Dr Lam's Hair Restoration Forum

Dr. Lam,
Firstly, I’d like to congratulate you on your wonderful website. It genuinely does communicate your (and Emina’s) passion and enthusiasm for performing this procedure and applying ‘uber detail’ to each component, elevating the procedure to a level of artistic expression and medical perfection for the benefit of your clients. Your website has answered many of my questions and soothed many of my concerns. Your and Emina’s commitment to your personal attention and ‘tag-team’ approach to the proecure itself shows a level of dedication to excellence that I have been longing for in my search for a hair transplant surgeon and team. I wanted to write and explain my personal situation, and then ask some questions that perhaps other men might have as well. I apologize for the length of this post. I am currently age 43. I started to notice hair loss back in college, perhaps as early as age 20-21. This was in the mid 80’s, and at the time, minoxidil was being researched. I went to the medical library at my University and pulled articles from journals describing early research on minoxidil on monkeys, etc. I actually convinced my father (a physician) to prescribe it to me compounded in white petrolatum, back in 1986! I then attended a hair loss clinic in graduate school in the late 80’s and received minoxidil compounded in a liquid alcohol solution. Of course, when it became FDA approved shortly thereafter, I received formal prescriptions for the ‘official’ Rogaine product. Despite using it consistently, I believe my hair loss continued throughout the late 80’s and into the mid 90’s when I was in my early 30’s. Since that time, and up until recently, my hair loss has continued, but at a much, much reduced rate. I look at pictures of myself from about 10 years ago, and I do not see much of a dramatic difference until now. However, of course there is a large difference comparing those pictures to pictures from the previous decade etc. So, essentially, I believe that my hair loss has stabilized, or at least the rate of loss has dramatically reduced. Of course, as you’ve heard from countless other men in my situation-it was highly distressing to me, to see shower drain fulls of hair during the ‘prime of my life.’ Now, my age has finally ‘caught up’ to the degree of hair loss I have. Compared to others, I feel sort of fortunate that I do have enough hair to part, but it is getting very thin on top indeed. Currently, if I had to rate myself, I believe I am a Norwood 3 or 4 at this point. Since, my hairloss has appeared to largely stabilize, I believe at this time I am a good candidate for hair transplantation. Of course, I have to ‘time’ the surgery properly, as my work is very visible and I want to be as discrete as possible. Knowing that you perform one to three surgeries per week is important as I will need to call and reserve my date soon! I have some questions related to my personal situation and I am hoping by answering these questions for me, that other men will also find them helpful. Here we go:

1) Rogaine and propecia: In the forum, you recommend being on Rogaine and Propecia for 6 months postoperatively to prevent shock shedding to one member. I also see another client in which you have recommended the use of these agents for 6 months PRIOR to hair transplantation. Is this a firm requirement to ensure success of the transplant? Or is it more of an ‘elective’ or optional type recommendation? If you have a client who doesn’t wish to be on Rogaine, Propecia indefinitely , would it be beneficial to start these two agents 4-6 months prior to hair transplant and continue for six months, for a total of 10 months to a year periprocedurally? Meaning to say, will the addition of these agents perioperatively, have a permanent beneficial effect in the transplanted follicles? I have never tried propecia, but I have been on Rogaine religiously in the past and never saw any appreciable benefits (as described above). Applying it (both liquid and foam) also gives the ‘wet look’ and makes the scalp shiny, actually worsening the cosmetic appearance around the vertex/crown region. Just curious on your opinions. Lastly, since rogaine typically is used for crown baldness, and the first hair transplant session may involve reconstructing the hairline and temple area as well as centrally, is it recommended to use Rogaine in these areas postoperatively?
2) Recently, I have started using hair color. I use a professional type (no ammonia), called Color Smart for men (by Loreal). I actually do recommend that brand as opposed to the “Just for Men” that you get at your corner chain drug store. To keep the color consistent, I have to apply it at a minimum of every 3 weeks. Is there any contraindication to applying this agent the day or two before the hair transplant surgery and then reapplying it (gently of course) about three weeks post operatively? Any issues with coloring the transplanted hair going forward, or transplanting donor hair that has recently been colored?
3) My hair is fairly straight; however, in the back region (where the anticipated donor sites will be) when that hair grows longer, it tends to get wavy. Since that hair will be transplanted, will there be a “disorganized wave” when that hair grows in? What I mean to say, will the hair curl unattractively, or will it ‘behave’ as it should once it grows in?
4) Related to #2 above, I have noticed something interesting. You stated in your forum that the ‘safest’ hair to remove along the back is in the midzone, not too far towards the neck, nor too far towards the crown, vertex, or hump region. When my hair started going grey (and even now), there was a ‘stripe’ of grey hair in that same region-picture the stripe of white hair on a skunk! I have also been told that “be happy that you have grey hair, because grey hair will not fall out.” Putting all of that together, it appears to make sense, could you comment?
5) Regarding hair transplant stages 1-4, they are gauged by the total number of hairs or follicular units transplanted. You also stated that you prefer not to do too much on the first session, going all the way to the crown/vertex, but prefer to construct the front hairline first. That sounds perfect to me. Based on this, could I have two sessions of “stage 2”, separated by 9-12 months, with the hairline/temples being done first and the crown second?
6) How helpful is it to provide older photos when there was less hairloss?
7) How does the hair look wet? I have read and watched the videos in which you want the grafts to slightly protrude from the plane of the scalp to avoid ‘pitting.’ I don’t see any pictures showing post grafting hair when wet. Will the hair have a totally natural wet look (as when getting out of the swimming pool), etc? As some of the videos showing freshly transplanted scalps show what I would consider a type of “orange peel” type texture. Does this smooth out over time?
What are the approximate dimensions of the donor site typically used for the various stages (1-4). If you plan two sessions with a client, how do you plan for multiple donor harvests? Does the first surgery use one side, and the second surgery use the second side? Or do you excise both sites at the same location and remove the old scar at the same time? What is the recommended length to leave the donor site hair to help camouflage the rear scar/sutures, as I would have to return to work shortly after the anticipated surgery.
9) Is there any numbness in the posterior scalp after surgery? If so, does it usually resolve and how long does that take?
10) My posterior scalp is very tight. I cannot ‘pinch’ any scalp between my fingers. What are the implications for donor site harvesting, closure, and final cosmetic appearance. Do you recommend scalp exercises? If so, what frequency and duration prior to the procedure. The link to the video where Emina is discussing doesn’t seem to be working at this time.
11) Would you comment on follicular unit extraction? The beauty of the tricophytic closure you employ is very nicely shown on your videos and I was just wondering on your thoughts on this other method of graft harvesting.
Sorry again for the length and the multiple questions. I have read your replies and I know they are very thorough, so I certainly don’t expect a reply to all of the questions at one time. I hope the time spent in answering will provide information to not only me, but to other future clients. I did lots of research on your website and I am hoping I haven’t asked a question or topic that you have covered elsewhere. If I have, I apologize. Thanks again!!

THANK YOU SO MUCH FOR THE KIND COMMENTS. YOU ARE RIGHT. THIS FIELD IS MY PASSION AND I LOVE IT. I ALSO WANT TO APOLOGIZE FOR THE LENGTH OF TIME IN RESPONDING. I TEND TO ANSWER QUESTIONS ALMOST EVERY DAY BUT I DID NOT SEE A QUESTION SINCE OCTOBER SO I FAILED TO CHECK THIS MORE REGULARLY. I WILL ANSWER THE QUESTIONS FOLLOWING THE QUESTIONS IN ALL CAPS:
1) Rogaine and propecia: In the forum, you recommend being on Rogaine and Propecia for 6 months postoperatively to prevent shock shedding to one member. I also see another client in which you have recommended the use of these agents for 6 months PRIOR to hair transplantation. Is this a firm requirement to ensure success of the transplant? Or is it more of an ‘elective’ or optional type recommendation? NO, IT IS ELECTIVE. HOWEVER, IF SOMEONE SHOWS EXTENSIVE MINIATURIZATION (VELLUS HAIRS, BABY HAIRS), THEN DOING A TRANSPLANT INTO THIS AREA WITHOUT STABILIZATION WILL LEAD TO A HIGHER INCIDENCE OF POSTOPERATIVE SHEDDING (ALBEIT TEMPORARY) OR TELOGEN THAT COULD BE MORE EASILY MINIMIZED WITH PREOPERATIVE MEDS. IT IS MORE IMPORTANT TO BE ON THESE MEDS BEFORE THE PROCEDURE. AFTER HELPS BUT NOTHING LIKE BEFORE THE PROCEDURE. ROGAINE AND PROPECIA WORK EVEN BETTER TOGETHER. If you have a client who doesn’t wish to be on Rogaine, Propecia indefinitely , would it be beneficial to start these two agents 4-6 months prior to hair transplant and continue for six months, for a total of 10 months to a year periprocedurally? Meaning to say, will the addition of these agents perioperatively, have a permanent beneficial effect in the transplanted follicles? I have never tried propecia, but I have been on Rogaine religiously in the past and never saw any appreciable benefits (as described above). IN SHORT, MAYBE. IF THE PROBLEM IS MINIATURIZATION, I AM JUST TRYING TO MINIMIZE POSTOP SHOCK, WHICH IS TEMPORARY. HOWEVER, THERE ARE NO CONCLUSIVE STUDIES TO SAY THAT PROPECIA AND ROGAINE WILL HELP THE TRANSPLANT. THE ONLY EXCEPTION TO THIS RULE I WOULD SAY (BUT WITHOUT FORMAL STUDIES TO BACK IT UP) IS THAT I TRY TO START SOMEONE ON ROGAINE IN 2 OTHER CIRCUMSTANCES. SOMEONE WHO HAS LITERALLY BEEN BUTCHERED BY A CARELESS SURGEON AND WHO HAS TERRIBLE BLOOD SUPPLY IN THE RECIPIENT BED DUE TO INSUFFICIENT TUMESCENT FLUID, THEN I TRY TO MANAGE THEM PERIOPERATIVELY WITH ROGAINE TO INCREASE BLOOD SUPPLY TO PROTECT THE AREA. ALSO, SOME PEOPLE WITH A NORWOOD 6 OR SO THAT HAVE CHRONIC SUN EXPOSURE TO THE SCALP USUALLY SHOW A REALLY BAD SKIN THAT MAY BENEFIT FROM PERIOPERATIVE ROGAINE. HOWEVER, IN MOST CASES, THAT WOULD NOT BE ABSOLUTELY NECESSARY. BECAUSE I HAVE NOT SEEN YOU AND THE FACT THAT THESE PRODUCTS WOULD NOT HURT BUT ONLY HELP I THINK IT MAKES SENSE TO START ON THEM EVEN BEFORE COMING TO SEE ME IF POSSIBLE. HOWEVER DESPITE THESE SCENARIOS LISTED ABOVE, THE ANSWER IS THAT IT IS NOT CRITICAL IN OTHER CIRCUMSTANCES TO BE ON THE MEDS. Applying it (both liquid and foam) also gives the ‘wet look’ and makes the scalp shiny, actually worsening the cosmetic appearance around the vertex/crown region. Just curious on your opinions. FOAM SHOULD DO LESS. PLUS AT LEAST YOU COULD DO IT AT NIGHT WHEN COSMETIC APPEARANCE IS NOT AS BAD. IN AN ANECDOTAL EXPERIENCE, SINGLE USE ROGAINE COULD LAST IN THE SCALP 22 HOURS VERSUS IN THE BLOOD FOR 4 HOURS WHEN TAKEN AS A PILL FOR BLOOD PRESSURE. I ASSUME YOU KNOW THAT ROGAINE IS ONLY TOPICAL. I STILL RECOMMEND TWICE A DAY IF POSSIBLE. BUT IF IT IS A COSMETIC NUISANCE DESPITE THE USE OF FOAM, AT LEAST CONSISTENTLY APPLY IT AT NIGHT. Lastly, since rogaine typically is used for crown baldness, and the first hair transplant session may involve reconstructing the hairline and temple area as well as centrally, is it recommended to use Rogaine in these areas postoperatively? THIS IS TOTALLY FALSE INFORMATION. IT IS OUTDATED. ROGAINE HELPS EVERYWHERE. THE FDA AND THE ORIGINAL STUDIES FOCUSED ON THE CROWN. LOOK AT MY BEFORE AND AFTERS JUST ON ROGAINE FOR THE FRONT. SEARCH MY BLOG WHERE I DEBUNK THIS OUTDATED INFORMATION.
2) Recently, I have started using hair color. I use a professional type (no ammonia), called Color Smart for men (by Loreal). I actually do recommend that brand as opposed to the “Just for Men” that you get at your corner chain drug store. To keep the color consistent, I have to apply it at a minimum of every 3 weeks. Is there any contraindication to applying this agent the day or two before the hair transplant surgery and then reapplying it (gently of course) about three weeks post operatively? Any issues with coloring the transplanted hair going forward, or transplanting donor hair that has recently been colored?
YES. YOU SHOULD STOP 7 DAYS BEFORE AND RESTART 2 WEEKS AFTER. THAT APPLIES TO ALL RECIPIENT AND DONOR REGIONS. THEREAFTER COLORING IS FINE.
3) My hair is fairly straight; however, in the back region (where the anticipated donor sites will be) when that hair grows longer, it tends to get wavy. Since that hair will be transplanted, will there be a “disorganized wave” when that hair grows in? What I mean to say, will the hair curl unattractively, or will it ‘behave’ as it should once it grows in?
INTERESTINGLY, MANY TIMES YOUR HAIR IN THE FRONT PERHAPS WAS A BIT WAVIER IN YOUTH BUT WITH FURTHER MINIATURIZATION AND LOSS OF HAIR, IT TENDS TO BECOME STRAIGHTER. IF THE HAIR BEHIND IS CURLIER, THE HAIR CAN ASSUME A CURLIER APPEARANCE. TWO THINGS THOUGH. WHEN WE PLACE THE HAIRS INTO POSITION, WE FOLLOW THE CURL OF THE HAIR SO THAT IT IS NOT ALL OVER THE PLACE. FOR EXAMPLE, IN THE TEMPLE, THE CURL MUST POINT DOWN SO THAT IT DOES NOT STICK UP. IN THE FRONT HAIRLINE SAME THING, YOU DON'T WANT IT POINTING LEFT RIGHT OR UP. ALSO, WE DO SOMETHING WE CALL REGIONAL HAIR TRANSPLANT IN WHICH WE USE FINER CURLIER HAIRS FOR THE TEMPLE AND STRAIGHTER HAIRS FOR THE CENTRAL ANTERIOR, ETC. THERE IS THOUGHT THAT OVER TIME THAT THE RECIPIENT SITE INFLUENCES THE NATURE OF THE HAIR BUT I CANNOT GUARANTEE THAT.
4) Related to #2 above, I have noticed something interesting. You stated in your forum that the ‘safest’ hair to remove along the back is in the midzone, not too far towards the neck, nor too far towards the crown, vertex, or hump region. When my hair started going grey (and even now), there was a ‘stripe’ of grey hair in that same region-picture the stripe of white hair on a skunk! I have also been told that “be happy that you have grey hair, because grey hair will not fall out.” Putting all of that together, it appears to make sense, could you comment?
WELL, GRAY HAIR CAN FALL OUT LIKE ANY OTHER HAIR. ALSO, WE TEND TO APPLY THE REGIONAL ELEMENT AS WELL MENTIONED ABOVE. WE WILL FOCUS THE GRAY MORE ON THE CROWN AND THE TEMPLES BUT SCATTER IT APPROPRIATELY SO THAT IT BLENDS WELL.
5) Regarding hair transplant stages 1-4, they are gauged by the total number of hairs or follicular units transplanted. You also stated that you prefer not to do too much on the first session, going all the way to the crown/vertex, but prefer to construct the front hairline first. That sounds perfect to me. Based on this, could I have two sessions of “stage 2”, separated by 9-12 months, with the hairline/temples being done first and the crown second?
YES THE ORDER IS RIGHT. THE STAGE DEPENDS ON HOW MUCH HAIR YOU HAVE TO DONATE. MOST PEOPLE THAT WANT A DENSE RESULT THAT ARE MORE A NORWOOD 4 AND BEYOND NEED A STAGE 4 X 2. ONE FOR THE FRONT AND ONE FOR THE BACK. SOMETIMES YOU NEED ANOTHER STAGE 4 TO TRULY MAKE THE CROWN DENSE. IT DEPENDS ON HOW WIDE YOUR CROWN IS. WATCH THE VIDEO LOG ON THE BILLBOARD EFFECT OF THE CROWN. I DON'T WANT TO SCARE YOU WITH BIG NUMBERS. I JUST NEED TO SEE HOW MUCH LOSS, HOW BIG YOUR AREA OF LOSS IS, AND HOW MUCH DONOR HAIR BOTH DENSITY AND SIZE ARE.
6) How helpful is it to provide older photos when there was less hairloss?
SORT OF. IT'S NICE TO SEE WHERE YOU WERE BUT NOT REALLY THAT HELPFUL.
7) How does the hair look wet? I have read and watched the videos in which you want the grafts to slightly protrude from the plane of the scalp to avoid ‘pitting.’ I don’t see any pictures showing post grafting hair when wet. Will the hair have a totally natural wet look (as when getting out of the swimming pool), etc? As some of the videos showing freshly transplanted scalps show what I would consider a type of “orange peel” type texture. Does this smooth out over time?
NO, IT SHOULD BE SMOOTH. THE HAIR SHOULD LOOK FINE WHEN WET. THAT SHOULD NOT BE A PROBLEM. SORRY I DID NOT PHOTOGRAPH ANY HAIR WET. DIDN'T THINK OF IT TO BE HONEST.
What are the approximate dimensions of the donor site typically used for the various stages (1-4). If you plan two sessions with a client, how do you plan for multiple donor harvests? Does the first surgery use one side, and the second surgery use the second side? Or do you excise both sites at the same location and remove the old scar at the same time? What is the recommended length to leave the donor site hair to help camouflage the rear scar/sutures, as I would have to return to work shortly after the anticipated surgery.
ALL OF THESE VARY FROM 15 CM TO 30 PLUS CENTIMETERS. IN GENERAL, HERE ARE SOME BASIC PRINCIPLES TO OUTLINE MY THOUGHTS:
1. THINNER AND LONGER HARVESTS ARE BETTER BECAUSE THEY MINIMIZE TENSION AND MAXIMIZE YIELD. I PREFER A 1 CM WIDTH WITH 30 CM LONG VERSUS A 2 CM WIDE AND 15 CM LONG HARVEST.
2. THE SECOND TIME, I TYPICALLY REMOVE THE OLD SCAR UNLESS WE PERFORMED A TRICHOPHYTIC WHERE I CAN'T SEE THE SCAR. THEN OFTENTIMES THAT FREES ME TO MOVE ELSEWHERE. HOWEVER, EVEN IN THESE CASES, I MAY GO BACK TO THE SAME AREA. JUDGMENT FOR WHEN AND HOW I DO IT WOULD FILL VOLUMES. YOU CAN READ EMINA AND MY NEW BOOK ON HOW WE DO THINGS. IT TOOK US 200 PAGES IN JUST WRITTEN TEXT TO EXPLAIN TO SURGEONS HOW WE DO WHAT WE DO. JUST KIDDING. IT IS CALLED AGING FACE: THE NEW PARADIGM.
3. THE DONOR AREA IS SUFFICIENTLY WELL CAMOUFLAGED WITH AT LEAST 1 TO 1.5 INCHES OF DONOR HAIR GROWN OUT.
9) Is there any numbness in the posterior scalp after surgery? If so, does it usually resolve and how long does that take?
THERE CAN BE LIKE ANY PROCEDURE THAT CUTS THROUGH SCALP. TYPICALLY ABOUT 4 TO 6 WEEKS OF GENTLE NUMBNESS. I HAVE NEVER HAD SIGNIFICANT NUMBNESS. THE REASON FOR THIS IS PSYCHOTICALLY ANAL DONOR TUMESCENCE AND PSYCHOTICALLY ANAL HARVESTING TO AVOID ANY MAJOR NEUROVASCULAR INJURY.
10) My posterior scalp is very tight. I cannot ‘pinch’ any scalp between my fingers. What are the implications for donor site harvesting, closure, and final cosmetic appearance. Do you recommend scalp exercises? If so, what frequency and duration prior to the procedure. The link to the video where Emina is discussing doesn’t seem to be working at this time.
USUALLY IN A VIRGIN SCALP, YOU DON'T NEED THE EXERCISES BUT GIVEN WHAT YOU SAID THEN THAT WOULD MAKE SENSE. THE CHANGES THAT I MIGHT DO FOR YOU IS LIMIT THE WIDTH OF THE DONOR STRIP TO NO MORE THAN 1 CM MAYBE GO DOWN TO 9.5 MM. ALSO IT MIGHT PUSH YOU TO A YEAR BETWEEN SESSIONS WITH SCALP EXERCISES BEFORE YOUR SECOND ROUND. ALSO, I MAY FORGO THE TRICHOPHYTIC CLOSURE ESPECIALLY IF WE PREPLAN 2 TO 3 PROCEDURES SO THAT I CAN LIMIT TENSION ON THE BACK SIDE. REMEMBER I HAVE TO TAKE 1 MM OFF THE BOTTOM LIP. I WILL PROBABLY JUST DO THE TRICHOPHYTIC ON YOUR LAST PLANNED PROCEDURE. MAYBE YOU SHOULD DO SCALP EXERCISES BEFORE JUST IN CASE TO HELP WITH HEALING. WON'T HURT. IF YOU HAVE A PROBLEM WITH THE LINK, SEND A URL LINK TO MY WEBMASTER: MIKE@PERFECT360.COM.
11) Would you comment on follicular unit extraction? The beauty of the tricophytic closure you employ is very nicely shown on your videos and I was just wondering on your thoughts on this other method of graft harvesting.
FUE IS GOOD TO TAKE OUT VERY FEW GRAFTS (SEVERAL HUNDRED) AT VERY HIGH COSTS TO THE PATIENTS. I THINK THE IDEA THAT YOU SIMPLY COULD SHAVE YOUR HEAD AND HAVE A CLEAN SCALP FOLLOWING FUE IS OVERSTATED. YOU CAN STILL GET A MOTH-EATEN APPEARANCE AFTER ENOUGH SESSIONS THAT COULD EVENTUALLY LEAD TO BALDING IN THE DONOR AREA THAT YOU PROBABLY WOULD NOT SEE WITH DONOR STRIP HARVESTING. ALSO, FUE HAS A MUCH HIGHER TRANSECTION RATE AND LOSS OF VIABLE HAIR EVEN IN THE MOST EXPERIENCED HANDS WITH THIS TECHNIQUE. WE REALLY ONLY USE IT FOR SCAR CAMOUFLAGE AND VERY MINOR AREAS BUT ALMOST ALWAYS IN CONJUNCTION WITH STRIP HARVESTING.
Sorry again for the length and the multiple questions. I have read your replies and I know they are very thorough, so I certainly don’t expect a reply to all of the questions at one time. I hope the time spent in answering will provide information to not only me, but to other future clients. I did lots of research on your website and I am hoping I haven’t asked a question or topic that you have covered elsewhere. If I have, I apologize. Thanks again!!
THANKS SO MUCH. NO BOTHER WITH THE QUESTIONS. I LOVE ANSWERING THEM. THAT'S WHY WE HAVE THIS TO HELP PEOPLE ANSWER QUESTIONS!!!
HAPPY NEW YEAR!!!!
SML

Hi Dr. Lam-
Firstly, thank you for your thoughtful replies. No worries about the delay-the holidays are a busy time of year and you are a busy guy!! I knew you would attend to it when you found the time. I have learned a lot from your replies, just a few follow up questions.
1)I found the information on Propecia and Rogaine very helpful and most definitely will get started on them. I have already started Rogaine in the evenings, and am awaiting my first script for propecia at the drugstore! Interestingly, I found out about Toppik from your website. Very interesting product. I got the dark brown, and have been ‘experimenting’ with it. I have not debuted myself in public with it as I am working to figure out how to best to apply it subtly, such as not to be too obvious. I have noticed that putting Rogaine on at night after Toppik application turns the Toppik purple!! Not a good scene. I’ll need to figure a workaround. Thanks for updating my outdated knowledge on Rogaine at the hairline. I can’t find your blog posting referring to this. Could you post the link?
2) Thanks for the information on the donor strip, size, and considerations when planning multiple, ‘staged’ type procedures. With respect to the broken links, I will email your webmaster. I’ve found a few that need to be repaired. I can copy you on the email to the webmaster for your information.
3) The information on regional hair transplantation is very interesting. It goes to the ‘uber detail’ of the procedure that you , Emina, and the rest of your team offer. As this decision is a big decision for most men, it is reassuring to know that one will be in such capable and caring hands.
4) One followup question; by way of explanation, since my last post, I have come across an old friend on facebook, and he had a hair transplant done in Pennsylvania and referenced that his surgeon used a ‘custom lateral slit’ blade and stated that it was a 'state of the art' type process. Is this something you incorporate as well? My friend doesn’t exactly know what it was so I figured I’d ask. Does it refer to the donor site? Is it just another name for the tricophytic closure?
5) A quick question about the combination unit grafting. I am assuming that this graft contains a pair of follicular units? So perhaps 6-8 hairs each? Are the combination FU’s in one block of tissue? Or are they separately dissected FU’s placed into a single donor site? Are these only used in the central forelock region?
6) I had originally planned to just send photos and do the online pre-procedure planning, but now, with the complexity of all of the surgical and aesthetic decisions, I think it would be worth my while to come to a real consultation with you. I will be in touch with your office shortly to make an appointment.
Thanks again Dr. Lam for your time, and I’d like to wish you and your staff a Very Happy New Year!!

1)I found the information on Propecia and Rogaine very helpful and most definitely will get started on them. I have already started Rogaine in the evenings, and am awaiting my first script for propecia at the drugstore! Interestingly, I found out about Toppik from your website. Very interesting product. I got the dark brown, and have been ‘experimenting’ with it. I have not debuted myself in public with it as I am working to figure out how to best to apply it subtly, such as not to be too obvious. I have noticed that putting Rogaine on at night after Toppik application turns the Toppik purple!! Not a good scene. I’ll need to figure a workaround. Thanks for updating my outdated knowledge on Rogaine at the hairline. I can’t find your blog posting referring to this. Could you post the link?
try this: hairtx.com/hairtx-blog/archives/59
2) Thanks for the information on the donor strip, size, and considerations when planning multiple, ‘staged’ type procedures. With respect to the broken links, I will email your webmaster. I’ve found a few that need to be repaired. I can copy you on the email to the webmaster for your information.
thanks!
3) The information on regional hair transplantation is very interesting. It goes to the ‘uber detail’ of the procedure that you , Emina, and the rest of your team offer. As this decision is a big decision for most men, it is reassuring to know that one will be in such capable and caring hands.
thank you again!
4) One followup question; by way of explanation, since my last post, I have come across an old friend on facebook, and he had a hair transplant done in Pennsylvania and referenced that his surgeon used a ‘custom lateral slit’ blade and stated that it was a 'state of the art' type process. Is this something you incorporate as well? My friend doesn’t exactly know what it was so I figured I’d ask. Does it refer to the donor site? Is it just another name for the tricophytic closure?
no, this is an alternative method for creating recipient sites. the lateral or coronal (aka perpendicular) slit goes side to side whereas mine go front to back (sagittal or parallel). the argument in favor of a coronal site is that the hairs won't rotate upward as much or change angles from what was placed (i simply have not seen this due to our well placed angles and size of our sites. actually, it was hilarious. i was at the last ISHRS meeting a couple months back and a guy who combined lateral slits and sagittal sites i one patient during a live patient viewing showed a famous lateral slit guy his work and said, "Tell me which sites are lateral slits versus sagittal." He combed through the hair of the patient and could not. Nor could I so this argument is bunk. Just go to a good surgeon). i think coronal sites are not bad. they are just another way to skin a cat. the reason that i don't prefer coronal sites are the following:
a. you can transect your normal hair if the angle is even slightly off, especially previously grafted hair because the coronal angle is "unnatural". not unnatural in the sense that you get unnatural results. but unnatural in the sense that hairs do not grow in a coronal distribution. they grow in a sagittal distribution.
b. although many can dense pack coronal sites, i can more closely pack sagittal sites based on my experience. in addition, i have now gotten my team to use such tiny tiny needles that they truly create very little scalp disruption when making sites, which leads me to point c.
c. coronal sites are against the natural blood flow of the scalp and have a higher chance of compromising blood supply. if done well, you should be fine but i rather minimize that risk to as much as possible. again, these are not negative comments about perpendicular sites, they are just meant to explain why i do not prefer them.
d. do i ever do coronal sites? yes, actually i occasionally almost every week. when i need the hair angle to be very flat like in the temples, i will use perpendicular sites. i don't always use perpendicular sites. it depends on what i am trying to do and the type of hair i am encountering. fine hair that lies well, i might go sagittal because i can get my sites closer together. if there is a good curl, then the hair will naturally lie flat if the curl is placed right (which we do). think of it this way, if you make a perpendicular site side to side in the temple, the width of the site takes up space so i can't get the sites close enough at times. sometimes i go perpendicular in the front 2 to 3 rows then switch to parallel. sorry for all the technical gobbledygook but this is a question that can't be answered in 2 to 3 sentences. the reason that i don't focus on sagittal sites on my website is that i don't want to suggest that they are better. they are just a different tool to achieve the same ends. i know docs who get very good perpendicular results, whereas i get very good parallel ones. hope that helps.
5) A quick question about the combination unit grafting. I am assuming that this graft contains a pair of follicular units? So perhaps 6-8 hairs each? Are the combination FU’s in one block of tissue? Or are they separately dissected FU’s placed into a single donor site? Are these only used in the central forelock region?
great question. it depends on the spacing between FUs. if you have good density and the two FUs are very close we can do a DFU (or difollicular unit) because the blood supply is kept better intact and same with the spacing. if you have relatively wide spacing then we can do what is more properly known as follicular pairing in which we place two FUs into one site. sometimes we use both methods if at the end of the case, we need more DFUs and we already dissected too many single hair FUs for example and we rather achieve better density in a more limited space than spreading out 1 hairs can achieve. i know this is a complicated answer again but there is not a simple one with the sophistication of the questions you are asking (they are excellent and i love them btw). hope i am not confusing you. as far as using them only in the central forelock. no, it depends again on the clinical situation. we can use them all the way through the midscalp and also remember the concept of the extended central forelock. see my video logs to understand this better. so long as single FUs surround our DFUs we get very natural results. obviously, we pick our patients very carefully depending on the curl, thickness, color, etc. when we decide on DFUs
6) I had originally planned to just send photos and do the online pre-procedure planning, but now, with the complexity of all of the surgical and aesthetic decisions, I think it would be worth my while to come to a real consultation with you. I will be in touch with your office shortly to make an appointment.
love to meet you!

Hi Dr. Lam-

Again, thank you for your detailed and thoughtful replies. I really don't have any further questions, just some final 'soul searching' on completing my decision to go forth with hair restoration surgery. I have profound confidence in you-you are undoubtedly a credit to your profession, and medicine in general.

I will be in touch with your team to make initial travel arrangements for my consultation. As I have taken a new position in this New Year, I have to wait a bit to be eligible for some time off to be able to fly to Dallas. Rest assured however, that I've made my decision to have my procedure performed by your capable hands.

With appreciation,

"ventuoguy"

thank you for the kind words. look forward to see you when you are ready.
best,
sml