Dr. William Lindsey

Lots of literature discuss the increased risk of infection and skin slough(loss) in smokers undergoing surgery. Although this is much more risky in facial surgery (in which I require patients to stop smoking for 10 days prior to ((more important than after actually)) surgery; wound infection is more likely in any surgery in smokers. I advise all hair patients of this and strongly suggest they quit prior to surgery. The issue is that smoking decreases the oxygen delivery in small blood vessel areas; and although the scalp is EXTREMELY vascular, I am concerned about the local blood supply to the DENSE PACKED individual follicles being compromised by smoking and decreasing graft survival.

As to alcohol; the main concern is anticoagulation: turning a dry surgical field in which DENSE PACKING is do-able into a bloody field with popping and prolonged surgical time; and decreased yield.

So, we recommend strongly, no smoking or drinking for 10 days before surgery.

Dr. Lindsey, RESTON VA

Dr. Mejia,

As a Facial Plastic Surgeon who does hair and lifts in Virginia, I think you gave a great potential explanation of anesthesia dosages and toxicity. Right out of a lecture. Good job, and good reassurance.

William Lindsey MD Reston VA

Russianhead,

Thanks so much for posting your experience. The ladies and I always appreciate reading comments online and we appreciate your support. I will see you in June.

Dr. Lindsey RESTON, VA

Botox, when used properly, is extremely safe. Pregnant women and people with neurological conditions should not be treated. There is a learning curve in using it, so the key is to pick an experienced practioner.

William Lindsey MD Reston Va

Dr. Feller is right on with his discussion of total scar formation, and delayed implications of fibroblast deposition around remaining follicles that may need to be harvested in the future. Recall from geometry that the scar circumference for a circle is 2 x Pi x radius. That is essentially (2 x 3.14 x 0.45mm)=2.826mm for a 0.9mm circular extraction site. Multiply that by 7000 and that is 19.8 meters of scar tissue on the back of your head. Compare that to 1 25 centimeter scar used to harvest 3500 grafts twice. I would take the strip too. However, FUE's are nice for selected problems and we do them as trained by Feller. Potential patients are informed of the tradeoffs and can make an educated decision. I am not sure FUE factories explain this to everyone as clearly as some patients would need. If your only tool is a hammer, then all the world is a nail. FUE is one tool, Strip is another; both are useful when used appropriately.

Dr. Lindsey RESTON,VA

Happy,

Thanks for sending your friend in this morning. Wendy and the ladies say hello and we all thank you for posting. Keep it up.

Dr. Lindsey

2 weeks for all strenous activity is a good rule but ask your doctor for his guidance. I had a patient mess up one side of his facelift by "swinging just a bit too hard on the 5th hole" a few years ago 9 days out from a facelift and I had to do a touchup. So, wait 2 weeks and slowly ease back into strenous activities. And, watch the sun exposure on your scalp/donor region and recipient regions(see my other posts on hyperpigmentation)

Dr. Lindsey RESTON, VA

Happy,

You are very welcome, and thanks for sharing your results. Wendy and the girls checked your post are excited for you too. I look forward to seeing you back.

Dr. Lindsey RESTON, VA

If you mean "does an existing scar predict future scars?" the answer is that is a pretty good predictor. Variables include the surgical site, wound tension, use of deep sutures, and postop stretching(see another posting I did a few weeks ago on limiting swimming after surgery).

Generally a good scar the first time in will get replaced with another good scar; and a moderately poor scar may be replaced with a good scar; but a keloid once will likely be a keloid on subsequent procedures.

W Lindsey MD

Bill is right on with his comments. Ifyou are interested see my comments on scar pinkness on this forum that I just posted.

Essentially scars are caused as fibroblasts migrate into wounds to deposit collagen and elastin after trauma. Over deposition leads to abnormal scar formation and can be related to your genes, excessive wound tension, local irritation, and other health issues.

William Lindsey MD, RESTON VA

It is normal to be concerned about your scar, everyone worries with good reason. In my experience of doing hair, plus around 2000 eyelid procedures, and around 2700 facelifts, almost all scars get worse for 6 weeks before improving. This means that they get pinker, and sometimes lumpier prior to resolving. However, it may be worth a trip back to your doctor to check, as the "golden" time for treating scar problems with cortisone shots is around 3 months. I am pretty aggressive with dilute steroid injections if there is any question and it often can "nip a small problem in the bud" and prevent a bigger issue.

William Lindsey MD, RESTON, VA

Interesting discussion threads. I think that Bill and others have some good points.

First, MD vs DO makes no difference when in a super-specialized field like cosmetic surgery--it is all in the natural aptitude and experience of the doctor. As an MD, double boarded in Otolaryngology and Facial Plastic Surgery, I know lots of docs who sound great on paper but can't operate their way out of a closet; conversely, my fellowship director, who is now deceased, never took his boards but possessed skillful hands the likes of which I only aspire to have. So qualifications on paper only show that you have a minimum level of intelligence required to get into a field's training. Its the experience that one gains in their first 5 years and first 50 or so cases of anything (facelifts/hair/noses) that really sets the stage for continued refinement. Having now done almost 2800 facelifts, I can look back at my first 20 cases as where I really pulled the training together and developed a style that undergoes continual refinement. The same with hair/noses/eyelids etc. My friends and colleagues who are DO's are equally able to do the same surgery as us MD's; assuming they have reasonably good training and use good judgement in the OR. Similarly, I know MD's and DO's who have an absolute lack of common sense who I wouldn't let park my car. The degree is not important.

Secondly, as to complaints, if you do enough of anything, you will upset somebody. Sometimes expectations are not achieveable inspite of a true effort by the doctor and patient to understand each other and arrive at a common goal. It is the trend that is important. If Dr X has done 1000 cases and has 15 unhappy patients, that is only 1.5%. Industry standard in facelifts and noses says that 9-15% of patients request a touchup; and those figures are from the "leading publishing doctors" in our field. Now if someone has done 1000 cases and has 150 unhappy patients, there may be cause for more concern.

Lastly, unhappy patients can be more vocal than happy patients and it is important to remember that on forums and internet sites. Remember the doctor can't argue with patients and say his side of the story due to confidentiality rules.

So my advice is go to the doctor's office, speak with some previous patients, and see if the doctor has gotten any letters from previous patients that he can show you(hand written ones, not typed that can't be authenticated).

In our office we have a book showing before and after photos AND containing well over 200 letters from patients describing their experience.

In picking your doctor, look at the credentials, discussions you see on forums like this, AND go and meet the doctor and see if you and he are a good fit prior to committing.

William H Lindsey MD

Reston VA

Your thread comments point a number of important issues:

1. Treatment plans need to be individualized for the patient and the doctor and patient have to communicate. I saw a man Friday who said he was advised to have 3000 grafts from a doctor nearby and I couldn't find room anywhere except the hairline for more than 1500. Anymore and the patient would certainly not see any improvement and would likely have damage to his still growing follicles.

2. Some doctors can provide mega-sessions and some can't. If you like the doctor who can't and like his work or track record, well you will need more than one case. But go with the doctor you have a raport with and some knowledge of what his philosophy is.

3. Some doctors are conservative and others overly optimistic when it comes to donor supply. For example, in late December we did a 3100 graft case on a patient who I really didn't think we would obtain more than 2000 grafts. We were up front with the patient and found his scalp to be more lax than expected allowing a larger strip to be harvested and with strict microscopic dissection of true follicular units we gave him a 50% bonus over what he and I expected.

So, there are lots of reasons for varying estimates; just make sure you have a doctor patient relationship and honest dialogue from the start.

William Lindsey www.lindseymedical.com

We offer botox to our patients, and find that men particularly benefit from relaxing the frown wrinkles between the eyebrows. We generally charge $350.00 for this and have a tremendous satisfaction rate. I personally have been treating my own frown with botox for 13 years.

William Lindsey www.lindseymedical.com

I also agree with Dr. Gabel and would add 2 comments on swimming/summer time activities. First, I swim a couple of miles a week and I have used various masks/goggles and I think just about all would apply undo stress to the donor area, possibly causing a wound separation. Additionally, the turning of the head from side to side will DEFINITELY stretch the donor area probably causing scar widening. Having personally performed 2700 facelifts in addition to hair transplants I can absolutely say that wound stretching in the first few weeks after surgery is key to hypertrophic scar formation. I authored a paper back in 1995 on the treatment of hypertrophic scars and keloids in the Archives of Otolaryngology or the Archives of Facial Plastic Surgery discussing this further if anyone has interest.

The second issue is sun exposure on recently operated upon skin can permanently stain the scar line, or cause the recipient area to become hyperpigmented, requiring bleaching agents or chemical peels as treatments.

So to conclude, I echo Dr. Gabel. If you have had a transplant, ease off stretching of the scalp and direct sun exposure for 4-6 weeks.

William H Lindsey MD RESTON VA www.lindseymedical.com

Congrats Virgin Hairline, if Dr Feller says he was going to Dense pack you, you got a fantastic job. Enjoy your results.

Thank you for that kind introduction Dr. Feller.

As Dr Feller wrote I am new to the internet and am just beginning to learn how the site works. Dr Feller has always spoken highly of these websites and has advised me to participate and show as much of my work as possible, which I will do from here on with some assistance from Dr. Feller in the beginning.

Thank you,

William Lindsey, M.D.