Joe Biden:  Thoughts About His Hair Transplants

Obviously, there are many examples of bad hair transplants out there.  I thought I would blog briefly about what is going on with Joe Biden’s hair-transplant result.  Although his hair transplant was done during the era of “plug” grafts, the reason that his hair transplant does not look truly that bad is that his hairs are white, which can be very forgiving.  If he had jet-black hair, his plugs would stand out terribly.  In addition, what is happening now is that his lateral humps (see related articles) have dropped downward away from his transplanted result.  The reason that he does not have such a noticeable problem is that he combs his hair over his exposed lateral humps (almost a reverse comb-over) to cover the bald scalp.  In summary, his transplant result is clearly not the best but given his hairstyle and his hair color, he has lucked out a bit with the way it looks.  Now, his Botox during his debate with Sarah Palin a few years back was atrocious and near frightening and still haunts me to this day!

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 loss forum.

Defining Hair Transplant Scalp Regions:  The Lateral Crease

Throughout many of these articles on hair restoration, I am trying to open up to you the reader the technical terms that I use in my day-to-day discussions and thoughts.  This article will focus on one particular region of the scalp, the lateral crease.  The lateral crease may be more colloquially defined as the line where one parts one’s hair.  It is the transition from the midscalp to the lateral hump, or put another way from the central hair to the temple hair.  Anteriorly, the lateral crease blends with the part at the hairline where the temple hair meets the hairline hair.  Posteriorly, the lateral crease ends where the crown begins, splitting down and outward where the lateral hump fades and splitting inward and across at the vertex transition point.  If these other related landmarks are not clear in your head, I would encourage you to review the related articles on these scalp terms to better understand them.

The light blue line shows the lateral crease. The white arrows show the direction of the hair angles in the lateral hump (below), in the central midscalp (above) and along the lateral crease as well.

The hair angles at the lateral crease go straight forward without any splaying rightward or leftward.  Just medial (toward the nose side) the hair angles can be directed inward a bit or remain straight, and just lateral (toward the ear side) the hair angles start to fall downward toward the ear as they are part of the previously mentioned lateral hump.  The lateral crease is important as an anatomic landmark for a few reasons.  First, it is important to understand it as a transition zone between two scalp regions:  the midscalp and the lateral hump.  With that idea, the hairs start to change angles as one enters the lateral hump from the midscalp.  Second, especially when it concerns the side where the person parts his hair, the lateral crease is fully exposed and open as hairs on either side are parted to opposing directions.  Accordingly, the lateral crease on the part side plays a pivotal area to add further density so as to limit the baldness that can appear when the hair is splayed here.  Accordingly, the lateral crease can be a very important area to transplant with sufficient density to achieve the desired aesthetic outcomes during a hair-transplant procedure.

Samuel M. Lam, MD, FACS is a board certified hair restoration surgeon in Dallas, Texas. To learn more about Dr Lam’s hair transplant procedures please visit our website www.HairTX.com or call 1-888-866-3388 to schedule a consultation.

Regions of the Head for Hair Transplant Part 3 of 4:  The Lateral Humps

The lateral humps are the areas of the scalp that fall on the sides of the head.   They start, as mentioned in the second part of this series, from the transition of the horizontal plane of the midscalp as it transitions over to the vertical side plane of the head and they end just above the ears where the hair stops.  Anteriorly, the first few centimeters are known as the anterior temple or temporal point and is the anterior border of the lateral hump.  The posterior border is the transition over to the crown hair on the back of the head.

The lateral hump gets its name for its appearance in someone with progressive baldness in which the hairs in the lateral hump begin to separate from the central midscalp and begins to resemble a camel’s hump.  It looks like an upside U shape in configuration.  With early baldness or even in moderate degrees of baldness, the lateral hump remains unaffected.  The first signs of loss occur anteriorly in the anterior temple region that progressively continues posteriorly to the lateral hump which then begins to fall away from the top to the bottom, slowly to reveal the upside U shape that continues to fall downward.

Figure reprinted with permission from Hair Transplant 360, Volume 1 (Jaypee Brothers Medical Publishers, 2011), Samuel M. Lam MD

In advanced degrees of hair loss, it is important to rebuild the lateral humps because a strong anterior hairline with a descended, unreconstructed lateral hump looks unnatural and ridiculous.  In fact, the extent to which a hairline can be rebuilt is contingent upon how bad the lateral hump is.  At times with very advanced lateral hump loss, only a modest hairline can be rebuilt to match the lateral hump region to create a pattern that would be natural in its appearance.

Besides the upside down U shape is there another reason that the lateral hump has a distinct name?  Yes, a couple.  First, the way that the hairs are angled here are unique.  The top first row aims directly anteriorly and with each progressive row they tend to fall away vertically downwards in a progressively cascading arrangement (See the Figure).  This is very important to recreate correctly or the sides of the head will look unnatural.  Further, the arrangement should be relatively flat to the scalp or the hairs will stick sideways unnaturally.  Second, if the hairs are not created in the aforementioned manner and are made to sweep inward to the midscalp, they will look like a combover since hairs that fall on the outer portion of the eye should fall outward and not be combed inward.

I hope this introduction to the lateral hump, which again is only really important with someone who has very advanced hair loss, can be instructive in understanding its role when performing a hair transplant procedure in select patients. To learn more about the lateral hump please watch Dr Lam’s video Understanding the Lateral Hump.

Samuel M. Lam, MD, FACS is a board certified hair restoration surgeon specializing in hair transplant procedures for men and women. To learn more about Dr Lam’s hair restoration procedures please visit our website www.HairTX.com or call 1-888-866-3388 to schedule a consultation.

Hair Transplant Focus:  Understanding the Lateral Hump

In my effort to educate the public on the facts of what I know as a hair transplant surgeon, I have come up with a video to discuss one particular part of the scalp, the lateral hump, in great detail to offer the thoughts of how I see restoration of the lateral hump as part of a successful hair transplant procedure in late stage hair loss and how to have enough reserve to restore this area in the future as needed.  I also cover the topic of the cascade effect and the combover as well as the reverse combover, and what those terms mean.