Keywords: full-time hair restoration technicians per diem hair restoration technicians surgical assistants hair restoration technician salary surgical coordinator

102.1 Introduction

As the hair restoration field grows, the need for well-trained and experienced hair transplant technicians increases as well. The overall success of a clinic is determined by surgeon, as well as the skill set of the staff. When deciding to use full-time staff or per diem staff, there are pros and cons for both scenarios. Unlike other cosmetic practices that rely primarily on the expertise of the physician for success, hair restoration requires well-trained and dedicated team of hair restoration technicians.

It takes approximately 1 full year to train a hair restoration technician to assist in follicular unit transplantation (FUT) and follicular unit extraction (FUE). All assistants should be proficient in both types of surgery, and should be cross-trained for all back office functions. It takes many years to master all techniques to be efficient and successful, including first assist, dissection and implantation of grafts, as well as having a thorough education in hair. Training can be very challenging as it is “on-the-job training,” with live donor tissue and actual patients. It is important that all assistants have knowledge of all procedures offered by the clinic, the basic anatomy of hair, preparation, preservation, and implantation of grafts, as well as postoperative care.

The number of staff needed for an FUE or FUT procedure ranges between three and six technicians depending on the size of the case, and their experience. A typical hair restoration procedure takes an average of 8 to 10 hours, and the technicians will be assisting the physician, trimming grafts, and implanting grafts. The time of the procedure depends on the experience of the physician as well as the experience of the staff. Typically an office has a surgical coordinator who has a great deal of experience with hair restoration, knows all the steps of the procedure, and has mastered all the skills of hair restoration, including preoperative skills, slivering and cutting, extracting grafts in FUE, implantation of the grafts for scalp as well as eyebrows and facial hair, and postoperative care. A full-service hair restoration practice may also require knowledge and skill in platelet-rich plasma (PRP) and scalp micropigmentation (SMP).

102.2 Full-time Technicians

Hiring full-time technicians has many advantages to a practice. A physician is able to train the technician to his or her standards. Although state law varies, a hair restoration technician usually has trained in medical assisting or surgical technology, and knows how to obtain a blood pressure, basic charting, and blood draws. A new hair transplant technician will work with a more experienced hair transplant technician in one-on-one training for a minimum of 3 months. Initially, the technician will review preoperative skills, which include the above, and how to properly assist the physician in removal of donor tissue whether it be a strip of tissue or FUE, and assisting in the creation of recipient sites. Next, the new technician will be trained on live tissue: how to properly sliver a strip of tissue, dissect grafts from the slivers, or trim grafts from FUE tissue, without transection or damage of the grafts. This requires direct visualization under a microscope, which takes some adjustment, as well as learning good posture to be seated at the microscope for longer periods of time. Initially, a technician should be able to cut 20 to 40 grafts an hour, which will increase with experience, and once mastered may cut up to 200 to 300 grafts per hour. Once the new technician is comfortable with cutting of tissue, he or she will learn to sliver a strip of tissue. Initially, the new technician should be slivering one-third of a strip of tissue in 2 hours, and with mastery of slivering, should sliver one-third of a strip of tissue within 30 to 45 minutes. The surgical coordinator will work with the new technician on proper handling of grafts, as well as implantation of the grafts, using both straight and curved forceps. Technicians will learn to select the appropriate grafts according to the surgeon’s directions, to place on the right side and left sides of the scalp, as well as the crown. With experience, he or she will work their way to eyebrow transplantation and facial hair transplantation, which increases in difficulty due to the rotation of the grafts and the angle of placement. Initially, the new technician should be implanting 50 grafts in the scalp in 1 hour, developing mastery of placement with 200 to 300 grafts per hour. The coordinator will check the work of the new technician, to evaluate the depth of placement as well as appropriate rotation, and ensure that no recipient sites were skipped. The new technician is required to learn about postoperative care of both donor and recipient areas, and is able to answer all the questions that the patient may ask during the procedure.

Once full-time hair restoration technicians are trained, they learn to work well as a team, and can assist each other at various stages of the procedure if needed. This leads to camaraderie, and the patients notice when the team works well together. A practice can do larger cases in less time when working with well-trained staff, and can also do multiple cases with a larger staff. Full-time staff, once past the probationary period, can earn an increase in salary, and benefits, health insurance, and paid vacation time. A happy staff leads to happy patients and a happy practice! Depending on the years of experience in a practice, a technician may be promoted to surgical coordinator, who, in addition to training new technicians, is responsible for setting a rotating schedule for their fellow staff and assigning staff to work with patients. It is also helpful to a practice to have technicians who are bilingual in Spanish, French, Armenian, Russian, etc. Full-time staff lead to overall practice stability, exceeding patient care and quality control. Salaries may vary from $50,000 to $75,000 or more depending on the location of the practice, years of experience, role in the clinic, as well as the degree of the assistant (nurse, medical assistant, and surgical assistant). The surgeon and patients benefit because this “team” knows that the success of their practice is also directly tied to their own success.

102.3 Per Diem Staff

A typical per diem technician has been trained in hair restoration techniques, and knows how to cut and implant grafts. He or she is used to many different offices, with different staff, techniques, and requirements. A per diem technician has flexibility in his or her schedule, and is under no obligation to accept a work offer. He or she can schedule days off, and are occasionally available on short-term notice. If there is an extended period of time in which a per diem technician cannot work, he or she can do so without any penalties. If the physician needs to take extended periods of time off work, a per diem technician may be ideal economically. However, quality control is more difficult with a per diem technician due to variable training and experience. Wages can vary and will depend on the years of experience, with hourly salaries of $30 to 45 per hour, or daily rate of $275 to 450. A per diem technologist is responsible for paying his or her own taxes and health care. Depending on the area, an experienced per diem technologist may be forced to work with an inexperienced hair restoration physician, or an experienced hair restoration physician may be forced to work with inexperienced per diem hair restoration technicians, leading to compromised results. Some practices that are not dedicated specifically to hair restoration may hire an experienced per diem technician to do parts of the surgery that should be done by a physician, which is unacceptable in the hair restoration realm and, in many states, illegal.