Hair transplant surgery is one of the most nuanced, elegant and difficult forms of cosmetic surgery performed today, but for some reason many new physicians entering the field and device makers never seemed to have received “the memo.” Listen to TBT’s “Undercover Tech” as she clues in prospective hair transplant patients as to what is really going on in these turn-key hair transplant practices. Remember, no two cases are alike and if you think one device or one way of doing things will benefit all patients, you are being sold a bill of goods.

Undercover Tech: A case can be made for using a larger punch in certain situations for certain patients, so I understand that, and I have my preferences and what I think heals better and typically looks better and leaves less scarring, but when people are using these devices, they're setting them up before they've even met the patient. The technicians are trained to come in and load the device, get everything ready, and typically they're taught by the device company, "Just load it with the biggest punch," because that's during their training and that's what's easiest to learn with, even though they've never seen the patient. They have no idea what this patient's donor looks like. They have no idea what the hair [inaudible 00:00:48] are. They don't know what type of tissue they may have. There's no prerequisite. It's just, "Let's use what's easiest," and you can tear someone's donor up very, very easily if you're just using a big punch and going with the standard settings, whatever's easiest to get the graft.

This is not any specific device, but when people are first getting into hair transplant, they think there's a formula to get this done, to do this, and there are surprises in every single case that I've worked in. I can count the number of times that I've had a case that goes exactly as planned, that everything works out, the day is exactly the length that I thought it was going to be, placing took the amount of time I thought it was going to take, harvesting was spot-on. There's always something.

The patient may bleed more than you think, and doctors jump into this thinking there's an anesthesia mixture that's going to work for every single patient when every single patient is very different and sometimes you have to tailor the amount of anesthesia that you use or the mix that you use. Some patients need a little more epi. Some have very minimal bleeding and you can get away with less epi and more bicarb. There's a lot of different things that go into every single aspect of it, and people jump into this thinking it's one size fits all, and I can use the same punch, the same tool, the same anesthesia mixture, this formula that they come up with to do hair transplant.

I think doctors who have been doing this and are maybe purchasing devices or FUE tools that have been doing FUT for some time are less susceptible to falling into this trap, but when-

Spencer Kobren: Exactly.

Undercover Tech: ... new doctors are jumping into FUE, which is what I'm seeing. So, most of the doctors that I work with are strictly FUE. It's just something they've added on to their practice as a way to make money, and it's something that's easy and they don't have to be super involved, they start with the misconception that hair transplant is just a one size fits all, very easy thing.

Spencer Kobren: Well, I mean that's ... Listen. I mean the vast majority of new clinics, guys who are just popping up, buying whatever device, it's FUE all the way, and sadly, I'm actually starting to see the pendulum swing in the other direction as more patients are having FUE and maybe going for their second case, say they're two or three years out. Now they're starting to go on the message forums. They're contacting us directly and saying that now they've been told that they're going to need at least one strip in order to meet their goals because they're essentially FUEd out.

Now, the best course of action for these patients would have been to have the strip initially and then go in afterwards to have FUE so that all of that sweet spot donor area could have been used correctly and it's not decimated by whatever tool was used. So now, they have even more limitations than they expected and they were trying to avoid a linear scar to begin with, but they're going to end up having to have a linear scar plus thousands of punctate wounds, which they wouldn't have had before if they were given the proper education, if they went in to see a doctor who does both FUE and FUT.