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.

Is Hair Restoration Artistic?

Is hair restoration an artistic endeavor?  Or in fact is it simply a rudimentary technical procedure in which hair is placed into the head and only the sheer number of grafts count?  I will explain in a point-by-point manner why hair restoration is truly artistic in my opinion, focusing on three major elements:  macro hairline design, micro hairline design, and recipient site creation/graft distribution.

Artistry in hair restoration requires good judgment when designing hairlines and making recipient sites.

1. Macro hairline design – Macro hairline design refers to creating the overall shape and position of the hairline, i.e., what is initially drawn on the head as a template upon which the micro elements of the hairline (see below) will be fashioned.  Every surgeon making a hairline will create a slightly if not significantly different hairline based on experience as well as artistic interpretation.  When I design a hairline, I am always looking at how that hairline shape would best match a facial shape, ethnicity, and gender.  I also make sure that it will age well for someone.  Every hairline I design I consider a work of art to make it not only look seamlessly natural but also wonderfully shaped to match a patient’s head to the best of my ability.
2. Micro hairline design – The micro hairline refers to the recipient sites that go into the general hairline.  When designing the individual sites, it is important that the hairline look natural from a distance but also even close up.  I really spend an inordinate amount of time during the procedure looking at my work from multiple angles to ensure that my hairlines look as natural as possible.  I really consider the micro hairline the final expression of my artistic design for the macro hairline.
3. Recipient site creation and graft distribution – To me the recipient site creation is one of the ultimate expressions of one’s artistry controlled down to the very site angle and distribution.  After I am done making my sites, I sit back for a minute, take a deep breath, and enjoy the glory of my creation.  I simply love seeing my sites before the grafts go into them because they are a work of art.  That is why I have so many photos and videos showing my recipient sites.  I consider showing you my sites is like showing the seams of a handmade suit so that you can see the quality that goes into the production.  I love blending in the technical and the artistic elements.  When I attain a number of grafts for a given size given to me by my assistants from their graft preparation (e.g., 600 2 hair grafts, 500 3 hair grafts, etc.), I like to sit down and figure out how best I am going to allocate those grafts in a creative way for optimal effect for a patient.  In fact, after I have created my work I always make a color-coded guide for my staff to know how to place the grafts but also so I have a written record of my distribution so when I see a patient come in with the grafts growing in nicely I can remember w hat I did.

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.

Christian Slater’s Hair Transplant

Christian Slater's Hair Transplant

Hair Transplant is as much an art as it is a science.  Many times we simply see very bad hair transplant work that scares us into not wanting to have the procedure done.  When the procedure is done well, it is seamless.  Take Christian Slater’s hair transplant, which I think is both natural and artistically rendered.  The hairline looks natural from a casual distance but also the shape of the hairline matches his face well.  The temple almost matches the hairline (but not exactly) but close enough that only a hair-transplant surgeon would be able to tell this.  Personally, I would slightly augment the temporal point to match the shape of the hairline better but this is truly quibbling.  Just wanted to show a good celebrity transplant to emulate.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To learn more about hair loss, or 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.

Scarring Alopecias:  What You Need to Know for Hair Transplantation

There are many types of scarring alopecias (scarring hair loss) like lichen planopilaris, discoid lupus erythematosis, etc.  This article will not try to review all the many types of histologic (tissue) diagnoses but to explain what goes through my head as a hair-transplant surgeon when encountering various scarring alopecias for possible hair restoration.

When I am evaluating a person for possible hair restoration, I am always concerned with the possibility of a scarring alopecia that could negatively impact my transplant result now or in the future.  I carefully evaluate the scalp for any signs of abnormalities that may hint at this likelihood.  If the scalp looks particularly shiny without pores this can be a telltale sign.  Also, redness and inflammation in the area may indicate something as mild as psoriasis or hint at something more ominous like a scarring alopecia.  Since I am not a dermatologist if I have even a remote suspicion of a possible scarring alopecia, I will send it to a qualified dermatologist for a scalp biopsy.  Without a biopsy, even the most experienced dermatologist can be wrong if a scarring alopecia is suspected.

Scarring Alopecia

It is important that if a surgery is planned that the patient’s condition be completely burned out.  My minimum criterion is at least 2 years of biopsy-proven time that there is not active disease.  However, this still does not guarantee that the disease will not come back.  In cases of just tissue scarring from trauma for example, this is obviously not a concern.  However, a case of lichen planopilaris for example may flare up again in the future causing transplanted grafts to fall out over time.

There are two principal concerns that I have if someone has been diagnosed with a scarring alopecia.  The first concern is will the transplanted grafts take and grow.  If there is any concern a surgeon can transplant a few “test grafts” to see if the grafts will grow in the scarred bed of tissue.  However, even if they do grow, this is no guarantee that the rest will grow.  The second biggest concern, as mentioned before, is whether the disease that caused the scarring alopecia will reactivate in the future causing all of the transplanted hairs to fall out again.  This is why the minimum of a 2-year period of burn out is typically advisable if still not longer.  Sometimes a transplant can look good for a few years then fall completely out when the condition of scarring alopecia returns.  For an experienced hair transplant surgeon, teamwork with an equally qualified dermatologist is a must when treating patients with scarring alopecia.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To learn more about scarring alopecias, hair loss disorders, or to schedule a 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 loss forum.

Trichotillomania and Hair Restoration

Trichotillomania describes a condition in which an individual repeatedly pulls his or her hair out of one’s head or other body parts due to an obsessive-compulsive disorder (OCD).  Sometimes trichotillomania is accompanied by ingesting the hair causing a condition of indigestible hair products in the stomach known as a trichobezoar that may require surgical extraction.  Patterns of hair loss are typically unusual and follow the center of the scalp more where there is less pain with extraction than the periphery of the hair, where nerve sensation is greater.

Trichotillomania

The question that I encounter as a hair-transplant surgeon is whether I should offer a hair-transplant procedure to someone who has this condition.  This is obviously a complicated question, as it truly depends on the person and the extent, periodicity, and current state of the problem.  Here are two extremes.  Someone that is currently suffering from the problem clearly is not a surgical candidate for two reasons.  First, sometimes the plucked hairs come back if they are not overplucked.  Second, the ongoing nature of the psychological condition must be treated with anti-OCD medications before even contemplating the possibility of surgical intervention.  The opposite extreme is someone who had this condition when he or she was a child and has now many years out from it no longer has any desire or proclivity to engage in that behavior.  Working with a psychologist or a psychiatrist can help a surgeon determine the candidacy for a suffer of trichotillomania to undergo a hair-restoration procedure.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To learn more about trichotillomania, or to schedule a 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 loss forum.