Jump to content
FORUM RECOMMENDED SURGEONS

Dr. William Lindsey

Regular Member
 View Profile  See their activity

  • Posts

    2,885

  • Joined

  • Last visited

  • Days Won

    1

 Content Type 

Posts posted by Dr. William Lindsey

    African American HT

    in Open Hair Loss Topics

    Posted

    We have done hair transplants on 8 African Americans in the past 8 years, 2 in the past month. Given that many guys don't allow us to use their pictures for publishing, I think I have only 2 AA men who allow me to show pics. I will put up one next week on this forum.

     

    We do significantly more scar revisions on black patients however, so someone out there is doing hair cases for African americans.

     

    I will say this however. Although much more technically difficult for the technicians to cut grafts for; black, kinky, thick hairs give great coverage in lower numbers than any other kind.

     

    If you were able to compare the "coverage per graft" between an average complexion black man, and a very fair skinned asian, you would see a huge difference.

     

    The asian's case would be quicker, and significantly easier, but would require a lot more grafts to get the same coverage, if possible at all, as the AA.

     

    Dr. Lindsey McLean VA

    Healing and hair growth with platelet rich plasma (PRP)

    in Hair Restoration Questions and Answers

    Posted

    Maybe or maybe not. I do not have expertise on this particular machine.

     

    As late as 2004 though, the machines that were available had some parts/tubes that did interact with blood, and required changing by staff between cases. Since those tubes are expensive and aren't seen without opening the "box"; they could be overlooked.

     

    Also, the commerically available fibrin glue kits early on, particularly in Europe, used pooled blood bank blood. Given the lag time between HIV infection and seroconversion (a positive test) there is certainly a potential risk, although small. And don't forget that hepatitis and other blood born illnesses are out there.

     

    My point is that exposure to blood products is no trivial matter; and should only be done when a significant benefit can be obtained. As to healing after hair cases, a valid case for these types of products has yet to be made.

     

    Dr. Lindsey McLean VA

    Is there an average minimum number of grafts?

    in Hair Restoration Questions and Answers

    Posted

    Boy how times change!

     

    I see old plug patients who describe their transplant as 100 plugs done in one setting in the 80s and early 90s.

     

    I saw a guy yesterday done by a competitor just up the street in 99 who had 400 minigrafts.

     

    He then had 1200 micrografts in 2004 by the same guy.

     

    I suggested 2000 fu's to try to get him less pluggy, and would do more if he had a better donor region. As it is, his 7mm wide scar, and multiple previous cases will limit my take if we want to give him a better scar than he already wound up with.

     

    Dr. Lindsey McLean VA

    Healing and hair growth with platelet rich plasma (PRP)

    in Hair Restoration Questions and Answers

    Posted

    Way back in 1987, I developed and tested Fibrin Glue's effect on flap adherence and published this in the American Journal of Surgery, Archives of Surgery, and over the next 8 years I won 5 national research awards on this general topic(American Medical Assn, Trilogical Society, Plastic Surgery Research Council, American Academy of Facial Plastic and Reconstructive Surgery). I say this not to toot my horn, but to show that I have some degree of expertise in the biologic effects of the products discussed herein.

     

     

    As a facial plastic surgeon, I have seen over the past 5 years, a huge marketing push by biotech/pharmaceutical companies to try to get doctors to use Platelet gels, and Fibrin Glue systems to decrease bruising and increase healing in facial cosmetic surgery.

     

    Having now done over 3000 facelifts without these products, I do not feel that these additional products are of significant help for the VAST majority of facial cosmetic surgery patients. In fact, the only thing I think that they offer is the hope of decrease bruising in cases where a large skin flap is elevated (facelift) and needs to be re-attached. We accomplish that with an inexpensive ace bandage.

     

    I can see no significant clinical advantage in hair transplantation, since there are no flaps to adhere, and sutures or staples are used to close the strip incision.

     

    Also, several of the commercially available options use products from other people, which brings the risk of infectious disease transfer into this elective surgery. And if it is from the patient himself, does he really want a hair transplant practice drawing blood and processing it in a machine used everyday on different patients, and then re-injecting his own blood products for no significant benefit??

     

    Now don't get me wrong, if you are having a mastectomy for breast cancer, or heart surgery, these products may make perfect sense. But for hair, sounds like a gimic, with potential risks rather than benefits to me.

     

    Dr. Lindsey McLean VA

    22 and losing fast!

    in Open Hair Loss Topics

    Posted

    I would agree with Bill. Particularly with your family history, try medicines for a while, a year or so, and see what that does. You may be able to put surgery off a long time.

     

    The "triangle" approach is still an option, but given your family; I would push for a much more conservative hairline than most 22 year olds want. That way if you do lose most of the front, you still have sufficient donor hair to frame the face with a nice forelock abutting the triangles.

     

    This thread is just one more example of why I say an in person consultation with a doctor is so important.

     

    Dr. Lindsey McLean VA

    pre-operation period smoking

    in Hair Restoration Questions and Answers

    Posted

    Right. Dr. Carman, I haven't been able to find any studies showing decreased graft survival in smokers. I completely agree with your thoughts on vasoconstriction altering graft perfusion and what would probably be early on ischemia and decreased growth.

     

    I learned way back in the early 90s, from a plug doctor--I hate to admit that. I recall discussing smoking with Dr. Davis, my mentor, in several conversations and he didn't know of any studies showing problems even with plugs. You would think that plugs, kind of like a small full thickness skin graft, would have significantly less perfusion to the central core and would have shown follicle death. But when I see old plug patients now, who say they smoked right through the surgical period, I have not ever seen a "dough nut" of a plug with a hairless center in those folks.

     

    Lastly, I don't think anyone has discussed whether follicular units are vascularized by plasmatic imbibition as traditional skin grafts are. I would guess they are.

     

    This would be an interesting area of research for someone with alot of time on their hands. Wish I were a fellow again.

     

    Dr. Lindsey McLean VA

    22 and losing fast!

    in Open Hair Loss Topics

    Posted

    We have no problem with younger patients AS LONG AS a complete and thorough consultation is done; and the patient has time to think about options. We don't like a 20 year old to fly in for a medium case, and think that this will hold him forever.

     

    We would be amenable to discussing correction of the frontal-triangle recession; as posted by us several times on this forum. It is important to go through the family history and make some kind of "guestimation" on where a patient will wind up, and plan for the future.

     

    Dr. Lindsey McLean VA

    Any new solutions down the road?

    in Open Hair Loss Topics

    Posted

    I am sure that hair cloning will be available, and probably genetic manipulation to prevent hairloss too. The question is when.

     

    I am fairly sure that cloning will be available if my 10 year old son needs it when he is 40; but I doubt if it will help me significantly in my lifetime.

     

    For now, surgery is the best we have to offer. It is not perfect, but it is a very nice option for many.

     

    Dr. Lindsey McLean VA

    What to tell others about why you shave your head?

    in Open Hair Loss Topics

    Posted

    Young guy 24,

     

    Come on in for a visit. Regarding scarring and FUE-I post alot on scars and they are hard to predict, but most people don't have significant scar issues with FUE from a cosmetic standpoint. Rather the issue becomes will the scarring from FUE limit procedures in the future. I am a fan of FUE for the right patient, meaning that someone with a limited likelyhood of becoming significantly bald can fill in select areas with FUE. For a young guy with a family history suggesting he will end up class 5, I would push for a strip. That way you can fix an area now, and as you lose hair elsewhere, you still have lots of donor hair NOT scattered with FUE scars, to harvest as needed.

     

    Recall, with a strip you might have 15cm (for 1500 grafts) of scar line, hopefully as a very thin line. With FUE, using a 0.9mm punch, you will wind up with 1500mm(150cm) of small linear scars. If you are going to need significant hair in the future, I am still a fan of strip.

     

    For an older guy like me though, I would probably choose FUE for my limited frontal triangle issues.

     

    That is why an inperson consult is critical.

     

    Dr. Lindsey McLean VA

×
×
  • Create New...