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Recipient sites are defined
as the sites where the hair grafts are inserted. Creating superior
recipient sites is mandatory to achieve consistently excellent results
in hair restoration. Dr. Lam creates all of his own recipient
sites himself.
Why are recipient sites so
important? The way that recipient sites is created will dictate
the angle, distribution, and appropriate size of each inserted graft.
If recipient sites are poorly created, the angles and distribution of
the hair can be very unnatural looking. In order to create excellent
recipient sites every single time, the surgeon must have a keen sense
of artistry, e.g., how to shape and pattern a natural hairline that
will fit one’s face and type of hair loss, and a profound understanding
of how hair grows differently in each part of the scalp, e.g., the hairline
(also male versus female), the temples, the lateral hump, the midscalp,
the vertex transition point, and the crown (vertex), as demonstrated
in the accompanying close-up videos and photographs. To understand
how hair grows differently in each section of the scalp, watch our hair
transplant educational video (Quicktime
| Windows
Media).
All of Dr. Lam’s sites
are created under loupe magnification for absolute precision.
He creates each site to mimic the natural sweep and flow of how one’s
hair grows. In addition, he is able to avoid injury to one’s existing
hairs without compromising his tightly interlocked and well-angled site
distribution. In the face of existing hairs, some surgeons shave
the head (which is unnecessary and unreasonable) or transect (cut) the
hairs so that one’s existing hairs are lost. Other surgeons
skip around and place a few grafts here and there in an uneven distribution
which will become obvious with ongoing recession of one’s existing,
non-transplanted hairs. Dr. Lam takes care not to harm one’s
existing hairs but plans forward for ongoing recession by creating a
tight wall of grafted hair that should look good despite recession of
one’s non-transplanted hairs in the areas of transplanted hair.
With loupe magnification,
Dr. Lam can carefully and precisely follow the angle of how each hair
grows and mimic it precisely. This not only permits a natural
looking result but also preserves one’s existing hair since the
instrument always parallels the existing hairs and would not be liable
to transect or injure existing hairs.
Understanding how to maximize
the aesthetic impact of a hair transplant is predicated on two principles
“the central forelock” and “the cascade effect”.
The central forelock, which occupies a circular area immediately behind
the hairline, is a zone of critical importance. The hair density
that other people perceive from any frontal angle (straight on and from
either side) is proportionately related to the density and site angles
of the central forelock. Dr. Lam pays particular attention to
the effect that the central forelock creates. The cascade effect
relates to how hair falls on the scalp based on where the hair is parted
or how the whorl of the crown falls so that hair can be optimally distributed
to create the appearance of maximal density. For example, if one
parts the hair from a split on the left side of the head, then additional
density of grafts should be placed at the part to cover the part and
to permit greater travel distance of those grafts away from the part
toward the other side of the head.
Finally, Dr. Lam’s
precision instruments only pass deep enough into the scalp to receive
each graft, which is meticulously verified through every stage of site
creation, i.e., proper graft to site fit for each definable set of sites
based on width and depth. He uses a specially prepared recipient
tumescent solution to lift the scalp away from the deeper tissues to
protect the blood supply of the scalp and thereby expedite healing and
improve graft yield. At other institutions, patients have remarked
on a rapid and incessant tapping noise during hair restoration followed
after the procedure with a difficult and bloated recovery time.
This outcome is directly related to the surgeon’s failure to protect
the underlying scalp during recipient-site creation. This is not
a minor issue. Dr. Lam takes pride in every site he creates for
every patient every time.
In order to understand how
recipient sites should mimic natural hair patterns, all you have to
do is examine an individual with very closely shorn hair and study the
pattern of how hair grows naturally on each part of the scalp:
In the above photograph, this
gentleman who has not had a hair transplant is shown in order to help
one understand how recipient sites should be angled and distributed
to match normal patterns in nature. The hair in the temple cascades
downward and arches slightly back in this person but this is not always
the case. As an exercise, find someone with a closely shorn (but not
shaved) head to evaluate how hair grows differently in each part of
the scalp.
In the above photograph of
the same gentleman, the clockwise whorl pattern of the crown (vertex)
area is evident. In the final two photographs of this section, you can
study how Dr. Lam perfectly recreated the whorl pattern based on the
remaining wisps of hair that the patient still possessed. In a totally
bald crown, Dr. Lam uses his artistic judgment to recreate the crown
from scratch. The crown is the singularly most difficult area to reconstruct
well in unskilled hands.
Recipient sites for the hairline,
central forelock and midscalp are created with
absolute precision so that the angles are straight forward and tightly
interlocked
except at the outer 1.5 cm where the sites gently curve outward to match
the
created angles of the temple region. Also, notice that the hairline
has an
irregularly irregular pattern that mimics the configuration of a natural
hairline.
These recipient sites are
created in the same tightly interlocked grid as shown
in the previous photograph. However, notice that in this person who
has significant
native hair Dr. Lam has not damaged any of the existing hair despite
creating
an uncompromisingly tight grid of interlocked sites.
These are the recipient sites
that Dr. Lam created for a female hairline showing
the natural curvilinear "cowlick" that is present in many
women.
This clockwise whorl of a
crown matches the patient's existing hairs precisely.
The upper portion of recipient sites turn upward at the "vertex
transition point"
where the sites move toward the horizontal plane of the posterior midscalp.
Notice that the transition from the crown to the posterior midscalp
is gentle so
that there are no abrupt changes from one region of the scalp to the
adjacent
region.
Another crown (vertex) recipient
site creation that shows the natural whorl of
the patient's existing hairs that seamlessly blends with the posterior
midscalp.
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