2500 Grafts

[CIT_Girl]

We placed 2500 grafts to the frontal and top areas of this patient in 5 and ½ hours.

The patient also had early thinning throughout the top of the scalp. We treated the entire scalp with PRP and Acell.

Prior to surgery we evaluated his cross sectional trichometry in 4 locations including the front, top, Crown, and donor area. Prior to surgery he had 76% loss at 14 cm above the glabella, 65% loss 18 cm above the glabella, and 45% loss 24 cm above the glabella.

5 months after his hair transplant and Acell/PRP treatment -
His hair loss at the 8 cm above the glabella was 52% (prior to surgery there was so little hair at 8 cm that we could not measure his the hair loss percentage). The loss at 14 cm above the glabella was 35%, the hair loss at 18cm was 47%, the hair loss at 24 cm was 0%. The area at 24 cm was treated almost exclusively with PRP and ACell. This shows that Acell and PRP can have a profound affect in some individuals and may influence area with less hair loss initially to a greater degree.

Following surgery we treated the donor area with Acell. At the 5 month mark we counted the number of extraction sites. We found that 61% of all extraction sites regenerated hair follicles. The Acell reduced the diameter of hypopigmentation and the degree of hypopigmentation, but Acell, did not eliminate hypopigmentation. It is unclear why some extraction sites did not regenerate hair. Furthermore, Acell does not seem to work this well in all patients. We feel that the minimal depth approach we use improves the potential for follicle regeneration.

Other methods of FUE use a much deeper full thickness extraction method, which removes all the stem cells. Acell cannot induce follicle regeneration when a full thickness extraction method is used. Similarly, a strip is a full thickness excision and this removes all the stem cells too. This is why Acell does not result in any follicle regeneration following strip surgery.

[gmonasco]

No after pictures?

[Follicle Death Row]

Originally Posted by CIT_Girl

Following surgery we treated the donor area with Acell. At the 5 month mark we counted the number of extraction sites. We found that 61% of all extraction sites regenerated hair follicles. The Acell reduced the diameter of hypopigmentation and the degree of hypopigmentation, but Acell, did not eliminate hypopigmentation. It is unclear why some extraction sites did not regenerate hair. Furthermore, Acell does not seem to work this well in all patients. We feel that the minimal depth approach we use improves the potential for follicle regeneration.

Forgive my incredulity but that's a game-changer if so. Maybe Dr. Cole is the man Spencer should sent over to Dr. Gho. Dr. Cole should ring the show about this next Sunday.

[forhair]

I found more 5 months post-op photos of this patient and an additional post-op shaved donor shot

[forhair]

I don't know if many have any experience with cross sectional trichometry (CST). Not many do, because it is expensive to perform. For this reason, you will not find may physicians who routinely perform it.
CST measures density and diameter of hair in a 4 sq cm surface area. Suppose you have 100 angel hair pasta (capellini) and you have 100 spaghetti pasta. If you grabbed each pile individually and measured the distance around each, you would find that the spaghetti pasta has a much greater circumference. . If you had 300 angel hair pasta and 100 spaghetti pasta, you might find the distance around the angel hair pasta is greater. From this measurement, you could calculate the cross sectional area of each bundle of pasta. The cross sectional area of each bundle is a function of the number of pasta and the diameter of each pasta.
In hair, we measure the CST to predict suitability to hair restoration surgery and to evaluate success of any form of treatment (medical or surgical).
In this particular patient who had 2500 grafts, he had pre-existing coverage. Because he had pre-existing hair, we were able to measure the CST in multiple areas on the top of his scalp. Each measurement is taken at a specific distance from the glabella. Because we record each pre-operative measurement, we are able to go back later and measure the specific location above the glabella in the patient's mid-line at a later date to determine his response to treatment.
When we compare the measurements on the top to a measurement in a specific location in the donor area, we can determine the degree of difference (or loss) in each location on the top of the scalp. As we add hair to the top, we can evaluate the change in the CST on the top and determine the degree of gain (or increase) in hair in each location on the top of the scalp.
In this case of 2500 grafts, we added hair mass to the front and top of the scalp. We also treated the entire scalp with Acell, PRP, and Thrombin injections. We were able to see an increase in the CST in multiple locations on the top of the scalp from both hair restoration and medical treatment. In other words, the percentage of loss in each location decreased both from transplants and medical treatment.
As you know, pre-existing hair is susceptible to fall out over time. Without treatment patients who started with a specified amount of hair, often see a decrease in their CST over time. With treatment, we hope to see an increase in the CST. If the CST increases, the patients definitely had a positive response to treatment. Patients often question their response to any form of treatment because the net gain in hair is often so slow and gradual that patients tend not to recognize their improvement. Measurement of the pre-operative CST allows the physician and patient to recognize improvement objectively because the test is very sensitive to small increases in the cross sectional area. The CST also allows for objective assessment of progressive loss over time without treatment.
The objective of FUE is to gradually increase hair on the top of the scalp one follicular unit at a time while at the same time reducing the total follicular unit density in the donor area one follicular unit at a time. In other words, the CST of the donor area is prone to decline as you add to the CST in the recipient area. In cases of extreme hair loss (NW 5 to 7) the overall goal might be to make the follicular density on the top of the scalp equal to the follicular density in the donor area. Put another way, the goal might be to make the CST in each location on the scalp similar.

[forhair]

Hi gmonasco, here are some more after photos per your request including a post-op shaved donor shot

[Follicle Death Row]

Very well done. Definitely making great progress with donor maintenance by the looks of the photos. I hope Dr. Cole and Spencer can get in touch because it looks like we're making big steps in the right direction now. Very interesting.

[drcole]

We are seeing a positive response in CST for a number of patients with PRP and ACell alone. When we measure the CST, we typically measure the percentage of loss on the top. In one patient recently, I found that an area in the recipient area went from no loss to a positive gain. I've seen improved coverage with it and I've see no change with it. The CST is very sensitive, however. Add one noodle to a box of spaghetti and you will not see any difference. You you will be able to measure a change in the CST. It is an objective means of evaluating a response to any form of treatment.

Not all patients get this high of a response to ACell treatment in the extraction sites. I've seen it as low as 20% in some patients. it would not surprise me to see it fail to work at all in some patients. I think in this patient, it is harder to evaluate the response to Acell because the donor area and the extraction sites healed with a similar skin tone. I have found that Acell does not eliminate hypo pigmentation, but it does reduce the size of hypopigmentation and Acell does help capillaries grow into the edges of the extraction sites. Both are positive responses in minimal depth FUE patients.

[drcole]

This patient had 1999 grafts placed throughout his frontal area. We also treated the frontal area with PRP and ACell. We kept the grafts in Hypothermosol at 8 degrees Celsius along with a 1:10 concentration of liposomal ATP. Following surgery the patient misted the grafted area with liposomal ATP four times a day to nourish the grafts with ATP.

The patient began to grow hair very early following the surgery and continued to progress in a rapid fashion. At four months, he had a significant improvement. The Liposomal ATP may indeed accelerate hair growth in the recipient area for many patients.

His cross sectional trichometry at 30 days, 90 days, and 120 days is as follows:

Location February 30 days April 90 days May 120 days
7 31% loss 27% loss 20.3% loss
13 10% 0 16% gain
17 19% gain 19% gain 17% gain
20 0 1% 0
31 0 0 3% gain

The values reflect a percentage of loss or a percentage gain or no change (0).

[Follicle Death Row]

60% is very high though. A question re the whole furore over Dr. Gho's HST if you don't mind doc; What do you make of what they're doing? Is it something you've looked at yourself (Longitudinal transection)? When I read the paper I thought yeah that could be possible but with what consistency?

Do you feel your shallow depth extraction can vastly expand donor available for FUE? I know a lot of people in the industry are very skeptical of such claims. I'm certainly not naive but I am open to the possibility that donor regen could one day be possible.

I know Dr. Rassman thinks HST is junk science but then he did slam FUE when Dr. Woods introduced it back in the day so it's all so confusing as to what's real and what's not.