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Most consumers and patients take for granted that “board certification” implies some level of expertise and qualification of a doctor. What does it ultimately mean to you? Why do we even bother with it? Is it to advertise achievement reflecting doctors’ credentials?

In the United States there are 24 approved medical specialty boards that are overseen by The American Board of Medical Specialties (ABMS), a not-for-profit organization. Certification by an ABMS Member Board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training with adequate supervised activities a medical institution AFTER earning their medical degree. After this training, they must successfully pass a level of competence through written and oral examinations.

Hair transplant surgery is not a part of the ABMS so there really is not a board certified hair transplant surgeon in the traditional sense the public thinks of. This is mainly because there is no formal supervised training or credentialing in hair transplant surgery. There is no curriculum and no oversight. There is no place to formally learn to become a hair transplant surgeon. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a doctor in the private practice of hair transplantation. We know of doctors who never performed a hair transplant surgery but only attended a seminar and within a week set up shop proclaiming that they were experts at Follicular Unit Transplants. If there was truly a board or some sort of governing body, the physicians who learn the field through an overnight effort would have been discredited and alienated from his/her peers. But this is not what happens because hair transplant surgery is not considered mainstream surgery and anyone with a medical degree (even straight out of medical school with no training) can legally perform it. Unfortunately, a license to practice any or all specialties of medicine comes after 4 years of medical school and an internship and with that completed, a doctor could proclaim themselves even a neurosurgeon; however, no hospital would allow this overnight sensation to practice neurosurgery.

Recognizing the need to become part of the mainstream, in the mid 1990’s the American Board of Hair Restoration Surgery was formed to independently certify hair transplant surgeons. The Board requires recommendations for other doctors and 100 hair transplant surgeries to qualify to take the Board’s examination. But the board can not certify adequate supervised training, as there is none. It is also powerless in its structure to monitor any doctor’s training or enforce any form of discipline. Why? Because there is no place for a physician to train to become a hair transplant surgeon. There is no education/training center. There is no residency. There is no fellowship in the traditional sense. Thus, the term “board certified” hair transplant surgeon is NOT the same nor does it hold the same value as “board certified” in the common sense that we think of a board certified plastic surgeon or neurosurgeon. In fact, states like California forbid doctors to use the term ‘certification’ unless it reflects the American Board of Medical Specialties’ endorsement, which is not the case today, nor should it be. The reality of this training process is that this is a one surgery field. Today, I know personally of doctors who started doing FUE after only attending one ISHRS meeting. When I spoke to the doctors about their results from the FUE they were doing in the first 6 months and they admitted to me privately, that they had very significant failures in their initial treated patient population.

This is why many hair transplant surgeons are not board certified in hair transplant surgery. Drs. Rassman, Pak, and Kim are not board certified in hair transplant surgery mainly because they felt that it had little significance to their practice or credibility. Since Dr. Rassman is widely regarded as one of the pioneers of modern day follicular unit transplantation (from the early 1990s) and even the innovator who started the FUE technique in 2002, his reputation stands on its own without a certification. When Dr. Rassman started performing hair transplant surgeries in 1991, the standard was ‘plugs’. He visited doctors who had great reputations in the hair transplant field and watched what they did. He figured out that the techniques that were used did not meet his standards and he refused to adopt that technique. He learned the details of how it was done by others over a period of a year and then he pioneered (a risky move) what eventually became the standard for hair transplantation across the world.

Dr. Pak was part of the original research team (working as an engineer) that developed FUE instrumentation from the mid-90’s (that eventually ended up in a U.S. Pat. No. 6,572,625 licensed to Restoration Robotics for the Artas® Robot) and has been trained exclusively by Dr. Rassman as a hair transplant surgeon. Dr Pak’s hair transplant surgery education was in the traditional sense of a fellowship or apprenticeship by working one on one with a mentor, Dr. Rassman, for more than a year. For that matter many well respected physicians have gotten their start from Dr. Rassman in the 1990’s and 2000’s. To this day, Dr. Rassman receives several emails a month from physicians requesting private fellowship training. In fact, we even found on multiple occasion, doctors from a foreign country that display photos of Dr. Rassman standing next to themselves to advertise to their patients that they were trained under him. These pictures were taken at conferences.

Misrepresentation in this industry are common. A series of website or “forums” or ‘Networks’ exist that define the best doctors in the world for its viewers. To get such endorsements, doctors must join that organization and pay a monthly fee in excess of over $1000/month. The implication is that if the doctor is not endorsed by that particular ‘forum’ that they are not amongst the “elite” and highly respected doctors in the world. The ‘forums’ or ‘networks’ collect these prospective patients and dole them out to the doctor so that the doctor might get there money back through professional fees. It becomes an interesting way to advertise through third party ‘endorsements’. To be as blunt as possible, these ‘forums’ or ‘networks’ are not neutral patient advocate sites but a subtle way for doctors to advertise by paying a membership fee. As I know most of the really great hair transplant surgeons world-wide, I know who is good, who is very good and who is not so good. The good and the bad surgeons may inevitably be endorsed by the website as long as the payment is made. I do not know them all. So you, the consumer, must be really careful if you accept the endorsements of these organizations without doing your research.

In the end the consumers (patients) are left not knowing what to believe. Board certification does not mean much if no one can enforce a certain standard of care or even oversee the training of surgeons. The Forum that endorse doctors do it for their profit, so they should not be trusted without really doing your own research. Sadly many great hair transplant surgeons are intermingled with the sleazy opportunistic ones and the entire profession is dragged through the mud as a whole but the consumer who do not get what they paid for, what they expected and end up blaming the ‘sourcing’ for their doctors.

Tags: hair transplant, surgery, surgeon, board certified

 

I received a follow-up from a patient after he met with me for a consultation —

Thank you taking the time for the consultation. I wanted to get some clarification on some density counts that you made on my hair. You came up with the number 20 after inspecting my scalp. What does that number refer to? I am looking at some hair loss blogs and reading up on how other people have done and many doctors are using numbers like 60 or 70 or 80 or 90. Is that the same scale? If so mine at 20 would be extremely low. I guess that is on a different scale. Maybe you can help explain the difference. I am a little bit confused.

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I used the term miniaturization in your case. There are two ways to determine what is the quantity of hair and the quality of the hair on your head. Miniaturization is a visual way to estimate the quality of your hair, which extrapolates into a projection of how much hair you will eventually lose and how fast.

If one takes 100 hairs, for example, and 50% of them are miniaturized and 50% are normal, that means that the genetic process is impacting 50% of your hairs. As this process advances, these hair will become finer and finer until they disappear. Assuming that the other 50 hairs remain normal, that would leave you with a bulk measurement of 50% of what it should be.

The second measurement we do is bulk measurement, where we quantify the impact of the good hairs and the miniaturized hairs together. This is a mechanical measurement with an instrument which is accurate to within 10%. Continuing with the above example of 50 out of 100 hairs being normal and 50/100 hairs being thin (but contributing to the bulk measurement), the bulk analysis would probably have shown less than a 50% reduction of bulk. The bulk measurement device (HairCheck) would add the two to come up with a metric, and this metric is always compared to the back and sides of your head.

Tags: hairloss, hair loss, bulk measurement, hair bulk, miniaturization

 

I met with one of my earliest transplant patients who had surgery in 1992 when I was just in practice for about 6 months. We performed 400 grafts on this patient and he reminded me of the troubles I had in using the glue to hold the grafts in place. At first I had to think about what he was talking about… and then I remembered the painful process of placing a large number of grafts close together.

In those early days, just 80 grafts was considered a big session. 400 grafts was a huge surgery and putting grafts close together caused them to pop out, so I came up with the use of a medical quality methyl methacrylate (a form of super glue) to hold the grafts in place. The problems I encountered was that the glue was stringy and I had to be able to limit the glue to one corner of the graft, holding it to the skin. I had to put the methyl methacrylate into an insulin syringe and then express it through a very tiny needle to produce a micro-drop.

I had to work out just how to do many grafts at one time to stop the popping before this “glue” bonded into the insulin syringe. The glue problem was never solved to my satisfaction, but eventually I developed a very sensitive touch so that when I placed the grafts and kept a steady hand, I did not disturb the adjacent grafts. Eventually I mastered this technique and taught it to my staff. Now the world does it that way.

The patient compared the procedure we did recently to the one I did to him in 1992 and we both has a good laugh. This most recent procedure was his third and the grafts that I placed in 1992 worked very well for him over the past 22 years.

Tags: hair transplant, history, surgery

 

Hi Doctor Rassman,

I’ve been trying to make sense of all the internet literature that states that “Board Certified” by ABHRS is not technically certification by medical standards. What would be the difference if ABMS were to include ABHRS? Would that keep incompetency to a minimum or make me safer?

Other statements made by AHLA such as, “the AHLC uses remarkably outdated information that is dangerous so avoid them etc.” It’s hard for me, to get a real confident feeling, not knowing how to determine whether I’m safe in my decision.

Thank you very much for your time and professional opinion

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Hair transplant surgery is NOT technically certified by medical standards. In the United States there are 24 approved medical specialty boards that are overseen by the American Board of Medical Specialties (ABMS), a not-for-profit organization. Certification by an ABMS Member Board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training at a medical institution after earning their medical degree, and has successfully passed a level of competence via written or practical or oral examinations. I (Dr. Rassman) am ABMS Board Certified in General Surgery and my colleague Dr. Jae Pak is ABMS Board Certified in Emergency Medicine.

Hair transplant surgery is not a part of the ABMS so there can not be any physicians that are board certified as a hair transplant surgeon. This is mainly because there is no formal training or credentialing in hair transplant surgery. There is no standard curriculum. There is no oversight or direct review of the quality of the work being done. Unfortunately, there is no ABMS sanctioned facility to enroll and learn hair transplant surgery. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a private practice hair transplant surgeon. Even ABMS board certified plastic surgeons do not receive training in hair transplant surgery as part of their formal training.

In the mid-1990s the American Board of Hair Restoration Surgery (ABHRS) was formed by a group of hair transplant surgeons to create an organization that could independently certify hair transplant surgeons. But the ABHRS does not monitor doctor’s training quality and once the testing process is complete, they do not have any authority to enforce any form of discipline. In states like California, doctors are not allowed to call themselves “Board Certified” if the only certification they have is from the ABHRS or other non-ABMS approved boards. They must qualify which board they are claiming.

Tags: hair transplant, surgery, board certified, medical board, hairloss, hair loss

 

I am looking into finding a doctor to discuss my plan of attack for hair loss, and i was wondering what is the ISHRS International society of Hair Restoration Surgery? Is finding a doctor off of that website reliable as finding one from the American hair loss association website?

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The International Society of Hair Restoration Surgery (ISHRS) website lists doctors who are members of a learning society. The American Hair Loss Association (AHLA) is a similar site. You must understand that any doctor can be a member of these associations and societies as long as they pay a yearly membership fee. These societies do not have the power to enforce or regulate a doctor’s practice and skills, and the hair restoration/hair transplant field does not fall under the American Board of Medical Specialties (ABMS).

In the United States, there are 24 approved medical specialty boards that are overseen by ABMS, a not-for-profit organization. Certification by an ABMS member board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training at a medical institution after earning their medical degree, and has successfully passed a level of competence via written or practical or oral examinations.

Since hair transplant surgery is not a part of the ABMS, there can not be any physician that is board certified as a hair transplant surgeon. This is mainly because there is no formal training or credentialing in hair transplant surgery. You read that correctly — there is no board certification in hair transplant surgery! There is no standard curriculum. There is no oversight or direct review of the quality of the work being done. Unfortunately, there is no ABMS sanctioned facility to enroll and learn hair transplant surgery. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a private practice hair transplant surgeon. Even ABMS board certified plastic surgeons do not receive training in hair transplant surgery as part of their formal training.
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I’ve been writing about hair transplant failures more and more on this site lately, because it is a growing concern. I have been seeing, on average, 1 patient per week (from outside my office) who had a hair transplant with a significant failure of the grafts to grow (greater than an 80% failure).

I just saw another patient who had received over 2000 grafts a few years ago. He was not a happy camper. There was very little growth and he had a very detectable scar which did not allow him to cut his hair short. He had such high hopes that the new hair from the transplant a few years ago would solve his image problems, but after much consternation and considerable anguish, he found that his situation was worse off than if he never had any procedure at all.

The patient explained that he did not like his doctor’s lack of concern in addressing the failure of his transplants to grow nor the detectable scar that plagued him every day. He was disappointed that his research on this particular doctor left no clue to the quality of this doctor’s work, nor his indifference to his plight. Before the surgery, when the doctor’s team “sold” him on the transplant solution, the environment was welcoming… but after the grafts failed to grow, he did not feel welcome by that particular doctor as he was made to feel that the failure of the transplant was his fault, not the doctor’s problem.

This particular patient had as much focus on his scar as he had with the failure for the transplants to grow, because he had the same look from the front and top view as he had before the surgery. He had no deformities from the surgery and his recipient area healed well with no scars present.

So what could be the possible causes for a failure of transplants to grow?

I should start off saying that I have never seen the cause of the problem stemming from something the patient did or did not do. Many of the patients who come to see me because their transplant did not grow felt that they were responsible for the failure. I think that patients feel that the surgery is a mysterious process and that there must be something wrong with them.

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Dr.Rassman/Dr.Pak,
Is it possible for you to provide a step-by-step guide describing the procedure a patient would undergo during a first consultation at NHI, please – are there particular requirements a patient should consider in preparation for such a consultation (e.g. hair length, washing instructions, medical records, etc.)?
Thank you.

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During a consultation, we get to know the patient, understand their personal issues about hair loss, and recommend possible treatments. That is it!

It’s not all that complicated, if you think about it. You come to see us because you are losing hair. We examine the hair, measure the hair density, look for any microscopic patterns which may not be obvious (miniaturization study). If your hair is long enough we can do bulk measurements. But most of the time (for men) the balding is obvious and thus the reason for the visit. So we mostly talk about options and educate the patient. We actually spend a good 30 to 45 minutes on the first consult on most patients. Some more, some less. And while we often think about charging a fee for the amount of time we spend with the patient, we decided the first consult will remain free for a while, at least.

As a final note, at NHI you see the physician (Dr. Rassman or Dr. Pak). You will never see or be screened by a sales man or an associate or any other version of a middle man. Getting a doctor’s opinion always reflects your best interest and because there is no sales personnel involved in the process, there is no motivation for commissions that will be earned for a successful sale. We encourage prospective patients to come to our Open House events which are held monthly. In this way, you will know that what you see is what you are going to get. Nothing is hidden.

Tags: hairloss, hair loss, hair transplant, consultation

 

I know you are primarily a hair transplant specialist, but who would you recommend as someone who only specializes in hair loss? It seems most doctors a visit are more knowledable about transplants than they are with hairloss.

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Some people see a dermatologist, but hair transplant doctors are generally the most knowledgeable when it comes to hair loss, because they specialize in hair. Just don’t get pushed into surgery, but use their expertise to help determine a treatment plan (or rather, a Master Plan).

Tags: hairloss, hair loss, doctor

 

Hi!

I was wondering what the procedure is to apply for a fellowship at your facility. I tried to speak to the ISHRS but as of the last 8 months, apparently all their programs are currently inactive so yours might be the only one still training people.

Please let me know.

Thanks

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While we have trained many doctors in the past, at this time we are not offering training for hair transplantation skills. Sorry.

Tags: fellowship, hair transplant, training

 

ISHRS 2011

The annual meeting of hair surgeons was in held in Alaska this past week. The meeting was very well organized, but because of the location, many physicians chose not to travel the long distance. The weather was ideal, as good as California in its best season. About 15% of the 260 doctors who registered were new to the field and used this meeting as an educational opportunity to enter the world of hair restoration.

The following review is very selective and is biased by the things that were interesting to me (Dr. Rassman) and what I thought could be interesting to some of the readers. Since there’s so much to cover, I’ll break this up into multiple posts to make things easier. Stay tuned for more.

There were many innovations in surgical tools that may be too technical for most, so I won’t discuss them too much here. That said, I did write a little about some tools that might have some interest, so let’s begin with those…

***

 
Tool for measuring scalp laxity

    A new instrument for assessing the safety of strip excision as it correlates to the size of a donor strip was introduced by Dr. Parsa Mohebi. He presented the second version of his Laxometer, which should be used to measure the limits of the width of a donor strip.

 
Using HairCheck for bulk measurement

    The HairCheck hair bulk analysis system, which we have been using for a year or so, was reported by many doctors as a positive tool for measuring the hair mass of scalp hair. Readers of this site probably know how much we’ve mentioned hair bulk analysis, and it’s good to see it finally gaining some traction in the physician community.

    The reason we like it is because it enables doctors to compare results over time with real numerical values, which shows the value of drugs like finasteride, and allows physicians to make the diagnosis of genetic hair loss in young men now more certain. Many young men with hair loss in the family who are concerned that they will also inherit the hair loss gene can now be evaluated for the presence of hair loss in its earliest stage. Proper diagnosis should cut down on unnecessary use of hair loss drugs.

 
Keep checking back for much more.

Tags: hair loss, hairloss, ishrs, alaska, tools

 

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