What actually matters? # patients per day, technician role, etc

[FirstAscent]

Hey all - long time lurker, first time poster. I'm in the early stages of choosing a surgeon for my first HT. I know that unpaid client testimonials and photos are the most important, but I've also read that there are a few specific practices that, all things equal, are more desired:

1. One patient per day is better than multiple patients

2. Doctor only surgery is better than techs doing extractions and/or implantation

3. Stick&place or DHI is better than premade slits

 

The problem is that there are very few surgeons that check all 3 of these boxes. Here are some examples from surgeons that are overall well respected here:

-H&W, De Freitas, and Lorenzo have a maximum of 4 patients / day

-Many elite doctors have techs doing extractions OR implantation (but rarely both)

-Feller & Bloxham, Feriduni, Bisanga do premade slits

 

So my question is: what really matters? And if your opinion is simply "none of that matters, just the doctor's results", why do people even mention these bullet points as being relevant?

----

Btw - don't know if this is relevant, but I've been quoted at needing 1,600-2,000 grafts. Not sure if the fact that I'm not a NW5 affects any of this discussion.

Edited January 25, 2022 by FirstAscent

[NARMAK]

I'm gonna start at the bottom and make my way up. If you're a Norwood 5, 1600-2000 grafts doesn't sound nearly enough to add appropriate density. 

In fact, we'd probably need to see pictures and if you're a diffuse thinner, better you take and start medication for circa 12 months first. 

Now, regarding the checklist. My opinion is that Doctors need to be appropriately present to supervise and be responsible for the incisions/slits and crucial extraction and placements where possible. 

All hair restoration clinics use technicians in some capacity and it should be encouraged to have properly trained and experienced technicians. 

As good as a single doctor can be, it is difficult to maintain a consistency and quality alone if you do everything and have to manage a large session. So therefore it's easier to have a team around you specialising in a specific area like technicians for extraction and implantation and you focus on specific areas for extraction/implantation as well as the overall angles and hair design. 

Pre-made slits vs Stick and place is an interesting one. The reason is because some find that pre-made slits help prime the healing response of the body and once you extract, you can implant ASAP. The downside by some being seen as that it means you then have to fill every slit you now created. 

That's where stick and place comes from the idea you take each graft and fill in as you go. So there's only ever a graft removed when it can 100% be placed i believe but maybe i'm misinterpreting things a little too. 

DHI is more imo to do with how Eugenix are doing it to keep grafts out the body for the least time. They also use pre-made slits it seems. 

The most important thing imo is to see who is consistently putting out good results and usually what follows is that those with good consistent results usually follow the same sort of principles with not that much difference in their methodology to create a stellar final result. 

[FirstAscent]

I was saying that I'm NOT coming at this from the perspective of someone who is NW5. 🙂 I'm probably NW2 / NW3. I wasn't sure if it's less relevant whether I'm the only patient for the day when I'm "only" having a 2k graft (or less) procedure.

 

I'll share my photos in a different thread in the future unless people think my specific hair situation would affect this specific topic.

Edited January 25, 2022 by FirstAscent

[NARMAK]

4 minutes ago, FirstAscent said:

I was saying that I'm NOT coming at this from the perspective of someone who is NW5. 🙂 I'm probably NW2 / NW3. I wasn't sure if it's less relevant whether I'm the only patient for the day when I'm "only" having a 2k graft (or less) procedure.

 

I'll share my photos in a different thread in the future unless people think my specific hair situation would affect this specific topic.

My bad, yes, i misread that lol. 

Yeah, if you're NW2/3, depending on exactly how much loss there is, that many grafts could give you a solid result in the right hands. 

But i stick by the rest. I think good clinics have achieved a great synergy between their technicians, tools and skills over time through experience and that's ultimately what delivers the results. 

[LaserCaps]

52 minutes ago, FirstAscent said:

Hey all - long time lurker, first time poster. I'm in the early stages of choosing a surgeon for my first HT. I know that unpaid client testimonials and photos are the most important, but I've also read that there are a few specific practices that, all things equal, are more desired:

1. One patient per day is better than multiple patients

2. Doctor only surgery is better than techs doing extractions and/or implantation

3. Stick&place or DHI is better than premade slits

 

The problem is that there are very few surgeons that check all 3 of these boxes. Here are some examples from surgeons that are overall well respected here:

-H&W, De Freitas, and Lorenzo have a maximum of 4 patients / day

-Many elite doctors have techs doing extractions OR implantation (but rarely both)

-Feller & Bloxham, Feriduni, Bisanga do premade slits

 

So my question is: what really matters? And if your opinion is simply "none of that matters, just the doctor's results", why do people even mention these bullet points as being relevant?

----

Btw - don't know if this is relevant, but I've been quoted at needing 1,600-2,000 grafts. Not sure if the fact that I'm not a NW5 affects any of this discussion.

The first thing you need to do is to ask about credentials.  Where did the doctor learn to do transplants? Does he have a Fellowship in hair?

Not sure if the number of procedures per day matters. A number of points can be made either way. (One a day, for example, could mean he is not getting enough practice....etc).

It is important to recognize the doctor is in charge of the surgical part of the procedure. In this industry it is the norm to have techs assist.  Once the doctor makes the sites, the Clinical staff will then place the grafts.  They can only go in one way, the way the doctor made the site.  With experience, these guys are truly amazing.  They can place hundreds in a matter of a few hours.  

Depending on their original training, doctors do prefer to do things in a particular way.  Plenty of instrumentation out there to make things easier.  Some instruments use large punches - which makes the job simpler.  Finer instruments, which still leave scars - but are not discernable to the eye, is tougher.  

Need vs what you have available is yet another point.  Perhaps the range he gave you is mostly based on what he believes can be harvested at any one time and has little to do with how many grafts would be required to give you density in the front, mid scalp and back areas.

Are you on any type of medical regimen?

 

[FirstAscent]

10 minutes ago, LaserCaps said:

Are you on any type of medical regimen?

 

I'm on Finasteride (but only recently started it) and am considering stacking minoxidil and/or anti-androgens. I'm 34.

[George Clooney]

I think you may be overthinking this a bit, which I am guilty of as well on more than one occasion.

What matters most, at least for me, are patient posted results. The pictures may not be perfect, the lighting might be off, but that's the only honest reflection of skill that we have here.

As far as the details of the procedure, let's say it's their techs that do the procedure, but they're hitting home runs every time. Would you exclude that clinic because your follicles weren't extracted or placed by someone that passed their MCATs? I would rather have the high school educated tech with green thumbs. 

While it's not a bad idea to ask for details, it also makes it hard to see the forest from the trees.

 

[LaserCaps]

51 minutes ago, George Clooney said:

I think you may be overthinking this a bit, which I am guilty of as well on more than one occasion.

What matters most, at least for me, are patient posted results. The pictures may not be perfect, the lighting might be off, but that's the only honest reflection of skill that we have here.

As far as the details of the procedure, let's say it's their techs that do the procedure, but they're hitting home runs every time. Would you exclude that clinic because your follicles weren't extracted or placed by someone that passed their MCATs? I would rather have the high school educated tech with green thumbs. 

While it's not a bad idea to ask for details, it also makes it hard to see the forest from the trees.

 

I tend to disagree.  There has to be, (and there is), a huge difference between a tech and an MD.  And while the tech is working under the umbrella of the doctor, I find it troublesome - to say the least - to allow techs to harvest and make sites.  If something did go wrong...a lawsuit waiting to happen.  

[George Clooney]

It's a fair point but I've seen some amazing "tech run clinic" results here and some really horrible MD results. Some folks are good on paper, bad in bed. But I totally understand your perspective.

[LaserCaps]

10 minutes ago, George Clooney said:

It's a fair point but I've seen some amazing "tech run clinic" results here and some really horrible MD results. Some folks are good on paper, bad in bed. But I totally understand your perspective.

I always go back to, "do the research." Find out where they learned to do transplants.  Do they have a Fellowship in hair? 

I've met and worked for many doctors.  Some branded "Pioneers," who were horrible.  One in particular, yielded no results on any of the patients he worked on.  I guess, if you've been doing it wrong your entire life, you will still do it wrong.  

I do value your point of view, considering the number of clinics out there who allow techs to perform the entire surgery.  Let's start praying for the ignorant.  

[Litheo]

On 1/25/2022 at 6:36 PM, FirstAscent said:

3. Stick&place or DHI is better than premade slits

As I'm currently in the research phase as well I had similar questions noticing that many of the doctors considered to be among the best do not use DHI, which is advertised as being superior to "older" techniques like pre-made incisions.

This post helped me to unterstand that at least for the best doctors, it doesn't matter what technique they apply, as they have mastered this technique and are able to produce consistent good results:

https://www.hairrestorationnetwork.com/topic/61948-dhi-stick-and-place-pre-made-slits-which-is-better-dr-konior-and-dr-mwamba-answer/

Hope it'll help you as well.