SAN DIEGO Hair restoration surgery can be a lucrative addition to a cosmetic surgery practice, but efficiency and speed are crucial, E. Antonio Mangubat, M.D., said at the annual meeting of the American Academy of Cosmetic Surgery.
Hair restoration surgery can be time consuming, with each procedure taking 2-6 hours depending on the amount of hair transplanted. But unlike most surgical procedures, the physician can work on up to four patients in parallel, if he or she has highly trained staff, said Dr. Mangubat, who practices in Tukwila, Wash.
"You're part of a team, and you've got to give up a little bit of that ego that says you have to do it all," Dr. Mangubat said. He estimates that his staff conducts 60%-80% of each operation. "I'm only in the operating room for my part of the operation, and I can go off and do other things."
Dr. Mangubat harvests the donor hair, designs and prepares the recipient sites, and supervises the other activities. Technicians place all the grafts and take care of all patient preparation and cleanup.
Competition in the hair restoration field is driving down prices at the same time that costs are increasing, in part because of the more refined approach required by follicular unit grafting. This gives much better cosmetic results, especially along the hair line, than do the old-style hair plugs.
So speed is important, but not only for increased production. Studies show that speed has a large effect on graft survival, with 95% of grafts surviving for 2 hours outside of the body, but only 86% surviving for 4 hours. Speed is also important for patient comfort. "Can you imagine being in there 12 hours versus 6 hours?" he asked.
Technology can also help. Dr. Mangubat uses a multibladed knife that can harvest up to eight strips of donor skin and associated hair follicles simultaneously. He closes the donor site with stapleswhich takes 3 minutes and gives a good cosmetic result at the expense of some patient discomfortinstead of sutures, which can take up to 15-20 minutes to do correctly.
And he's a proponent of using a graft cutter, a device in which thin slivers of donor tissue are placed on a series of blades and smacked with a hammer into smaller pieces. In the pre-graft cutter era, a 1,000-graft session lasted 5 hours and required four staff members (three cutters and one placer) for a total of 20 person-hours, not counting the physician's time.
But using a graft cutter, a 1,000-graft session takes 4 hours and requires a single assistant to place the grafts, for a total of 4 person-hours. This greatly increases surgical productivity with no decrease in patient satisfaction, Dr. Mangubat said.