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

Question

I’ve visited two different surgeons for hair transplant consults and received to very different opinions on how many grafts I’ll need. I asked both how involved they are in the actual surgery and they said they stop in a few times to check on things. They do not do any of the harvesting, cutting or implanting. If this is the norm, how can I pick a surgeon based on his/her reputation when they aren’t even participating in the surgery and it’s luck of the draw which techs I get that day?

Ken Anderson, MD, FISHRS · Answer

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

Jae Pak, MD · Answer

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.

Ross A. Clevens, MD, FACS · Answer

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,

Munir Somji, BSc, MBBS · Answer

The answer is simple. Choose neither of them as neither are surgeons. It is also illegal. Unfortunately, this is common practice in the world today resulting in disastrous complications most of the time away from home.

Michael Vories, MD · Answer

Technicians should not be performing surgery. If you have encountered a clinic that operates the way you described you should run as fast as you can from it. FUE hair transplants are a surgical procedure, and the physician should be performing all of the incisions for extraction and graft placement.

Robert Jones, MD, FISHRS · Answer

It is illegal in 50 states for technicians to do the extractions for FUE surgery. If your surgeon says that his techs do the extractions sites and planting, head for the door. the ISHRS has a strong position on this practice. Please find on the link below.find a surgeon that does the surgery!!Dr. Robert Jones

William Rassman, MD (retired) · Answer

Selecting a doctor for any medical need has many common rules. You should look for a doctor who:
Is caring and compassionate.Takes an interest in you as an individual.Takes the time to learn about your problem, listens to you and does not lecture you by imposing his/her views upon you.Is willing to educate you and bridge the gap between his/her knowledge and yours.Has excellent credentials in the specialty field you need.Has built a reputation of excellence in the field based on their results, and are recommended by family, friends, patients, or a physician that you trust.When these attributes are applied to selecting a hair doctor, the same rules apply:
Caring and compassionate– This starts when you first contact the office. How are you treated by the doctor’s staff on the phone? When you come to meet with the doctor, what is your first impression? Is the office clean and the staff friendly and organized? A caring doctor will meet with you and does not send a salesman in to gather information on your needs as his first bonding experience with you is in taking your history and learning about your concerns. The consultation agenda should be set by you with the purpose of establishing a basic patient/physician relationship. Good communication between both parties is key.Taking interest in you– Does your doctor care about you by showing real concern? Does he look into your eyes when speaking with you? Does he treat you with respect? Do you get the opportunity to share who you are and what you do with him? Does he want to learn about your lifestyle, your family, your culture?Time– The time the doctor schedules for you will tell you much about how he values you as a patient. For all new patients, I usually schedule a full hour for getting to know the patient, so I get enough time to examine the patient and listen to their concerns.Education– The doctor should educate, but not lecture, the patient during the consult once the issues have been presented. The first step in educating the patient is making sure that a detailed history of the patient is taken, understanding what has brought the patient to the office, followed by an examination of the affected areas. Just like a visit to your primary care physician, the examination is crucial. Your doctor should look closely at your hair, use a video magnifier to determine how far the thinning extends and this should lead him to an assessment of the point where the balding is advancing to.Credentials in the field – A heart surgeon should be well trained with years of experience before he works on your heart, just as a hair surgeon should be well trained and have substantial experience in the hair transplant field before they work on your head. What credentials should you look for? There is no Board Certification in hair restoration that is recognized by the American Board of Medical Specialties (ABMS). Only physicians who have met the standards of one of the 24 specialties recognized by the ABMS boards can call themselves “Board Certified”, and you can check on the ABMS website if they are indeed ‘Board Certified’ and in what specialty. You can also check with your state medical board to verify license status and education.Reputation based on results and personal recommendations– Talk to your friends and family to see if they have had any experience with physicians in the specialty that you need. Often there is an internet forum that discusses personal experiences with physicians, but you need to be careful that the site treats all posters the same (not just those that discuss advertisers or sponsors). Some forums may allow fake or misleading postings in order to promote particular physicians. Keep in mind that many people only post when they have something negative to say, but a physician that has many negative postings may in fact deserve their reputation. It is often said that a bad heart surgeon buries his bad results, but in the hair transplant field in particular, assessing the skills of a hair surgeon is easier since everything that is done by the surgeon sits on the head of the patient for the world to see. You can not hide a bad hair transplant. The best way to determine the quality of a surgeon’s work is to meet many of the surgeon’s patients, look carefully at the results from all angles, and ask yourself if those are the type of results you’d want on your head. By meeting patients directly, you can see not only what you are going to get from a hair transplant, but you can speak one–on-one and get the inside scoop on the doctor’s character, integrity, and skills.

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

Answers (7)

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