ACell, a Current Review of Applications in Hair Transplant Surgery

[plopp]

There are different results from plucking hair. if you pluck an intact follicle or a nearly intact follicle, you are not going to get regrowth in the donor area. As such, I continue to disagree with the those who feel that nearly intact follicles will result in regrowth of hair.

A little bit of mesenchymal tissue is not enough to feel confident that a hair will regrow in the donor area.

i do agree that patients should not depend on this "plucking" technology and focus on more traditional methods of restoring their hair at this time.


If we suggest that we have a new FDA approved product that may be combined with plucked hairs and produce two hairs from a single hair, we may expect a euphoric response from both patients and physicians. When we have not demonstrated the capacity to duplicate hair, however, we should be careful to avoid the implication that we have discovered a means to clone hair. I’m not suggesting that Dr. Cooley and Dr. Hitzig will not produce subsequent evidence, however. In the interim, we should exercise greater caution.


I suggest we stick to evidence based medicine that depends on the following: hypothesis, methods, and results, followed by conclusions based on the results. We should create an objective study to evaluate the potential for duplication of plucked hair grafts. How can we do this? It will not be easy and it may be nearly impossible to prove. There are many obstacles in the way to obtaining useful data. The greatest challenge will be to differentiate which of the more than 20,000 to 30,0000 follicles in a donor area might be the original plucked follicle. Finding a needle in a haystack might be easier simply because the needle looks different than the hay.

A theory that predicts everything predicts nothing. There are infinite probabilities from plucking hairs so there are infinite potential outcomes. Dr. Cooley has stated that sometimes he plucks an intact follicle, but other times he plucks a nearly intact follicle. When an intact follicle is plucked, we can anticipate very little regrowth in the donor as my hair plucking efforts with FUE have demonstrated. When we pluck a nearly intact follicle, the total amount of residual tissue remaining in the donor area has infinite uncontrollable outcomes such that regrowth is unpredictable. In fact, Dr. Cooley has provided insight that nearly intact follicles from the beard and scalp may have a higher yield when treated with Acell. How much tissue remains in the donor area? Is there only outer root sheath and follicular sheath, or is there some inner root sheath and dermal papilla that remains? Does the amount of tissue and embryological origin have any affect on regrowth? Take for example Figure 1. The upper follicle is an intact follicle. The lower follicle is a plucked nearly intact follicle that lacks only a tiny fraction of the outer root sheath and dermal papilla. The residual fraction in the donor area is estimated by the orange. Suppose that only this tiny amount of tissue represented by the orange color remains in the donor area. What is the probability that his tiny fraction can produce a follicle that is an exact duplication of the original follicle especially without Acell treatment? We do know from transection studies that we often leave far more tissue in the donor area than is depicted by this orange fill, but we do not get 100% regrowth of transected follicles. When we leave 50% of the intact follicle in the donor area, we can expect no more than 50% of them to grow. With so little tissue remaining in the donor area following plucking, how can we imply that we are duplicating hair follicles?

Hi Dr. Cole,

I have a great respect for your expertise in hair restoration and really do appreciate your input on Acell and its possible applications in this field.

I think it's best to take a cautios approach to any new, not fully tested, discovery in medicine. However, I think your comparison is unfair. You obviously has far more expertise in this field than I do, so maybe it's stupid of me saying this, but surely there is a demal papilla attached to the lower follicle? Does it really come from a plucked hair, or am I seeing things wrong? The picture you provided here, gives a whole other story of a plucked vs a dissected follicle: http://www.baldtruthtalk.com/attachm...1&d=1296839761

I think the key is not how much that is left of the follicle, but rather how much of it that is removed. As long as even a small amount of the dermal sheath is left intact, additional MSCs will migrate to the area of wounding. Since the environment provided by what's left of the follicle is left unchanged, the follicle will be regenerated. However, if too much of the follicle is removed, there is the possibility of triggering a response of fibrosis and subsequently scar the follicle.

[RichardDawkins]

Simple answer :

1) A plucked hair is plucked from its sourroundings (stem cells and everything else for regeneration is still there)

2) FUE : Well here you stance out the WHOLE follicle as an Organ and also you cut out the sourroundings of the follicle as well

So there is obviously a difference. In the first case you didnt detroy or take away the ability for regenerating a new follicle or to be more prcise to create new dead material (a visible hair). Its the same as what women do in general when they agressively wax their bikini zone or legs or whatever. The hair always comes back. The whole area where a follicle lives is filled with stem cells and the factors for regeneration. If you take away something from this it will regenerate as simple as that. Think of it as a family who lives in a house, where you take away a family member each time. The house can still be filled with people etc

In the second case : You took away everything. Its like you would take away the whole house here and not its residents. So therefore the house is gone and also the ability to fill this house with people again.

Also your statement doesnt make sense to me. If it would be like you said, how would it even possible for eye brows to grow again? I tweeze them very often and there is a huge amount of white tissue sourrounding it. How do you explain that.

And then on the other hand you demand for a study? So why would you perform a study if you personally believe that plucked hairs dont grow? If you want docs to help you with this, then just ask them directly, i am sure they will gladly help you with the protocol etc.

As some of them already said, they plucked a whole area and tattoed it and all the hair did grow back, i really dont know why you keep on argumenting about "If plcuked hairs do grow or not"? All people here male or female KNEW for good that plucked hairs grow because they almost do pluck hairs on a weekly routine.

No there are not infinite outcomes of plucked hairs there are only a few

1) Donor regeneration Yes or No
2) Successful transplant in Recipient site Yes or No

There is nothing in between which should interest people. Only because we cant explain why certain things work, it doesnt make them automatical "Not working"

I Repeat FUE is not hair plucking. With Fue you extract the whole organ, and then its clear that nothing will ever grow there again. Plucking is just tweeze em out and thats it, but its not about extracting a WHOLE ORGAN.

The tissue left in the donor side has its genetic SOP Modus, its called Survival and regeneration. I would say it otherwise, the Doc out there who is capable of stopping stem cells to regenerate follicles, should be considered for a nobel price because he had suppressed regenerative abilities, which at this point in time is IMPOSSIBLE. No one can stop cells from regenerating only by plucking hair. Nature had this already in mind that sometimes hars will be plucked, so its clearly obvious that they will gow back.

Another example, if you would lose your nail (it has some characteristics like hair) why does the nail grow back after some time? If you get scared, why do the wounds heal amost scarless in minor injuries. How can the liver regenerat itself?

If it would be like you said, i think we all should just shoot ourselfes because then our body wouldnt be capable of regenerating anything and therefore the whole mankind would be dead within the next 4 months.

Also you are only making assumptions because you ask us how far the chances are that small tissue remakrs can form a new follicle.

Ok then here is another one "How far are the chances of a small clump of cells to form " A Human"? Dont answer this, it was a rhetorical question.

I am really diasgreeing with you and also get a little bit angry at this point, not because i desperately want plucking to work (almost anyone knows that it works) but more of this really sheer ignorance here and not listening to hairloss sufferers.

Acell is no magic here, its just increasing or accelerating mother natures healing abilities and thats it no hocus pocus no nothing. And to give you another example.

You yourself put your Grafts into a storage solution. Why do you do this? Correct to increase the odds of survival for the time out of the body. So and Acell when brought to the plucked sites is just working as an in vivo Cell Matrix or Accelerator thats all.

And btw a lot of users here were willing to help you with this, like plucked hairs and Acell tests and also CIT Multiplication test, they send you emails etc but you never answered them, so if you really want to have a study going on then you should listen to what those people have to say and what they send you in emails.

[John P. Cole, MD]

There are different results from plucking hair. if you pluck an intact follicle or a nearly intact follicle, you are not going to get regrowth in the donor area. As such, I continue to disagree with the those who feel that nearly intact follicles will result in regrowth of hair.

A little bit of mesenchymal tissue is not enough to feel confident that a hair will regrow in the donor area.

i do agree that patients should not depend on this "plucking" technology and focus on more traditional methods of restoring their hair at this time.


If we suggest that we have a new FDA approved product that may be combined with plucked hairs and produce two hairs from a single hair, we may expect a euphoric response from both patients and physicians. When we have not demonstrated the capacity to duplicate hair, however, we should be careful to avoid the implication that we have discovered a means to clone hair. I’m not suggesting that Dr. Cooley and Dr. Hitzig will not produce subsequent evidence, however. In the interim, we should exercise greater caution.


I suggest we stick to evidence based medicine that depends on the following: hypothesis, methods, and results, followed by conclusions based on the results. We should create an objective study to evaluate the potential for duplication of plucked hair grafts. How can we do this? It will not be easy and it may be nearly impossible to prove. There are many obstacles in the way to obtaining useful data. The greatest challenge will be to differentiate which of the more than 20,000 to 30,0000 follicles in a donor area might be the original plucked follicle. Finding a needle in a haystack might be easier simply because the needle looks different than the hay.

A theory that predicts everything predicts nothing. There are infinite probabilities from plucking hairs so there are infinite potential outcomes. Dr. Cooley has stated that sometimes he plucks an intact follicle, but other times he plucks a nearly intact follicle. When an intact follicle is plucked, we can anticipate very little regrowth in the donor as my hair plucking efforts with FUE have demonstrated. When we pluck a nearly intact follicle, the total amount of residual tissue remaining in the donor area has infinite uncontrollable outcomes such that regrowth is unpredictable. In fact, Dr. Cooley has provided insight that nearly intact follicles from the beard and scalp may have a higher yield when treated with Acell. How much tissue remains in the donor area? Is there only outer root sheath and follicular sheath, or is there some inner root sheath and dermal papilla that remains? Does the amount of tissue and embryological origin have any affect on regrowth? Take for example Figure 1. The upper follicle is an intact follicle. The lower follicle is a plucked nearly intact follicle that lacks only a tiny fraction of the outer root sheath and dermal papilla. The residual fraction in the donor area is estimated by the orange. Suppose that only this tiny amount of tissue represented by the orange color remains in the donor area. What is the probability that his tiny fraction can produce a follicle that is an exact duplication of the original follicle especially without Acell treatment? We do know from transection studies that we often leave far more tissue in the donor area than is depicted by this orange fill, but we do not get 100% regrowth of transected follicles. When we leave 50% of the intact follicle in the donor area, we can expect no more than 50% of them to grow. With so little tissue remaining in the donor area following plucking, how can we imply that we are duplicating hair follicles?

[t-bone]

yes the acell and prp were directly into scalp.I hear Dr.De Yarmann soaks grafts in acell when doing transplants as well.

[Havok]

I agree with you completely. Hair grows back after plucking. I have no special, secret, magical plucking technique. I got better at plucking hairs with adequate epithelial cells attached to the shaft. No one has seen any thinning or lack of regrowth in the areas I've plucked. Nor would I expect them to, because I am not extracting complete follicles.

I've attached a photo of two single hair grafts from the same patient. The one on the right is plucked, and the one on the left is dissected from a strip. Both are single hairs from the same patient, so we're making a valid comparison. I chose the meatiest pluck I could get for this example. It even has the dermal papilla attached, which is quite rare for plucks. The difference is that the intact follicle on the left has the dermal sheath, which is quite apparent when you compare the width of these grafts. Also attached is a histologic stain of a plucked graft.....there is no dermal sheath on it. Hair will regrow at the plucking site because mesenchymal stem cells in the dermal sheath will regenerate a papilla, and epithelial stem cells in the isthmus will interact with this papilla to form a new hair fiber. Fifty years of basic hair research support this statement.

Someone on this Forum mentioned how frustratingly slow hair growth studies can be, and I echo this. I am accumulating more clinical experience with this technique, and time will tell what role it will play. There are many very good questions and it will unfortunately take time to answer them. Later this year, I will provide an update on my results. In the meantime, I recommend patients seek out standard medical treatments and if they are a candidate, do FUT or FUE.

Dr Cooley

so is dr cole confused? how can his plucked hair be different than dr cooley's plucked hair? either way this seems incredibly promising and i would gladly wait few years if it actually works.

[HairTalk]

i have been getting prp therapy for a year and just had my first acell treatment with prp.It has only been a week so will post before and after in 3 months.I go to dr.de yarmann in Lajolla Ca.

Were the ACell injections just straight into the scalp, or were they used to aid transplantation?

[t-bone]

i have been getting prp therapy for a year and just had my first acell treatment with prp.It has only been a week so will post before and after in 3 months.I go to dr.de yarmann in Lajolla Ca.

[plopp]

lol, rich, you're seriously starting to freak me out. do you even have mpb?

As for nemo's point, the claim that hairs would grow back ever weaker is unsubstantiated. There are also 'internet theories' that they grow back thicker (especially if you don't want them in the first place...)

However, scarring alopecia is a real thing. Given that you actually pulled of a complete patch of hair from your neighbour in one go, you must have applied quite some force. Further, given that 7 year olds 1) are prone to fibrosis given their young age and 2) likely have quite weak follicular structures still, you may very well have induced permanent hair loss.

As Dr Cole (TS) stated, regeneration of the follicle is no sure-fire thing (especially not when it comes to Gho, but let's not get there rich ), and is really the last hurdle before I jump on the plane and get some autoplucking done

[RichardDawkins]

Of course Bro of course. You plucked her hairs out 15 years ago and they didnt grew back.

Strange that some people who pluck their hairs out almost every month (because this mental illness or whatever) will grow it backif they stop it.

Ahhh now i see, First time poster registered April 2011 right. And let me guess it seems to happen that you got the exactly right adress, which beauty salon we should Ask RIGHT

[SilverSurfer]

I am a repair patient. Dr Cole did my work and I must say it is great. By the third month I could already see an improvement and by the 8 month mark you couldn't see any signs of the mess that was there before. I would definitely recommend him. I would recommend him to you because he will be as straight forward as possible, you will get great yield with fewer grafts and most important his work is totally natural and undetectable.

[tk72]

Who would you guys recommend for hair transplant repair and why? I had 700 grafts done about 15 years ago when I was 23 and would like to have them removed along with pitting and scar. I just want to be able to shave my head until they get kinks workout with acell, histogen, follica or whatever. Also any doctors opinions would be greatly appreciated. Thanks.

[RichardDawkins]

At hair site Doctor Hitzig answered some questions really honest, i was impressed.

Especially considering the amount of beard hair (only 35)

[HairTalk]

I doubt this will nail the coffin of insipid back-and-forth that's been going on, but I thought I should mention:

ACell used in hair-transplantion surgery currently (March, 2011) is being studied by a few doctors (e.g., Cooley, Bernstein) — I've gathered this from calling the clinics. Tests are to involve use of the compound in fully-bald men, and would involve observation of donor and recipient areas (not necessarily in the same subject). Definitive results should be available in early 2013 (patients would be operated on through early 2011; progress would be monitored over twelve months; results would be analyzed, organized, then shared). These results should provide quantitative and qualitative data.

Until that point, then, anyone not immediately involved in this research would have no strong claim to the efficacy — or to the lack thereof — of the compound in relation to hair-transplantation.

[UK_]

Ahh before it goes down i just wanted to show you guys the question about plucked hairs from the root, some people here still believe that they are gone *cough* *cugh*

http://www.baldingblog.com/2011/03/0...t-by-the-root/

Cool, plucked hairs grow back, so baldness is cured right?.. what are we all still doing here? lol.

[RichardDawkins]

Ahh before it goes down i just wanted to show you guys the question about plucked hairs from the root, some people here still believe that they are gone *cough* *cugh*

http://www.baldingblog.com/2011/03/08/does-hair-regrow-if-pulled-out-by-the-root/