I posted a few months back about a Neogroaft procedure I received that was performed by only techs and nothing from the doctor.

It's been almost 6 months since my Neograft procedure, no hairs have come in and the doctor has used techs to do the procedure. The techs used the Neograft device, created the slits and installed the hair. I have 0 results from this procedure after 6 months. Do I have any legal action against the doctor for using techs to cut into my head and create the slits?

Doctor Answers 10

Poor Results from NeoGraft

I am disappointed to hear that you experienced poor results from NeoGraft. Our experience with NeoGraft has revealed that patients do experience natural looking results within 3-4 months. I suggest you schedule a follow-up appointment with the board certified surgeon who dispatched his/her techs to perform your procedure. Before the meeting, jot down a list of questions. I am curious as to your surgeon's diagnosis of your recovery process and your lack of results. You have every right to disclose your disappointment with the procedure.


Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 103 reviews

Technicians did my entire procedure, and no hair grew after my NeoGraft procedure!

This is a common problem with the NeoGraft device.  NeoGraft was introduced about 6 years ago, and is simply a machine that a physician (or, more likely, as you have experienced, a technician) uses to perform the follicular unit extraction (FUE) procedure. It is more or less a motorized, hand-held circular punch, attached to suction. I attended a physician's office in Florida in 2009 for a demonstration of the NeoGraft device. I've been performing FUE procedures since 2003, and I was very interested to see this device. While at this meeting, hosted by the NeoGraft corporation, it was interesting to note that I was the only dedicated hair restoration surgeon in attendance. The others there to see and perhaps purchase the machine were spa owners, obstetricians, several family practice doctors, and a few business managers for doctors who dabbled in cosmetic surgery in general. I was pretty surprised. The graft placement feature of the NeoGraft device with positive pressure is a gimmick, as I asked the head trainer for the NeoGraft corporation to place a graft using this. We were observing an live procedure, and we watched as he tried several times, but was not able to place a single graft with the machine.

NeoGraft has done a tremendous amount of marketing, and I see physicians who have never done a hair transplant around the country acquire this machine, piggyback on the marketing done by NeoGraft, and start to offer this complicated, and permanent procedure to the public. In much of the country, the doctor will simply hire a technician (the going rate for a NeoGraft tech in Atlanta is $70/hour) to perform the procedure.  Some States, like California, don't allow technicians to cut human skin, but most States allow it.  In States that don't allow it, like California, it still happens every single day at clinics all around California.

It should be noted at this point that hair restoration technicians have the same exact medical training requirements as grass cutters: absolutely none. The physician only need sign the papers and be on the premises. No joke. So, whether using the NeoGraft, or the much more advanced ARTAS robotic hair restoration system, or any other device, including a 50 cent 1mm biopsy punch, it is the experience and dedication of the surgeon and his team that will determine the outcome.

Hair Restoration is it's own specialty now. There's a global society (the International Society of Hair Restoration Surgery) and a Board. Choosing a surgeon 100% dedicated to hair restoration is paramount. If "NeoGraft" suddenly appears on a long list of other procedures a physician offers, I would be wary, as it is unlikely that the physician has a full-time, highly-trained team of hair restoration technicians, and is just hiring one of many "hired gun" technicians that will arrive at the office, and do the procedure for $70 an hour. There are hundreds of subtleties and nuances in hair restoration, and assuming that because a physician now offers NeoGraft, in addition to all the other procedures offered, will be competent and excel at hair restoration surgery is simply foolish. Look at the experience and dedication of the surgeon who will be performing the surgery, and make sure technicians are not actually the ones who will be performing the surgery. Also make sure the physician you choose is actually a trained surgeon. The majority of hair restoration "surgeons" are, in fact, not trained in surgery at all, and hold no board certificates in any surgical specialty whatsoever, so examine your physician's credentials carefully. You should feel perfectly comfortable asking for a copy of the surgeon's resume to review. Look for many years of dedication exclusively to hair restoration, not just cosmetic surgery in general.

This problem is so rampant and common that the International Society of Hair Restoration Surgery, the global community of physicians practicing hair restoration, issued a consumer alert about this issue. I see patients every month who had a hair restoration performed by a technician with the NeoGraft device presenting to our office asking for help; asking me to repair the unnatural looking hair transplant results. This is often very difficult, and occasionally impossible. Because as we say in this specialty, "the good thing about hair restoration is that it's permanent. The bad thing about hair restoration is that it's permanent." Consult with more than one surgeon, make sure he or she is actually a trained surgeon, and get a feel for who you think will be the best for you. A machine absolutely does NOT guarantee good, or even acceptable results.

Ken Anderson, MD, FISHRS
Atlanta Hair Restoration Surgeon
5.0 out of 5 stars 138 reviews

Neograft Done Illegally By Assistants

Unfortunately this is a quite common problem I see in my practice.  It always blows my mind that patients don't do their research before selecting a doctor especially when there is so many good resources available online such as the ISHRS, RealSelf, etc.  I also never understand that a patient shows up to their surgery and doesn't question the doctor or stop the procedure when they see a technician performing surgery on them.

If you went in for a nose job and the doctor walked out of the room and left his assistant to perform the surgery would you stay? Of course not.  It is the same thing with Hair Restoration Surgery.

It is illegal and unethical to allow technicians to perform surgery.  You should definitely have a discussion with the doctor.  Reporting to the medical board, etc is a possibility but this will not really solve your problems.  Unfortunately the hair follicles that were removed and did not survive are gone and your donor zone is more limited.

I would recommend seeing a qualified hair restoration surgeon in the future for your concerns.

Amir Yazdan, MD
Irvine Hair Restoration Surgeon
5.0 out of 5 stars 22 reviews

I posted a few months back about a Neogroaft procedure I received that was performed by only techs and nothing from the doctor.

It's the skill of the persons doing the hair transplant more than their credentials. Many of the very skilled and experience techs are the very people who taught the doctors how to perform the hair transplants and set up their hair transplant center.


I have no idea why you are not growing hair since I wasn't there at the procedure. Hopefully, they took only about 4 hours for the procedure, so the grafts returned to the scalp for their blood supply as soon as possibly. You should ask your surgeon about it.

Thank you for your question.

It may not be the technicians

The right technicians have incredible experience in FUE/FUT. The one I team up with has performed thousands of procedures, more than most physicians. The device, in the right hands allows for excellent graft harvesting. Often better than other devices, or strip method, where the majority of physicians employ technicians to perform this task. They have to manually cut the follicle from the removed strip of scalp which has a higher degree of error. Making the small needle sticks in the scalp again, can be performed by a physician or skilled professional with vast experience,AS LONG AS IT IS SUPERVISED BY THE DOCTOR AND PATIENT IS AWARE AND CONSENTED TO IT! A good team, with technicians, can obtain great results in a safe manner and environment. There are places where these procedures are performed and there is no supervision by an experienced physician. Hopefully you did not visit such a place.

There are several reasons for poor graft take including poor technique, harvesting, graft handling, deification, temperature issues, and placement. The reason for hair loss can also play a role in poor graft take as medical conditions and scalp disorders can have an effect.

You need to visit with your physician to discuss this issue. Review your consent that you signed before your procedure, and any other paperwork you received. 

Michael S. Beckenstein, MD
Birmingham Plastic Surgeon
4.9 out of 5 stars 18 reviews

NeoGraft

6 months is too early to determine if your grafts survived.  It may be at least a year before you see hair growth.  Technicians are often more qualified than doctors to extract follicles and implant them.  The technicians I use have literally performed hundreds of thousands of extractions and/or placements over the course of 15 years or more in some cases. It would be very unusual for a doctor to have that hands that much hands on experience.  Depending on where you go, some doctors are more involved than others.  Some oversee the procedure, others do some of the extractions and placements.  Overall, the doctor generally decides on the game plan.  As far as legal action, that's something an attorney would be able to answer better than me.   My guess is that if phlebotomists can stick needles in arms to draw blood, hair transplant technicians can make slits in the scalp to place hair.  I think in another 6 months you will be much happier when the hair grows.

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 31 reviews

Grafts failed to grow at 6 months

Skilled teams of people headed by a surgery licensed in the state, produce hair transplants on a consistent basis. safety is always a concerns as well and safety is best guaranteed when a licensed doctor does the surgery.  The use of any technology, the ARTAS, the NEOGRAFT, the HARRIS SAFE SYSTEM, are only as good as the surgical team. You need to wait another two months before you call your hair transplant a failure. If your surgery was not performed by a licensed surgeon and only technicians, then you can report the doctor whose office it was performed in, to the medical board of the state. They will investigate the situation and possibly take a legal action against the doctor whose offices it was performed in. 

William Rassman, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 27 reviews

It is illegal for techs to do hair transplant surgery in California and other states.

Only physicians can legally cut into the skin in most states (ie: Harvest FUE grafts and make recipient incisions). The laws of most states require that only a licensed MD can perform (harvest) FUE or make slits in the recipient area as these are surgical incisions. Technicians can not, by law in most states, do these functions. You have recourse if you suspect that a non-physician has done these steps to include filing a report with the U.S. Department of Health and Human Services, Office of Inspector General at 800-447-8477. 

You can also contact the California Medical Board and file a compliant under Medical Board 
LINK

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 88 reviews

FUE procedure done by technicians

Unfortunately with the popularity of hair transplant procedure, many doctors that are not specialized in hair transplant have started to offer it at their clinic as a side job.  Some of these doctors buy these automated instruments such as the ARTAS or Neograft and hire traveling technicians to perform the procedure for them.  These technicians not only perform the extraction they also do the incisions, because simply the doctor that does not have experience in hair transplant can not do it. According to the law any kind of incisions whether for harvesting or for designing the recipient area should be done by the doctor. So not only using technicians to do the doctors job is illegal, but also  With  traveling technicians and unexperienced doctors the results can be very unnatural with poor growth. That is why it is of utmost importance to do research when choosing a hair restoration doctor who specializes in hair transplant only and doesn't do it as a side job.  Also if the the doctor only offers Neograft and ARTAS and doesn't offer other options, that is a bad sign.   This kind of procedure has to be customized individually with best technique for each patients needs and concerns.  
At this point there is not much you can do, but wait and see if there is more growth.  You can also point out the identity of the doctor so others would not use them. 

Michael Meshkin, MD
Newport Beach Hair Restoration Surgeon
4.8 out of 5 stars 27 reviews

No Growth after Neograft FUE Hair Transplant

That is very unfortunate that you have had no growth after undergoing a hair transplant. Usually by 6 months, there should be some growth and in most cases, 60% of the final result.

In terms of legal action, you need to find out what the laws are in the state that you had the hair transplant performed at. In some states, the doctor is the only one who can make the incisions to extract the grafts, and make the incisions (slits) where the grafts are placed. Even though FUE is a small round incision, it nonetheless is an incision that penetrates the skin. In my clinic in Oregon, I perform quite a bit of FUE for my patients and I personally draw out the hairline, administer all medications and injections, perform all the FUE incisions and extractions, and make all the slits where the grafts are placed. Then, with my staff, I place the grafts in the appropriate areas. It is a very time consuming and tedious process that I feel is the physician’s responsibility. If you feel the laws were broken, then you may want to consult an attorney.

The ISHRS (International Society of Hair Restoration Physicians) has come out with a position statement that basically states that it is the responsibility of the physician to make all incisions in the scalp whether it be the strip incision, the FUE incision, or the incisions where the grafts are placed.

Steven Gabel, MD, FACS
Portland Hair Restoration Surgeon
5.0 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.