Dr. Sam Lam provides insights and updates into the latest and greatest in hair restoration methods and advances.
Hair restoration expert, Samuel M. Lam, MD, facial plastic surgeon, Dallas, Tex., provided an overview of what’s new in hair restoration at the 2020 Annual Meeting of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). These are his insights for the 10 areas covered in his presentation, “Hair Update: Latest and Greatest.”
In terms of follicular unit extraction (FUE), graft survival is better today than it was in 2018, says Dr. Lam. In fact, he says they survive nearly or as well as strict grafts. Why? New generation hybrid punch technologies, including Harris Hex Punch, Devryoye Hybrid Punch, and the Trivellini Mamba Punch.
“These hybrid punches have two big benefits. One is a set of huge rotational energy. They're just a gentle, gentle oscillation method that treats the graphs very well. The second thing is that they have a flared punch, so there's a blunt front, and a sharp edge on the side. So, it cuts sharp, but it bluntly touches the graph without much damage.”
Men don’t want to risk side effects with topical finasteride, says Dr. Lam.
“There's still a risk of side effects, but it's greatly diminished without an oral component. You still can get incredibly good results with topical finasteride.”
Addressing hair loss shouldn’t be left to medical therapies alone, says Dr. Lam.
“I think …nutritional supplementation can truly help people with hair loss.”
Scalp micropigmentation (SMP) can help hide scars and be used for central density, especially after a hair transplant, says Dr. Lam. SMP can also create a shaved scalp look.
“Scalp micropigmentation is your friend and done well by good artists, not just someone that has just been trained overnight to do this.”
From overplucked eyebrows to what Dr. Lam calls “unattractive Mark Groucho-style tattoos,” eyebrow transplant is the hardest thing to do well, he cautions, and recommends only working on eyebrows after spending 5 to 10 years performing hair transplants first.
“4.5x magnification loupes are huge for eyebrows and have been a game changer in how I do it. We must make those angles tight and low. This is the absolute hardest thing to do.”
Dr. Lams says he performs female hair transplant for patients with hair loss from chemotherapy, brain surgery, and high hairlines.
“Female hair transplant is a huge part of my practice for traction alopecia cases, for chemotherapy loss. Hairline recession [also] occurs with aging.”
A type of scarring hair loss linked to sunscreen use, frontal fibrosing alopecia (FFA) may look like conventional hair loss, says Dr. Lam, but it’s very different.
“[It] is a type of scarring hair loss that has been linked to sunscreen use. And oftentimes if you just stop the sunscreen, some of this can be reversed… Graphs that are transplanted may not survive well. [FFA is] one of those things that I highly encourage you to really research and understand before you begin to do transplants because if you transplant this, you will fail. It will be not the right thing for the patient.”
Dr. Lam says facial hair transplants can involve beard FUE as corrective surgery to replace bad hair transplants on the scalp and for a sparse beard itself.
“Facial hair transplants are huge, especially beard-to-beard transplants… this is something I do quite a few of, taking beard from underneath the chin and migrating it up to the face.”
More than simply a hair transplant procedure, this is something that deserves an entire lecture to discuss, says Dr. Lam. Notably, it’s something that can help to address gender fluidity and other specific requests or needs.
“You can get really nice transplants, especially for someone that may either have undergone female feminization surgery or is contemplating that.”
Dr. Lam explains bioenhancements as “fertilizers that help hair grow better,” and it’s one of his favorite subjects, he says.
“To me this is the reason that my grafts are growing so much faster and better…. I think part of the reason, besides good technique, [hair transplants] survive so well is using all these different formulas of hypodermis salt, ATP, ACell and PRP.
Dr. Lam is the course director for the 12th annual Hair Transplant 360 workshop: A Comprehensive Hair Transplant Course: FUT & FUE Hans-on Course, July 23 and 24, 2001 in St. Louis, Mo.
“It’s a great course for you to learn how to learn a lot about how to do this,” he says. “It’s hands on, which is the key.”