NORWOOD 6 members who have had HT surgery

[John P. Cole, MD]

There is no question that we are getting some regeneration with Acell.

I think beauty is in the eye of the beholder. About 90% of guys with bad hair transplants seem to be happy with them at least up to a point where it becomes more and more obvious. About 10% with a bad hair transplant can't stand it and about 3% become almost suicidal.

It's better to do it right from the beginning. However, some people are happy with just a little bit of hair to help frame their face and they top it off with products when they want it to look fuller. Others, want as much as they can get. Others want more than we can offer.

With all the cow licks on my head, i've never been able to really style my hair, but at least I have it. It's going to go where it wants to go, but at least I have it.

I think all opinions are important. The beauty of what we do is the ability to satisfy many different opinions.

I never met Bobman, but it seems like a great result especially based on where he came from.

[Dan26]

^^^

Drcole what do you think of ppl who are destined for nw6 get a conservative and somewhat dense hairlien via FUE (say nw2-2.5) and perhaps SMP in the crown just to make the head appear full. Assuming they are ok with shaving their head now or down the road.

For me, especially as a younger guy, rocking a shaved head (lets say 1 guard) with atleast a hairline to frame it is much better than spending my 20's bald.

This way you can escape the 'bald/balding' stigma and just be a dude with a shaved head.

You could actually use the best donor area for the hairline and some of the donor area that is bordering the nw5-7 area for less important parts.

May sound crazy but I acutally think if you are a young guy destined for nw6 by 30, it is a good idea to get on meds RIGHT AWAY and see if you tolerate it...then just go for a conservative frontal/hairline HT so you can stop worrying about your hairloss (even if at the time you are a strong nw2 but know your destined for full reession)...If i had the money I think I would have done that...could definitely hold on to my crown for a solid 5-10 years with treatment, and worse case scenerio you start losing, shave ur head, perhaps SMP in the crown, no/limited scar in the donor so looks good at 1 guard, and ur good to go...

[yeahyeahyeah]

There is no question that we are getting some regeneration with Acell.

I think beauty is in the eye of the beholder. About 90% of guys with bad hair transplants seem to be happy with them at least up to a point where it becomes more and more obvious. About 10% with a bad hair transplant can't stand it and about 3% become almost suicidal.

It's better to do it right from the beginning. However, some people are happy with just a little bit of hair to help frame their face and they top it off with products when they want it to look fuller. Others, want as much as they can get. Others want more than we can offer.

With all the cow licks on my head, i've never been able to really style my hair, but at least I have it. It's going to go where it wants to go, but at least I have it.

I think all opinions are important. The beauty of what we do is the ability to satisfy many different opinions.

I never met Bobman, but it seems like a great result especially based on where he came from.

If you are getting regeneration with ACell, then why is donor limitation an issue?

[John P. Cole, MD]

Definitely an option with a few unknowns.

We know medical treatment can slow down loss and in instances reverse it. What we don't know is how long it will last.

We know that SMP can help. What we don't know is the long term issues (pluses and minuses) with SMP. I'm going to visit Rob Jones soon to see what he is doing with SMP. He went to Milan, but said it was a waste of time as he saw very little. People who are doing SMP say that results tend to vary. Depth is key. if you go too shallow, the result is not there. If you go too deep, the pigment will bleed and last too long and turn blue. There is not pigment that just fades away on it's own. It's tricky.

Here is another option. Build a great hairline now and then relocate it later on in other places as you loose more hair. Good option if you doctor knows how to do it.

We talk about the safe donor area and worry about extracting outside it. Ok, sure, we worry, but isn't it better to use this potentially non-permanent hair in places it can do more good when you are young? If you loose it later on, at least you had it to do some good when you were young and needed it most in cosmetically significant areas. You could even put this hair in the frontal hairline and let it potentially recede over time to a more natural, more mature hairline. Just a thought.

I think the most important thing is to discuss options with individuals and let them decide what to do based on a long term approach.

What I would not recommend is a strip in an individual heading to a NW 5 or 6 or 7. You eliminate plenty of options doing it this way. Of course individuals like bowman refute this approach, but it is important to know that not all individual have a bowman donor area that allows a more aggressive approach. We also don't know what his situation will be like in another 10 or 20 years when the grafted hair is prone to fade with time.

[John P. Cole, MD]

If you are getting regeneration with ACell, then why is donor limitation an issue?

Great question! Suppose you take out a three hair graft and get only 1 hair to regrow. Suppose you take out 20 grafts and get only 50% of them to regenerate a single hair. It's just too early in the process to make any exaggerated claims. We need more time to study what we are seeing. I think we have a tendency to be too positive about something new. We must take a wait and see philosophy first. It's like Pilofocus. It seems great, but there are plenty of things that can go wrong. Also, consider body hair. We had great results early on and then some not so good results and then some terrible results. We can't over promote a technique or approach until we have a firmer grasp on long term results and the percentage of responders. Just wait. Be patient.

Put simply, it is an issue until it is no longer an issue. For now, it is still an issue.

[Dan26]

Appreciate the insights/info Dr.Cole!

I think nowadays FUT is only reasonable in a select few scenarios...I hope it becomes extinct in the near future!

[brunobald]

Dr Cole,

I have a few questions I have been thinking over regarding donor regen.

First off have you ever tried transecting a thinning hair in the front of the scalp and then applying acell to see if it will regenerate into a healthy follicle. I know this does not have many practical applications but it would be interesting to see the results.

Secondly I was wondering just how little of the follicle needs to remain post transection for regeneration to occur. If we are talking about small fractions of the follicle, would it be possible to culture a replacement mix of follicle cells and inject them into the wound site. Maybe some dp and dermal sheath cells, im hoping the healing action of the fue punch closing over may induce a regeneration effect with the addition of the cultured cells. The healing wound would be producing tissue to close the hole we just need to push it in the right direction with the correct signals to produce a follicle not just skin.

[yeahyeahyeah]

Great question! Suppose you take out a three hair graft and get only 1 hair to regrow. Suppose you take out 20 grafts and get only 50% of them to regenerate a single hair. It's just too early in the process to make any exaggerated claims. We need more time to study what we are seeing. I think we have a tendency to be too positive about something new. We must take a wait and see philosophy first. It's like Pilofocus. It seems great, but there are plenty of things that can go wrong. Also, consider body hair. We had great results early on and then some not so good results and then some terrible results. We can't over promote a technique or approach until we have a firmer grasp on long term results and the percentage of responders. Just wait. Be patient.

Put simply, it is an issue until it is no longer an issue. For now, it is still an issue.

When will your studies of the application of acell and donor regeneration be concluded. I am aware that you have been conducting it for a while.

[thinkingaboutit]

I was about to write a lengthy reply to this post, and then I stopped my self and deleted my reply. I have learnt to not get into discussions or arguments on forums where it can get a bit clicky etc. I won't go into why etc.

Anyway, I would consider myself a close a a Norwood 6, I think I am borderline, I am VI to 6, and I just turned 38, a few months ago. I had FUE about 14 months ago, and now I have almost a full head of hear. Some well known people (I am not going name names at this moment in time) said I was not a suitable candidate. Those clinics that met me in person, said I had very good donor hair and I would need about 5,500 to 6,000 grafts. Some said I would need to 7,000 to 8,000 grafts. However, the vast majority said I would need about 5,500-6,000 grafts.

So in short, I now have a hair. For me it's a miracle. It's not as thick as I would like it to be. However, considering what it was 14 months ago to now, it's a world pf difference. I was someone who shaved my head dialy religiously for more than 7 years, and wore my bold hair proudly. Know I love the fact that I have a choice. It's one of the best decisions I made. I wish I had done it sooner. I was told my most clinics that I would need a minimum of 2 or 3 transplants. So I would need t go back after 12 or 18 months, depneding on how I felt. Anyway, that's my story. A lot of people have asked me to post pictures. Which I don't. Some some may think I may be a fake. I am not here promoting any company. I will post pictures soon. I realised that I could post a picture and blurr my face out using photoshop.

Anyway, that's my story. These forums can be great places, but there are also some not so nice people. That's my 2 cents.

[fred970]

Thank you for your contribution, it gives me so much hope. Less than 3 months before my first FUE now. I'm so nervous. I'll keep you guys posted on various forums of course.

[thinkingaboutit]

Some pictures....for a number of people who have asked for them before before. So I was Norwood VI To 6. Although English/British born my ethnicity is Indian as you will see from pictures, and at the moment my hair is very short I am growing it, and it looks a lot better when it is longer but it will give you guys an idea of going from a Norwood 6 if you have Donor hair. Also I took these pictures in the last 5 -10 minutes using my iPad Mini so not the best photos - sorry. But it's something.

I have never uploaded pictures here, so i hope it works. I hate having my pictures on the internet. Hopefully it will show that I am a real person. And give some hope to not "always" listen to the experts who say it's not possible. There many people with agendas.

[thinkingaboutit]

A quick last note, I believe I will need another session in another 12 or 14 months, so long as there is enough donor hair. The clinic seems to think there is enough donor hair left. Anyway, thank you to everyone who has advised me and shown support during my interactions on this forum. Some good people here. However, I also need to remind myself occasionally that hair is not everything in life. There are more important things. But it sure helps to have hair.

[Clark Kent]

I was told by dr wong that i am a nw 6. although the there was still a lot of hair there you could see where the hair was receding too. I had my first ht 11 days ago. sucks im only 21 but hopefully this will wield good results.

[John P. Cole, MD]

I think your result is good, Thinking about it. the photos are a bit blurred, but it seems good. It also appears that your hair is at least medium. Medium and coarse hair will fair better than fine hair. One should always remember to compare apples and oranges.

I think the level of transection probably affect survival of both top and bottom halves of the follicle. A low bisection will probably result in a higher survival for the top half and not as good for the bottom half. A middle cut probably has the best survival for both top and bottom. A top cut probably has a best survival for the bottom half.

i just returned from the Japanese society meeting last weekend in Japan. MOst of the lecture are on basic science here. There was a lot of talk about stem cells including the Japenesse equivalent to the Jahoda/Chritiano study. There is considerable confidence, as well.

Robert Hoffman gave a great lecture on Nestin producing follicle stem cells. these cells need very little stimulus to carry on minor regeneration of structure such as nerves and blood vessels. It the right setting, it is not surprising that they can carry out more complex structures such as intact hair follicles.

One not is that in our initial Acell trial we used other pro-inflamatory induces and we got faster growth than we are seeing in our follow up study where we used Acell alone. The combination, as expected, may turn out to be the optimal recipe.

[35YrsAfter]

Robert Hoffman gave a great lecture on Nestin producing follicle stem cells. these cells need very little stimulus to carry on minor regeneration of structure such as nerves and blood vessels. It the right setting, it is not surprising that they can carry out more complex structures such as intact hair follicles.

One not is that in our initial Acell trial we used other pro-inflamatory induces and we got faster growth than we are seeing in our follow up study where we used Acell alone. The combination, as expected, may turn out to be the optimal recipe.

This is why I believe that advances in regenerative medicine will lead to more effective treatments for men in the higher Norwood categories.


35YrsAfter also posts as CITNews and works at Dr. Cole's office
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I am not a doctor and the content of my posts are my opinions, not medical advice.
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