Review of Hair Transplant Related Medical Literature: by Dr. Alan Feller and Dr. Blake Bloxham of Great Neck, NY for Hair Transplant Web.
“Notes from the Editor Emeritus, 2005-07”
Original Publication: ISHRS, Hair Transplant Forum International. Volume 28/ Number 4/ July -August 2018. Page 137
Dr. Robert Haber
Author: Robert S. Haber, MD, FISHRS- Cleveland, Ohio
Dr. Haber’s article may be split into two major topics:
First Topic:
The first topic is that each evolution in the modernization of hair transplant procedures came with significant resistance and battles.
He commented that at first all the significant advances in HT were largely resisted and challenged but were then generally accepted based on experience and merit: His examples were comprehensive and perfect:
- Plug harvest to Strip Harvest.
- Naked eye dissection to Microscope usage.
- Small sessions to Megasessions.
- Cutting grafts to size (minigrafts) to Follicular units.
- Multiple stacked donor scars to a (longer) single scar.
However, after introducing the FUE technique and the kind of donor scarring it leaves behind, he correctly stopped short of adding it as example #6 in the evolution of HT. Instead, he pivots his article to his second major topic which discussed how non-doctors and mid-level practitioners (RNs, PAs) are now performing FUE, and the legal or illegal ramifications thereof.
Second Topic:
His belief is that because a punch is easier to use than a scalpel it opened the door to both legal and illegal performance of hair transplant surgery which may have spurred the development of something even more sinister: machines such as those from “NeoGraft and ARTAS which are promoted as requiring minimal training or expertise”.
He is 100% correct.
He goes on to suggest that from the creation of these machines forward: rather than experienced hair transplant specialists competing with each other in the thousands, such experts will now be competing with amateur hair physicians in the tens of thousands (worldwide presumably) who seek simply to add it to some other existing practice to increase the bottom line. And he is, again, 100% correct because as he states later in the article many of these doctors simply do not possess the experience or support staff of a seasoned FUT/FUE doctor. More ominously, many of these doctors will unlawfully delegate the use of these machines to unlicensed/unqualified personnel freeing them up to perform some other billable procedure on another patient at the same time.
He states that little can be done about unlawful delegation and that the battle against this reprehensible practice has moved to State Medical Boards and State Attorney General offices.
Discussion
As for the first topic:
It is interesting that Dr. Haber didn’t definitively include FUE as the next level in the evolution of HT. After performing hundreds of FUE procedures myself since its introduction into North America I agree with his decision to stop short of doing this. The reasons for his hitting the brakes is something I am going to ask him about in an upcoming phone/skype interview, but my belief is that FUE is more of a branch to a dead-end in the evolutionary development of HT rather than the next step. In brief this is because of the lower growth rates and increased donor damage it inflicts on the patient. Add to this the fact that most doctors offering FUE megasessions over FUT megasessions are failing to provide their patients with informed consent. If they did, I believe the number of requests for FUE megasessions would drop to near zero as would the number of destroyed donor areas from doctors irresponsibly applying this procedure.
As for the second topic:
Dr. Haber correctly points out that the ISHRS has moved to exclude from membership any doctor that admits to unlawful delegation of FUE to unlicensed/unqualified personnel. Dr. Ken Washinick even created a movement complete with logo to increase awareness among doctors and patients alike. The problem is that while some doctors have admitted to engaging in this reprehensible behavior and left the ISHRS some simply do not admit to it (called lying) and are among the membership to this very day.
Moving Forward:
There is just so much the ISHRS can do, as mentioned by Dr. Haber, but there is much more that can be done beyond the ISHRS. There already exist explicit medical rules and regulations regarding what procedures may and may not be delegated. I am currently working with two attorneys about this problem and in our research have already found that in at least two states there already exists on the books regulations that prohibit the delegation of surgery to so-called FUE technicians.We will report on the progress of our efforts as we move forward right here on hairtransplantweb.com.
Video Interview with Dr. Haber about this article.
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