• What are the risks of having a non-doctor perform a hair transplant surgery?
• There are quite a few aspects that need to be considered.
  
  The non-physician may lack the knowledge about hair and scalp disorders that may preclude hair restoration, and such conditions may be a clue to other systemic disorders.
  
  The non-physician may lack the ability to perform various complimentary surgical procedures that may be needed to optimize the patients' results or deal with an operative situation.
  
  Often these technicians only know how to do one type of procedure with only one variety of instrumentation. Usually, they only know how to perform FUE.
  
  These people may not be trained in the aesthetics of hair restoration.
  
  The non-physician may not be competent in dealing with underlying medical conditions or medications that are being used. The non-physician may not handle medical emergencies such as excessive bleeding, hypertension, allergic reactions, etc.
  
  The non-physician is unlikely to carry medical malpractice insurance
  
  The non-physician may not be accessible in case of an emergency
  
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• What are the factors behind a successful operation?‍
• To have a successful outcome, there needs to be careful planning from the time of the consultation forward. The patient should understand what can be achieved and how it may best be achieved. It is imperative to present realistic expectations. The patient should have an opportunity to ask all the questions they may have.
  
  The physician must be confident that the patient has a condition amenable to hair transplantation. The patient should be informed about non-surgical therapies such as medications and scalp pigmentation.
  
  It should be clear what areas are to be transplanted and the proposed densities.
  
  The physician should be well trained and can perform various procedures such as FUT and FUE. The ability to perform multiple flaps and grafting procedures can be beneficial.
  
  There is an adage:" If all you have is a hammer, everything looks like a nail." Having a singular or cookbook approach is generally not beneficial to the patient.
  
  The physician should have a competent staff with significant experience to handle the various cases. The team should have adequate experience with FUE and FUT and know how to prepare and insert grafts.
  
  There should be a system for quality control and the tracking and understanding of the use of proper medications. There should be proper storage of grafts.
  
  There should be a system for follow-up for patients and access to the medical staff should any problems arise

• How permanent are the results? Could the patient need a second procedure after a while?‍
• The results are permanent if the hair is taken from the safe donor area and the patient does not experience any medical conditions that could alter the survival of the grafts.
  
  Some grafts are lost due to the aging process.
  
  We advise patients that secondary or refinement procedures can be in order depending on the patient's density, and additional procedures may be in order if additional areas of the scalp are to be transplanted. Much of this depends on the extent of hair loss the patient has and whether they will consent to medical therapy such as finasteride.

• Which patient profile is the right fit for the operation?‍
• I don't think a particular profile "fits" for hair restoration. We treat type II Norwood patients to type VI and sometimes type Vii. So much depends on patient expectations, and some patients will be satisfied with a frontal tuft, while others will expect a full head of hair. Not all expectations can be fulfilled.
  
  Many patients look very attractive with a bald scalp and should consider having a shaved look. The HT procedure is usually cosmetic, and thus no one should feel compelled to undergo it, and it is a very personal decision.
  
  In general, we would NOT elect to perform surgery on a patient less than 22 years of age. 
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The right fit depends on donor availability, medical history, expected hair loss in the future, possible willingness to use medications, and expectations.

• How should a patient choose the right doctor and the clinic?‍
• I think that the patient should review the physician's credentials and experience. The potential patient should ask about the staff's experience and ideally, meet in person with the physician.
  
  Is the physician a member of ISHRS? Have they taken ISHRS courses? Patients should inquire as to training. Many HT physicians are dermatologists who receive extensive training in hair disorders. Such training can be beneficial. There are, of course, physicians from other backgrounds who have sought such training and perform excellent work.
  
  What is the view of the physician as to aesthetics? Is the physician familiar with ethnic and cultural aspects of the patient to provide an appropriate approach to restoration?
  
  Is the physician certified in medical emergencies such as ACLS?
  
  The patient should inquire about the accessibility of the physician and staff after the procedure.
  
  The patient should inquire about the calculations involved in deciding on the number of grafts to be used. Related to this, the patient should ask how long it will take to perform such a procedure.
  
  Inquire about lab work that may be required, and does the clinic inquire about all medical conditions that might affect the outcome.
  
  Inquire as to who will be doing which aspects of the surgery. In our facility, the physicians are responsible for harvesting tissue, site making, and suturing.
  
  Only the physician, licensed physician assistant, or licensed nurse practitioner should harvest FUE grafts in terms of FUE.
  
  The patient should review the actual before and after photos and possibly speak with prior patients about their experience.

The patient must feel comfortable with the relationship with the physician such that there is an open dialogue. Often the patient and physician will have a long-term interaction if further procedures are desired.

• Can you talk a bit about your experience in the field?‍
• My training started in internal medicine and then emergency medicine. I subsequently did a residency in dermatology and became a board-certified dermatologist.
  
  I started performing hair transplants during my training, but these were the older large plug type graft implants. Once I finished my residency, I became experienced with more extensive facial and body cosmesis surgeries.
  
  I became experienced in extensive scalp lifting and various scalp reduction procedures.
  
  I was one of the first physicians to perform follicular unit grafting and presented one of the first lectures on extensive grafting sessions, which was a thousand or so grafts. We have come a long way since then.
  
  I have invented various procedures and devices for hair restoration and have a patent on a technique referred to as mosaic transplantation based on a computer algorithm developed with the Florida International University computer department.
  
  I have been performing hair restoration for over thirty years. 
  
  John Cole and I co-developed the FUE procedure known as follicular isolation technique, FIT.
  
  To enhance the outcome of strip harvesting scars, I developed the ledge closure technique for FUT. This is a type of trichophytic closure.
  
  I have lectured and demonstrated surgery throughout the world. I have authored numerous articles and chapters in texts, and I have been involved in basic science research and clinical studies.
  
  I have served as a Board Member of the ISHRS multiple times and have served as Secretary and President in the ISHRS. I have been Chair of Scientific meetings and was honored to be awarded the Golden Follicle Award for my contributions to hair restoration.
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I have also served on the American Academy of Cosmetic Surgery Board, and I have been President of the American Society of Hair Restoration and the International Society of Cosmetic Laser Surgery.

• Is there anything you would like to add?‍
• I think it can be easy to imagine hair restoration and treatment of hair loss as simple entities that can be learned quickly.
  
  Having performed hair restoration since 1987, my impression is that I am still learning. There are many nuances, and there is a good deal of finesse to achieve optimal results for patients. Each patient presents unique issues.