Category: Hair Transplantation

I have a hair transplant procedure scheduled with a ABHRS surgeon yet I’m starting to have some concerns due the HLH/HTN websites.

Concern 1) On the HTN/HLH website there are a handful of doctors mentioned often in the forums – shaprio, wong, hasson, fellar and ironically these are the same docs that do most of the advertising – any other doctors basically sounds inferior. I find it hard to believe so many doctors are being excluded and if you mention their name on the forums the immediate majority response is see one the “HLH/HTN” inner-circle of doctors… Are these sites more of a gimmick then a legit source of information and where do you recommend finding a valid source of information regarding a hair transplant surgeon?

Concern 2) How much weight to put on the ABHRS certification. One of the boards member I believe is closely tied to MHR/Bosley – and that company just gets flamed on the HLH/HTN forums?

Thanks In Advance For The Time!

The advertising websites like Hair Transplant Network (HTN) and Hair Loss Help (HLH) provide a forum for their doctors to “pitch” the public with a storyline about themselves. These sites do restrict doctors to those who they believe perform only follicular unit transplantation and those who are willing to pay a fee to get the endorsements of the HTN/HLH websites. Some physicians do not like the politics of these websites, and certainly the HTN/HLH forums can be harsh on doctors (particularly if they are not paying members). Members are not necessarily spared from harsh criticism just because they pay their monthly fee, though. I have seen firsthand that these forums will try to implement controls on its user audience, but if freedom of speech is what is claimed, clamping down on vocal forum users can be difficult. Some forum users have too much time on their hands, are malicious jerks, or just lonely people who use the forums to obtain an audience. Others like the comradery of the group and provide interesting feedback on a variety of disparate subjects, so their input can be illuminating. If I were to have one criticism of those sites, it would be that many forum participants are out of their league with regard to the medical jargon and what it means, or when the issues of complications of surgery come up, there is a naivety in forum participants that everything is black or white. You need to do your own research — view photos, meet patients — and use these forums as a starting point, but don’t just accept 100% of what is written. As for why some doctors seem to be in the inner circle, I think it has to do with participation. The more these doctors participate, the more fans they gather, and the more vocal those fans become about those doctors. As for me, I tend to devote most of my available time to this site.

With regard to the American Board of Hair Restoration Surgery (ABHRS) certification, what this shows is whether these doctors passed the oral and written examination, and gained a standard of knowledge. The problem with the ABHRS is that the training of a hair restoration doctor is a willy nilly process that does not prove if the doctor is capable of performing the surgery with knowledge or wisdom under any reasonable situations that reflect the reality of the field.

When I took (and passed) the American Board of Surgery examination, it was two years after a five year intensive period of practical training with mentors (expert surgeons) watching me every step of the way. I was judged competent by these professors because they watched me as I made decisions and they followed the outcomes of my patients by direct observations of my results. The ABHRS can not replicate that type of control, so that means to me that their certification may have limited value to book testing alone. There are no great systems out there for quality certification of skill and knowledge as they integrate with each other in the field of hair restoration surgery. As I have said over and over again here on BaldingBlog — let the buyer beware!

Dear Doctor,

I have been doing a lot of reading about hair transplants because I see one in my near future. I have heard enough horror stories to know the importance of choosing a great transplant surgeon.

It just seems to me that the doctor’s role is “overrated.” I certainly do not mean any disrespect by that, but it seems that the transplant technicians have more of a role in the outcome, whether it be good or bad, than the doctor himself.

From what I understand, the doctor justs removes the donor strip, sutures the incision and makes the recipient sites. I may be ignorant of the matter, but this seems like something any general surgeon can easily do. The technicians though are responsible for dissecting and actually placing the grafts. If a transplant’s outcome is judged to be a success or not by the number of grafts that actually grow, then it seems that the technicians were more responsible for the outcome than the surgeon who merely made the holes in the person’s head.

I hope you don’t take anything I wrote as a slight against you or your profession, but if what I wrote is not true, please tell me what am I missing in my thinking?

The role of the technician is very important. What they do requires special skills that are tedious and at times require years to perfect. The hair that is cut from the strip must be efficiently dissected under the microscope and handled efficiently. Such work is best for a technician who has these functions as their sole activity. It takes a certain type of personality to be able to perform this type of work, great dexterity, and hand-eye coordination. Not to say no doctor has these things, but the complete skill list is honestly not the type that most doctors have. When I started to do the hair transplant procedures in larger and larger sessions, I originally participated in the cutting and placing the grafts, for it was I who defined the standards that the technicians would be held accountable for. So in the early days (1992-1993), I was the fastest graft preparer and the fastest graft placer, but as the graft counts went into the thousands of grafts, the work required more and more labor. Four or five technicians are a minimum number required for a large case of over 3000 grafts in 6-7 hours.

If I was to do this myself without the technicians, it would take me more than 24 hours and I would be exhausted, my eye strain would be incalculable, and the grafts may have died off by the time their turn came to placing them. If a graft is out of the body more than 8 hours, the death rate for the grafts runs 1% per hour. One could say, “Hey, lets get 5 surgeons to replace the 5 or so technicians,” but what that would do is:

1. Slow the process down, as doctors are generally not good at such disciplines.
2. Reduce the quality of the work, as doctors can not do repetitive work reliably for they often lack the patience.
3. Drive up the costs substantially out of the reach of most recipients, as doctors make more money than technicians.

Those reasons, in a nutshell, are why technicians are used throughout surgery. Another example where technicians are used in surgical procedures — open heart surgery. It is the pump technicians that control the patient’s circulation.

Now with regard to what the surgeon does, it is not as simple as you suggest. There is a special skill required in planning the surgery, and I suppose to prove this you’d have to spend a day with me to see the many patients that come in for repairs with results reflecting a lack of strategy in their hair transplant procedure. When a doctor just looks at it as cutting out a strip and putting holes in the head of the patient, the results can be frequently substandard. So while I don’t take what you said as a slight, I hope this helps explain things a little better.