hair transplant procedure..who actually places the grafts!

[Guest]

I just recently had a 2000 graft session from a very well known surgeon. When I arrived they took pics of my head. The doctor then proceeded to numb the donor area and extracted the strip to be used. He had 4 assistants that then begin to disect the grafts. While they were doing this he made all of the inscision sites on my head. After that he told me they would then begin placing the grafts into my head.....To my suprise it wasn't him that inserted the grafts it was his medical assistants....Is this a common practice? Or should he have been the one to complete the procedure? He left the room, and for about 4 hours two girls were placing the grafts into my head....I felt very uncomfortable with this...

[Guest]

I just recently had a 2000 graft session from a very well known surgeon. When I arrived they took pics of my head. The doctor then proceeded to numb the donor area and extracted the strip to be used. He had 4 assistants that then begin to disect the grafts. While they were doing this he made all of the inscision sites on my head. After that he told me they would then begin placing the grafts into my head.....To my suprise it wasn't him that inserted the grafts it was his medical assistants....Is this a common practice? Or should he have been the one to complete the procedure? He left the room, and for about 4 hours two girls were placing the grafts into my head....I felt very uncomfortable with this...

[Pat - Community Publisher]

Jason,

 

As session sizes have grown larger physicians have become much more dependent on their technicians. A large session of follicular units is really a team effort these days.

 

Thus few surgeons, even the top ones, place all the grafts or even most of them. Experienced and well trained technicians are perfectly capable of doing the placing properly. In time they often become better at it than the surgeon.

 

Having a team of techs placing the grafts also gets the follicles back into the body faster and that is a plus.

 

Personally I do think the surgeon should carefully inspect and adjust all the grafts as needed once they are placed.

 

Congrats on your surgery and welcome to our community.

 

Pat

[jagdish]

Jason, This is really uncomfortable situation. I faced the same. I came to know that if you incist and pay more, the doctor will place the grafts. But who knows it before going for their first HT?

 

Jagdish

[Robert_]

Originally posted by jagdish:

I came to know that if you incist and pay more, the doctor will place the grafts.

 

Jagdish

 

That isn't necessarily true. Pat is correct that physicians have come to rely heavily on technicians during the procedure. The technicians are not just people that walked in off the street. They are skilled professionals that have been trained to conduct the task by the doctor him/herself. It is true that the physician supervises the procedure, but many of the grafts can be placed successfully and perfectly by the skilled technician. After all, who do you think it is that are carefully trimming the grafts that have been excised? This question has been coming up a lot lately and while I can understand the concern, I can attest to the high level of skill that many technicians have. After all, the physician did not become a "top doc" by relying on techs whose work would compromise his integrity, ethics, reputation, and result of his labor did he?

 

-Robert

[RichG]

I had my procedure performed by Dr. True. He cut the donor strip, closed the wound, and punched the graft holes. A technician administered the local anesthesia and a team of technicians placed the grafts. I believe Dr. True may have stopped in the room for a few minutes while the grafts were being placed. I understand with the larger procedures, it is necessary for the physician to rely on a team of technicians to participate in the surgery, however I personally would feel much better if there was a thorough examination of the work by the Physician following the procedure. This would ensure that any problems that might occur due to one of the Tech's having a bad day etc... can be caught and corrected early.

[thinkingaboutit]

If some of the better doctors profess to doing only one surgery a day, where are they during the long periods when grafts are being placed?

 

I understand that technicians can be very qualified and capable, but where is the doctor?

[Robert_]

Many times they are utilizing the time that can be freed up by the technicians placing some of the grafts to see other people for consultations.

 

For example, I know that Dr. Cooley concentrates on excising the donor strip and creating the recipient sites for the grafts while the grafts are being trimmed by the technicians. He then begins to place grafts, concentrating on the all-too-important hairline area. Brandy begins placing grafts further back, in the forelock and vertex area. After the crucial hairline placement is complete, he may go and conduct a consultation if there are ones scheduled that day. Thinking, when I met you at his office he was going back and forth from the operating room checking up on the patient and back to the room we were in the entire time.

 

Other physicians utilize their time similarly.

 

I want to make it clear that I do NOT want to come across as defending those doctors that have 2 or 3 procedures going on at the same time and bounce from room to room. In my opinion that is unsatisfactory. Dr. Cooley performs one procedure per day.

 

Hope this helped answer your question, thinking.

 

-Robert

[PCC]

The success of a state of the art follicular HT is heavily promoted as being dependent upon the artistry of the surgeon. No where is this more crucial than the placement and angulation of graphs in the hairline zone. Yet this role is routinely being performed by non physicians. Somehow this seems contradictory. However, this concern should not detract from the vital role that the skilled, dedicated, and experienced techicians play in the process and their contribution to the overall quality of care.

It would also seem like the placement of graphs could be considered an invasive proceedure. This may be allowable in that they are acting as an agent of the physician, much like an EMT or paramedic in the field does. Yet I do not believe there is any formal licensure or certification for HT technician.

 

Phil

[Guest]

Indeed PCC, sometimes the doctors seem to drop the ball and let the newbie techs handle these critical procedures by themselves, and as we have read, there was a certain patient who fell prey to this as admitted by his Doctor.

 

I think the patient should be fully made aware that the Doc will only do a certain function of the procedure and that the 'unknown'technician factor should be at least considered in their decision to hire a Doctor.

[the B spot]

I posted this on another thread, by my feeling is that the doctor should place the hairlines PERIOD. That is what I paid for, and that is what I expect. I am completely fine with techs placing grafts behind the hairline or outside the extreme whorl of the crown, as they do this everyday. PCC is correct that angulation and placement is VITAL to produce the most natural hairlines. Imagine shelling out 15,000 for a tech to place your hairline? What if you don't like it? Who do you fault? The doctor or the tech? Ultimately it is the doctors responsibility to ENSURE that the HT is performed to best of HIS or HER ability. This is my opinion, but I paid a lot of money for my HT, so I wouldn't have it any other way.

[Guest]

did your surgeon actually place the hair grafts.

[the B spot]

Yes, all of my hairline grafts were placed by Dr. Shapiro and I did not have to pay extra I am not saying the techs cannot do this, I am saying that I believe the dr's skill comes out in the hairlines and how the transplanted hair fades into the native hair, which is controlled by the incisions AND graft placement. Techs are techs, and they do one hell of a job, but at the end of the day it is the doctors skills I am buying and I expect his or her staff to be trained accordingly. This is all my opinion of course, but I will say that HT's are judged solely on how the hairline is done, and then we look for density, coverage, etc... You can dense pack up to 70cm/2, and have complete coverage on the scalp, and if your hairline is SLIGHTEST bit "odd", you wasted your time. This is why certain doctors are the BEST, and the others are a half a notch lower. Nothing bad or evil, just a difference in artistic skill and a willingness to push the limit and not use a cookie cutter template for every patient. We have to remember that a hairtransplant should be designed patient to patient and should appear "real" or unoticeable to anyone. Applying this philosophy tests the artistic ability of the surgeon, and staff, as we all have seen some phenomenal results. I hope this helps anyone who is thinking of doing a HT and will help them during their consults or decision making process.

[troy]

I remeber asking about the placement of the grafts and why the techs do it, I was told, m the docs make the incisions and the grafts can only go in the way of the incision, so long as the doc does the incision angulation is already determined. Also it took a team effort, and I do think it should be supervised by the doc and examined closley when the job is done and if the doc says it looks good he is responsible, but I think we all feel more comfortable the more involved the doc is.

[Gorpy]

Well, that's not exactly true. This is from Dr. Keene's site: (http://www.hairrestore.com)

 

"As demonstrated in the photo to the right, follicular unit graft hair has a natural angle. While the slant of the incision creates the angle of growth to some extent, the natural angle of the graft contributes. If it is not placed in the recipient site at the proper angle, it will appear less natural, and may be at odds with native or surrounding hair. This is not always discernable in a photograph, but can be seen when up close and in personal contact."

 

(Just to be clear - this part is my own opinion)

Other reasons for the doctor to do the hairline:

It is impossible to tell just from the incisions how the hairline will look. You have a general idea, but it will need some final artistic adjustments. It's like an artist doing a painting. At some point he/she stands back away from the painting and looks for some needed final touches. That's exactly what Dr. Keene did with me and that's what I paid for.

 

There are such things as very fine hair that can be placed along the hairline in appropriate places. In other words, there are different kinds of single hair grafts. They might all go into small .5 mm incisions, but they are not all alike. How does a tech know which single hair grafts to place where? That would be relying on the techs artistic ability.

[troy]

Im not sure, it would be nice if some docs chimed in on this.

[Gorpy]

I'm sure you could put 10 docs in a room and they could debate the issue for hours without coming to an agreement.