Harley Street HT Clinics
Valued member
A successful hair transplant is not only built on the amount and quality of hair growth, but also good donor management, limiting the changes to the donor region. The donor hair follicles are a finite resource and should be treated by the clinic as gold dust.
Traditionally, and correctly, the doctor would perform all the surgical steps to a hair transplant, making an incision into the skin, is a surgical step. With their team of technicians in support, having specific duties to ensure the smooth running of the procedure. However, over the years FUE standards and protocols have been diluted, with the lines between who performs what becoming blurred. Concerningly a growing number of clinics adopted the model of technician-led FUE, with the technician for all intent and purposes performing the entire procedure, especially if the clinic uses the implanter for graft placement, as the doctor is not even making the recipient sites.
Technicians are generally not medically qualified; a clinic may have a nurse as a lead technician, but it´s not a rule and not commonplace. As a result, these clinics are performing what are surgical steps of the procedure using non-medically certified staff. This is contrary to the UK guidelines set by the General Medical Council (GMC), the British Association of Aesthetic Plastic Surgeons (BAAPS), and the Cosmetic Practice Standards Authority (CPSA).
FUE is a blind harvesting technique; meaning, it´s not possible to see below the surface of the skin when making the punch incision, it is only possible to see the hair shaft direction as it exits the skin. The angle and orientation the hair exits the skin can be, and often is, contrary to the hair follicles positioning under the skin. Consequently, for FUE to be performed to the highest standard, it´s important to have a better than good medical understanding of hair characteristics and skin physiology, to stop the risk of transection spiraling out of control. For example, a hair may exit the skin one direction, logic may suggest the punch will follow the same direction into the skin. However, this increases the risk of transection, hair characteristics don´t always work like this, hair follicles are different shapes and sizes, and direction of the hair you see maybe different to the position of the hair follicle under the skin.
Medically unqualified technicians cannot be expected to appreciate these subtle but important nuances to anatomy, while some may be able to learn, it does not change the fact that a medically unqualified individual should not be making incisions into the skin. As this practice spread the ISHRS, The International Society of Hair Restoration Surgery took an uncompromising approach against technician-led hair transplant surgery. “any procedure involving a skin incision on the scalp constitutes a surgical act and must be performed exclusively by a licensed, trained physician.”
It´s not unusual with tech-led FUE to have two technicians punching on either side of the head in tandem, for the clinic it means a faster procedure, more patients per day, less cost. The cost of a technician is a fraction of the cost of a doctor, so having a large tech team doing the punching is cost effective and opens the ability to perform multiple procedures daily. You just don´t want to be the last one of a busy day.
With limited standards and protocols in place this will lead to mistakes that can spiral. For instance, transection and over harvesting. Often with two technicians punching on either side of the head for speed will increase the transection rate and hit double percentage figures, simply by the law of averages, then with larger FUE procedures there is the issue of fatigue and concentration, as well harder to find areas to punch, so more likely to over harvest, and or transect adjacent hair follicles.
Often technicians will use a larger diameter punch compared to an experienced doctor, a larger punch requires less skill but will cause more damage. A larger punch is faster, more tissue is removed, so larger scarring and the risk of overlapping adjacent hair follicles and splitting them at best, and at worse transecting them.
A hair transplant is elective surgery; it is important to do your due diligence. A golden rule - never judge the competency of one clinic by the standards of another, as standards vary. Never assume the doctor will perform the FUE punch, always confirm, in writing, you do not want a bad surprise on the day, you´ve paid your money, head shaved, meds administered and the technicians come in ready to punch and you assumed it would, obviously, be the doctor; you are now in an awkward, compromised situation.
Traditionally, and correctly, the doctor would perform all the surgical steps to a hair transplant, making an incision into the skin, is a surgical step. With their team of technicians in support, having specific duties to ensure the smooth running of the procedure. However, over the years FUE standards and protocols have been diluted, with the lines between who performs what becoming blurred. Concerningly a growing number of clinics adopted the model of technician-led FUE, with the technician for all intent and purposes performing the entire procedure, especially if the clinic uses the implanter for graft placement, as the doctor is not even making the recipient sites.
Technicians are generally not medically qualified; a clinic may have a nurse as a lead technician, but it´s not a rule and not commonplace. As a result, these clinics are performing what are surgical steps of the procedure using non-medically certified staff. This is contrary to the UK guidelines set by the General Medical Council (GMC), the British Association of Aesthetic Plastic Surgeons (BAAPS), and the Cosmetic Practice Standards Authority (CPSA).
FUE is a blind harvesting technique; meaning, it´s not possible to see below the surface of the skin when making the punch incision, it is only possible to see the hair shaft direction as it exits the skin. The angle and orientation the hair exits the skin can be, and often is, contrary to the hair follicles positioning under the skin. Consequently, for FUE to be performed to the highest standard, it´s important to have a better than good medical understanding of hair characteristics and skin physiology, to stop the risk of transection spiraling out of control. For example, a hair may exit the skin one direction, logic may suggest the punch will follow the same direction into the skin. However, this increases the risk of transection, hair characteristics don´t always work like this, hair follicles are different shapes and sizes, and direction of the hair you see maybe different to the position of the hair follicle under the skin.
Medically unqualified technicians cannot be expected to appreciate these subtle but important nuances to anatomy, while some may be able to learn, it does not change the fact that a medically unqualified individual should not be making incisions into the skin. As this practice spread the ISHRS, The International Society of Hair Restoration Surgery took an uncompromising approach against technician-led hair transplant surgery. “any procedure involving a skin incision on the scalp constitutes a surgical act and must be performed exclusively by a licensed, trained physician.”
It´s not unusual with tech-led FUE to have two technicians punching on either side of the head in tandem, for the clinic it means a faster procedure, more patients per day, less cost. The cost of a technician is a fraction of the cost of a doctor, so having a large tech team doing the punching is cost effective and opens the ability to perform multiple procedures daily. You just don´t want to be the last one of a busy day.
With limited standards and protocols in place this will lead to mistakes that can spiral. For instance, transection and over harvesting. Often with two technicians punching on either side of the head for speed will increase the transection rate and hit double percentage figures, simply by the law of averages, then with larger FUE procedures there is the issue of fatigue and concentration, as well harder to find areas to punch, so more likely to over harvest, and or transect adjacent hair follicles.
Often technicians will use a larger diameter punch compared to an experienced doctor, a larger punch requires less skill but will cause more damage. A larger punch is faster, more tissue is removed, so larger scarring and the risk of overlapping adjacent hair follicles and splitting them at best, and at worse transecting them.
A hair transplant is elective surgery; it is important to do your due diligence. A golden rule - never judge the competency of one clinic by the standards of another, as standards vary. Never assume the doctor will perform the FUE punch, always confirm, in writing, you do not want a bad surprise on the day, you´ve paid your money, head shaved, meds administered and the technicians come in ready to punch and you assumed it would, obviously, be the doctor; you are now in an awkward, compromised situation.
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