Why Do Hair Transplant Surgeons Rely on Assistants to Place the Grafts?

Hair restoration surgeon Dr. Michael Beehner is recommended by the Hair Transplant Network. To view this discussion and other hair loss topics, visit our Hair Loss Social Community and Discussion Forums,

I’ve noticed that some hair transplant surgeons do all of the work in their procedures themselves. They take the donor hair, close the wound, make all the recipient sites and then do all the planting of grafts. While this seems to be very laudable as they can absolutely control the quality of their patient’s procedure, does anyone think that this approach is too much for one person to take on? The thought of one person doing that very detail-oriented work for hours upon hours seems like it would take its toll in the form of fatigue. And, when fatigue is a factor, mistakes can be made more easily. This is in no way a criticism of their method. Any thoughts on this way of working?

With the size of cases we routinely do today, it is impossible for the hair restoration physician to do everything, even apart from the dissecting of the follicular unit grafts under the microscope. Once a fair number of grafts have been cut and prepared, it is absolutely necessary for two pairs of hands to get busy placing grafts. One of them can, and often is, the physician. If only one person is placing grafts, the grafts will be out of the body too long and past research shows that, after being out of the body over 8 hours, the percentage that survive starts to decrease.

The issue brought up about fatigue is an important one. It’s important for everyone on the team, including the doctor, to take periodic breaks to rest the hands, arms and shoulders, and also your psychological state. On a few occasions I have cut grafts for a couple hours straight, and that is too long. You need a break away from your task every 30-40 minutes in order to keep the quality of your work top-notch. If I see the girls on the scopes too long, I will encourage them to all take five minutes to rest or walk around the block.

In our own hair loss clinic, I do all of the planning, the nerve block and local anesthesia, the harvesting of the donor area and suturing it up, and then the placing of all the incision sites where the grafts are going to go. This last task, if done conscientiously, can sometimes take 1 1/2 to 2 hours to do, making sure the size of each site matches the different size grafts (1-hair, 2-hair, and 3-hair grafts) and that the angle is just right and that native hairs are not damaged. My routine is then to start placing grafts along with one of my experienced assistants until all the grafts are prepared. I then let one of the girls take my place after they have had a break between those two tasks. I always save out around 50 grafts, usually half 1 and 2-hair FU’s, which I then, at the end of the case, will put in where needed in the hairline area, using the “stick-and-place” method. This gives me a final chance to “fine tune” the hairline and get it exactly the way I want it.

So don’t look for a clinic where the poor doctor takes on all of the tasks. If it’s a 300 graft case, which doesn’t exist anymore, then it might be okay. Rather, look for a clinic where the doctor carefully supervises the quality of the work of the technicians and in which the whole team cares as much about the grafts surviving as the doctor does. Gentle handling, care to keep the grafts moist at all times and proper rotation of the graft within the site as relates to the curve of the hair are all crucial and you want a staff that takes pride in doing each of these things right and not an assembly-line operation, where the goal is to get the case done as fast as possible.

Dr. Mike Beehner, M.D.

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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