Hopefully, I can help clarify this whole thing.
You see, years ago, the docs placed the punch out grafts, and even the micro and minis. But the cost was so high per graft that it kept many guys from getting their hair transplants. The bottom line was that most patients could not afford it.
Then the docs thought, let's train surgery techs to cut and place them. Techs cost much less in overhead than docs. Obviously this approach also allowed the Doctor to do more grafts per day. That's also when the hair mills started doing assembly line production, with that same Doctor doing two, three, and even more patients in one day. They started focusing on volume and that's when graft prices started coming down across the board. But you see many more patients could now afford the procedure so in the end, it was viewed as good for everyone. I do not completely agree with that.
But here's the bottom line. Some docs got kind of lazy since they had techs doing the graft dissection. They did not have to worry about it anymore. And you know human nature. most people will not do the things that they no longer have to do.
But here's the problem. COMPETENTCY!!! Trust me, over the years, there are docs out there "that you don't want cutting your grafts" because they either don't have, or they lost the touch. Some of them were not used to microscopic dissection either. THE BIG QUESTION IS, how many surgeons do you see actually dissecting the strip? Proficiency comes with training and practice, under a microscope. Oh sure, there are techs that are not competent, but the whole issue is skill under the scope. I have seen many very talented techs that can cut grafts as lean down to the peripheral size of the recipient site. That skill is worth its weight in gold. The truth of the matter is that most docs will tell you that their senior techs or other team members are far more skilled at dissection than he is.
But don't get me wrong. There are still a number of surgeons who are very much invloved with the placement, especially if they utilize the "stick and place" method. They want precise acute angulation with the single hair grafts. And as a result of their hands on approach, their skill level is greatly enhanced.
So really, it's not always an issue of whether the Doctor or tech is doing the dissection and placing, "IT'S AN ISSUE OF SKILL AND COMPETENTCY" in that dynamic aspect of the procedure.