The Structure of Scientific Revolutions: Shifting Paradigms
September 11, 2008 by dr. lam · Leave a Comment
Thomas Kuhn's The Structure of Scientific Revolutions
Thomas Kuhn’s The Structure of Scientific Revolutions had a profound impact on my thinking as an undergraduate major in European history at Princeton University. Kuhn’s thesis focused on how scientific research and understanding are driven by a specific model of the universe, until a crack appears in that model, that will eventually cause it to be supplanted by a new model. An example is how Newtonian physics dominated our thinking of the laws that governed the physical world until Einstein poked holes in it when looking at the deficiencies of that theory at the outsized extremes, e.g., the speed of light. The concept of gravity was replaced with the perception of curved space and a space-time continuum. Quantum mechanics surfaced to create a newer model that differed from Einsteinian physics by focusing on the deficiencies of Einstein’s theory at the sub-atomic level. Einstein spent the remainder of his life failing to create a “unified theory” to marry the discrepancies of both theories. Super-string theory emerged to provide the mathematical unity that Einstein sought and that only now is becoming unraveled as a viable theory.
With Kuhn’s thesis firmly in mind, I wrote my new book, Aging Face: the New Paradigm, to express a new paradigm shift. As you know, fat grafting represents the core of the paradigm shift, i.e., getting surgeons to abandon browlifting and excessive facelifting (I do facelifts in those who would benefit from them. In fact, I am doing one combined with a fat transfer today) and to see faces from a volumetric standpoint rather than a purely gravitational model. Hair restoration using stronger-density grafts in the central midscalp and feathering that forward along the perimeter with finer grafts. The trend toward tinier and tinier grafts throughout have left patients with weaker density and no more natural a result. Also, vertical, purse-string, cranial-based, short-incision facelifts (which I am doing today) that change the paradigm from pulling backward (does that fix gravity?) to pulling upward to counteract the effects of gravity.
Although Lakatos argued against Kuhn’s thesis and proffered that change is more gradual, I am firmly in Kuhn’s camp and have built my new book on his theory. We as humans tend to need models to perceive “reality”, and especially in the world of scientific advancement and knowledge, I think models are indispensable. However, Kuhn’s theories have been a bit bastardized in non-scientific circles.
UNDERSTANDING THE NATURE OF A TRANSPLANT (PART 2)
September 10, 2008 by dr. lam · Leave a Comment
As some of you know, I wrote a blog last week or so on the nature of a transplant comparing fat grafting with hair transplant in terms of understanding the dip and the growth of a result. Here is the link to that blog if you would like.
Getting back from the ISHRS (International Society of Hair Restoration Surgery) meeting last week in Montreal, I was fascinated to learn about how transplanted hair grafts placed into a scarred region can actually over time repair the scalp skin and make it look normal again. That was really exciting news. Along thoe lines, I have seen consistently nice skin changes in my fat grafting patients a year out but couldn’t document the changes with absolute certainty…until now.
I did a charity case exactly a year ago in a nice young lady who had a car accident and was left with scarring despite operations to fix it. I did a single session of fat grafting for her and besides making her face more balanced, I put the fat under her scars, most notably, her right nasolabial groove (smile line), and as you can see a year after, the scar is significantly improved using standardized photography (Please click on the image to blow it up further. It is important you see the image in full resolution and fuller size to appreciate the change). My patient noticed that too and said, “Yeah, I was wondering about that. My scar was starting to look good but I couldn’t understand why.” I think it will continue to improve for another year so I am excited to post another blog in a year to see how her scar looks 2 years out.
The reason for this change is not entirely clear. However, the purported thinking is that the transplanted tissues have a “stem cell” change to the overlying and underlying structures that not only heal tissues but provide ongoing rejuvenation on a cellular level. That is really, extremely and profoundly cool to me.
In Montreal For Meeting
September 3, 2008 by dr. lam · Leave a Comment
Hi Everyone,
I just wanted to say that I flew out today to Montreal for a Hair Transplant meeting so I am going to take 2 days off the blogs if you don’t mind. I am really tired with finishing my book this week and then flying out so I hope you understand my taking a short and much-needed respite. I just had a great dinner with Emina (my hair-transplant coordinator) at Toqué, great restaurant here in Montreal, to celebrate our finishing the book together. She was a great asset in the hair chapter.
I need to wake up at 6 am to go to attend workshops, and Emina is going to go do a second part of her teaching assistants cutting and placing grafts, which again I am very proud of her so I am signing off until Monday where I will have some fresh blogging for you guys. Again, I hope I am not letting anyone down but I need a 2-day break. Maybe I will share with you some of my adventures in old Montreal. A bientôt!
UNDERSTANDING THE NATURE OF A TRANSPLANT
August 27, 2008 by dr. lam · Leave a Comment
Fat Grafting Evolution Photos
In January of this year, I sat for my hair transplant board examinations in Houston, Texas and am fortunate to be one of about 120 diplomates of the American Board of Hair Restoration Surgery in the entire world. It was a very rigorous examination, testing me on every aspect of surgical and medical hair restoration but also on hair loss diseases and basic science information related to hair. The thing that I want to focus on in this blog that I got out of that examination is understanding how a “free graft” transplant works. This knowledge is applicable both for my hair transplant patients and my fat grafting patients. I oftentimes joke that I am no longer a plastic surgeon but a transplant surgeon now. Okay, that was not that funny.
In Unger’s magnificent book, Hair Transplantation (4th Edition) he has a drawing of a hair follicle start to get fully connected to the surrounding blood supply somewhere around 6 months postoperatively. This is the time that a hair transplant begins to take root so to speak and start to show significant growth that continues upwards of 18 months to 2 years following a hair transplant procedure.
Now the main purpose of this blog is not to talk about hair restoration but to use it as a model for one to understand how I perceive the evolution of a fat transfer. Fat grafting, like hair transplantation, relies on placing a “free graft”, i.e., a graft placed into the surrounding tissue that must take hold for it to grow. Unlike a microvascular free flap that has the blood supply actually sewn together, these free grafts must have enough blood supply over time to become a live graft.
This is why I inform my fat grafting patients that there can be a dip in the result between the early swelling of 3 to 5 weeks and the “result” that begins to appear after 6 months when the blood supply begins to take hold. Like a hair transplant the result begins to manifest about 6 months out and improves up to 2 years post. That is also why I put together the fat grafting evolution series in my before and after gallery to help you better understand this principle. The photo shown is of my patient that I just uploaded last Friday showing her before, 1 week after, 3 months after (the dip), and 1 year following (the result but still improving).
I know many patients have a great fear that the fat transplant will not last. Simply put, that is what happens with other surgeons who do not know how to handle and inject the fat well. My fat not only lasts but improves over time. I think many surgeons at 3 months encounter one of two problems. Either their fat is gone because the fat graft did not hold well, or the fat is in the “dip” phase and they decide to go back and do a touch-up. If the fat is going to hold, the individual will look grossly overcorrected at 1 to 2 years post. This is why I always say to my patients put your seatbelt on at 3 months and patiently wait. If you dip hard (20% do), you should be fine. If not, let’s do a touch-up at a year on my nickle.
Tingo and Crazy Words for the Face from around the world
November 18, 2007 by dr. lam · Leave a Comment
I was given a book named Tingo by Emina, my hair-transplant coordinator. For a full name of the book, what Tingo means, and some crazy words about hair, check out my blog on my hair transplant site. Okay, basically, the author of this book, Adam Jacot de Boinod, wrote a book on foreign words that have funny meanings. Let’s explore a few of the ones that relate to the face: Read more