FUE Donor Area Healing With ACell 3 Mo. Post-Op

[topcat]

Okay well I feel the question has still not been answered. If Acell is promoting regeneration that show a 4 sq cm area with all the follicles removed by way of fue apply the mix and show the regrowth.

Of course I think Dr. Bisanga is highly skilled and has natural talent and I also like him as a person. He is very easy going and very easy to get along with which is something that is personally very important to me. Of course you are highly skilled that is well known and I have always told others the same and nothing different regardless of what others might think I am honest.

The highly skilled guys should all get together of which there are very few and start their own club. No need for me to mention who I believe belongs in that club but it would make it so much easier for other patients. The forums could be eliminated and we wouldn’t have all this nonsense that goes on and I say this only as an outside observer on something that has had a tremendous effect on the direction of my life but in reality most of it has been good for others not so much. I still see too many being misled by those that they believe are doing good as they keeping honing their image as being the good guys.

[John P. Cole, MD]

Topcat, there are different ways to harvest follicles. One way is to take part of a follicular group. Another way is to take all of the follicular group. sometimes, this is easy. Sometimes, the donor area is not conducive to this. If you harvest part, the donor area will look more natural, but you will move fewer hairs because you leave more in the donor area. I do this often and this is what Dr. Gho has been doing in my opinion. He suggests that he is taking only part of the group down the middle of a group. There is not instrument capable of doing this. If the is able to do this, he should sell the tool because he could make a fortune.

Thanks for the diet information. Dr. Bisanga was one of my top surgery techs when he worked for me. He did not have a license in the USA so I started him as a surgery tech in hair transplant surgery in about 1998. We started him off in practice in Cyprus because he had alot of talent. You found a good one. Both he and I have always liked to eat so talking about nutrition is a good way to get both of us interested in the subject.

[topcat]

Thank you for the nice answer. I think my diet would be too long to go into, why I eat what I eat and when I eat it. I would say that I do consume much more cholesterol than most and I’m sure as a doctor with your training you would highly advise against this as that is part of your training and the information you are exposed to which would be understandable.

Personally I believe most of the medical training is controlled by those at a much higher level for the benefit of those that are in control much like many other things in the world and most doctors can’t think outside of that box and even if they tried that are quickly put back into line.

My only question is the suggestion of the 1 inch or 4 sq cm area having all the follicles removed and showing regeneration. This same question was posed to Gho well over 10 years ago and we still have not seen an attempt so of course it is very normal to ask the question.

I’m sure you can appreciate someone just getting to the point it does not mean one is being rude. We are all men here equal in my eyes. My main concerns here and why I continue to post is to see honesty and highly skilled work that doesn’t harm the patient.

[John P. Cole, MD]

Topcat, I agree that nutrition is very important. it's probably the one area that we've over looked in hair restoration surgery. I think a well balanced diet obviates most issues, but an improved diet is probably very important. Glad to hear that you have not lost density from harvesting. I measure cross sectional trichometry on all patients with hair that is long enough to measure. This is a measure of 4 square centimeters of hair surface area. basically, it's like taking a box of spaghetti noodles and measuring the surface area of the bunch. a box with more noodles will have a larger surface area. A box with larger noodles will have a larger surface area. I measure the surface area after FUE and i also have alot of data on those who have undergone strip surgery. in a nut shell, surface area of 4 sq. cm of hair decreases alot more after strip surgery than with FUE.

One of the things that happens with FUE is you tend to get white dots on the scalp. these are very easy to see and I most likely could find them on you Topcat. One thing that makes this case so difficult to evaluate is that they white dots are absent. That's probably part of the Acell affect.

Many hair restoration patients are very concerned about diet and health. I've not seen diet alone regenerate hair. Still, I think it is worthwhile for you to describe your diet.

Thanks, Artista. Many times it is the forum members that alert us to new ideas to be quite frank with you. We had 5 sites growing hair when they were still pink and easy to find. We will work on circling this week when we get time. I do think this is important. It's just not as easy as it seems

[Artista]

Dr Cole, Thank you for being so active here! Also-
Thank you so much for your hard work and ongoing dedication to the use of Acell.
I have been a huge Acell advocate way before it was even considered as a possible treatment for hair loss.
The 4x4 sample photo on this thread is an eye opener !!

[topcat]

As far as regeneration goes. Dr. Bisanga has gone into my lateral hump area 3 times to harvest what is left of my scalp donor and to be quite honest the area is as thick as ever……….hmmmm…..regeneration from superior nutrition…………..I don’t have documentation so you see where we get into some hairy issues if I were to start making that claim.

It has been stated on these forums for years. Extract every follicle from an area 1 square inch then let’s see if one has regeneration without attributing it to some normal hair cycling. Surely you can find one volunteer for the sake of science.

[topcat]

My own case is very well documented with what I would say is the quickest healing I have seen in watching the forums for years and viewing many cases. Some of my photos clearly show hairs growing as early as 8 weeks in the recipient area. I am 50 but my body can perform the same or better than the majority of 20 year olds mostly better. I have found this to be all diet related and as the old saying goes “let medicine be thy food and food be thy medicine”

Nutrition is truly the key.

[John P. Cole, MD]

I certainly appreciate all the feedback I can get regarding any procedure. Years ago, I could learn from all my patients regarding what works well and what does not work so well. Then patients began to come from all over and it became more difficult to evaluate each response to treatment.

PRP is supposed to deliver growth factors that promote improvement in the quality of existing hair. If you have received one of these treatments within the past year, we will be contacting you next week to evaluate how you responded in areas that we did not graft or in short term responses in areas that we did graft. We expect you to do better in areas that we grafted long term in areas that had existing hair even if PRP has no benefit.

If you have pre-existing hair, we expect these areas to improve about 8 to 12 months after a procedure without PRP. If you improve sooner, it suggests a PRP benefit. If you improve in areas that we did not graft, then that suggests a PRP benefit. Then there is the possibility that you improved due to PRP and grafts over a span of time.

Combining PRP and Acell should result in a greater probability of improvement without grafts, but they do not guarantee such improvement. What we need to know is how many respond favorably. This is why we will be contacting you beginning next week.

Then again, you might heal faster with PRP. This is common especially with a 1X PRP concentration. Then we also feel you will get more growth factors with a 5X concentration of PRP and this might help improvement in yields and in the quality of existing hair. A high cell count improves the probability of swelling. Swelling is not necessary to induce hair growth. What we want is a low cell count and a high platelet count. Only the Angel system allows this sort of differentiation.

Now getting back to your question. Does Acell reduce redness? Does PRP improve healing? Might my last procedure not heal as fast as the more recent procedure?

We feel that Acell improves healing long term. We also believe that Acell can prolong redness, but Acell may not. We believe that PRP speeds healing in many, yet some may not heal as fast with PRP. PRP should improve healing in most, however.

In general, I have heard that my technique heals faster than most. Small incision sites heal faster than larger ones. Still we never expect anyone to grow hair before the 3rd month and at 3 months only 30% will grow. If you have pre-existing hair, don’t expect an improvement for 8 to 12 months and then plan on 12 before your hair looks fuller. Only those that were totally slick bald will see results at 3 months. Those that started with hair in an area that is grafted will not see new growth. What they will see is an improvement in coverage after 8 to 12 months. Your hair will suddenly appear fuller. It is similar to planting seed in a mature field of crop such as corn. You will not see the new corn stalks, but after they reach maturity, the whole field looks fuller. Alternatively, if you plant crops in a fresh area of dirt, you can see the new growth immediately. Once that crop grows, however, you can’t see new seedlings emerge because they are hidden. Such is the case with crops planted in mature fields. What you see is a thicker filed of crop only after the new seedlings grow to a height even with existing mature crops. Such is the case with hair. Only after new grafts grow to a style-able length will you see them.

Then there is this particular case. I studied this result last week. Then I studied the overlay we did beginning this week.

Here is my response. At 4 weeks I saw 5 grafted sites growing hair. Each site was still a little bit apparent most likely because Acell stimulates vascularity. I could see hair in pink extraction sites. Thus, we know 5 of 12 sites were growing hair at one month. Then, 3 months later I evaluated the area. My belief was that 3 sites had no growth and one site might have a single or a two hair re-growing. Then I looked at the overlay.

With the overlay, I feel there are 6 sites growing, 3 sites with no growth, and 3 perhaps. When I look at the overlay, I feel it is off slightly so there may be 7 or 8 sights growing and 4 or 5 sites not growing. The good news is that there area sights growing. The bad news it is hard to be exact at this point.

Yes, Acell can prolong redness, but in the long run, Acell can improve the overall donor area and perhaps also the recipient area. Still, we need to study this all further.

[ITNEVERRAINS]

Hey Dr Cole,

I have a ?, it's a little derail so I apologize but it does concern Acell. I was in your clinic March 29th, did about 1300 grafts and did receive Acell, I believe over the donor and recipient areas.

The donor area was business as usual, but the recipient area was honestly minimally red, especially in the crown. I followed the post OP to the 9's, is this indicative of that or should I be concerned. I can see minimal growth forming and I know where we're at in the grand scheme, but all other procedures I was pretty red for awhile afterwards. This time, no redness. Is this due to Acell being awesome?

Hoping the same method of this regeneration is what I received. I know everyone is different, but it is promising. See you soon for scar revision.

[John P. Cole, MD]

At about 4 weeks we could see hair growing in 5 extraction sites. At 5 weeks, the healing was so good that we could see only 3 distinct extraction sites without hair. Of course this was with the hair long. We elected to go to the three month mark to shave the hair down again so we could see the extraction area clearly.

In the first 5 weeks we saw only 1 or 2 hairs in each extraction site that was growing hair except one that hair multiple hairs. Actually, i would have been happy to see 1 or 2 hairs following the removal of 3 and 4 hair groups, but what i found at 3 months was multiple hair growing the the extraction sites. This very positive news.

I think now the goal will be to do a comparison using one side with our Acell/gel and photopolymerizing liquid on one side and nothing on the other side or plain gel with no additives to compare the healing.

[topcat]

Thank you for the reply and look forward to seeing the overlay.

[John P. Cole, MD]

by the way, simple donor areas have tight bundles with fewer hairs per group. this is a wide spaced hair grouping that probably contains more than one follicular unit per grouping because a follicular unit by definition contains no more than 4 terminal hairs. Complex donor areas are more difficult to evaluate, but they are ideally suited to this study where we wanted to evaluate regeneration when a larger punch was used. One could have alternatively used a 0.8 mm punch and taken small pieces of each follicular grouping. That was not the study design in this case. we wanted to evaluate regrowth of completely intact larger groupings rather than hope to see regeneration of smaller bites of each group. that would have been almost impossible to evaluate in this particular patient.

[John P. Cole, MD]

We will show you in an overlay next week. This is a complicated donor area and it is easy to confuse one's self because the groups are so large. Never the less, there are 12 extractions in 1 sq cm. There are four blank spots . in one of the blank spots, there may be one or two peripheral hairs growing. This may represent growth in 9 of 12 extractions, with only a partial regrowth in one. Alternatively, it could be 8 or 12 regenerations or 66%.

[Ted]

Using that 4 hair follicle as a reference point I certainly do not see 70% regrowth but bare skin where the extractions sites were made and that is very evident with the extractions made immediately around that reference point. Maybe someone else sees something different.

I agree. I would like to see the regenerated hairs circled.

Other than that it looks very nice! Absence of scars is a great improvement!

[topcat]

Using that 4 hair follicle as a reference point I certainly do not see 70% regrowth but bare skin where the extractions sites were made and that is very evident with the extractions made immediately around that reference point. Maybe someone else sees something different.