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Wash and drain the lettuce. Shake the lettuce to remove excess water.
Tear the lettuce into bite size pieces and set aside.
Combine garlic, green onion, onion, soy sauce, fish sauce, sugar, vinegar, hot pepper flakes, and toasted sesame oil in a large mixing bowl and mix it well until the sugar is well dissolved.
Add the lettuce to the seasoning mixture and mix it gently by hand.
Sprinkle with the sesame seeds and serve it right away as a side dish for rice.