NeoGraft Hair Transplant: Will this New Device Make FUE More Affordable And Safe?

The targeted removal of follicular unit grafts, known as Follicular Unit Extraction (FUE), certainly has its place in the field of surgical hair restoration. However, since the procedure has proven to be extremely labor intensive when performed correctly, and limited by the number of grafts that can be safety harvested intact per procedure, many in the field have chosen not to offer this procedure to their patients.

We have also seen some dismal results coming from some of the clinics that have over marketed the procedure without actually learning how to perform it correctly. IAHRS Member, Dr. Alan Feller has repeatedly warned patients about the three detrimental forces that are unique to FUE procedures, these are:

1.Torsion
2.Traction
3.Compression

Will the NeoGraft device help to eliminate these possible detrimental graft destroying forces and allow more hair transplant surgeons to offer FUE to patients who qualify for the procedure?


UPDATED: VIEW IMAGES

So the device is essentially a 1 step scoring and extraction device? I take it that the grafts are vacuumed out into the receptacle once a certain depth is reached?

A couple of questions:
1. What size is the extraction tool--inner and outer diameter?
2. What potential for damage to the grafts as they are vacuumed out into the receptacle?
3. How does the tool help mimic the graft angle better than a regular hand-held punch?
3a. If this does create an easier extraction method, reducing the above factors laid out by Dr. Feller, is the size of the extraction increased to accommodate a lack of "feel" gained by using a regular punch.

Looks interesting--I would like to see it in action in person.

Take Care,
Jason

Quote:

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Originally Posted by the B spot

So the device is essentially a 1 step scoring and extraction device? I take it that the grafts are vacuumed out into the receptacle once a certain depth is reached?

A couple of questions:
1. What size is the extraction tool--inner and outer diameter?
2. What potential for damage to the grafts as they are vacuumed out into the receptacle?
3. How does the tool help mimic the graft angle better than a regular hand-held punch?
3a. If this does create an easier extraction method, reducing the above factors laid out by Dr. Feller, is the size of the extraction increased to accommodate a lack of "feel" gained by using a regular punch.

Looks interesting--I would like to see it in action in person.

Take Care,
Jason

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Hey Jason,

I’m having Dr. Bauman on the radio program this Sunday 3/15, so feel free to call in with your questions and your FUE insight.

If you don’t have an XM subscription you can watch and listen live here:

http://www.thebaldtruth.com/watch-live/

Arrrrggg! I will not be able to listen this week!!!! Trust me, I am going to my wife's parent's this weekend----I would much rather listen to your show than listen to them screech at each other for 3-4 hours :mad:

I used to wonder why people drank wine at these functions----now I know :D

Hopefully Dr. Bauman can respond here if/when he finds the time---Technology is so awesome---I know Dr. Shapiro is a real tech nut, so I am bringing this to his attention!

Take Care,
Jason

No worries Jason,

I’m convinced my future in-laws think I have a drinking problem..I get it!:) We’ll be archiving the broadcast so you can listen at your leisure.

The video looks impressive. The machine looks like a combination dental drill and water suctioning machine that you see in dentists offices. I assume that there would be less damage done to the follicles since the suction would not be strong enough to rip apart the hairs themselves. Have you ever tried to break a hair, it takes some strength. The skin probably just gives once the cut is made deep enough. I’m no engineer, but this tool looks like it works and if those pictures are the results then they look good.

Spencer, how long has Dr. Bauman been using this thing and on how many patients?

Wow, this is awesome! It would be fantastic if this could bring down the cost of FUE. How big is the punch?

We have just received this information from Dr. Bauman, he has been in surgery all day. He says that when he has time he will be more than happy to answer all your questions.

Dr. Bauman wrote:
"Personally, I use an 0.8mm punch when using the Neograft.
These updated photos have a brief description:

http://www.baldtruthtalk.com/picture...&pictureid=767

In this Neograft hair transplant case, a 0.8mm limited-depth instrument makes a small 'scoring' incision around the follicle. The grafts can then be manually extracted with forceps or extracted with suction from the Neograft machine.

http://www.baldtruthtalk.com/picture...&pictureid=766

The extracted grafts are examined and sorted by intact follicles per graft. Grafts with transected follicles are counted and tracked for quality-control purposes. This handful of grafts was obtained approximately 1/3 of the way through the Neograft FUE hair transplant procedure. FUE grafts are typically smaller than microscopically-dissected micrografts. Therefore, they require extra care and attention to remain viable for implantation.

http://www.baldtruthtalk.com/picture...&pictureid=765

FUE with Neograft allows a minimally-invasive approach to hair transplantation with no visible linear scar. This is a 0.8mm limited depth instrument making a scoring incision around the graft. To maximize the harvested yield per procedure, patients are encouraged to allow us to 'buzz' their hair to a 'zero' with an electric clipper. A 'zero' length on a clipper is actually approximately 3mm

http://www.baldtruthtalk.com/picture...&pictureid=764

This shows the manual extraction of an FUE graft during transplantation. A very specific, gentle approach is used to remove the graft from the skin without trauma to the follicle.

http://www.baldtruthtalk.com/picture...&pictureid=763

FUE harvesting during a Neograft procedure is a team approach. Tiny incisions are made with the Neograft device around each graft and then they are literally 'plucked' from the skin.

http://www.baldtruthtalk.com/picture...&pictureid=762

Careful extraction of an FUE graft during an hair transplant procedure. The initial incision was made with a 0.8mm Neograft device.

http://www.baldtruthtalk.com/picture...&pictureid=761

The major advantage of any FUE procedure is the lack of a linear scar. The tiny 0.8mm harvest sites close 50% in size within 24 hours and can be completely undetectable within a weeks time, depending on the quality of hair in the donor area. Eventually, when the surrounding hair reaches a certain length (approximately 8mm) the area is completely camouflaged.

http://www.baldtruthtalk.com/picture...&pictureid=760

The recipient area of a hair transplant procedure is the thinning area where the follicles are transplanted to. The Neograft device assists with implantation throught the use of dual mechanical implanters which use suction and positive air pressure to gently place the grafts into the sites the surgeon has created--without the use of forceps. For this patient, we transplanted 1603 grafts into the recipient areas. All grafts were placed into sites that were 1mm in size or less. Hair growth typically begins around 6 weeks, with improvements in coverage occurring from 4 to 6 months, full result in 12 months.

http://www.baldtruthtalk.com/picture...&pictureid=759

Fast and efficient FUE hair transplant procedures is what Neograft promises. Can the Neograft deliver? FUE is typically tedious and slow. The question is whether Negraft will accelerate the process allowing for more efficient FUE-type harvesting.

http://www.baldtruthtalk.com/picture...&pictureid=758

This is an updated photo to reflect the status of the recipient area at post-op day #8. Please note that although the transplanted area appears 'full,' it is expected that the transplanted hairs will shed within the next few days and then begin to regrow within 6-12 weeks. Half of the result should be visible at 6 months, full results in 12 months.

http://www.baldtruthtalk.com/picture...&pictureid=757

This is an updated photo to reflect the status of the donor area at post-op day #8.

Thank you for your prompt reply Dr. Bauman.

I guess the only thing left is to actually check the machine out. I am encouraged by these type of advancements--It is my hope that fue becomes commonplace and lest costly as a result.

The work you posted looks very clean and the patient should have a great result!

Take Care,
Jason

I saw this machine in Montreal and got the guys to talk me through it,it looked impressive.

I think the only concern i had was that the storage area for the grafts should not be overfilled if the suction method of extracting the grafts was used.

I seem to remember it was quite expensive too.

It will be good to see one year results from patients who have had this machine used on them.

Thanks for a great informative post.

bm.

That was a great radio show tonight! Dr. Bauman sounds like he's way ahead of the pack. I enjoyed listening very much and Im interested in seeing more pictures of this procedure.

I second that Spencer. The bald truth is the best show on radio today! Your take on life is so right on! Thank you for helping all of us to feel that we’re not crazy to worry about our hair!!!

Dr. Feller, Dr. Bauman and All--- I love the ingenuity to try and get "better" using the amazing technology at our fingertips. It is a testament to a select few who strive to get better every day, regardless of past success.

With that said,
I think the person doing the extractions must still have the "feel" to mimic the angle of the follicle, regardless of what tool is used. Once Dr. Bauman explained he used this machine with a .8mm punch/extractor, he confirmed my suspicion that his personal skill has a tremendous impact on the success of the NeoGraft's use.

For those who have not seen a .8-.9-1.0mm punch in use, let me tell you it is HARD WORK and exhausting. It is very labor intensive, and is very draining physically and mentally. This is why Dr Feller, Dr. Bauman, and others continue to stress the fact that FUE is not a miracle solution, not everyone is a candidate, and donor management is just as important as ever.

Because I have not seen the machine in use and Dr. Feller already established some concerns I will refrain from any additional technical debate.

However, perhaps if this machine can obtain VIABLE grafts on a majority of FUE candidates, it has the potential to reduce the overall stress of the FUE scoring and extraction process and allow additional clinics to offer FUE. That remains to be seen.

On a potentially negative note, technology such as this is often very cost prohibitive and would likely pressure any clinic to do larger than advisable sessions in an attempt to recoup costs. That could have a very damaging effect long-term on the patient and reputation of the clinic. Dr. Feller's point about unpracticed doctors performing FUE is certainly legitimate when viewed in this light.

Spencer, Dr. Feller, Dr, Bauman-- perhaps we could put together a "meeting of the minds" to observe the viability of the machine and exchange ideas and techniques on FUE in general. Given much of the ignorance and over-selling of FUE, it would be a step in the right direction to have well respected doctors come together to share ideas. Just an idea!

Take Care,
Jason

Brilliantly articulated Dr. Feller! I enjoy reading your posts and listening to you when you call Spencer's show. I like how you couple your engineering background with medicine, providing a unique perspective that not alot of people have or can conjecture on their own.

We engineers are cool, aren't we? :-)

TeeJay

I too greatly welcome the dialogue that goes on between esteemed colleagues and educated lay people. In the 18 plus years of being intimately invoved in the plastic surgery and hair restoration field, I have been witness to an endless number of new technologies- most of which were released with great fanfare, only to be discarded a year or two later as the touted advantages prove to be short-lived. Examples: Dr. Rassman's hair implanter carousel; thread lifts for facial rejuvenation; and Thermage skin tightener. Even the initial laser hair combs and Rogaine, two innovative treatments that now have a potential role in treating hair loss (at least LLLLT hoods such as Revage that seem to be the best system and perhaps the hair combs) got released initially with such incredible accolades that the hype was much more than the reality - all in the name of making money, and perhaps secondarily in helping patients. Maybe when selling cars or perfume, hype and marketing should take precedence over data, but when it comes to medicine- surgery in particular- restraint must take precedence.

I have not seen the NeoGraft system in use, other than a promotional /educational video put out by Dr. Bauman in conjunction with the very company that plans to benefit from such a device- and I cannot think of anyone better than Dr. Bauman to get the message out about this device. What concerns me however, is that there is, quite frankly very little evidence that this device is superior to standard techniques of FUE- in fact, having the delicate hair follicles exposed to suction and air flow, I have similar (but unproven) concerns as Dr. Feller- about the viability of the hairs. Second, in my practice, my FUE grafts after dissection are typically placed into recipient sites 0.5 to 0.6 mm in size, occasionally 0.7 mm- while the automatic planter for the NeoGraft works with recipient sites 0.8 mm and larger, unless I misunderstood. Smaller recipient sites allow for denser packing and more impressive results, and potentially less scarring.
I rely on my carefully trained team of assistants to allow me to harvest (then implant) as many as 1800 FUE grafts in a single 8 hour procedure- equal to apparently the peak number of grafts that the NeoGraft can obtain. Then for planting, these same assistants work with me to place the grafts into recipient sites that I have made with 0.5 to 0.7 mm recipient sites. This is the artistry of hair restoration, and no machine is going to take the place of individual surgeon artistic skills and passion and the skills of talented assistants.

I greatly look forward to seeing some data - reliable US released data by respected peers such as Dr. Bauman- before making any conclusions other than the NeoGraft does seem to allow for the obtaining of FUE grafts with the use of fewer assistants. This is not an advantage for me at this time, but I do hope that the device does improve the results of FUE hair transplants.


Jeffrey Epstein, MD, FACS
www.foundhair.com

Dr. Feller, Dr. Epstein, Dr. Bauman and all,

It’s great to see truly passionate experts discussing any possible advancement in the field of surgical hair restoration. Baldtruthtalk.com was created to help better educate and to empower, not only the hair loss consumer, but the hair loss physician as well. Education is an ever evolving process and I’ve learned over the years that while asserting opinions is important for obvious reasons, asserting them in a doctrinaire or dogmatic manner usually creates a less than comfortable environment in which to learn and to share ideas.

In my view, until it’s proven that the the Neograft machine damages grafts, terms like “detrimental forces”, “torsion” and “desiccation”, are simply words used to make a theoretical point.

Dr. Feller, your insight holds great significance and is a needed part of this dialogue, but it’s equally important to understand that there might be more than one way to skin a cat. I think Dr. Bauman’s track record speaks for itself, as do the track records of all of your esteem colleagues in the IAHRS.

As Dr. Epstein so eloquently eludes to, there are very few in the field who have been as effective in promoting state of the art surgical hair restoration to the mainstream consciousness as Dr. Alan Bauman. I see this as just one of Dr. Bauman's considerable contributions to the field.


I look forward to continuing this dialogue in a professional and mutually respectful manner.

Beautifully put Spencer.
Loo,king forward to seeing more from Dr. Baumann on this device.

Very well put Spencer. I think this machine looks like it might have real value and I don’t think Dr. Bauaman would risk his reputation on a machine that didn’t work.

Thanks for stating your opinion Dr. Feller. Again your insight and your passion for the profession is what makes your online participation so invaluable.

My question at that start of this thread was:
Will the NeoGraft device help to eliminate these possible detrimental graft destroying forces and allow more hair transplant surgeons to offer FUE to patients who qualify for the procedure?

It’s simply a question. At this point until I see more results this entire thread is simply a vehicle to share our thoughts and ask questions about the Neograft machine. I’m hoping we can continue this dialogue without pointing fingers or eluding to the unethical marketing of FUE by well respected members of the field.

That’s it, no big deal. We’re just having a friendly discussion, and I think it’s fair to state that it should be conducted with professionalism and courtesy. I know this is a foreign concept to our online world, but I think it’s time the we begin setting some higher standards for the profession.

bspot, I don't know how I missed this before, but I just noticed something classy at your signature. You're a Cubs fan! ;)

Now, back to the issue. Not that I am any expert on FUE instrumentation, nor a licensed physician, but in the past 29 years, I have seen alot of these come and go. Several years or more ago, there was a big hype about the FUE implanter, remember? Where is it now? Where are the published findings? In the New England Journal Of Medicine? No. In the education arm of the ISHRS? No. Any other society or affiliation, association, not to my knowledge. It's just my opinion but this has that sort of laser comb smell to it.

And some of you have brought up some of the valid points that Dr. Feller mentioned in another thread and noted below. Yet if you consider the dynamics of torsion, traction, and compression in the extraction process, are they not ultimately controlled by the tooling as well as the surgeon's feel? What is going to replace the feel in the extraction process? What about dermal depth analysis? Oh, I know someone is going to say, "that's what this new machine is supposed to do".

It's just very difficult for me to imagine that a machine, albeit "cutting edge" technology can make all of the adjustments on every FU targeted for extraction concurrently. And then with the same extraction size for every FU regardless of size. Same size for a single hair FU as a five hair FU extraction? Really? What about extracting MUGs? One size fits all? Really?

I have a hard time believing that any prudent FUE surgeon who also is considering the lowest degree of invasiveness "per patient" is not going to utitlize a combination of punches and extraction tools. How does the FUE surgeon balance out the level of invasiveness (post-op scarring) with transection? Or is the issue going to be pursued and confined to "speed and efficiency" of the extraction process? Give me a break.

Who's ever publishing transection rates or let's be positive about this, FUE YIELDS regardless of the methodology? NO ONE, extraction equipment or not. And before anyone speaks up to dare challenge what I am saying, be ready to present your verifiable and substantiated clinical findings.

Don't get me wrong, I am all for scientific research and technological advancements in this field of surgical hair restoration, and yes there are some docs who always seem to jump on the bandwagon and really push these new devices. Is it really to advance the field or advance one's bank account? And really, I mean no offense to anyone in particular. But ultimately, who is really benefitting from speed and reduced OR staffs? The patient? Really? Really? Or could it just by chance be the clinic or the ones who hold the patent? And why most of the dialogue in the economics and proficiencies of the procedure? What happened to yield?! Every HT patient cares about yield right?

What happened? Did I miss something? What happened to the patient?

We’ll be continuing the NeoGraft discussion tonight on the live broadcast. If you don't subscribe to XM Satellite Radio, you can watch tonight’s program here:
The Bald Truth Live!

Feel free to call in to join the discussion. The toll free number is 1-877-885-0007. The program airs at 5pmPST/8pmEST.

Great show last night guys. You guys sounded like you were having a blast. Vey informative as usual too! How come TeeJay got to do the show with you guys. I want in.:)

Paul

The show was very entertaining , I enjoyed listening very much. Hairloss stuff can be so dry when I read about it, but it’s cool to listen to the people in the know talking about it.

I still don’t know however if the Neograft is a good thing or a bad thing. Spencer seems to be on the fence about it and Dr. Law said it had some value, but Dr. Feller makes it out like it’s worthless. What’s the answer?

I'll throw in my 2-cents as a pure layman and as a happy hair transplant patient (strip method). I even had a chance to say this on the show last nite. (Thanks Spencer, you're THE MAN!).

If I am going to undergo cosmetic surgery (and I have), then I am going to do as much research and due diligence beforehand as possible. When I put all of the information that I have learned regarding the strip method next to all of the information that I have learned regarding FUE (regardless of how the FUE is performed, machine, or no machine), I conclude that the strip method has a substantially greater knowledge base attached to it and is significantly more time-tested, trusted, and "doctor approved". I also conclude that the strip method produces consistently, very well-known high yield rates (meaning that the % of transplated grafts that grow in their new area is 90% or more). The FUE method, on the other hand, and again based on what I have read and learned, seems to produce very sporadic yield rates, sometimes as low as 50%.

The mere fact that "yield" is a focus point in HTs means that when a patient undergoes an HT, he/she is actually reducing the total # of hairs on his head. He/she is simply creating the illusion of a fuller head of hair thru the cosmetic redistribution of hairs across the head. If I am going to pay my money to reduce the total # of hairs on my head, then I am going to go with the method that offers the best possible guarantee of the minimization of this reduction, and the strip method seems to be the clear winner. I'm too conservative and I'd be too nervous to undergo FUE of any type, not knowing what % of my precious grafts were going to survive the surgery. And I'd be on "pins & needles" for the 6 months or so that are needed to get some idea of the HT results. So, as a pure layman, FUE isn't something I'd even consider, irrespective of how the grafts are extracted (machine, or no machine).

I say this, and at the same time have complete and total admiration for Dr. Bauman. If I lived in Florida, there is not a doubt in my mind that I'd choose him to be my physician. His results are incredible and I love the fact that he is so leading-edge in his practice, using the latest tools and technologies in an effort to make patients happy and advance the surgical HT field. I like to be leading-edge in my own work, too, using the latest tools and technologies, even if they aren't time-tested yet, or accepted entirely by my peers and colleagues.

I guess the dividing line here is this: as a doctor, charging ahead with new tools and technologies, as well as challenging them, ultimately benefits HT patients, even if it may not seem so at the immediate moment, and it certainly endears me (and probably other patients) to the doctors that use and/or challenge these new tools and technologies. But as a patient that is altering his physical appearance (quite expensively, too!) and undergoing the risks of surgery, I am just not interested in the additional risk that FUE seems to come with, no matter how it is performed, even if that means the strip method is slightly more invasive and produces a linear scar, both of which in my opinion (as a veteran HT patient) are no big deal.

TeeJay

Quote:

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Originally Posted by Dr. Feller

Gil,
In the end, as you've already eloquently noted, it's all about RESULTS.

The device is described as making extraction FASTER, but not a word was said about extracting grafts SAFER.

I do not see where this mega-machine improves graft safty by lowering graft trauma. In fact, I see the opposite with respect to that spinning punch and the gauntlet of suction tubing the graft must travel through.

This is why I am so adament about articulating and describing the forces working against us: Torsion, Traction, Compression. Any proposed FUE advance must address either one or ALL of these forces to be of any use.

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I could not agree more Dr. Feller. I just shuddered when I read about the dynamics of how it works and the additional trauma the grafts would sustain. I mean I don't know how it could be avoided considering the mechanics.

Where is the scientific evidence regarding lowered transection and improved yields? Because without that, I am trying to figure out what benefit it has for patients.

Great post TJ and I agree with alot of what you stated. The only thing though is your statement about being time-tested or not. Something like this piece of equipment must be time-tested or clinically substantiated with scientific proof. And for the reasons you stated, donor limitations and yield. All of my work was done by strip but now I am out of laxity. If I ever do have any touch-up work, it may have to be done by FUE because I don't think I can regain enough laxity after four strip procedures.

But if I do ever have FUE, you can bet it won't be by Neograft.

Saw you on the show TJ, your hair transplant looks very natural. You were quite good on the show too, were you nervous to be at the radio station and to talk on the radio?You sounded quite relaxed.

If there was evidence that the hair grafts really got “cooked” how can this machine be sold and used for hair transplantation? How can you tell if the grafts were heated to the point of being destroyed and don't you think it would be counter intuitive for a company to sell a hair transplant machine that results in inferior hair transplants?

Quote:

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Originally Posted by HelpROGER

Saw you on the show TJ, your hair transplant looks very natural. You were quite good on the show too, were you nervous to be at the radio station and to talk on the radio?You sounded quite relaxed.

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Hey HelpROGER,

Appreciate the hair transplant and radio compliment. It's been an interesting hair journey, man, but I am very lucky. One botched up surgery with a non-IAHRS clinic (800 grafts), and then a great surgery with Doc McAndrews of the IAHRS (1600 grafts). Doc McAndrews really fixed me up good.

Being on the radio was friggin' sweet. Spencer is one of the coolest guys ever, seriously -- laid-back, easy-going, and fun. Turns out I wasn't feeling nervous; I just gave into the experience entirely, which was an awesome one and I have Spencer to thank. I did knock down a thing or 2 in the studio, and spilled some water all over the place, but I think that may have been the little bit of scotch I downed, as opposed to nerves:)

TeeJay

Why don't they add some kind of a cooling sheath, something that does not conduct heat, to the inside of the punches used? This will solve the heating problem.

Thanks Dr. Feller. What you say makes sense, but I'm the type of person who needs to see proof for either side.:)

With this Neograft machine,were any hair transplant doctors involved in its development?

The Neograft website is pretty vague to say the least.

They claim its been in use for 3 years now so i would assume there should be ample examples of patients who`ve had a HT with this machine.

I`m not saying its a good or bad thing,just would like to see some documented results.

bm.

Gentle readers, let me remind you that doctors are required to give full disclosure when they have a financial interest in a product that they are discussing and promoting. This is important whether we are talking about a ten dollar disposable punch or an $85,000 machine. There is always a conflict of interest whenever anyone profits from selling or promoting anything, but in medicine doctors are held to a higher ethical standard by their medical licensing board, in order to protect the unwitting patient’s life and limb (scalp and hair). It would be proper to have full disclosure here.

And, don’t forget that prototypes of powered punching, sucking, and graft insertion machines have been available since at least 1996 (ref: Hair Replacement Surgical and Medical; Stough and Haber; pub, Mosby 1996 chapter 11, section D, pages 370-374 “Automated Hair Transplant Systems: the Boudjema Technique”). One of the latest versions has been renamed the “Neograft” machine. There have always been problems with this technology that continue to plague those brave enough to use it today. There are still many unanswered questions and a paucity of available documented results. Hmm?
Also, gentle readers, we should all be reminded that whatever experience one has had in the past practicing FUE with hand tools, motorized technology is powerful and represents a potential paradigm shift in FUE. It is not clear that this possibly faster, and possibly easier (due to decreased user stress fatigue) method can produce equal or better results than manual FUE (much less strip surgery ). When one newly incorporates a specific machine into their practice, one with which they have only recently received training, one must be careful not to include older manual FUE before and after results in the discussion of “Neograft” powered surgery. That would be confusing and misleading. As always, pictures should be accurately labeled, in this case at least as to whether a hand punch or motorized punch was used (and even clarify motorized as to whether rotary, oscillating, etc…). These small details are relevant and people are looking. Do the pictures represent suction extraction or manual extraction, pneumatic insertion or manual insertion?

By the way, there also many issues taken state by state, as to what unlicensed individuals (technicians) participating in FUE surgery are legally allowed to do. Can they man the punching device and essentially drill a patient’s scalp one to 1500 or 1600 hundred times? I think patients may be alarmed to find out that the procedure is easier for the doctor “performing” FUE surgery (and to whom they gave their hard earned cash) because he is not even scoring the skin, much less extracting the tissue (grafts). This may be one reason some doctors have kept their FUE practices shrouded in secrecy. This is only legal according to Neograft, Inc. (and by extension any doctor acting as their contracted representative). In fact, this is reminiscent of the LIMA scandal in New York in the early 1990’s where two enterprising technicians set up shop after hours and performed half price plug transplants in the doctor’s own office. When supplies diminished without explanation, the doctor set up a camera. Boo-yah! Two technicians were prosecuted and one did hard time in jail at Ryker’s Island! How quickly we forget! In the LIMA case the doctor was being taken advantage of. But what about the doctor who is complicit in allowing illegal undertakings to go on in his office? I’m not naming names here, but will he lose his medical license or end up in Ryker’s Island all so the patient can have his hair replaced one at a time and have a perfect donor area as well. Jail time or…arghh…!

Interesting Dr. Law---I remember the Lima scandal----the legal system worked very quickly to put the techs out of commission.

Unfortunately, we are unable to say the same for the many others committing the same crimes using the exact techniques who just happened to have M.D. after their name.

Again, your 100% right about disclosure--- it will be interesting to see if this machine goes the way of the dodo, like so many that come before.

Thanks Again,
Jason

It's not very often that you see a physician speak up and direct to the true issues of this new technology. I personally don't know of any state that allows anyone that is not a licensed physician to make any type of laceration in flesh tissue. You would think that every medical board in this country would be jumping on that one, but for some reason, it goes on unregulated.

And like Dr. Law pointed out, we are not talking about a few cuts here. We are talking about thousands of extractions being done, and who knows if some of them are making the recipient sites as well. I mean even if that doctor's state he is practicing in is indifferent to this obvious malpractice, how can that physician in good conscience allow this to go on. And what really gets me is that an extremely high percent of these techs making these cuts and incisions have aboslutely no to very little medical schooling or formal training or certification or even state licensing. They don't even have a nurse's aide certificate. They know nothing about taking or reading vitals, nothing about emergency medicine. Just how can any state or even the federal government allow this to go on?!?

There were and still are a few new FUE clinics that simply pay any licensed physcician who is willing to hang his shingle in their clinic. Then the tech states that he/she is working directly under the supervision of the licensed doctor. What a crock. One clinic had two docs who practiced in an entirely different field of medicine.

My understanding is that only a PA is allowed to makes these incisions under the direct supervision of the OR surgeon. It is clearly not an issue of having shingles nailed to the wall to be in compliance with the law.

Thank goodness there are some independent clinics and HT practitioners who do not allow these things to go on, and have a sense of responsibility in the oath they took and are genuine in looking out for what is in the patient's best interest and care.

Part of the challenge in this industry is that HT techs learn the trade and skills "inside" because it is a non-regulated industry. And there are many, many experienced, reputable, competent, skilled, techs that are worth every penny they are compensated. And I personally feel many of them should be recognized for their service to patients and the hairloss community as a whole.

Possibly some of the trade organizations can make this a regular event at their annual conferences and each doctor/clinic can submit their candidates for recognition. Heck, send these hard working dedicated techs on a cruise or something!

IT'S WHY THIS ENTIRE INDUSTRY NEEDS TO BE REGULATED HOLDING ALL PRACTIONERS FULLY ACCOUNTABLE.

And absolutely true and obvious that PROPER DISCLOSURE should be made whenever there are financial interests in the products being promoted. And when proper disclosure is not made, IT SPEAKS VERY LOUDLY ABOUT THAT INDIVIDUAL'S ETHICS AND CHARACTER. We tend to pay attention to the things that people do, but you sure can learn just as much about them in what "they don't or fail to do".

That’s an interesting point Jason. I bet some assistants are better than some doctors.

Dr. Feller-- I agree to a certain extent---I would like to see more emphasis given to extended training programs and inspection of actual surgical procedures.

For those of us who support only the best doctors, it is rather easy to say there is no issue. However, for those who prey on the uneducated and uninformed with falsities and half-promises, there is very little recourse--even in our legal system.

I have looked at just about every HT case that is publicly available in the last 20 years--in almost every case, the doctor prevailed through summary judgment/ruling. Admittedly, some doctors are unfairly targeted for legal action, but the same is absolutely true for the patients who are permanently disfigured and did not achieve success, if only because there is no "actual standard"

For all the organizations that HT doctors belong to there is no actual medically recognized standard---ie-- You MUST microscopically dissect grafts, You must use the smallest possible incision making instruments customized to the patient, You must have an adequate staff to perform X amount of grafts, You must disclose the process for unsatisfied patients, etc...

I know I am preaching to the choir--but a regulatory board made up of actual HT doctors and learned lay-people-- that could at least enforce the minimum standard would be better than what we have now.

Much like Attorney's and the Bar Association--- public censure is a very powerful tool, just as 30-90 day suspensions and stripping of license.

I believe a separate license (above and beyond state license) to practice Hair Transplantation is necessary, coupled with requiring an extended training
program and yearly/bi-yearly training (ie going to the ISHRS and attending lectures) ----it can't hurt and it can only help.

I do not pretend to have all the answers, but if all the cards are on the table and myself, Dr. Feller, Gillenator, Spencer and a couple others visited every clinic doing HT's--- even with a minimal standard, many would still fall very short.

Take Care,
Jason

Dr. Feller,

Let me tell you something straight. A good man has nothing to fear including regulation. And whenever business starts complaining about regulation, it's about money. Now let's be honest here and not start insulting the intelligence and competence of individuals like bspot or myself. Not that I took anything personal or am suggesting you offended me because you did not. And listen my friend, I know firsthand that you care about your patients. You are not that far away from me or should I say some of your patients are not far. If you go back though and read your last post to bspot you'll see how you conveniently attribute the uninformed patient who gets whacked as being "his fault". That the patient was irresponsible? He should have first methodically completed his online research right? And because he did not, you can't hold the industy responsible right? I am sorry, and in all respect sir, you are dead wrong.

Let me explain. You all took an oathe right? Go back and read it again sir because you will find that there are no disqualifiers for the uninformed patient. That's the whole idea behind the oath to begin with, primarily there to govern the ethical conscience of the practitioner. To practice medicine in the best interest of the patient. In other words, soviety recognizes the threat AND abuse of the crooks in this industry.

Your comments in my opinion are centered around the fact that regulation is bad for business and there are nothing but incompetents in Washington. I could not agree more with you! And please please don't take this wrong because I don't mean anything personal. But you know darn well that you and any other any licensed physician are out to make money. You don't pay all of the dues and six figure tuition because you are all mercenaries. And no don't think I am nuts and believe there is something wrong with making money. I love America and the free enterprise system if you want to call it that. But that's idealism, not reality and history just proved it again when the regulations on Wall Street were lifted and what happens every darn time?! Abuse and corruption. Give me a break please.

And listen Dr. Feller, you all in the ISHRS know doggone well of the abuse AND CRIMINAL ACTIVITY that takes place in this industry. Listen to me for a moment. I mean really listen. The difference between you and me is that I have seen and listened to COUNTLESS cases of abuse in the past 29 years. I get the worst of the worst. You cannot possibly understand the psyche of the hairloss sufferer to make those convenient generalized comments. Many of these patients go off the deep end are emotionally driven in their decisions right or wrong. If I have learned anything in three decades of helping patients, I have learned that everyone responds differently to hairloss. I really need to write a book about it. It is so misunderstood. Oh I know you see some pretty botched cases from time to time, but trust me, nothing like I have. This is not about business, IT"S ABOUT PATIENT SAFETY!

And let's get real for a moment. All of the HT docs could have instituted the standards and protocol bspot referred to including some defined required standard to meet, both on the physician and technician side. You all could have established a fair unbiased board because it would include educated experienced lay people like myself, and even people outside of this specialization, but from another area of elective surgery that has no direct relation to the HT industry. A board that would act punitively to all offenders. Like bspot said, the other professions have them, but not HT doctors. That's because it's bad for business. I don't care what you say Dr. Feller or how much you want to defend our capital system and the so-called good guys in the white hats, YOUR PROFESSION AND FIELD OF SPECIALIZATION HAS DONE NOTHING ABOUT IT SIR, period.

And since the HT industry refuses to self regulate in the interest of PATIENT SAFETY, the government has to!

I am going to give you one example of why we need safety regulation. There is a HT doctor not far from me who uses target ads in the local paper, on the radio, presented as the are's top HT doctor! And IMHO, does some of the worst strip work I have ever seen. Whenever I get one of his whacked patients referred to me, I ask them how they heard of him. They always say, he's on the radio, tv, sports page, etc, etc. I ask them if they did any research on the internet and they say they don't spend time on computers. They hunt, they fish, they play softball, they lift weights. Get the idea? Things are changing for the better but not everyone is into computer research and it's not their fault anyway you want to call it.

Again that's why the physicians oathe to be licensed and practice medcine acknowledges that patients cannot be held responsible when a corrupt physician takes advantage of them and their distressed emotional state. The oathe recognizes that there will be abuse. There would not be a need for people like Spencer and myself and a few others if not for the corruption.

No offense but please don't insult us with that philosophical rhetoric about govt regulation never works. Partient safety comes first and foremost right Dr. Feller? Thank you sir.

I had to swipe willworkforhair’s .gif for this post...Well done Gillenator, there’s always a place for respectful, healthy debate. Next time tell us how you really feel?;)
http://www.threadbombing.com/data/media/2/clapping.gif

More than a decade ago, I was personally moved to initiate the consumer advocacy movement that has helped to evolve this field, so I can certainly see Giilnator’s point.

Last week we received a request for membership in the IAHRS from a hair transplant surgeon who promotes himself as a pioneer in the field. He's worked for a large chain hair transplant clinic and is known by many in the industry. During our initial investigation we were informed that this applicant had lost his NY Medical license in 2003, and was denied a license in OH based on having been convicted in a U.S. District Court of 19 felony counts of misapplying money and funds belonging to a gaming establishment operated by an American Indian tribe.

Apparently this “physician” still has a medical license in the state in which he practices, and I’m sure he’ll be performing surgery on some unsuspecting schnook on Monday morning. Can we really blame the patient for not having the where-with-all to do his Due Diligence to the extent that you our I would? I’m just not comfortable with that notion.

Hey Dr. Feller,

Happy Saturday!

I was actually applauding Gillinator's welcomed efforts to help prospective hair transplant patients avoid becoming just another of the walking wounded. I agree with your assessment of government intervention, however we’re not on the same page when it comes to patient culpability.

My views on the free market system are no different than yours, and I appreciate the freedom that this country has offered me.