Dr Lam's Hair Restoration Forum

[ravimanohar]

Dear sir,
May i know ,how you make holes in recepient area By scalpel or needle.If needle then -what size.For single/double/triple grafts-size of needle ,you use to make to slits to place these grafts.
may i know -you make vertical or horizontal slits?

[dr. lam]

most sites are made with a needle: 18G, 19G, 20G and sometimes 21G for really fine 1-hair grafts. sometimes i use punches to remove bald scalp. hope that helps. i like very small incisions to create my sites. they look more natural and create less trauma to the scalp. thanks for the question.
best,
sml

[ravimanohar]

Dear sir,
Thanks for your valuable reply.
May i know ,you make horizontal or vertical slits.
please elaborate on -puches to remove bald scalp.

[dr. lam]

i use vertical or sagittal or parallel sites. i like that better because it follows how hair naturally grows and i can pack it in more tightly than perpendicular sites. the punches i use at times when there is tremendous baldness and the hair is fine in order to remove some bald scalp. the punch is between a 0.8 mm to 1.5 mm round punch to remove scalp. i like finer hair when i do that because it just looks much more natural when punching.

[ravimanohar]

thanks for reply.
after puching out,you suture it? pls elaborate
lateral slit/horizontal slits are on the same ?just wanted to clarify.
if horizontal or vertical slits-per sq cm would give same density?.pls let me know.

[dr. lam]

1. lateral slit and horizontal are the same.
2. after i punch it out, i put a graft into the space so there is no suturing.
3. i can get per square centimeter tighter arrangement of vertical than horizontal arrangements. i use horizontal arrangements for the temple where i want my angles particularly flat which is a favorable quality. however, if i want a higher per sq cm of density in the temple then i work harder to use verticals in a flat as i can get it orientation to do the same job.
best,
sml

[ravimanohar]

thanks for the reply

Can hair transplantation be done in patient with stable scalp psoriasis(with no itching).If so,what prophylatic medications to be used to prevent "Koebner reaction".

[dr. lam]

i have done that with a few caveats:
1. it would a great idea to have a dermatologist bless the procedure so to speak and make sure that it is stable and i am not involving the psoriasis in the transplant.
2. i would always to make sure that i am not moving psoriasis from one area to another unless they are both affected.
3. i do not know what to say about how to limit Koebner's reaction except i have never seen it with a transplant. that is typically on naked skin when you scratch the area. however, again i defer to a dermatologist for his/her thoughts about it since i am not one.
best,
sml

[ravimanohar]

thank you so much for the reply

[dr. lam]

ok, no problem. i guess i answered that same question on another part of this forum so you can ignore the redundant answer.

[ravimanohar]

thanks for reply
Dear sir,
If a person has 5 cm hairline from glabella and he has diffuse thinning in frontal ,midscalp.U still maintain that hairline or you do for higher hairline.

[dr. lam]

it depends. last week i worked on a surgeon from the East Coast who had a 5 mm hairline but the hairline was diffusely lost and not strong so i was able to go behind it to where i wanted to go. i have had patients with bad hairlines (done elsewhere) that were weak with a few scattered hairs that fortunately were so poorly done that they only had 1 hair grafts left. i used these also as "sentinel" hairs and moved my hairline to a more appropriate location. for someone with a relatively strong retained hairline, i have to follow it and build it back from the actual hairline itself. hope that makes sense.
best,
sml

[ravimanohar]

thanks for the reply.
Due you use trimacinolone in tumescene fluid?does it have any negative impact on grafts(hair growth of the transplanted hair)?

[dr. lam]

i do use it in the recipient area in very dilute amounts but not in the donor area. it does not have any negative impact on results. i think the reduction in swelling actually helps growth.

[ravimanohar]

thanks for the reply.will all the transplanted hair falls off, if so in how many months and why?