How should someone decide which hair transplant surgeon to select when technicians do most of the work?

Dear Commissioner Gordon,
That’s very concerning. As mentioned by other doctors on this answer, it’s simply outside the law to have technicians piercing skin with an FUE instrument of any sort. Also illegal for them to make the recipient sites. I would say both of those doctors would have quite a problem if the medical board looked into their practices. However, it happens more than you think, and I see many patients in my office who want me to repair bad work. Often it isn’t possible, which is something that these patients are very upset to learn. The medical qualifications to be a hair transplant technician in the USA are exactly the same as the medical requirements for the guy that empties the dumpster outside my office: absolutely none. If any surgeon tells you they have the techs do the surgery, then you’re not talking to a surgeon. You’re talking to a person using their credentials to get paying customers in the door, then brokering surgery between these same customers and a team of people of questionable, if any, medical training to perform surgery on the customers. Nothing more.
A couple of guidelines I would personally use:
Does the practice offer both linear and FUE surgery? If they only offer one I would avoid that practice. Huge red flag. Neither method is a catch-all, and FUE is NOT a newer method to perform hair transplant surgery that supplanted the traditional linear strip method. Does the practice perform hair restoration surgery full-time, or does the doctor do other procedures as well? I would stick with a dedicated hair restoration surgeon. It is its own specialty now, and there are doctors in the USA who are 100% dedicated to their craft, and not dabbling with it here and there because they bought a fancy machine.Look for the designation “FISHRS” after the doctor’s name. Very few hair restoration surgeons have completed the requirements over the many years it takes to attain this important distinction. Before you make a final commitment for hair restoration surgery,  it’s a good idea to ask your hair restoration surgeon a lot of questions so you can have confidence in your decision.  If you need a starting point, here are some concerns that go through patients’ minds:
1) Who will evaluate my hair loss and recommend a course of treatment?  What is their education, training, licensure, and experience in treating hair loss?  What should I look for when selecting the right surgeon for me?
2) Who will be involved in performing my surgery, what role will they play, and what is their education, training, licensure, and experience performing hair restoration surgery?  No doubt you are doing your homework to choose a highly-regarded and credentialed surgeon – he/she should be the one doing your surgery.
3) Is everyone involved in my surgery covered by malpractice insurance?
4) What are my surgical options?  What is difference between FUT (strip) and FUE?  The following articles provide an unbiased, fair, and truthful comparison.
5) It is important to know that both FUT (strip) and FUE results in scars.  There is no such thing as “scarless” surgery in hair transplantation. The ISHRS is concerned about false and exaggerated advertising claims related to hair restoration surgery such as “scarless surgery” or the claim that the surgery can be completely performed by a machine.  The fact is that any incision whether by machine or hand that enters the skin beyond the most superficial of depths causes a scar to form, and there is currently no machine capable of automatically performing all the aspects of the hair restoration surgery. Available technology can only assistant trained surgeons performing hair restoration surgery.  Click for Red Flags and Misleading Messaging.
6) How long will my procedure last?   Many surgeries require multiple procedures.  Patients should have a clear understanding of the time commitment necessary to achieve their desired results.
7) Will people notice my hair transplantation?  Patients should feel comfortable addressing this significant concern upfront because a hair restoration surgeon can suggest options for making the transplantation less noticeable.
8) How much will it cost?  Surgeons encourage patients to be open about financial questions before the surgery.  Though rarely covered by insurance, deductible and co-pay questions are best handled early on.  If a payment plan is required, both patient and surgeon benefit from a clear discussion on this matter.
9) Will it be painful?  Many patients, men in particular, may be reluctant or hesitant to ask about what level of pain they should expect during the procedure.  Fortunately, today’s hair restoration surgeons have a number of pre- and post-operative methods that can make you comfortable and ease your mind about your surgery.
I hope this information is helpful to you.
Kind Regards,
Ken Anderson, MD, FISHRS

In the United States and other countries, it is illegal for technicians to perform hair transplant surgery.The surgeon is responsible for harvesting your hair follicle and making the incision of where the hairs will be transplanted.  The technician or assistants usually dissect the hair follicles under a microscope and inserts the grafts into the pre-made incision sites.If the doctor is occasionally checking in while a technician is doing all the work you should report the violation to the medical board.

Thank you for your question. It is important to work with a board certified facial plastic surgeon trained and experienced in NeoGraft. It is important to review their background, education and number of NeoGraft procedures performed per year. This site is a great resource to find your medical team, and move forward with a consultation with a board certified facial plastic surgeon. 
Best wishes,