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

[amadeus]

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

[bigmac]

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.

[Thomas Law, MD]

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…!

[the B spot]

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

[gillenator]

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".

[Jkel]

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

[the B spot]

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

[gillenator]

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.

[SpencerKobren]

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?


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.

[SpencerKobren]

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.

[SpencerKobren]

Happy Saturday to you too.

I have to assume, given the nature of your business, that when you say:

"You're not on the same page when it comes to patient culpability?"

you mean that it IS up to the patient to do his own research to make a FREE and proper choice; and to live with the benefits OR consequences of that choice.

I hope that is correct.

Being free to make a choice doesn’t ensure the patient has the where-with-all to do his due diligence in the same manner in which you or I would. I think it’s best to move on and focus on the points made by our users.

[tbtadmin]

NeoGraft Graft Placement Demonstration | Dr. Alan Bauman, Boca Raton, Fl.

Provided by IAHRS Member Alan J.Bauman, M.D.

This video demonstration was featured on Rachel Ray's "plastic surgery breakthroughs" show on September 25th 2009.

[the B spot]

If you look at the video, when they are attempting to "shoot" the grafts into the recipient sites, they go in half way, or in slightly, which requires them to be scrapped over into the sites, re-suctioned, and re-inserted. It is my understanding that this machine is supposed to limit the handling of the grafts because they are fragile.

One of the problems here is the claims that this machine is better and faster and Doug claimed (elsewhere) a less than 5% transection rate, for those doctors with no experience doing FUE, including those who are using the machine for the 1st time.

I looked at this thread as an opportunity months ago to see some willingness to actually engage in proper discussion and acknowledge both positive and negative about this machine.

Anyway, nothing personal whatsoever, certainly love the innovation, but the very reason for these forums is disclosure, transparency, discussion, praise and sometimes warning for those of us associated with the HT industry.

Take Care,
Jason

One Caveat: I am 100% in favor of ANY equipment that is shown to clearly benefit the patient over existing, established equipment.

[Jeffrey Epstein, MD]

Wow, I sure missed an interesting discussion on regulation of the hair transplant field.
All of you have some particularly interesting perspectives and ideas, and unfortunately, there is no one correct answer. The problem is, as Dr. Feller stresses, is that who is regulating the regulators. Government employees (and that includes Congressmen) are susceptible to the pressure/advice put on by lobbyists (i.e. those that give money to these employees to help them get reelected or get them tickets to the Dolphins-Jets game tonite (Go JETS)- or maybe there is not graft (no pun intended) or bribery involved, but rather these regulators are susceptible to the advice they get from special interest groups. Has anyone seen what has become of the Obama health care reform- one by one, each component gets torn down by the different interest groups?

It's not a simple- well, everyone has the same incentive- except for those who are practicing bad medicine- and that is, do what is best for the patient. But do you know that different fields of plastic surgeons have for years fought to limit who can perform plastic surgery for largely economic gain? As a board certified facial plastic surgeon, I have nothing to lose by the cosmetic surgery field being regulated such that only board certified plastic or facial plastic surgeons can perform hair transplants along with other plastic surgery. Yes, that would be good- very good- for me economically. However, that would likely remove some of the more experienced and talented hair surgeons from the field- something that would be bad for patients.
And yes, the Florida Bd of Medicine members are vulnerable to the advice of surgeons such as myself, thinking that they have only the best interests of the patients in mind.
On the other hand, there are far too many poor surgeons doing subpar work on unsuspecting patients - see how infomercials and beautiful websites are able to drive business. It is through a site like this- the BTT/IAHRS- that a truly reputable and honest consumer advocate like Spencer is able to try to help the prospective patient who is smart enough and motivated enough to do his/her homework.

That's my two cents on the topic

Dr. E

[hotty_ca]

Here's a suggestion

If I could make a quick suggestion. Why not do what all other industries use to ensure quality, which is oddly enough, follow Quality Assurance practices? You know, measurables. If done properly there is basically no need for government involvement (the need for which has always been a completely nonsensical argument that never got to the heart of bad surgery, and that was stopping bad surgeons). And there's no need to have any grand unanimity amongst ht practitioners. Simply put if you want to make the industry better and put pressure upon the bad doctors to improve or alternately leave you just need to do the following.

First you create an organization of surgeons where the criteria for membership is adherence to certain QA reporting standards. What are these QA standards? Well for starters they are not anything to do with the actual ht work. So surgeons who get involved with this organization won't have to change their practices. We're talking about standards of reporting only.

This means that every patient gets documented the same way. Same picture angles, same camera, same lighting, yadda yadda yadda. At the same schedule (ie. 1 month, 2 months, etc). Obviously you'll need to get patient buy-in to this. That's simple. You ask them for it. All patients who accept are given random id numbers, with any identifying features blacked out.

Next problem. How do you get patients to come in on any regular basis? Well you give them incentive or you don't. Up to the surgeon to give their patients sufficient incentive to follow thru. If the patients don't show up that's just missing data.

The organization I've described does the following. It opens up the database of results to the public. Allow them to slice and search according to every dimension of measurables you can come up with. On the other side of the patient/doctor divide, membership in this organization would require that you meet a minimum standard of reporting or you can't say you're a part of the org. And you'll need to keep providing that evidence or you lose membership. In other words, you'll need to provide X number of patient data a month. Obviously the schedule on something like this is up for debate.

What else does the patient get out of this org? If they have a complaint they can force their case to be included in the dataset. That would be a requirement of membership.

The whole point, basically, is that you provide measurable, standardized data that consumers can pick their surgeons by and provide ratings on. If you're a good surgeon you'll have tons of good examples, certainly more than bad ones. If you're not you'll likely avoid participating. The membership, itself, is the selling point. And it'll give you a constant benchmark of where you stand next to your peers.

This is a simple solution that doesn't require any complex bureaucracy. It's driven by the industry itself and doesn't need gov involvement. It encourages improvement within the industry. And it's transparent. It just shines a light on the information. Those who can hack it will stay and those who can't will go. Problem of bad unethical surgeons more or less solved.

Btw, I've been suggesting this for years. Nobody's done it. I wonder why.