Dr. William Lindsey

I respond to online consults that arrive within a day. However I almost never remember to look at the PM section.

2 thoughts on online consults:

1. They are never as good as real life evaluations

2. Make sure you include a picture or 2. I get lots of requests for "how much do I need" and no pic. If I could predict that with any success, without pics; I should have sold my stocks one month ago.

Dr. Lindsey McLean VA

We tell patients to use whatever they like after day 10.

I personally prefer nutragena t-gel shampoo. Helps dry skin more than anything I have seen.

Lindsey Medical does NOT sell fancy shampoos that advertise hair growth properties as there has been no controlled scientific studies published in a peer reviewed journal to substantiate their success. Some docs sell their own brand of shampoo to increase the bottom line.

The only problem with t-gel is that is smells like the tar in it--a bit. If you want your hair to smell really good, wash out the t-gel and do a rinse with something that smells nice.

Dr. Lindsey McLean VA

I was just reminded of a similar "scam" in facial plastic surgery.

A few years ago, I shared an office with a plastic surgeon who claimed to be a pioneer in laser treatment of wrinkles. He had a large practice and was quite successful with body work (breast/lipo/tummy tucks).

Anyhow, he did a laser evaluation for a company using their device on maybe 10 patients, several of whom worked at the office. None of us could tell that any cosmetically significant change had occurred. He did back it up with histology showing more collagen in the treated areas.

Coincidentally, I did facelifts on a couple of the staff, and low and behold, but the 2 postop pics that made it to the meeting were the patients that I facelifted! Their scars were not noticable, and indeed it looked like the laser did a miracle. He never revealed that they had a facelift in addition to the laser. The non-facelifted laser patients never had their pics used; but I am guessing that the company was not hurt by these 2 ladies' nice result.

I didn't find out about the details of the presentation until long after the events had passed.

Just goes to show the value of these educational sites in exposing treatments with no scientifically proven efficacy (other than money to the provider) such as LLLT.

Dr. Lindsey McLean VA

At first glance I wanted to give some wise-crack answer like PGP, which I always appreciate.

But my guess is zhiangde may really be curious.

So no you should not feel anything related to growing. Maybe a bit of pain the first 2 nights after the procedure near your strip, and very likely some numbness above your scar in the back for a while followed by tingling as the nerves grow back together.

After that PGP is right on, you should feel happiness.

Dr. Lindsey McLean VA

Amen Stimpson.

Dr. L

Stress screws up your body's ability to heal normally, making you more likely to get a wide variety of things, and making healing less ideal. While that may sound like I ought to be watching "the view" rather than operating, I am telling you that stress is a big problem in postop healing issues.

Dr. Lindsey McLean VA

Things are ALWAYS worse at night. That's because you are laying/lying there with nothing on your mind trying to go to sleep and you feel that tightness. The more you try not to think about it the worse it is.

I had exactly the same problem with an ache being worse at night. You know the cure? EXERCISE. Get yourself tired at some point during the day, avoid caffeine after 3pm, and put on something that doesn't distract you while you go to sleep--like Leno for me. Your symptoms will significantly decrease.

Dr. Lindsey McLean VA

Get in to your doc and have an exam. I post lots of stuff on scars and the summary is: usually if you can make it to 6 months, your scar won't change. Note that I said "usually", not always. People are unique and there are no guarantees.

I have had an occasional person come in 3 years after a procedure and will have just started having a scar issue. I suspect that stress, or incidental trauma, or something is a "trigger".

In any case, get in to your doc and get checked. It may be treatable with steroids; or it might require a revision; or not.

Dr. Lindsey McLean VA

Stimpy,

It all evens out. If your brother has a full head of hair, he has other issues. We all do.

Maybe his dog chews his shoes, or his wife can't cook.

Dr. Lindsey

We advise patients to take Propecia right on through the perioperative period. It won't cause any trouble.

We advise guys to come off of minoxidil 5 days preop and start back 5 days postop. Since the mechanism of action of minoxidil is not certain and there is likely a vasodilation (expanding of the blood vessels) phenomenon, we want folks off of it preop so that bleeding is not enhanced. Dense packing and bleeding are arch-enemies. We also don't want people applying material to the scalp for 5 days postop for fear that some guys would be too vigorous and pull out grafts.

Dr. Lindsey McLean VA

I haven't seen any studies discussing why that seems to occur, but I would agree that I see more "oldest brothers" with hair loss. Now before you say that its just because the younger brothers haven't gotten old enough...I would add that my comment above is related to guys in their 40's and above.

Although hair loss is very genetic, there is a lot of luck involved too. Plus, hair loss is likely a multi-genetic issue, so that even though siblings share alot of the same genes, there is variability too. Science just hasn't gotten accurate enough to pinpoint all of these genetic clues yet.

Dr. Lindsey McLean VA

In my experience numbness occurs in almost everyone and patients recall we discussed that preop. I would guess that about 25% say that it is resolving at 1 week(hard for me to believe given nerve physiology); another 70% say its "mostly normal" at 6 months; and about 1 person per year has a very difficult time with the numbness that seems to persist indefinitely.

Nerves ARE finicky, and it is difficult to predict anything about nerve damage and return of function. For example, I have taken out large tumors in the cheek saliva glands, surrounding the nerve which works the face, and have seen people with completely weak faces, recover in a week; and I have seen folks have permanent weakness in similar cases, where the nerve was not even exposed in the surgery. NERVES ARE UNPREDICTABLE.

But, for the vast majority of people, numbness is shortlasting and is easily tolerated.

Dr. Lindsey McLean VA

Right, no time too soon, unless you are postop from another procedure.

Dr. Lindsey McLean VA

FUE is great for someone with limited needs. If you truely need only a few hundred grafts and your family history suggests that you won't end up needing thousands of grafts to frame your face later on, its probably a perfect solution for you. If someone has a family that winds up class 7 and that person is young and is worried only about the hairline, they should probably either do a conservative strip(so as to limit scarring in the donor field) or wait until their hair "declares" what its going to do.

Dr. Lindsey McLean VA

NW4

No one can guarantee scar results. While uncommon, just last week I had a fellow who had a modestly wide scar from previous transplants that we revised. He was skiddish, and we only revised the left half of his scar as he wanted to make sure he would get a lasting improvement. He comes in today for suture removal, and I will post him next week.

But, an option if you are really worried about scarring, is: get a very small case, a few hundred grafts via a 5 cm strip. That way if you have a scar problem, its a small scar rather than the entire back of your head. It might cost more to do it this way, but its one way of predicting your eventual scar results.

Dr. Lindsey McLean VA

Bill,

Before you hang the practitioner, it could be that no suture was left in, but rather a deep suture extruded. Extrusion is a statistical issue, and in my experience about 1 person in 30 extrudes a deep suture--whether it is hair surgery, facelifts, or skin cancer reconstruction. I have had patients that I myself took out there sutures, call me and say that I left one in; only to find that upon return to the office, that all they had was a bit of dry skin along the scar line.

Either way, this man appears to have a nice result.

Dr. Lindsey McLean VA

Young guy 24,

Your situation sounds alot like that episode of Seinfeld where Elaine had a boyfriend who shaved his head, then she saw an old pic of him with great hair and asked him to grow it out again. When he tried to George diagnosed him with male pattern baldness.

Hey, if the girl doesn't like you because of your hairstyle, you are best getting another girlfriend anyway.

If someone is going to do something about their hairloss, such as medicine or surgery, it ought to be for themselves; rather than for another person.

Granted, alot of guys address their hair to look better; and many of our patients do comment that they get more attention from females after the procedure grows in. BUT, I bet that at least half of that extra attention is due to the patient's increased confidence in themselves, rather than an aesthetic improvement.

I have done more than 3000 facelifts, so I can say that I have spent lots of time with women. I find MOST to be less superficially attracted to appearance than us men. Yes, an attractive guy will get their attention, but if they already know someone who is nice/cool/funny; a good 80% of the women that I have worked with say that looks are significantly less important.

So do any cosmetic improvments for yourself; and if you like the way you look right now don't change for that particular girl.

Dr. Lindsey McLean VA

Dr Arocha's last thread gives good advice. But like many of you weight lifters, I too, arched my back, held my breath and did anything possible to get my bench press as high as I could. My wife, a cardiologist, finally beat it into me that I would wind up like my Dad, who died of a heart attack, if I kept it up. So one week after I turned 42, I maxed out with a #345 bench, and gave my self til age 43 to get 350. A year went by and I am sure its mental, but I never got more than that 345.

At my 43rd birthday, I reconciled myself that I was indeed getting older and I now follow my wife and Dr. Arocha's advice; and I suggest any of you guys getting older do the same.

It is a real ego let down, not to be pushing the weight to your personal best, and not have a new goal in mind at the gym; but its best for your longterm health.

Remember if you want your hair to be growing when you are 70, you have to live to 70 first.

Dr. Lindsey McLean VA

Dr. M

I thought I had placed this question yesterday but don't see it. So, would you tell me regarding that study you mention above:

Who is the author?

What institution do they come from?

What peer reviewed journal has it been submitted to or published in?

Thanks

Dr. Lindsey McLean VA

Folks have often asked why I use staples and my friend and mentor Dr. Feller uses staples. While my answer has multiple parts, one part is that you don't need any special tool or expertise to remove sutures.

I do use staples about 25% of the time, and I can't tell any significant difference in results IF a nice tension free closure is the usual result by the operating surgeon. IF the surgeon typcially has wide wounds closed with tension, neither skin staples or sutures will likely make it a great scar.

Dr. Lindsey McLean VA

Dr. M,

Thanks for submitting this. Would you be able to tell me who the authors of this study are?

And to what peer reviewed journal has this been submitted?

And has it been accepted for publication?

Thanks

Dr. Lindsey McLean VA

You just paid a lot of money for the best surgery you can get. Let the doctor take out the staples if at all possible. You will be more reassured, and although problems are uncommon, dealing with a small problem at day 7-10 is better than dealing with a big one later on.

Dr. Lindsey McLean VA

Sutures came out Thursday and he has a copy of his pics to post upon return to his hometown.

He did a great job keeping things clean and we'll check his scar in about 3 weeks.

Dr. Lindsey McLean VA

Not exercising for 6 months would drive me crazy.

We tell patients not to work out the morning of surgery, and they can resume (unless otherwise told) the day the sutures are removed--day 7-10.

I ask them not to Arch their back while bench pressing, nor to do crunches which stretch even our 2 layer closure, for 6 weeks. Otherwise, they are free to go to the gym.

Dr. Lindsey McLean VA

Dewayne

Thanks for your recommendation. For clarification I am in Virginia, about 3 miles over the Maryland-VA border in McLean; and about 1.5 miles off of the capital beltway.

My website has a map page.

I only replied to that as I had another fellow call last week and ask where my Maryland office is located.

Thanks

Dr. Lindsey McLean VA