Hair surgery techniques to redistribute hair to areas of alopecia include scalp reduction surgery; scalp and rotation flaps, advancement flaps, and free flaps; FUT by strip harvesting; and FUT by the follicular unit extraction (FUE) technique. The more aggressive hair surgical techniques such as flaps and scalp reduction are largely abandoned for cosmetic cases, but are used primarily in reconstructive surgerical cases from trauma and infection. The most common surgical method for hair transplantation is FUT either by the Strip technqiue or by FUE.
With the recent worldwide interest of hair transplantation using FUE, many hair surgeons, plastic surgeons, dermatologists, and medical spa physicians are jumping on board. The introduction of this surgical technique into cosmetic practices is accelerated by certain FUE device manufacturers promoting a “turnkey” model for increasing the surgeons income.
But with the recent increase in physician training in FUE, and an increase in consumer interest, new and different challenges in the hair restoration field have emerged. The primary controversy is physicians with no formal training with this newer hair transplantation technique, and even worse physicians without any training or experience in hair transplantation; are contracting with non-physicians or hair technicians to perform the entire FUE surgical hair transplantation.
Irvine based hair transplant surgeon, Dr. Ken Williams, recently published in Dermatologic Surgery an article on this subject is entitiled: Current Practices and Controversies in Cosmetic Hair Restoration.
In his paper, Williams “raises concern for the future viability, practice, and art of hair restoration surgery. The concept of physicians with outdated, minimal, or even no knowledge of hair restoration to allow nonphysicians (hair technicians) to perform hair surgery from start to finish is unethical and potentially criminal. In the view of many surgeons in the hair restoration specialty,it is inappropriate to advocate these “new” hair technician responsibilities.”
Even the worldwide medical society of hair surgeons, the International Society of Hair Restoration Surgery , has decided to establish best practices and standards by stating donor harvesting and expanding the duties of hair technicians is a “serious disservice to the patient.”
Todays medical literature reveals ample science-based evidence of the efficacy and reliable clinical outcomes of hair restoration surgery through the last few decades with Strip and FUE surgical techniques. Modern day hair transplantation began in the fifties using a now outdated technique where a 4mm circular manual punch removed large pieces of scalp tissue containing numerous hair follicles causing an unnatural look. Today, individual follicular units are removed and transplanted with motorized or robotic devices with a punch the size of the tip of a pen-1mm, and all patients can enjoy restoration of their hairlines with their own natural hairline.