Surgical processes? How many patients a day and what parts should a doctor be doing?

[Nelly]

I think we should discuss in an open and transparent way the surgical steps taken in doing FUE and the role of each team member as a whole in each step.  This is so that a clear indication is given on what is deemed gold standard and what isn’t?

 

FUE: 

hair line design should be done by operating surgeon. I’ve read and herd clinics allow other members of staff or patients to draw their own hair line? 

There is no clear consensus on any forum I’ve seen that a doctor should make the cuts into the donor area for extracting the follicles. What are peoples opinion on this. Should it be delegated to a tech or should the doctor do this.

seperation of grafts use of microscopes to be done by doc or tech?

incisions done by doc or tech. Surely same creedance applies to both extraction and incisions. But mostly doctors will do this part.
 

implantation should this be done by doctors or techs? Forceps or implanter pens.

would be interesting to read the communities thoughts on this. 
 

Imo, docs should do the extracting and incisions. And I know some doctors are moving into doing implantation with forceps too. 
 

 

 
 

 

[Melvin- Admin]

The doctor should be doing the incisions, I don’t think one doctor can monitor more than 2 patients without sacrificing quality. Extractions can be done by technicians, but it depends on their skill and experience. 

[A_4_Archan]

Incisions is must by the doctors....extraction can be performed by the techs if they are very well experienced...and implantation is generally performed by techs ....and if the implantation is done using pens thn it should be done by the doctor himself...and max 2 surgeries should be performed...

[Doron Harati]

The dorctor MD surgeon should do all surgical parts: punch and incisions, extractions and placements by the technicians.

[ITA]

In my opinion, the phases that a surgeon should do personally are the incisions (which in almost all the best clinics are actually performed by him), but also the positioning, in my opinion, should be performed by the same surgeon, the other phases such as shaving or selection of the grafts (compulsory made with microscopes or magnifying glasses) can be delegated to the technicians. The extractions, if the doctor does it is better, if you find technicians who are not experts, you risk finding yourself with the donor area with non-uniform withdrawals.

[Nelly]

So preference should be:

 

doctor extracts

doctor does incisions

technicians replace grafts and separate

and a max of 2 surgeries in a day.
 

I agree with the above. I don’t think an unlicensed person should be making any cuts in someone’s head. By the same token you wouldn’t train a recpetionist to start cutting into someone’s brain just because they have experience, and skills. They should be licenced to do so.

Do we know if there is any licensing arrangements  for techs? Are they insured to cut into peoples head? 
 

I know physician assosciates are now heavily involved which is more ethical imo and licenced nurses who do minor procedures. 
 

And surely you wouldn’t pay 10-20k dollars to have a doc do 1 hours worth of work I.e just the incisions. Seems ludacris

[mr_peanutbutter]

this is actually a very valuable thread. this or something similar is pin-worthy

[Nelly]

4 hours ago, mr_peanutbutter said:

this is actually a very valuable thread. this or something similar is pin-worthy

What’s your opinion?

[mr_peanutbutter]

48 minutes ago, Nelly said:

What’s your opinion?

i think as long as they dont tag both the surgeons and the technicians (by name) both incision any extractions should be done by the surgeon. incision is a no brainer but even with extraction you can really damage the grafts; so if its done by technicians it should be known to the people who of the technician has done the extraction if you present a case. the technician will be as important as the surgeon then. 

 

 

i noticed both @DrMunibAhmad and dr zarev are basically do everything and they have the best results (including survival rate of the grafts). however obviously this comes with a price tag many cant pay.

[Nelly]

3 hours ago, mr_peanutbutter said:

i think as long as they dont tag both the surgeons and the technicians (by name) both incision any extractions should be done by the surgeon. incision is a no brainer but even with extraction you can really damage the grafts; so if its done by technicians it should be known to the people who of the technician has done the extraction if you present a case. the technician will be as important as the surgeon then. 

 

 

i noticed both @DrMunibAhmad and dr zarev are basically do everything and they have the best results (including survival rate of the grafts). however obviously this comes with a price tag many cant pay.

That’s interesting. I agree a technician doing the extraction should be named. There is a political issue that I’ve just thought about and I suppose it is a barrier to entry. If surgical extraction is delegated because it is technically challenging to retrieve grafts a new surgeon can relatively easily enter the fray and do incisions only. Maybe that’s why particularly here in the U.K. the old guard is very anti-tech extraction. 
 

but imo I think any cuts made into the skin should be done by a doctor. And also if possible doctor to implant. But must be a Herculean task to do all 3 so can understand implanting done by techs. 
 

grafts can still be damaged on implantation.

[Fue3361]

Me, personally, I’d not go to a surgeon that does more than 1.  Maybe if he really had a stupidly good reputation, but usually not.

 

But, in general, more than 2 is a big red flag.

[Big Rome]

6 hours ago, mr_peanutbutter said:

i think as long as they dont tag both the surgeons and the technicians (by name) both incision any extractions should be done by the surgeon. incision is a no brainer but even with extraction you can really damage the grafts; so if its done by technicians it should be known to the people who of the technician has done the extraction if you present a case. the technician will be as important as the surgeon then. 

 

 

i noticed both @DrMunibAhmad and dr zarev are basically do everything and they have the best results (including survival rate of the grafts). however obviously this comes with a price tag many cant pay.

I think Pinto does every step also 

[mr_peanutbutter]

1 hour ago, Big Rome said:

I think Pinto does every step also 

lars heitmann in switzerland too

[TEXAN35]

Of course, the basic requirement is that doctors do all the design and incision.

I would prefer if the Doctor can do some implantation specially in critical areas like hairline or in temple. Also, I would prefer a doctor to be in the operating room around 20-25% of the time at least monitoring the work of the tech. if we are paying 5 to 10 K , I think it's reasonable to expect the Doctor to spend 2-3 hrs in the Operating room.

The treatment should be fair to all their patients.

[Nelly]

On 7/1/2023 at 8:58 PM, TEXAN35 said:

Of course, the basic requirement is that doctors do all the design and incision.

I would prefer if the Doctor can do some implantation specially in critical areas like hairline or in temple. Also, I would prefer a doctor to be in the operating room around 20-25% of the time at least monitoring the work of the tech. if we are paying 5 to 10 K , I think it's reasonable to expect the Doctor to spend 2-3 hrs in the Operating room.

The treatment should be fair to all their patients.

I think that it’s more than reasonable. I think all doctors need to take higher levels of accountability. I’m seeing an ever increasing volume of doctors attempting several cases in the course of the day, which is clearly to line their pockets with as much income as possible. 
 

as safe as the procedure is there are ethics and good will and a doctor just being there as a name sake is shocking. 
 

It’s a shame there isn’t a gold standard that all clinics and doctors should aim for. 
 

assuming it would be bad for the industry but would be a lot better for the patients potentially wanting to have work done.