of the tissue can be done by a technician.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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3 hours ago, Melvin-Moderator said:

My understanding is that the skin must be scored by a physician, however, the removal of the tissue can be done by a technician.

Hmmmm. I believe removal of tissue can only be done by a physician. Of all the surgeons I've observed, this has been the case. Techs can place grafts and extract the hair follicles/grafts from the tissue after the surgeon removes the tissue.

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9 hours ago, Melvin-Moderator said:

My understanding is that the skin must be scored by a physician, however, the removal of the tissue can be done by a technician.

What happens for cases when the scored tissue does not extract and needs to be punched again to loosen it up?  Can the tech rescore and take it out?  It has happened a few times in from my experiences

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