Category: FUE

This is in response to a post from earlier this week about technicians performing most or all of FUE procedures with a NeoGraft tool:

Specialty Techs are in nearly every aspect of medicine and they all are equally skilled in their own field. Phlebotomy, radiology and even hair transplant techs to name a few, all have to maintain a high level of skill and responsibility as they are dealing with the health and well being of a patient. The question is, who would you rather have working on you? A doctor with an MD behind his/her name who just took a weekend course in some new procedure or a highly skilled tech with 5 or 10 years of experience doing the same thing, day in and day out with a high level of pride and commitment.

With regard to the techs who operate NeoGraft…how is what they do any different than when they are handling, dissecting and transplanting human tissue from a strip method? If anything, NeoGraft is a “tool” which in “experienced hands” has the ability to offer fewer complications, lower rate of transaction, faster recovery times and an overall better procedural outcomes.

I would encourage those who throw around the term “surgery” when speaking about NeoGraft to exercise a little common sense because handling, dissecting and transplanting strip tissue should be considered “surgery” as well if you really think about it.

Personal Note: I have seen the techs that use the NeoGraft systems with my own eyes and every time I am extremely impressed with the level of skill, dedication and pride these individuals posses.

“FUE performed by non-physicians is a grey area and illegal in most states. Legally, a procedure where there is a cut on the skin requires an MD to do it. There are cases where a registered nurse or a PA (Physician’s Assistant) can perform certain tasks, but it has to be supervised by the physician. A surgical tech performing FUE is a dark grey area.”

One more thing…I’m not sure where you get your information but it is completely inaccurate and misleading. Please provide everyone with just ONE state that mandates what you claim along with the link to the official state website where the rule is listed. Otherwise, please stop making things up.

Thank you for your comments.

To put it simply, no matter how minor of a surgery (suturing a cut on the skin, making a cut on the skin, or even just giving a prescription pill or IV to a person) it requires some form of license issued by the state where the act is performed. You may not have to be a surgeon, but you have to have had some medical training and hold a license (nursing license, PA license, etc). A normal person off the street, no matter how talented, cannot perform FUE even if they are trained or are better than the surgeon at doing it.

The focus here should be the protection of the public. When the person who is doing the surgery has a license to do it, that means that they were officially trained and certified to do surgery in the state. I know that there are many, many doctors who perform hair transplant surgery and do not have a clue on what they are doing. Many of these doctors use technicians to perform almost every step in the surgical process (in their medical offices) and it would be clear that the technicians are more competent than the doctors they work for. But this is not an argument for allowing non-licensed people to perform surgery, but rather that we need some protection for the public when a doctor is not competent in delivering a surgical service, not in allowing non-licensed people to perform surgery. Unfortunately, an MD in almost every state in the United States can do any surgery he wishes (brain, heart, hair, etc..) and will only be held accountable when someone experiences irrevocable harm or death. It is insane that the only protection for the public against these doctors is our criminal system after the damage is done. One can look at the cardiologist who administered Propofol to Michael Jackson, who is being held accountable by the criminal justice system for manslaughter.

I have found two interesting situations where non-physicians have performed surgery (one good and one bad).

• Example 1: The incredible story of African American lab tech that wasn’t formally educated beyond high school, but became a pioneer in heart surgery and actually operated on white Americans in the 1940s: Vivien Thomas
• Example 2: Title of the post is self-explanatory: Non-Doctors Doing Hair Transplants?

Now to the issue where you insist that I’m making things up, here’s the Medical Board of California’s Business and Professions code #2051: “The physician’s and surgeon’s certificate authorizes the holder to use drugs or devices in or upon human beings and to sever or penetrate the tissues of human beings and to use any and all other methods in the treatment of diseases, injuries, deformities, and other physical and mental conditions.” Emphasis mine. That’s just one of many examples that I found, but that should be satisfactory.

So to cut into your scalp, no matter how minor and safe it seems, the issues are one of license (legitimacy) and competence. Both, in my opinion, need to be considered as you make the decisions on who is going to do your hair transplant. I am sure that the NeoGraft system works in the hands of competent operators and that most doctors who now do surgery (with or without that tool) are probably less competent when compared to the standard of care that we perform in our office on a daily basis. I know that this is true, because I see the results of less-than-competent hair transplant surgery on a near daily basis as patients come to see me for repair advice, to address the failures of their surgery or the next step in their hair restoration process that was started elsewhere.

Hi,
I have a question. I am willing to do hair transplantation both back area and front area as well. I was deciding first to go front area and then back area. How many months or days gap should be given between two surgeries. Kindly help with information. Regards

First, you need to have your supply and demand understood. If your donor density is enough to address the balding problem, then starting in the front is the best way to go about the process. Will you be doing an FUE or a strip method for harvesting the grafts? That may be important in the timing.

Strip wounds will heal easily in 3-4 months and likewise, FUE wounds may heal in less time. As the areas of your focus are different (front and crown) you can have the second procedure as early as 3-4 months following the frontal surgery, provided everything is well healed.

I’ve just come across the DHI Direct Hair Implantation approach. DHI claims that it is better than FUE and Strip Surgery for reasons that include the following: (*) it leads to a 100% natural result, and (*) it involves no scars or holes. I do find it difficult to believe anyone claiming to have achieved 100% at anything. I also find the “no holes” idea self contradictory. However DHI seems to be rather convincing, except for the fact that no single Doctor’s career seems to be at stake. I have several questions, which I’ll limit to the following:

* Are you in a position to shed some light on the quality of the technique’s results? Perhaps in relation with FUE and strip surgery performed by average (and top notch) doctors?
* Are you aware of which method is used for the extraction of follicles? I couldn’t find this information on the company’s website.
* Is it possible for anyone to claim 100% natural results?

Finally, I’d like to disclose my personal situation and perhaps gain your opinion. I am 27 years old and have experienced gradual hairline recession. I’ve been on propecia for 1.5 years now. I’d like a lower hairline, but am in a position to wait at the expense of some self esteem issues. Should I go for a non-invasive technique such as DHI’s, or should I await the development of hair cloning techniques? Or might it be worth going for FUE or Strip?

Sorry for the difficult questions. I’m just confused, and I’m a PhD candidate researching informed consent!

If there is a cut on the skin, then you will certainly have a scar. All follicular unit extraction (FUE) procedures done, regardless of how small the instrument used, will produce some scar and from what I know about DHI, they are doing FUE. The point is that the small scars (dots or scar tissue) would not be as noticeable to the casual observer as a linear scar from strip surgery — especially when there is hair growing around it. If you sent a series of good pictures, I can offer you a telephone consultation.

As you have stated, you should always be cautious when someone (or some company) claims 100% of something. Sounds like marketing. With respect to certain medical groups, it is not my place here on BaldingBlog to endorse or discredit anyone. If you are interested in a particular doctor or clinic, you need to see the doctor, and meet some of their patients (in person). See if the claims stand up to your scrutiny. Anyone can have a convincing internet presence. Now you have to do the hard work of finding out the real truth.

You can wait for cloning, but it’s still in the early development stage and there’s no guarantees. It depends on how long you are willing to wait.

Check this out:Keep it under your hat but Gordon Ramsay’s had a £30,000 hair transplant

They mention that chef / TV personality Gordon Ramsay had a hair transplant using a “radical new treatment” called follicular unit extraction that “leaves no scars”. The press is so uninformed about things they report on sometimes. Hasn’t FUE been around for like a decade? What’s radical about it now?

Of course, you know that I pioneered follicular unit extraction (FUE) and published the first article in the medical literature on the technique in 2002. As for why the press is misreporting information, I don’t know why it happens. Perhaps it’s just laziness on their part.

FUE is far from a radical technique and it is incorrect to state that it leaves no scars, as anytime the human body is cut upon, there is ALWAYS a scar to some degree. The difference here between traditional hair transplants with strip harvesting (which leaves a linear scar) is that FUE leaves punctate scars that can be seen through the hairs in the donor area if the scalp is shaved very close there. Most people who have longer hair do not have visible scars, but that does not mean that it “leaves no scars”.

Good luck to Gordon Ramsay for the courage to address his hair loss concerns.

Dr. Rassman,

Good day sir. Big fan of the blog and all the information you provide. I will keep it short and sweet.

With all the advancements in FUE harvesting, do you think the strip method will become obsolete in the not too distant future?

Thanks and have a good day!

I really believe there will always be a place for hair transplantation with the strip technique. Follicular unit extraction (FUE) is not always the perfect or a preferred surgery, as many people seem to think. Grafts extracted using FUE are not the same as grafts cut under the microscope, and the growth and success is definitely different no matter how good the surgeon is. I speak from experience, as I was the first to publish about the FUE technique in 2002. Shortly after that publication, surgeons all over the world quickly jumped on the bandwagon to adopt it in their practices with varying results. Over the years, I have seen FUE promoted and sold to naive patients as a “better” surgery than the strip, but this is mostly marketing hype and leads to misinformation.

The two techniques (FUE and strip) both have their own unique place in hair transplant surgeries. For example, if you have a Norwood Class 4-6 balding pattern, a strip method of 3000 to 4000 grafts would be a perfect surgery to achieve a full look in ONE shot with a relatively lower cost than the FUE surgery. The strip scar wouldn’t be noticed by anyone unless you decided to shave your head (and if you were going to do that, why even have the surgery). Plus, I would almost never advise a Norwood 6 patient to have the FUE surgery, because there’s a higher incidence of transected hairs in the grafts from that technique. This would be a liability to someone who can’t afford to lose a single hair! Now on the other hand, if you are a Norwood 2 or 3 and wanting your front corners filled in, an FUE surgery may be perfect — especially if the hair is worn buzz-cut short.

Even if the ACell auto-cloning technology proves itself, the strip surgery may still remain the ‘workhorse’ of transplant surgeries. We may be doing combination of all the techniques combined.