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Comments for Hair Restoration Blog http://www.hairtx.com/hairtx-blog Sun, 23 Nov 2008 12:47:12 +0000 http://wordpress.org/?v=2.2.3 Comment on My First Blog…from Hong Kong by dr. lam http://www.hairtx.com/hairtx-blog/archives/1#comment-4 dr. lam Fri, 02 Nov 2007 03:41:03 +0000 http://www.hairtx.com/hairtx-blog/archives/1#comment-4 Hi, Obviously, I am always cautious to say that it is my way or the highway since I am sure there are many ways to get good scar closures. However, that being said, I would honestly tell you that I have had no greater success than with the trichophytic closure. My honest opinion is that it is the gold standard today for great closures. Remember though two things. First, good closure begins way before the closure itself. I use a tumescence solution (and I don't mean 2 minutes of throwing some saline solution in the back but I mean 30 minutes of time) to get a truly taut platform to minimize transection (killing grafts unnecessarily) and also to lift the hair follicles very far away from the deeper nerve and blood supply. Why? Simply put, if your blood and nerve supply are maintained to the best of my ability, there is tremendously better healing to the incision line than otherwise possible not to mention limited discomfort and a shorter recovery time. In addition, a trichophytic closure must be undertaken with a beautiful suture closure not staples. See my response as to why that is in my forum section of this website, i.e., the Ask Dr. Lam section. Also, when I do a suture closure, each suture bite is placed in the mid-follicle plane so that hair follicles don't get buried or distorted and also each bite follows a perpendicular skin orientation so that each edge is perfectly approximated to the other side. Each of these details makes for a great closure. Okay, the sad news. No matter how good a closure I do, your healing is your healing. I have seen despite all of these great efforts of mine a scar that is still visible under close inspection. Now, I don't mean a big ugly scar, just one that I could still see if I combed through the hair. That is up to your healing. Especially if you already had a prior procedure I can't promise you how my scar will look because the closure could already have been suboptimal and that can affect my scar. Also, when I must then decide should I remove the old scar I then can get another scar and limit my ability to transplant hair. Sometimes when I feel the tension on the incision, I elect not to do a trichophytic closure. This is extremely rare in a virgin case but in a second or third op more common. I just want to be honest with you so that I give you the proper information before you fly here and have me do your work. As far as temporal points, I always must do a proper evaluation before I make sure that you are a candidate for temporal points. Remember that i have a limited number of hairs to do the job and I will only do the temporal points if I believe you won't need the grafts elsewhere and/or you have sufficient donor density for me to do the work and still have enough paint to finish the unfortunately ever expanding canvas. Okay, I know this is a long answer but good wound closure and ethical hair restoration cannot be answered in two sentences. hope that helps, sml Hi,
Obviously, I am always cautious to say that it is my way or the highway since I am sure there are many ways to get good scar closures. However, that being said, I would honestly tell you that I have had no greater success than with the trichophytic closure. My honest opinion is that it is the gold standard today for great closures. Remember though two things. First, good closure begins way before the closure itself. I use a tumescence solution (and I don’t mean 2 minutes of throwing some saline solution in the back but I mean 30 minutes of time) to get a truly taut platform to minimize transection (killing grafts unnecessarily) and also to lift the hair follicles very far away from the deeper nerve and blood supply. Why? Simply put, if your blood and nerve supply are maintained to the best of my ability, there is tremendously better healing to the incision line than otherwise possible not to mention limited discomfort and a shorter recovery time. In addition, a trichophytic closure must be undertaken with a beautiful suture closure not staples. See my response as to why that is in my forum section of this website, i.e., the Ask Dr. Lam section. Also, when I do a suture closure, each suture bite is placed in the mid-follicle plane so that hair follicles don’t get buried or distorted and also each bite follows a perpendicular skin orientation so that each edge is perfectly approximated to the other side. Each of these details makes for a great closure.

Okay, the sad news. No matter how good a closure I do, your healing is your healing. I have seen despite all of these great efforts of mine a scar that is still visible under close inspection. Now, I don’t mean a big ugly scar, just one that I could still see if I combed through the hair. That is up to your healing. Especially if you already had a prior procedure I can’t promise you how my scar will look because the closure could already have been suboptimal and that can affect my scar. Also, when I must then decide should I remove the old scar I then can get another scar and limit my ability to transplant hair. Sometimes when I feel the tension on the incision, I elect not to do a trichophytic closure. This is extremely rare in a virgin case but in a second or third op more common. I just want to be honest with you so that I give you the proper information before you fly here and have me do your work.

As far as temporal points, I always must do a proper evaluation before I make sure that you are a candidate for temporal points. Remember that i have a limited number of hairs to do the job and I will only do the temporal points if I believe you won’t need the grafts elsewhere and/or you have sufficient donor density for me to do the work and still have enough paint to finish the unfortunately ever expanding canvas. Okay, I know this is a long answer but good wound closure and ethical hair restoration cannot be answered in two sentences.

hope that helps,
sml

]]> Comment on My First Blog…from Hong Kong by christopher Failla http://www.hairtx.com/hairtx-blog/archives/1#comment-3 christopher Failla Fri, 02 Nov 2007 03:19:20 +0000 http://www.hairtx.com/hairtx-blog/archives/1#comment-3 HI Dr. Lam, I am shopping for a doctor to reclose my already tricho closure and have a small procesure to build the temple points (side of head). Is the tricho closure the only method of getting a virtually undetectable scar? Because there is a doctor here in los angeles that wants to see me, but he dosent really specialize in the tricho closure. I called your office and am waiting a response on price and availablity. thank you HI Dr. Lam, I am shopping for a doctor to reclose my already tricho closure and have a small procesure to build the temple points (side of head). Is the tricho closure the only method of getting a virtually undetectable scar? Because there is a doctor here in los angeles that wants to see me, but he dosent really specialize in the tricho closure. I called your office and am waiting a response on price and availablity. thank you

]]> Comment on My First Blog…from Hong Kong by dr. lam http://www.hairtx.com/hairtx-blog/archives/1#comment-2 dr. lam Tue, 30 Oct 2007 23:19:50 +0000 http://www.hairtx.com/hairtx-blog/archives/1#comment-2 Good morning, I am writing from lovely Hong Kong where I am lecturing. I have created this Hair Restoration blog section for the purpose of being able to tell you about any new thoughts that I may have on hair restoration, hair loss, or hair transplant. This will be much easier for me to give informal comments and opinions or to tell you about new goings on at LIHR than to have it formally created in various sections of the official website. You are welcome to make comments here as you would like. If you would like to ask me questions about hair loss and hair restoration, please do so in the official Ask Dr. Lam Forum section of this website. Most likely, this blog will be just a place for me to put some updates and thoughts that I have but I would love for any of you to blog about hair loss and hair transplant as well. Best, SML Good morning, I am writing from lovely Hong Kong where I am lecturing. I have created this Hair Restoration blog section for the purpose of being able to tell you about any new thoughts that I may have on hair restoration, hair loss, or hair transplant. This will be much easier for me to give informal comments and opinions or to tell you about new goings on at LIHR than to have it formally created in various sections of the official website. You are welcome to make comments here as you would like. If you would like to ask me questions about hair loss and hair restoration, please do so in the official Ask Dr. Lam Forum section of this website. Most likely, this blog will be just a place for me to put some updates and thoughts that I have but I would love for any of you to blog about hair loss and hair transplant as well.
Best,
SML

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