Should Surgeons or Technicians Place Grafts? With Dr. Lindsey

[Melvin- Admin]

 

[Melvin- Admin]

There’s been a lot of talk about techs placing grafts, and whether its better for surgeons to do it. Hopefully, this video helps clear some things up.

[jimcraig152]

Dr Konior's (AKA:  The GOAT) unabridged take on the subject is quoted below. Direct link to that posting can be found here (last post in the thread).

Further reading on tech-driven hair restoration facilities by Dr. Konior can be found here. A very eye opening and quite humorous read I would encourage everyone to read. A bit out of context, so be sure to read that posting, but the following is an excerpt from that posting:

On 2/11/2019 at 7:15 AM, Dr. Raymond Konior said:

Face it, most technicians have little to no formal education, i.e. they receive “on the job” training.  Who is training them and who is supervising them?  We in this practice respect the doctor-patient relationship and feel that the patient is entitled to the doctor’s presence in the operating room from beginning to end. 

Even at the highest professional level, philosophies and/or opinions vary. Even Dr. Konior acknowledges that in his post. Surely, great results can be achieved either way. But as you've told me privately, let's not let bias be positioned as fact.

Perhaps you can pose the same question to Dr. Konior and Dr. Nadimi tomorrow? Would be interested in knowing if Dr. Konior's position has changed in the last 13 years. I do believe Dr. Nadimi does do 100% of all graft placement. I could be wrong, but please ask that question tomorrow.

On 3/8/2008 at 3:01 PM, Dr. Raymond Konior said:

I suppose it's time for me to "chime in". I will try to keep this simple.

 

It is a fact that I am present in the operating room for at least 99% of a procedure, and it is more common for me to be there for 100% of the time. I have a very strong opinion about how grafts are placed and who places them. I place grafts with one person who has worked with me for 15 years now. I have never said anything about getting tired or about hand fatigue. The plain and simple fact is that I don't fatigue, whether I am involved in a 6 hour case or a 14 hour case. I challenge anyone to identify themselves with proof that would substantiate anything to the contrary.

 

Some have posted their opinion regarding the placement aspect of the procedure. Comments suggest that it simply does not matter who does this. Some have said that they prefer the feel of a tech's hands on their head over that of the physician's hands. Others have commented that women are better at this portion of the procedure because men "can't thread a needle". I would have to ask these individuals, who would you want to sew in your coronary bypass graft? Who do you want performing your Lasik procedure? Many have trivialized surgical hair restoration and placed it into a category of being nothing more than a simple procedure. However, this is a surgical procedure and it is my firm opinion that nothing about it should be trivialized. Consistent excellence requires that each and every portion of this operation be performed with precision and quality.

 

The surgical hair restoration process requires a team. Any single flaw in an otherwise perfect team could jeopardize the final result. It is my opinion that I have a duty to my patients to be present for this delicate part of the procedure. I have witness dozens of techs in many different offices over the years. I have interviewed several "expert" techs from quality offices over the years. The fact is that very few meet the rigid requirements I have for graft insertion. I spend a tremendous part of my life looking through surgical loupes and see this part of the procedure from a perspective that a lay person could not possibly appreciate. I certainly do have respect for many technicians who are at the top of their game. There is no way we could accomplish what we do without their valuable assistance. However, any patient who has traveled a distance to be treated by me, who has made a financial sacrifice for bettering their appearance, and who has placed their ultimate confidence in me being the person who will be responsible for a life-altering event is entitled to my presence and my full attention for the entire duration of the procedure. Other docs have differing philosophies on this matter and I respect that. This is simply my belief and I stick by it without reservation.

 

Comments about things like refusing to remove staples are hard for me to comprehend since my office is glad to help out colleagues. I view the Coalition as a team. Most of us are friends and we support one another because we are professionals with patient satisfaction being the end goal. Many of us have patients from all corners of the country and often beyond. It is not at all uncommon for us to assist with staple and suture removal. I can only apologize if anything to the contrary was said.

 

With respect to recommendations, I certainly do not apologize for giving conservative estimates when they seem appropriate. Any scalp on any given day has the potential of being interpreted in different ways by different physicians. The balance of risk versus reward for a given situation is quite complicated. I tend to view "damaged" scalps with much more caution ??“ and for good reason. It is rare for someone who truly had the misfortune of being "maimed or mutilated" from a surgical misadventure to be completely corrected in a single procedure. My experience suggests that this subset of patients tends to favor a conservative approach (not always, however). Certainly it is often technically possible to perform more grafts than are recommended during a consultation, but risks increase as the size of the strip escalates. Sometimes you win and sometimes you lose ??“ and I have hated losing since I was a kid. I do try to explain risk and reward scenarios with patients so that they realize there really is no single best answer. There are many options that can get someone to their final destination ??“ the route to the finish line may be different however. The key here is avoiding failure at all costs.

 

My average consultation lasts 45-60 minutes. Many times I wonder whether a positive connection has been made or not. Face it, not everyone hits it off. Knowing that patients have a choice to go where ever they want, and knowing that part of my mission in life is to protect those who seek surgical restoration, I often tell patients this line, "If for whatever reason you do not have my confidence, please go to someone like me, another Coalition doc, someone who will treat you professionally and as in individual". In the end, I am glad that our community colleague had the vision to go to someone who is on my very short list of physician recommendations for prospective patients.

Edited December 12, 2020 by jimcraig152

[Melvin- Admin]

Dr. Lindsey has over 20 years experience, you may consider one doctor the GOAT but that does not discount another doctors decades of experience. One thing that you should know about hair transplants and the industry in general is there is no blanket absolute answer, the sooner you learn that the better.

 

[jimcraig152]

Right. I am not discounting Dr. Lindsey's position on the subject. Dr. Konior acknowledges that and states that he respects his peers' philosophies; he can't be more right in that regard. More important is:

1. The patient's goals are achieved
2. "Consistent excellence", as stated by Dr. Konior, is achieved

If these things are achieved, does it matter? And I agree with you, there is no blanket absolute answer. Even on this subject at the highest professional levels.

[Richie888]

I have worked with people with qualifications coming out their ears that I wouldn't trust to run a bath and have have met experienced people who haven't been as highly qualified but in any given task have exceeded themselves.

The point being that I agree with what has been said but also the fact that if you trust in the surgeon you have chosen and they achieve proven great results, then you can trust that they have trained their techs to a suitable point to carry out the job. It is not a one trick pony job placing grafts but it is not comparable to heart surgery on any level. 

It's also easy for Konior to play down techs requirements whilst he charges $15 a graft, but for people requiring larger surgeries with smaller budgets then the need for more viable options is required. Again, it's all down to PROVEN results coming from the clinic the patient has chosen. 

 

[Melvin- Admin]

Well, I don’t believe Dr. Konior charges $15 per graft, that’s a blanket statement. There have been otherd eho are charged less, a lot less. He charges per job, not per graft. 

[JohnBob]

Should Surgeons or Technicians Place Grafts?

 

Well I guess if we as doctors we will get two types of answers:

1- doctors who use techs will say there isn't a problem using them for the x reasons

2- doctors who don't use them will say they prefer to not use them for the y reasons

 

We as potential patients should carefully listen to both kinds of answers and make up our own minds. 

 

By the way, Melvin you hair is looking perfect man, in those normal day today exposures I would have never guessed you had a HT. 

[Richie888]

11 hours ago, Melvin-Moderator said:

Well, I don’t believe Dr. Konior charges $15 per graft, that’s a blanket statement. There have been otherd eho are charged less, a lot less. He charges per job, not per graft. 

Well he has quoted upto $15 for people on this forum. You can ask them the complexity of their requirements but by all standards that is still a high price and may be competitive in the state's but not Europe. 

[Melvin- Admin]

4 hours ago, Richie888 said:

Well he has quoted upto $15 for people on this forum. You can ask them the complexity of their requirements but by all standards that is still a high price and may be competitive in the state's but not Europe. 

My point is he doesn’t charge that for everyone, as I said he charges per case, not per graft. I’ve heard several others say it came out to $8 per graft. So again, we shouldn’t be making blanket statements about his cost. If you submit a consultation, he may charge you more or less. The only way to know, is to submit a consultation.

[smurf]

On 12/12/2020 at 6:23 PM, Melvin-Moderator said:

Well, I don’t believe Dr. Konior charges $15 per graft, that’s a blanket statement. There have been otherd eho are charged less, a lot less. He charges per job, not per graft. 

I was quoted $12/FUE by Konior last month fyi. 1600 FUE

Edited December 22, 2020 by smurf

[smurf]

I think he will quote $20/FUE if he doesnt want you as a patient lol.

[PizzaWolf]

16 minutes ago, smurf said:

I was quoted $12/FUE by Konior last month fyi. 1600 FUE

Same.

[asterix0]

@jimcraig152 That is an excellent excerpt by Dr. Konior, thank you for sharing that!

[BDK081522]

As Melvin has already mentioned, Dr Konior doesn't charge a universal per graft amount. Each case is unique and as such, he charges a comprehensive surgical fee based on the complexity of the case. If you wanted to break it down to a per graft basis then I would venture a guess that his rate is between $8-$15. Also, agree that there is no universal better implantation protocol in the tech vs Doc debate. Whatever the clinic deems is the best option for optimal outcome is the correct technique for that clinic. Again, the reoccurring theme of individualized care based on best practice. Some clinics best practice are to use techs to implant and others would be better served with the physician doing the implants. Your job as a prospective patient is to figure out your own goals and what you're looking for in a clinic that will affect your appearance for the rest of your life. 

[Melvin- Admin]

2 minutes ago, BDK081522 said:

As Melvin has already mentioned, Dr Konior doesn't charge a universal per graft amount. Each case is unique and as such, he charges a comprehensive surgical fee based on the complexity of the case. If you wanted to break it down to a per graft basis then I would venture a guess that his rate is between $8-$15. Also, agree that there is no universal better implantation protocol in the tech vs Doc debate. Whatever the clinic deems is the best option for optimal outcome is the correct technique for that clinic. Again, the reoccurring theme of individualized care based on best practice. Some clinics best practice are to use techs to implant and others would be better served with the physician doing the implants. Your job as a prospective patient is to figure out your own goals and what you're looking for in a clinic that will affect your appearance for the rest of your life. 

Well said.