Hair Transplant Recovery:  Social and Professional Concerns During Your Recovery

One of the major topics that patients ask about hair transplant surgery is “What is the recovery process like?” or “When can I go back to work?”  I try to frame the answer in such a way as to help that person understand the situation as well as possible so that he can make a decision regarding when to go back to work and how he will look and feel during the recovery process.

3 days after hair transplant with notable forehead and eyelid swelling

To boil it down, the number one problem that can arise during the early recovery phase is swelling.  I would say about 30% of my patients have significant swelling in the forehead area for the first 2 to 5 days that could last as long as 7 days but I have not seen it last longer than that.  The swelling typically works its way down the forehead to the eyes down the cheeks into the neck area before being resorbed.  This makes social encounters difficult the first week without sunglasses to hide the situation.  You can use your hands to push the swelling around the sides of the eyes down into the cheeks where the distortion is less.  This distortion occurs more commonly when transplanting the hairline and central midscalp but far less commonly when transplanting the crown region.

Scabs can also be visible in the first week in the area of transplantation.  This is perhaps the second most visible sign you have had a procedure done.  After the first 24 hours with the method that we show you, you can wear a baseball cap or hat to cover the scabs if you cannot cover them with your existing hair.  After the first 7 days, we will show you how to remove all the remaining scabs so you should be fine to go back to work after the first week.

The third most important element to recovery is some mild to moderate discomfort and tightness in the donor area, i.e., the back of the head where the grafts were taken.  Most individuals only experience mild discomfort for the first 2 to 4 days but others feel more uncomfortable achiness that requires some narcotic medications to manage.  If you are on narcotic medications, it is very important to be taking a stool softener before you become constipated not afterward.

The final point to make is that down the road between weeks 4 to 8 there can be something devastating known as telogen effluvium, which refers to shock loss.  Everyone is prone to it no matter how much “protection” you are on, meaning using finasteride (Propecia) and minoxidil (Rogaine) beforehand.  It is something that starts to come back 2 to 3 months later slowly but it is important to mention so that all patients are aware of this possibility.

Although there are other topics to cover regarding care instructions in the first week and when hair starts to grow in, they are topics for other blog articles.  This article focuses more on social and professional integration after a hair-transplant procedure.

Dr Lam is a board certified hair restoration surgeon in Dallas, Texas. To schedule a consultation please call 1-888-866-3388, or visit Dr Lam’s hair restoration forum to ask him a question.

Kevin James, Ralph Macchio, Their Hairpieces, and Understanding the Lid Effect

I was watching the movie Grown Ups the other day and I could not help but stare at Kevin James’ hairpiece.  Most likely you did not even notice it.  The reason that I see results that look fake and you may not is that I have significant experience with hair restoration and know how to detect even very small degrees of unnaturalness.  Believe it or not, his hairpiece does not look entirely fake because of his hairline, well not exactly as I shall explain.  Today, hairpieces can truly look amazingly natural due to the hair fiber technology, how they are woven, and how they are applied to the scalp.  The reason that I noticed his hairpiece is that it did not match his temple area.  I call this the “lid effect.”  A more glaringly obvious example of the lid effect is Ralph Macchio on Dancing with the Stars.  His temple recession is so significant that it does not match his hairpiece at all.  You may have been able to spot this one out more easily.

………….	Kevin James Hairpiece	…..	Ralph Macchio Toupee

The lid effect refers to the appearance of a baseball cap or lid that sits on the head like a bowl but that does not match the degree of recession in the temple hair.  In general, the degree of anterior temple hair loss should match the degree of hair loss in the central hairline in order to look natural.  In fact, the two areas unzip at an equal rate, where the hairline loses hair to the same extent as the temple area does.  When the hairline is rebuilt with a hair transplant or a hairpiece and the temple area is not similarly matched, the result can look fake.

For someone who has become accustomed to wearing a hairpiece and/or who simply does not have adequate donor hair to fill the entire head with hair again, I recommend at least considering a hair transplant in the temple area to match an aggressive hairline that has been established with a hairpiece.  Creating a temporal point and temporal hairline does not require a lot of hair and even the baldest man should have sufficient hair to rebuild a temple that can then match the appearance of the hairpiece.  Somehow hairpieces today can look relatively natural in the hairline but they simply do not work well in the temple area.

Dr Samuel Lam is a board certified hair restoration surgeon in Dallas, TX. To schedule a hair transplant consultation please call 1-888-866-3388, or visit www.HairTX.com for more info. To ask Dr Lam a question please visit our hair restoration forum.

The Principles of Making Results Seamlessly Natural Results for Hair Transplants Even Close Up

Many of the other blog articles have touched upon various elements of quality control that lead to excellent surgical outcomes.  What I would like to do is to talk more globally about problems that I see that make a hair transplant result look fake when looking closely at the work.  Unfortunately, the public thinks that there are only two conditions that lead to fake results:  too big a graft (called a plug) and too straight or malpositioned a hairline.  Although these are two very big no-nos that can lead to bad results, there are a host of subtle problems that lead to an overall bad result especially when multiple sins are committed.

Correction of previously bad hair transplant work: hair angles are too perpendicular, grafts are too large, temples do not match, and the hairline design is too straight.

One of the most common mistakes that I see performed is that hairs that are transplanted too perpendicularly to the scalp in the frontal hairline.  First of all, hairs simply do not grow that way.  Second, they do not create favorable density in that arrangement.  Third, the insertion point of the graft to the skin is grossly visible making the graft look grafty even when the graft is a single hair.  For all of these reasons graft placement is crucial, I place my graft angles at 10 to 30 degrees relative to the scalp whereas 70 to 90 degrees simply just looks bad.

Also, grafts can sometimes look like grafts when they are placed too far apart from one another no matter how small they are.  That is why I densely pack them together so that you cannot see them, blurring the whole lot out.  The number one thing that I see at hair-transplant meetings that is a dead giveaway that something surgically was done is that few hairs were used to cover too wide an area of the baldness leading to single little tufts of hairs populating a widely bald scalp.  This does not look natural and that is a big reason why I do not transplant the crown and the front of the scalp at the same time in 90% or more of the cases.

The next problem is how the hairs are shingled, i.e., how they are layered next to each other.  I notice when I teach junior surgeons at the course that I run in St. Louis that they tend to make recipient sites in a radial fashion, i.e., their hand arches in a circle around the head mimicking the shape of the round head.  Grafts should not be placed in this fashion because not only is visual density compromised when all of the grafts are splayed open apart like an open book but because the result does not resemble how hair naturally grows on the head.  Somehow this radial orientation of grafts just looks off to the casual viewer.

The next set of problems occurs due to bad hair-transplant technician work.  When hair grafts do not fit into the recipient site, the grafts can either be chocked off and not grow or be compressed into a tuft of hair resembling a plug.   Conversely, if the recipient site is too big and hair follicles fall into the hole the graft can show dimpling at the skin, another sign of artificiality.   My team is trained to check for graft-to-site fit carefully with me before I begin to make my recipient sites and also they check that the right graft fits into the right sites as they progress.  Assistants can also damage hairs during insertion.  If the grafts are placed with too much trauma, they will either not grow or will grow out kinky like pubic hair.  Finally, if grafts are placed too high relative to the surrounding skin, the result can be a bumpy, cobblestone appearance or it may not grow out at all.  If the grafts are placed too deep relative to the surrounding tissue, they can either grow out as a cyst or show a dimpling pattern on the skin.  If grafts are inadvertently stacked one on top of another, this can also lead to cyst formation due to buried, or piggy backed, grafts.  This is why having quality assistants is so important to creating the best results possible for any given hair transplant procedure.

Other issues of poor quality control relate to the surgeon’s bad design work.  For example, grafts that are too big placed into the wrong area can look fake.  Or, as mentioned, if grafts are angle and directed poorly they can either have unnatural looking results or compromise density.  All of these myriad elements that go into a quality hair-transplant result my team and I manage consistently in every single hair transplant procedure to attain consistently high-quality results.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To schedule a hair transplant consultation please call 1-888-866-3388, or visit www.HairTX.com for more info. To ask Dr Lam a question please visit our hair transplant forum.

What I Learned from Writing Questions for the Board Exam in Hair Restoration

As many of you know, I am an active participant in the education of other surgeons.  I run a national course on hair restoration and also participate as faculty in many workshops.  I also have written a textbook on hair restoration, Hair Transplant 360, along with many scientific articles on the subject.  Most recently, I flew out to Phoenix for a weekend to help write questions for the written re-certification examination for the American Board of Hair Restoration Surgery, of which I am a proud diplomate.

What I learned from an entire day locked up in a room with 3 of my colleagues and an expert moderator was the importance of clarity when writing exam questions for prospective examinees.  We had a very heated debate throughout the day about a question’s validity and also the clarity with which a question was posed.  To me, I did not mind ruffling feathers or making others in the room feel uncomfortable if the intended outcome was to have a clearer, fairer, and appropriate examination.  At the end of the day, we harangued and menaced each other until we got a workable 80 questions out for the next examination.  To me, I am very proud of what we accomplished but I am more proud of the intended outcome for the prospective examinees.

I think what I have learned from this process is always to think about the goal for a procedure, which in the world of hair restoration is to have a better result for a patient even if that means ruffling feathers during the procedure regarding quality control.  If we keep our mind on the goal, which is to have a better outcome, we can all as team members performing the procedure understand that challenging each other to be better is part of the process to achieve excellence.

Dr Samuel Lam is a board certified hair restoration specialist in Dallas, TX. To schedule a hair transplant consultation please call 1-888-866-3388, or visit www.HairTX.com for more info. To ask Dr Lam a question please visit our hair restoration forum.

Understanding the Importance of Graft-to-Site Fit in Hair Transplantation

A graft must fit a recipient site like a hand fits a glove perfectly.  Too tight and the graft becomes pinched inward leading to either hair death or a tufted fake appearance.  Too loose or too deep and the hair can fall inward into the site and cause unnatural pitting. Too short a site will lead to the hair either causing a cobble-stoned appearance or drying out and dying.  Therefore, before I make several thousand recipient sites, I always check for each sized graft will fit perfectly in terms of depth and size and progress from there.  Unfortunately, in many clinics graft-to-site fit is an afterthought rather than a preplanned strategy.  This to me is terrible negligence that leads to significant risk in a hair-transplant procedure results.

Always check graft-to-site during hair transplantation (from Hair Transplant 360, Lam SM)

Samuel M. Lam, MD, FACS, a board certified hair transplant specialist in Dallas, TX. To schedule a hair transplant consultation please call 1-888-866-3388, or visit www.HairTX.com for more info. To ask Dr Lam a question please visit our hair transplant forum.