Hair Transplant Recipient Site Creation

Hair Recipient Site Creation

Hair 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.

Hair Transplant Recipient Sites

recipient-site-headAll 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:

natural_hair_crown natural_hair_patterns_temple

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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