Written By Dr. Alan Feller- Philadelphia, PA
If you’ve decided to have a hair transplant you made the right decision. However, there is another decision you have yet to make: which doctor/clinic do you select for this life changing procedure ? How does one even begin the process of selection ?
Having practiced hair transplantation exclusively for 24 years I can rightly be called an “insider” and as such am happy to share what key things any person contemplating hair transplantation should look for when selecting a TOP NOTCH clinic. In fact, I recommend you print out this article and check off each item as you research clinics and when you visit for consultation:
- Has that clinic performed hair transplantation EXCLUSIVELY for at least 7 years?
The overwhelming number of Hair Transplant clinics are brand new to the field. These doctors simply added hair transplantation to their existing practices as a “side income”. Or, these clinics may perform a few hair transplants per month in addition to another area of medicine that they practice mainly. These clinics represent the lowest end of the hair transplant industry and produce some of the most horrific results I have ever seen and repaired. Find a clinic that practices hair transplantation exclusively, there are plenty of them out there. Don’t settle for less.
- Is the facility solely dedicated to hair transplantation and occupied exclusively by the hair transplant clinic
One measure of ability and competence is: SUCCESS. A clinic that has experience and many happy patients can easily afford its own stand-alone clinic from front to back. Also, a proper hair transplant requires a large team and the associated space needed to accommodate them. So when I see a doctor sublets a room on the premises of another practice I know that doctor is not full-time, does not have a large enough staff and should likely be avoided. Top Notch clinics have their own exclusive offices.
- Did you meet with a doctor or a salesman
Hair Transplantation IS surgery. It may be minor surgery that is performed in office, but it is still surgery and it should be a surgeon who evaluates you and speaks with you as to what you need and how it should be done. In our state it is illegal for salesmen to perform medical evaluations, but it still done in other guises and such clinics should be avoided. Hair Transplantation is complex and the person actually doing the surgery should be the one who goes over every detail with you BEFORE you book a procedure. Not some salesman in a suite with slicked back hair. I’m not oversimplifying, this really exists. Look for it and avoid it. You are NOT a number. You are paying top dollar for CUSTOMIZED work , so you should be speaking and interacting with the artist himself, not the guy who is looking to sell the painting for a paycheck or a cut of the income. Top Notch clinics have no buffer between patient and surgeon.
4.Does the clinic perform ALL forms of hair transplantation?
There are two major forms of hair transplant surgery. FUT- Follicular Unit Transplant (also known as the Strip Method); and FUE-Follicular Unit Extraction (also known as the “one by one method”-also sometimes falsely referred to as the “scar free” method). Do not go to a clinic that cannot perform both. Unfortunately there has been an explosion of clinics that only perform FUE. This is because the overhead and experience required to perform such a procedure is far lower than for FUT. The problem, however, is that FUE typically doesn’t grow as well as FUT and thus patients may be guided into a procedure they shouldn’t be having due to lack of choice. Most clinics performing only FUE are usually incapable of performing large scale FUT due to lack of staff and/or experience. Denying patients the gold standard of care before offering alternatives like FUE are against state medical regulations and can result in revocation of a medical license if caught.
- How many staff will be assisting during your surgery
Your doctor may be the most gifted surgeon in the world. However, without a properly trained and motivated staff Top Notch results are literally impossible. In my office I have a formula I usually stick to which is one technician for every 450 grafts. So if I am performing a 3,000 graft surgery I will bring on 7 of my full-time in-house technicians. Most clinics do not have full-time in-house technicians or enough technicians in general to perform large cases properly. These clinics should be avoided. Do not be shy about asking your doctor how many exclusive full-time in-house technicians they employ. Ask specifically if they share their technicians (travelling technicians) or are employed full-time and exclusively for that clinic. If not, move on! There are plenty of Top Notch clinics that are successful enough to have their own in house team that works together every surgery like a professional football team. Why pick a clinic that simply can’t compete?
- If having FUE, is a licensed physician actually doing the surgery or a technician?
There are several stages involved in the performance of an FUE procedure. The very first is cutting around the graft with a surgical too. This is called “scoring”. In almost all states the licensed surgeon must do this part. A recent court decision in Florida found a doctor guilty of giving this responsibility over to a technician. This decision marks a crucial reaffirmation of the same laws that already exist in most states. My state has had such laws since I went into practice 24 years ago. Unfortunately, there are many clinics that ignore the law and still allow unlicensed and untrained strangers to perform the surgery. It is wrong and it is illegal. Ask your doctor who is doing the actual scoring of each and every graft.
- If having FUE, is the physician using manual tools or a gimmicky machine?
Most clinics using machines to remove FUE grafts are newbies, part-timers, or doctors who simply didn’t want to put in the hard work to learn how to perform FUE properly. Manual is by far the safest and most efficient way to extract FUE grafts. The utilization of machines is solely to speed up the process for the doctor and make it easier for him. Remarkably, NOT to improve the extraction quality. Problem is, the faster the doctor goes, the more damage the grafts typically endure which negatively affects the results. If you are going to have an FUE procedure I strongly advise you go with an experience surgeon who uses manual tools. I have actually designed, invented, and patented powered surgical tools for FUE in the early days of the procedure but abandoned them because they simply cannot compete with manual surgery performed by an experienced and meticulous physician. Nothing is more gentle than the human hand.
- Can the clinic show you at least 50 examples of their before/after results ? Most new clinics cannot show more than a few before and after photos, and in many cases the patients in the photos were NOT performed by that clinic or doctor. This practice is rampant in the FUE-only clinics that utilize machines. To my mind a clinic just beginning to get good should be able to show 50 good or exceptional examples of their surgical results. If you see one or two dozen, just move on. I personally would look for a clinic that can show a minimum of 100 results including their five most recent.
- Does that clinic have a high profile on the internet ? If a clinic you are considering does not have a high online profile, something is wrong. A good clinic should have tremendous numbers of results and patient comments somewhere online. If not, then that clinic either has little to be proud of, or, they just aren’t producing work on par with their competitors. Simply ask the doctor or the receptionist which chat forum you can go to to read contributions by the doctor and his past patients online. If they can’t give you any, or act like they don’t know what you are talking About, I suggest you move on. There are plenty of Top Notch clinics whose doctors are not only willing to be scrutinized on a regular basis, but are eager to educate the public as to how they perform hair transplantation in general.
- Does that clinic participate in at least one national chat forum or appear on any elite lists of screened doctors ? I believe that the best clinics utilize online chat forums to willingly show their work and to explain what and how they do what they do. I have participated since 1999 on various chat forums and have received many patients as a result. It’s free, informative, and it works. Why would a successful doctor NOT participate? Transparency is everything, and a participant on a chat forum is usually very transparent. A doctor who refuses to participate may be concerned their work is not up to par and can’t compete. Use the internet as a filter. Of all the many hair transplant clinics out there, the very best post their results on a chat forum somewhere online to be held accountable for their work.
- Do the technicians all use microscopes to inspect and dissect the grafts? Hair grafts are very delicate so to see them well the best optics should be employed. In the old days a simple hobby magnifier was all that was needed. But that was when the grafts were bigger and chunkier and didn’t produce the natural results we obtain today wherein the grafts must be smaller and more finely cut. Thus, expensive dissecting microscopes are a requirement. Look into the surgical area of the clinic and see if you see these microscopes. If you don’t see at least 6, I would leave. If you see one or two, that simply isn’t good enough.
There are many other criteria, but these broad strokes may help. Remember, you only have one scalp. If you go to a clinic that is sub par you may not, and most likely will not, enjoy the very best results.
Do not be shy about questioning your doctor. Those days are over. This is a costly procedure that you are paying for out of pocket, you should get the best there is out there. Ask your doctor how many years he/she has performed HT EXCLUSIVELY. That is, does the doctor make his living and feed his family on the income of the clinic, or is it just a sideline? Take the initiative and be aggressive. As a doctor I have absolutely no problem when patients ask the above questions. It shows they are informed and that’s exactly the kind of patient I want. Happy hunting.