Dr Lam's Hair Restoration Forum

Hello Doc,

I would like to know do you use the FUE method for HT? If so, have you done numerous FUE methods with visible photo results to refer me to see on this website gallery of before and after photos of your patients? What is the fee for FUE vs. the other HT method that you use and please do provide an idea about your fee for stage 1, 2, 3 and 4? Can hair be transplanted on the scarred scalp area from where the donor hair for HT were taken? Thanks.

P.S. I had HT in 2006, not the FUE type, but the misco dissection method and in a year the hair grew well my overall hair looked dense but for the past year I am seeing a increase in hair loss like male pattern baldness in other area and in transplanted too. The bathing tap water where I live is so bad that it literally leaves the rust types of spots on the plumbing fixtures, so I am wondering if that is playing a major role in my losing more hair so fast. If stress causes loss too, which type of doctor, medical expert, can test my stress level clinically? Need your input on this please.

i do not do FUE for central hair loss. i think the cost is too high, the # of grafts too few, the yield poor, the growth poor, and the donor area depleted with donor waste. if you want hair transplant fees, write to marcy@lamfacialplastics.com. i have been asked not to publish that info. i can transplant hair into the donor area. most likely the hair loss is not due to water or stress although it can occasionally be related to stress. most likely the stress levels can lead to some hair loss but it is most likely just progressive male pattern baldness (if you are a guy).
best,
sml

Alright, thanks 4 ur reply. No matter how thin all HT docs claim that donor hairline will be it really doesn't turns out to be fine or tiny line so I was considering the FUE method. And I have pain in my donor site which didn't turn out to be a tiny scar, but I suppose it could depend on HT surgeon's expertiese or technique to leave the smallest scar or something. Yes, I am a man. Regards

sorry that you have pain. typically, that is due to cutting through the donor tissue without tumescence and without the care to protect the nerves. i have helped patients who have gone through the several-cases-a-day chains that bang patients through like flies. i have done botox to help those patients with chronic pain. when the nerve and blood supply is compromised, the wounds tend to heal not so good. this is why it takes me literally 1.5 hours just to prepare, harvest, and close my donor area. no joke. if you don't understand tumescence (and i don't mean throwing in 10 to 20 cc of some fluid i mean dedicating 150 to 200 cc of fluid to limit transection and to protect the deep nerve and blood supply tissue), watch my video in the donor closure section. however, you are right at times i get a visible line if you comb through the hair that i can't predict.
best,
sml

Well...thanks for clarification and I do think that doc didn't do all that for sure as I was there to close my donor site. Yes as I am touching that area, it is highly painful so you think I can get that improved and if I do then will my regular medical insurance BCBS would cover it since I feel it deals with suffering though the scar is the result of selective procedure HT? I am mean I don't know if it is your domain to repair nerves afterwards or what...any guidance on that? I will be getting another HT depending on the right time when I am back in US

Here some pics attached and please advise what stage would be beneficial for my balding status now and also comment on my HT result and your outlook. One doc did horrible HT procedure which resulted in bad and painful scar at donor site, see pcis and all his 100-500 grafts hardly survived and some so wrongly placed that I am paying to get it laser out.

Second separate doc did 1000 or more grafts in 06 also that left poor scar too but not that huge as the 1st one. The HT result hair survived and gave me more hair 2nd time around. So you can see the result in pics.

Now I still feel bald as can be seen in pic so want future HT but am worried about existing scars and donor site damage in future or how old damage can be corrected and by whom and how. Any input would be appreciated. Please delete my pics here after our consult on line for privacy reasons. Thanks.

this is a tough one. as far as insurance, i don't take it so you might have to find a doc who does. i have no idea if your case would qualify. i would say your scar just looks widened and not hypertrophic meaning that the pain is most likely caused by nerve irritation rather than a thickened scar. however, again i can't give you direct medical advice just general guidelines. i would consult with a doc to consider direct botox injections there.

what is your age? my fear is that you look young and that you are using a lot of donor tissue already and already with poor donor healing. that may not be related to technique. sometimes healing is healing and you just don't have a good predisposition toward it. that is always hard to say since i was not there. my other fear is that i might worsen your scarring given what i am seeing. there really is no easy way to look at this.

i hesitate to give you a stage because i don't even know the total extent of your donor hair and i fear further hair loss and trying to figure out what would be the best for you. given these limitations, if you want to have a real consultation with me, i would say an in person one might be necessary so that i give you the right advice. don't plunge ahead for another session until you probably manage the pain issue. my goal is to help you and not to hurt you. sorry for not being more explicit in my goals.
best,
sml

Thanks for a quick response. Fine if you don't accept insurance. I paid for previous procedures out of pocket. I am 42 yr. male. Thanks that I look young. I will do something about the pain issue now. When the time is right, then I can come in for an in person consult with you, but right now I am at a distance. One thing I did forget to ask you, do you shave head to do the HT? My surgeon had shave donor and areas where the HT was done. Is it true that native hair could be shocked to fall if the site is not shaved or is it for surgeon to view and transplant more easily in that area? Regards. P.S. What is botox and how does it help? Frankly, I don't think it's my healing. I do feel it was that 1st surgeon was clearly inexperienced doing trial and error. He had hardly done HT but that I found out late. Second surgeon's practice was dedicated to HT but then his assistants did pretty much the entire procedure, except the surgeon perhaps did cut the donor strip. Dissection of grafts and implanting was rest all done by assistants. So I feel those were not well trained. Rest God only knows .

FYI, I have pics of HT 2nd procedure and brief video even and surgeon has more detailed video so that will tell if I am predisposed to poor healing or if there was something inappropriate about his method of performance and whether he did tumsecene (excuse typo). I mean this is to help the next surgeon if need be. Thank you.

i appreciate your wanting my help. however, this forum is meant to answer general hair questions and not to provide a detailed consultation for your particular circumstance. it goes against the grain of the intentions. i believe that any "advice" that i give you is dangerous since i am not seeing you in person and we have not established a physician-patient relationship. you can ask me any general question but i should not review any further photos until a formal consultation. again, i appreciate your participating in this forum. i really do!
best,
sml

Thank you for your help so far. I will come in for a personal consult when I am in US. I asked my previous HT surgeon this "I do wish to know what exactly you did at that time to do the donor site closure, meaning the techinical medical method which was used to perform it. I do wish to advise you that my donor scar is not narrow and does have pain in it." This is the response I received from his office, "Strip scar closure is performed by the doctor, using self dissolving monocryl sutures, in two layers. Tricophytic closure is performed to minimise the appearance of the scar." Now I know that no tumscent was performed since I was there." Also, here is what you say you do, "Dr. Lam takes as much pride and care in ensuring that the incision in the area of the donor hair looks as good as all the transplanted hair. First, he uses a specialized tumescent anesthetic that allows him to remove only the desired hair follicles without disturbing any deeper parts of the scalp so that the incision heals better and faster. Also, numbness, if any, can be present for a much shorter time. He also routinely performs a meticulous closure known as a “trichophytic” closure in which hairs grow through the tiny scar to make the incision hardly noticeable, even with close inspection. Many of his patients who previously had a procedure done elsewhere have commented the difference in their overall experience and marveled at Dr. Lam’s work, especially how unnoticeable the incision line is." My doc didn't really do such trichophytic closure as claimed as my scar doesn't have hair growing through the scar. I don't recall neither he mentions it that he did tumscent technique either. No tiny hair are growing from the scar so I hardly think that his trichophytic technique if done really was effective. Thank you.

ok, i want to be completely honest and accurate:
1. not every one of my scars are completely undetectable. healing is variable and you can have widening.
2. no matter how good the surgeon is, some people heal poorly.
3. if you are already widened, i may be able to improve the situation but the blood supply may already be compromised and the tension present on the wound.
bottom line: i do beautiful work but even in my hands i can't make any level of promise to you.
best,
sml