There is an issue developing online that very few people are noticing. I see it every day and I think it is one of the biggest misrepresentations in the entire hair transplant industry today. I'm talking about discussions online where patients talk about who did their FUE hair transplant. Was it a doctor or was it hair transplant technicians? If it was a technician, why say it was a doctor? Who is it exactly that you are trusting your donor zone to? What kind of outcome can you expect?
The hair transplant industry is going through a massive transition. For years, even decades, the status quo in surgical hair restoration has involved a doctor removing a donor strip of tissue then handing it off to a team of dedicated hair transplant technicians tasked with preparing the grafts for implantation into recipient site incisions prepared by the doctor. It was a 50/50 distribution of the work with the more important and technically challenging aspect, the donor strip removal, performed by a doctor. Today we have a paradigm shift toward FUE hair transplant surgery. The most recent statistics show that roughly 1/2 of all hair restoration surgeries performed in the world (among ISHRS members) are FUE. With this increase in overall FUE procedures there has been a massive shift in the surgical duties and who performs them. Where once the hair transplant operating room was helmed by an experienced doctor that had many years of medical school training conducting the most critical part of a hair restoration surgery, we now have a team of technicians that have replaced the doctor in this crucial role. FUE extraction is being carried out by non-licensed hair transplant technicians with little to no formal medical training. The only training they have received has been "on the job".
This is happening all over the world and contrary to what some doctors may say it is also happening in North America. The way is works is this; A doctor wants to get involved in FUE but he's been far too used to performing strip and not being so involved in surgery for the whole day. So, he starts investigating the requirements in his province or state on the legality of a hair transplant technicians "breaking the skin" with a surgical instrument. Some states and provinces (in Canada of course) have different regulations. Some will allow hair transplant technicians to perform the procedure as the doctor will argue that an FUE extraction is less invasive than a minor biopsy. What they don't tell their regional medical board is that these "minor biopsies" are performed thousands of times on one patient in a day. This is conjecture of course but you get the idea. Regardless, it is allowed to occur. In other states the regulations are much tighter and only a doctor can break the skin of a patient, period; no exceptions.
So what does this mean for the patient? It means that if someone is considering surgical hair restoration, and of course I'm referring to FUE (follicular unit extraction), then they need to do a few things to protect themselves. First, they should ask the clinic or clinics that they are interested in how much involvement the doctor has in the actual procedure. How much of the procedure does the doctor perform? Does the doctor perform all of the follicular unit extractions? Does the doctor make all of the incisions into the recipient scalp for placement of the grafts? Does the doctor take part in these actions and has assistance from his technicians or does the doctor only make recipient site incisions and leaves the extractions up to the technicians completely? I think that these should be standard questions that anyone asks when they are considering FUE. If the clinic responds that it is hair transplant technicians that are performing the extractions you should then contact the state medical board or College of Medicine (if provincial) and ask if a technician without a medical degree is allowed to break the skin 3mm to 5mm deep thousands of times on one patient scalp.
Are You Paying For a Hair Transplant Technicians or a Doctor?
If you find out that the doctor of your choice does not perform the extractions and does not place the grafts and is only making the incisions into the recipient scalp then it should be pointed out online. When a patient says "I had FUE with Dr. X" but you know that the doctor only makes incisions then it is your duty to speak up and remind everyone that the doctor only does about 25% of the job. Hair transplant technicians are doing the other 75%. Think about it. There are four main duties in a typical FUE hair transplant procedure.
- The extraction.
- Additional graft trimming and counting.
- Recipient site creation via a needle or blade.
- Graft insertion.
The doctor is only responsible for one part of a four step FUE hair transplant procedure so it is in fact misleading, if not irresponsible, for the doctor to get the credit when the vast majority of the work was performed by unnamed hair transplant technicians. Any hair transplant doctor that cares about his results will certainly have a lot of oversight into how a procedure is performed but just because he's supervising does not make it the same as doing the work himself. If the doctor is doing LESS work than he would had your surgery been FUSS, why is FUE so much more expensive? In the past the higher price for FUE was attributed to the dedication of the doctor doing such tedious work but now that there are hair transplant technicians with a fraction of the training a doctor has, why is it still 50% or more per graft than a comparably sized FUSS surgery?
I'd like to be clear. I think that some hair transplant technicians are probably better than many doctors so this is not an anti-technician diatribe. This is not that surprising actually when you realize that the majority of hair transplant doctors are not surgeons by trade so they do not have the dexterity that one would expect from a properly trained surgeon. My problem is that there is absolutely zero consent for the patient to sign off on when it comes to acknowledgement of hair transplant technicians performing surgery. I am not aware of any consent forms that talk about a technician performing the procedure. I am not aware of any consent forms that talk about how the doctor has only 25% involvement in the surgery. If a patient knows this and is still fine with progressing with surgery then there is nothing wrong with having a technician perform the surgery. This is my honest feeling on the issue but I also feel that a few things should change in the industry.
- Know who is performing the procedure. Is it the doctor that gets the credit for the results or is it his staff? Clinics should have this listed, not only in their consent forms, but on their websites as well. It is the only honest thing to do.
- If the staff does the surgery, how long have each involved been performing FUE surgery? This information should also be on the website. How often have they performed FUE surgery during this time frame of their experience? Once a day? Once a week? Every once in a while?
- What are the names of the staff performing the surgery? Normally the staff have a right to privacy but when they are the ones performing your surgery under the name of the doctor I believe that this right to privacy is rendered null and void.
- Patients need to stop being brainwashed into saying their doctor performed a procedure when the doctor had very little (and something NOTHING) to do with the surgery itself. For instance, in Turkey I went to a hair transplant clinic for an undercover consultation where the doctor only drew the hairline and then disappeared completely.
It is absolutely the right of any patient to know who is going to do the surgery and what degree of involvement they have. It is time for you the patient to demand this information and if any clinic gives you a hard time about asking such questions you should walk away. So can you answer the question? Who's performing your FUE hair transplant? The doctor whose name is on the door or anonymous hair transplant technicians?