Dr. Ken Anderson - 1779 grafts - ARTAS and PRP with ACell

[Ken Anderson, MD, FISHRS, ABHRS]

Clinical History:
Dr. Jacob Lee is a 38 year old physician with diffuse thinning across the frontal forelock area, central bridge, and anterior crown. He desired no linear scar in the donor area.

Surgery:
ARTAS® Robotic Hair Transplant procedure with platelet-rich plasma with ACell® (PRP withACell) performed on August 15, 2014 by Dr. Ken Anderson, M.D. Patient has had one procedure of 1779 grafts.

Results:
Dr. Lee is very satisfied with his results at 15 months. “AFTER” pictures taken on November 13, 2015. He is going to continue on LLLT preventive therapy to maintain his existing hair.

[Gabe Zingaretti, PhD]

That's great results. I am glad to see there are more and more pre-post pictures coming out publically.

Thank you so much for sharing

[Occulus]

Clinical History:
Dr. Jacob Lee is a 38 year old physician with diffuse thinning across the frontal forelock area, central bridge, and anterior crown. He desired no linear scar in the donor area.

Surgery:
ARTAS® Robotic Hair Transplant procedure with platelet-rich plasma with ACell® (PRP withACell) performed on August 15, 2014 by Dr. Ken Anderson, M.D. Patient has had one procedure of 1779 grafts.

Results:
Dr. Lee is very satisfied with his results at 15 months. “AFTER” pictures taken on November 13, 2015. He is going to continue on LLLT preventive therapy to maintain his existing hair.

Dr. Anderson, given the diffuse hair loss pattern, and the relatively significant amount of hair that was present in the implantation site, was this a difficult surgery? Or did the ARTAS's ability to avoid existing hair help?

[Ken Anderson, MD, FISHRS, ABHRS]

Dr. Anderson, given the diffuse hair loss pattern, and the relatively significant amount of hair that was present in the implantation site, was this a difficult surgery? Or did the ARTAS's ability to avoid existing hair help?

Thanks for the question. This case was not a particularly difficult case; Dr. Lee is a healthy man with no previous history of scalp surgery. It was a bit unusual in that there was very little frontal hairline work to be done, which is not typically the case, so if anything it was a bit easier than many cases. Regarding the implantation sites: I created the sites by hand like I've been doing since 2003, because the site-making capabilities of the ARTAS system did not exist at the time I performed surgery on Dr. Lee in 2014.

[JohnMPB]

I'm curious as to why the patient was not advised to use Finasteride or dutasteride to help maintain the remainder of his hair. The LLLT has shown promise in some studies as a minor growth stimulant at best and even then we don't know the long term efficacy.

[Ken Anderson, MD, FISHRS, ABHRS]

Great question. That information was simply omitted. He's been on finasteride for 4.5 years, and continues that therapy. We added LLLT in efforts to further curb the rate of hair loss.

It was my first blog post on this forum; I can see I'll need to be a little more detailed on my posts. :-)

KWA

[JohnMPB]

Thanks Dr. Anderson, that's great to hear.

Can I ask what kind of results you see in your clinic in regards to LLLT? As there are many options now, which models/manufacturers do you recommend?

Lastly, what is your opinion on treating hair loss with dutasteride rather than Finasteride? Can users expect better results?

[Ken Anderson, MD, FISHRS, ABHRS]

Hi JohnMPB,

Thanks for the follow up question. Sorry for the delay in answering you; I’d love to spend more time answering questions, but I operate every day, and insist on seeing my own patients in consultation every day to make accurate assessments and discuss patient expectations and goals. Add that to the PRPs/microneedling/growth factor treatments, and there’s not a ton of time for questions (I’m a really hands-on surgeon, and insist on doing much more of the surgical work than every surgeon that I’ve worked with in this field).

In any case, I am having success using LLLT. I use one myself. A majority of our patients (including myself) are seeing the progression of their hair loss slow down or appear to stop. That’s really the minimum that I’m expecting from the therapy. A minority of patients are experiencing some hair regrowth, but it’s not a significant amount of regrowth, and not anywhere near the results one could expect from a hair transplant surgery. I also encourage my patients to use the device in the days following surgery. I find it reduces scabbing and promotes more rapid healing, which is important to many business executives and public figures as they need to be back to daily life as quickly as possible.

With regards to dutasteride: I do not routinely prescribe it. While it makes intuitive sense that reducing the DHT levels even further would help with the hair loss, and it likely does, the problem is the potential sexual side-effects. Clearly lowering the DHT further will increase the likelihood of untoward side-effects. The pharmacokinetics of the medications are very different, and a main reason why I don’t prescribe it. The half-life of finasteride in plasma is 4.5 hours. The half-life of dutasteride is on the order of 5 weeks. It takes the human body about 5 half-lives of any given medication to eliminate the medication from the body. For finasteride, that’s about a single day. If a patient is having untoward sexual side effects from finasteride and discontinues therapy, the brain will take some weeks to adjust to the new levels of DHT, and the person’s libedo slowly returns to pre-medicaiton levels over some weeks. That’s with a 4.5 hour half-life. With dutasteride, upon cessation of therapy, the body will require about 25 weeks to clear the medication, and the brain will take a considerable amount of time after the cessation to return to pre-medication levels of libedo. In my opinion the risks of prescribing dutasteride for hair loss outweigh the benefits. It may be one of the reasons the FDA has not approved its use for the treatment of hair loss.

I hope this information is helpful to you.