In parts one and two of the series, “Plastic Surgeons Beware, FUE is No Turnkey Procedure,” the controversy was introduced and background information of FUE hair surgery addressed. In part three of this series, the details of the problem are further outlined.
PROFIT AS A MOTIVE
To members and leaders of the authoritative hair surgery organization, The International Society of Hair Restoration Surgery (ISHRS), FUE is considered one of the most difficult and demanding surgical procedure to acquire the surgical skill sets and to perform. It has a long learning curve and typically requires the surgeon to be present in the operating room up to 10 to 12 hours to complete a 2000 graft case. But the most troubling aspect of automated FUE is the “turnkey” promotion of certain FUE devices by sales people and business marketers.
Take for example one company located in the western United States that promotes the automated FUE device, NeoGraft. This company targets this technologically advance device to plastic surgeons, dermatologists, and med spas physicians who have either no or limited training in hair surgery.
Numerous physicians who are being sold this “turnkey” model” FUE device by sales representatives representing NeoGraft without any patient oriented motivation or interests. These physicians lack the basic understanding of FUE hair surgery. Then there are some physicians have a sincere interest in entering the field of hair surgery, while some doctors just want to add FUE procedures to their already successful Strip practice.
Sadly from my conversations, though, many physicians are entering hair surgery for personal financial gain based on “turnkey” assurances by sales people. In personal conversations, many physicians iterated they are minimally interested in mastering hair restoration surgery, or are primarily interested on additional income for their surgical practices in a weak economy.
One of the “turnkey” premises in marketing this device is a huge profit margin. Marketers selling the NeoGraft FUE device claim quick profits. Amazingly, they simultaneously claim the surgeon does not have to learn, master, or even perform hair surgery because the doctor can hire hair technicians.
Like the Tom Cruise “Show Me the Money” scene out of Jerry Maquire, one NeoGraft advertising claimed you can begin hair surgery and the “average revenue generated from a 2000 graft FUE Hair Transplant procedure: Between $14,000 & $18,000. We look forward to showing you how NeoGraft will be a positive addition to your practice.”
Another NeoGraft advertisement boasts, “In the past, most physicians gravitated away from offering hair transplantation simply because it did not offer a good enough return for how much time and effort was required. With the introduction of the latest, most advanced 4th generation NeoGraft, combined with an incredible turnkey business model for effortless implementation into your practice, those concerns are now a thing of the past.”
In this “turnkey” model, neophyte hair restoration surgeons are not required to learn hair basic knowledge or acquire advance hair surgery skills to start performing hair surgery. This is because affiliated staffing companies provide hair technicians with little or minimal skills or training to perform the entire surgery from start to finish.
The business “turnkey” plan and financial model is based on hiring “highly skilled” and “certified per diem technicians” to perform the entire hair surgical procedure. Sales people mention nothing that removing human tissue from the human body requires a physician and surgeons license, and the physician and/or hair technicians may be in violation of state laws and subject to sanctions, license revocation, imprisonment and fines.
The automated devices sold by sales peoples and businessmen are based on a quick profit and commission. There is no observed concern by sales people for the proper training of physicians, or the legitimacy of establishing the skills and knowledge of hair surgery of the purchasers of NeoGraft.
No one is making the argument a plastic surgeon, dermatologist, or physician practicing in a med spa are not capable of learning how to perform FUE, or acquiring the cognitive skills of hair science. But what is troubling is well-meaning specialty surgeons enter hair surgery practice having little or no training in hair surgery since their residency or fellowship. These surgeons have not kept current on the art and science of hair restoration in the last 10 years, lack continuing education and training, and are not members of a professional surgical hair organization such as the ISHRS.
I don’t want NeoGraft to gain a bad reputation because of terrible surgical outcomes and failures because of unethical surgeons and “turnkey” marketing by slick business people. My exhortations to colleagues is to acquire the skills and learn the most up-to-date hair surgery information before you buy a $90K device. Constantly apply this new knowledge and skill, and do not enter into a new cosmetic specialty field until being fully committed to ethical patient care and surgical hair restoration practices.
As a disclaimer, It takes a long time and many years to acquire the skills and knowledge to successfully perform FUE and FUT hair surgery. Attendance of the ISHRS annual scientific meetings as well as other learning opportunities offered by this fine organization, are required to improve the skills and knowledge of hair restoration surgery.For these skills and knowledge the collegiality of ISHRS colleagues who unselfishly shared their techniques and skills to perform hair surgery is deeply appreciated.
Hair surgery is my passion and joy. I am a hair loss sufferer and patient who has had 4500 FUE grafts implanted in my scalp. I understand those patients who have loss their hair and desire to restore their youthful appearance. I still have more surgeries to go and I can’t wait to finally finish the crown region of my scalp.
In the end, I am worried about the future credibility of legitimate hair surgeons who perform automated FUE with this great device. Great technology in the wrong hands will cause bad patient outcomes and the reputation of NeoGraft will be tarnished. I don’t want either of these events to happen.
Patients don’t want “turnkey” hair surgeons or those surgeons who are in hair surgery for financial gain. I believe patient’s want their hair surgeon to be intimately involved in the preoperative, intra-operative, and post-operative phases of surgical hair care; and not just hire a technician to perform the procedure. Hair loss suffers want their hair surgeon to be current state-of-the-art hair surgical knowledge, regularly obtain up-to-date continuing education, and perform hair surgery because it is in the best interest of the patient rather than the financial interest of the doctor.
Dr. Ken Williams is a member of the International Society of Hair Restoration Surgery, and the American Academy of Cosmetic Surgery. He is board certified primary care physician practicing hair restoration surgery in Irvine, California. He performs FUT surgery but is primarily dedicated to FUE, and was one of the first physicians in the United States who experienced the long FUE learning curve using NeoGraft.