Like anything in life, don’t pursue something if you are not passionate about it.  Many of my facial plastic surgery colleagues are intrigued why I love hair transplant so much.  They see hair transplants as a tedious, boring job where thousands of grafts are meticulously placed into the head.  I see it as an amazing artistic expression where I can select the right sized grafts with the right distribution, angles, and pattern to make the best results for a patient.  I find it truly a challenge for both left and right brains:  my left brain working with the number allocation of grafts and my right brain deciding how aesthetically to allocate those grafts.  In short, it is a fun, exciting, and rewarding challenge about which I am very passionate.

Am I the only one who is passionate about it?  No, my entire team loves their job too.  It is important that your team loves their job as much as you do so that they can also deliver excellence.  Without superior graft dissection and graft placement which is the team’s contribution, your hair transplant result will fall far short of its aesthetic mark.  I like when a patient says, “Man, I see that all of you get along so well together and really love your job!”  He is right.  Passion starts from the top and it should suffuse everyone there.  You can tell it when you look into your surgeon’s eyes.  Is he or she excited to see you?  Is the team enthused about seeing you too?  Do they care or are they punching the clock?

This article strives to go beyond picking a surgeon based on just his or before and after photos (which is perhaps the most critical expression of one’s work and should not be downplayed) but to get into why someone consistently achieves excellence.  If someone cares that his or her work is excellent and takes pride and passion in the work, then the only option is to have a great result.  When you find the right surgeon for you, use both sides of your brain:  your left brain should tell you analytically why that surgeon is better based on photos, testimonials, experience, etc. and your right brain should seal the deal based on rapport and understanding the above concept of deep-seated passion.

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

The goal of hair restoration is to build up enough hair density that one does not have much see-through effect. Put another way, rows upon rows of hair grafts must be placed so that each row adds to the visual effect of blocking one’s view of the bald scalp behind it. This brief article will explore some of the ways that I use various graft sizes and density patterns effectively to create a visual wall with less see-through effect to the back of the head.

Unfortunately, many prospective patients who come to me ask me a very simplistic question:  “How many grafts will I get?”  Although a sufficient number is clearly important, this question falls far short of understanding the rigors of what are important for a quality, natural, and dense hair transplant.  All of these blog articles are intended to go beyond the number count and to understand what goes on with quality work in hair restoration.

Artistically designed hair transplant to create optimal visual hair density

This article will focus on how I decide to create optimal visual hair density by using the concept of creating a layered visual wall going from front of the head to the back.  Remember that finer hairs must go along the hairline and the densest result is typically the most critical in the area known as the central forelock.  That being said, you do not want to create a result in which the central forelock dominates to the point that the fronto-temporal area looks weak, especially in someone who already is very bald in that area.  Accordingly, if I use strong 4-hair grafts or di-follicular unit (DFU) grafts in the central forelock I will try to balance it with stronger 3-hair grafts more densely packed on the sides of the central forelock.  Conversely, if the person already has a relatively strong central forelock, I may use stronger grafts in the fronto-temporal area to reduce the see-through effect overall.  With the many sized paintbrushes that I use to design my work, I can creatively select the best sizes and distribution to overall fashion the densest results that are also natural in appearance.

Dr Samuel Lam is a board certified hair transplant surgeon in Dallas, TX. To schedule a consultation please call 1-888-866-3388, or visit Dr Lam’s hair transplant forum to ask him a question regarding hair loss or hair transplant procedures.

The central forelock is one of the most important concepts that exist for hair restoration. If the central forelock, that lies immediately behind the hairline looks empty, the person will remain looking bald. Every graft that is situated in the central forelock also blocks light from the front and the two 45-degree side angles as well.

The concept of the extended central forelock is a newer one. The problem with the central forelock is that it does not block light passage to the rear of the head as illustrated. Therefore, the extension of the central forelock all the way to the beginning of the crown not only thickens the central forelock by putting more grafts behind it but now the light passage is blocked from all frontal view angles, making the person appear less bald. Using these concepts by an experienced hair-transplant surgeon when appropriate can help to create optimal visual hair density in the right person.

Central Forelock and Extended Central Forelock in Hair Restoration

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

One of the most important concepts when designing recipient sites, i.e., the “holes” into which the hair grafts will be placed, is to make very low angled sites, especially near and at the hairline.  What I like to call the “picket-fence” look is due to the fact that recipient sites are made almost 90 degrees to the scalp.  This simply looks unnatural.  In addition, you lose the ability to shingle the grafts like shingles on a roof when you make them too perpendicularly.  Low angled sites cast a shadow effect on the bald scalp making baldness less visible.  For all of these reasons, an experienced hair transplant surgeon should truly focus on keeping his angles for his recipient sites as low as possible when designing sites that go in the front of the scalp like the hairline and central forelock.

Picket fence bad hair transplant (from Dr. Lam's textbook, Hair Transplant 360)

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

I just finished a phone consultation with a gentleman from North Carolina that prompted me to write this blog article.  He saw a hair clinic chain that sold him a special product that contained minoxidil (Rogaine) along with other vitamins for several hundred dollars.  He was also sold a shampoo service for $2000 for which he had to come in monthly.  Are you kidding me?

The practice of hair restoration is a multi-billion dollar business but what disturbs me is the charlatans out there trying to hoodwink a prospective individual with overly expensive Voodoo treatments that have no scientific backing.  The reason that the product with the minoxidil works is the fact that it has minoxidil in it, which you can buy at Costco for a few dollars.

Am I saying that no products other than the two FDA-approved medications, finasteride (Propecia) and minoxidil (Rogaine) work for hair loss?  No, not at all.  In fact, my mother tried a product, some kind of Chinese remedy, that she swears has thickened her hair.  We sell a product in our salon that is a pro-thickening shampoo for like $15.  So I am not opposed to things that could help in addition to FDA medications, which have been proven to help.  However, I am opposed to people charging hundreds if not thousands of dollars on hair-loss solutions that are unproven and do very little other than rip a customer off.  Ok, I shall get off my soap box now.

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

At times I get the question during a consultation, “What makes you better than [fill in the blank name]”?  Even though I may spend 30 minutes detailing every little nuance of what makes us better:  a more artistically designed and customized hairline, better donor harvesting and donor closure, better recipient site creation, more gentle graft handling, expert graft dissection and placement, etc., I still get that question.  I respond, “After all the things I have said, what really matters is a deep-seated passion for what I do.  As importantly, that passion resides in every team member that will work on you.”

I think sometimes we get lost in the mechanics of hair restoration, which I find of course to be absolutely critical.  If you are not a technically competent and artistically minded surgeon, you will fail to accomplish anything great for a patient.  But deeper, much deeper than these requisite skills, lies a more fundamental element that must pervade every procedure:  unending, bottomless passion for the craft.  If you don’t have this, you don’t have a result that will be worth speaking of.

They say that cooks that prepare food without love do not create great repasts, whereas those that do create works of art.  I would totally concur with this statement.  The Hungarian psychologist Mihaly Csikszentmihalyi came up with the concept of flow, the time when skills and passion intersect and the person gets lost in his work.  Think of a great sports player who is completely in sync with his work.  That flow is what drives me deeply.  I am entranced with hair restoration, and my work supports my passion.

Just like any good sports team or racing team, you are only as good as your weakest member.  What I am very proud to say is that we are all excellent at what we do but more importantly we are very passionate about our work.  I remember a few years ago when I called one of my graft-preparation team members “a cutter”.  She responded by saying, “Dr. Lam, I am not a cutter but a dissection expert.”  I think that speaks volumes about her level of commitment and pride in what she performs, and that is something I would never exchange for a million bucks.

Another patient said, “I have heard Dr. X had a good reputation but I have chosen to come to see you based on a referral.”  I responded, “Yes, he is a good physician.  The best way to make your choice however is to look deeply into your surgeon’s eyes and see what is staring back at you:  boredom or passion.  That is how you are going to decide on who should do your work.”  (Of course, evaluating the results with close scrutiny is still very important!)

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

Many times hairs are just moved from the back of the head to the front of the head based on the number of hairs that are bundled in each follicular unit. For example, 1-hair grafts are placed into the front hairline and 2-hair grafts behind that and so on. However, little is paid to the concept of selecting the best quality hairs for the best locations since other elements define a hair graft other than the number of hairs on that graft. For instance, there can be a preponderance of gray hairs in certain areas of the scalp. Also, hairs can be curlier or thicker in certain areas of the scalp than others. It is therefore important to think of these characteristics when transplanting hairs from one part of the head to the other. Fortunately, my staff is very attuned to these regional aspects and believes that it is a very important part in how we deliver quality in our work.

Using the principle of regional hair restoration, the finest hairs were used for the hairline and the thickest hairs were used to create central hair density.

Other places simply do not focus on this element because it takes too much time and effort to pay that much attention to these kinds of (what I consider and so does my team) important details.  How do I know that other teams neglect regional aspects?  The reason that I know is that I have spoken with them about this matter.  Further, I have hired technicians in the past who were oblivious to regional aspects of hairs to be transplanted where they previously worked.  It was simply not emphasized probably because either it was not understood or more likely cared about.

How do we use regional aspects of hair for hair transplantation?  We do so in many ways.  First, we select the finest 1-hair grafts for the frontal hairline and even finer hairs for the temple region.  Thicker 1-hair grafts we tend to combine into one graft by placing two 1-hair grafts into a single recipient site, a process known as follicular pairing.  Whiter hairs are used for the temple region or are more equally distributed across the scalp so that one area does not look grayer than another.  Curlier hairs are used more for the central forelock where they can create more visual density where it counts.  Thicker hairs are also used for the central forelock if that is the principal area of baldness or would be allocated to fill the most important deficit of scalp baldness.  Through these mechanisms, I believe we are able to achieve the twin goals of greater visual density and supreme naturalness when performing a hair transplant procedure.

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

In the past decade, attending almost every meeting of the International Society of Hair Restoration Surgery (ISHRS), I have witnessed topics of growing interest.  I believe that temple restoration or also known as temporal point restoration has become a very major part of creating aesthetically pleasing and balanced hairline work.

As mentioned in previous articles, the temple must per force be transplanted when the anterior hairline is aggressively transplanted and the temple hair is not, leading to an unbalanced appearance that can resemble a toupee.  The illustration on the left shows a conservative hairline design that does not mandate a temple reconstruction.  The illustration on below shows a more aggressive hairline reconstruction that with the current position of the temples does not look natural.  The lightly shaded gray shows a proposed temple reconstruction that will make the anterior hairline appear natural and balanced.

Temple Hair Design Based on Anterior Hairline Position (from Dr. Lam's book, Hair Transplant 360)

Many considerations must be taken when deciding on temporal point reconstruction.  If the person is very young, the fear would be that over time that person would run out of hair to maintain a natural result in the temple area.  Therefore, the surgeon should be careful not to build the anterior hairline so aggressively that the temples would need to be rebuilt at the same time or very soon with further hair loss.  Someone with a very narrow face may look even narrower with an aggressive temporal point design.  In general, artistically the surgeon must decide with the patient to what extent the temples should be rebuilt.  I have also performed isolated temporal points in someone who has had previous transplants in the anterior hairline where now the temples have faded back making their transplant result look less natural or balanced.

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

One of the biggest topics that has fascinated hair-transplant surgeons, at least as presented at the International Society of Hair Restoration Surgery (ISHRS), is temporal point transplantation.  The temporal point is the hair point that emanates forward from the temple that can be reconstructed to frame the face from the side as part of an effort to frame the face that includes the anterior hairline.

Why undertake a temporal point reconstruction?  As alluded to, it provides a very strong masculine shape that is both attractive and youthful.  It can support the shape of a strong anterior hairline and create a visual match, where the hairline and temple look well balanced and natural.

Temporal Point Reconstruction

Why should one not perform a temporal point reconstruction?  First, if a surgeon is inexperienced in building up the temporal point then he should not do it.  It is one of the most technically difficult areas to do well for the surgeon who must create very flat recipient sites that are also angled correctly sweeping downward and then backward as the point is approached.  It is an equally daunting task for the assistant who must place the grafts at an uncomfortably low angle and also with a proper curl that aims down toward the scalp and backward.  Second, if a younger gentleman is coming for a hair transplant (let’s say younger than 35 years of age), it might be unadvisable to undertake a temporal point transplant because it takes a lot of grafts that might be better allocated toward the central scalp or anterior hairline.  Further, it might not age as well for an individual who is more rapidly losing hair and may require numerous hair transplant sessions in the future to maintain a result.  Finally, sometimes the temporal point design simply does not look good on an individual and may overly close his face inward by making the forehead appear too narrow, for example.  For all of these reasons, it is important for an artistic and technically proficient surgeon to decide in whom and how to design a temporal point for hair restoration.

Dr Samuel Lam is a board certified hair transplant 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.

The principle of modern hair restoration is predicated on “donor dominance.”  Donor dominance refers to the concept that hair transplanted from the donor area (back of the head) and placed into the front (recipient area) will never be lost despite ongoing hair loss due to the fact that the transplanted donor hair retains its native characteristics that preclude it from hair loss.

Recipient dominance implies the exact opposite, i.e., the recipient area has influence to some degree over the transplanted hair.  Fortunately, recipient dominance is not the prevalent condition otherwise transplanted hairs would be lost over time.  Instead, recipient dominance expresses itself in unique and subtle ways. For example, in eyebrow hair transplants, the eyebrow region hairs that otherwise grow very fast when transplanted can be influenced by the native skin in the eyebrow region so that over time the hairs start to grow more slowly and grow even finer than originally transplanted.  Similarly, hairs transplanted from the body such as from the chest can start to grow faster and finer when moved from the body to the scalp.  These curious conditions can be leveraged to advantage in the above circumstances.

This gentleman underwent a corrective eyebrow hair transplant. Hairs can become softer and grow more slowly after an eyebrow hair transplant due to a principle known as "recipient dominance."

Another example of donor influences (but that is not formally entitled donor dominance) refers to the effect that transplanted hairs can have on the recipient skin.  For example, hairs transplanted into an area of scar tissue sometimes can start to make the scar bed softer and less scarred.  This can occur possibly due to the stem cells that naturally exist within a hair follicle.  For example, if someone who has had Accutane in the recent past, the oil glands within the hair follicle become reduced which is the source of skin renewal.  This is why people that have had recent Accutane treatment cannot have a skin peel or laser to the skin.  Perhaps the new oil glands in the transplanted hairs help rejuvenate the skin, and this is the explained mechanism by which the donor hair influences the recipient area.  All of these ideas are fascinating to me as a hair transplant surgeon.

Dr Lam is a board certified hair transplant 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.