ACell, a Current Review of Applications in Hair Transplant Surgery

[RichardDawkins]

https://www.hasci.com

[Kiwi]

Hey UK, can you please explain what the HST is?

[UK_]

Well if it comes to a hair transplant, what would you rather do? Risk it with the HST or have a regular FUE...? I would take the HST any day... Dr Gho was in the news recently over here, that's where it stated he had a growing waiting list until 2012...

[Follicle Death Row]

Dr. Gho is charging other surgeons 50,000 euro for training and the rights to his patented triple wave extraction tool and proprietary preservation medium. I think the phenomenon of transection and transplantation that Dr. Gho describes is real but with what consistency and results. In the interview with Spencer Dr. Gho offered to even go to another doctor's practice to demonstrate and share his technique. I'm still skeptical but it would be interesting if someone took him up on his offer.

FUT just seems barbaric to me. I like the idea of FUE as it seems better to thin the donor all over and have more of a balance between top density and side density than cutting a strip out and giving you half the density or less on top. There is always the problem though of not enough hair and we still can't create any new hair (c'mon Acell with FUE & Plucking). FUT has some awful implications when it comes to scarring, hair length and trying to maintain a decent hair style as the sides and back seem to race ahead and create the bozo the clown look.

I look forward to future developments such as Aderans and Histogen when we can have the best solution.

[John P. Cole, MD]

Thanks. My skeptical mind would first lean toward how do we know which follicles were there before transplantation and which were the after transplantation. This is not answered. Even a bald scalp might have some pre-existing hair that was either there or resting. If resting, it might soon begin to grow after a study resumes. Here we have only hair that was partially removed yet was able to regrow in both areas, the transplanted area and the donor area. Great, but how do we know this occurred other than the investigator's supposition? We don't other than to take his summation of the results. While i want to concur with his results, I cant' based on the lack of objective data. Furthermore, we lack methods here. How were the follicles extracted and what did they look like. What were the minimal requirements for an extracted follicle? Perhaps Dr. Gho is on to something, but he has not given up enough information to repeat his findings. Without this information we are paralyzed Give us more so that we can better understand his protocol.

[UK_]

http://informahealthcare.com/doi/abs/10.3109/09546630903359814

I dont know if Dr Gho is using Acell or not.

He states that he has a waiting list of patients until mid-2012 for his HST procedure.

_______________________________________________

Dr Cole, I dont know whether you caught eye of the research coming out of Berlin Tech, the full article can be accessed here:

http://www.ncbi.nlm.nih.gov/pubmed/21277344

[John P. Cole, MD]

By the way, you are seeing the beginning of acceptance of FUE by the FUT physicians. I've always said that it will take the patient community to demand the change. You cannot expect the vast majority of physicians to see the potential of a new protocol or procedure. What you need is patient demand to make most physicians alter their treatment protocol or methods. you are seing a very rapid acceptance of Acell and PRP, but FUE has taken a decade to gain acceptance. In 2002 hardly any physicians offered FUE. In 2008 over 10% of all hair transplant surgeries were done by FUE. By the time the 2010 census comes out don't be surprised if over 15% of the procedures done to restore hair loss are by FUE. Every FUE procedure takes away from the percentage of FUT procedures. Eventually 50% or more of all restoration procedures will be done by FUE.

[John P. Cole, MD]

You know, i've tried to get Dr. Gho to tell me specifically what he is doing, but have not been able to get this information from him. It is very hard to get behind something you don't know much about. When FUE first came out in the turn of this century, no one knew how to do it. When i first began doing it in 2002, i had no idea if the grafts would grow because they lacked adipose tissue. i tried my best to have patients wait for results, but they just kept coming. Fortunately, the grafts grew beautifully. We had a few poor results that were over come with advancements in the procedure, but over 98% were great from the beginning. Body hair was a different animal in that sometimes it did really well, while other times it did not do so well. The point is that I did not know what Dr. Woods was doing in 2002 and I don't know what Dr. Gho is doing today. It is impossible to replicate a procedure that you do not know how it is specifically done or how to improve upon it based on how it is currently done.

[John P. Cole, MD]

This was pretty impressive. While a child that amputates the tip of a finger is likely to regrow the tip without Acell, an adult is not. This is not to say that it cannot happen in the absence of Acell in an adult. Still, it may be more likely in the adult and child with Acell. What is described in this article is quite amazing and indicative of the power of this extra cellular matrix. Certainly, without Acell, we did not see the follicle regeneration that we are seeing in FUE extraction sites that we are seeing with Acell.

Furthermore, with Acell we are seeing improvement in hypopigmentation when follicle regeneration does not occur. Both the diameter and degree of hypopigmentation in FUE extraction sites with Acell is reduced when follicle regeneration does not occur.

[RichardDawkins]

Thanks Dr Cole for the valuable input here.

Try to extract the hairs like in the Gho protocol, i think regeneration will be more consistent then.

But i was right Dr Cole will be the first to admit if he was wrong in the past and the first who asks the community for help. Such a shame that other clinics still run with the FUT i dont care about anything else thing.

[UK_]

Acell seems to work wonders for some.

http://singularityhub.com/2011/07/12/miracle-powder-regrows-fingers-now-thigh-muscle-for-marine/

[John P. Cole, MD]

Yes, i do believe that Acell has the capacity to regenerate hair in donor area extractions. I am concerned about how often this occurs. I have a difficult time believing what your eyes are telling me. I want to see more proof. I am still open to the plucking theory, but continue to have my doubts, but them i have my doubts about what I seeing with donor regeneration, as well. I'm thinking of additional objective studies to evaluate what I am seeing. I also am concerned about the delivery of Acell. Very recently i switched to a more viscous hyaluronic acid that rapidly metabolizes to deliver the Acell.

I do think Acell might increase hair shaft diameter, Gillenator. This is good and bad. On the hair line, i really don't want this, but in other areas, it can improve coverage.

I really don't know what causes some hair to grow in curly or kinky. It can happen with any form of HT, be it FUT or FUE. It is not terribly common, but it occurs. i have not seen an increase incidence with Acell, however.

It is always good to see your comments, Gillenator. I miss hanging out with you in DC. I also miss your chili. It is awfully good. I hope you are in good health.

[gillenator]

Possibly that is why some grafts regrow with a wiry projection of the hair shaft, due to partial transection?

Another question, "Can Acell improve hair shaft diameter?"

[HairTalk]

There is no question that Acell will benefit transplanted grafts. We encourage all patients to apply Acell fine particle to all the grafts and to have a low concentration of Acell injected into the recipient area. Hair transplant yields can vary based on a number of factors. One is the transection during graft harvesting and preparation. Another is trauma during graft implantation. Another is the storage solutions and temperature that grafts are stored in prior to implantation.

Graft transection is far more common than anyone will admit to in my experience. While visiting a clinic recently, i found that they were trimming off their transected hairs and implanting grafts without the transected hairs. In the absence of Acell, these transected hairs might have a 30 to 50% chance of survival, but not in the trash can. I encouraged them to stop trimming of the transected hair follicles and to also add acell to their grafts in an effort to stimulate growth of the damaged hair follicles.

Even without transection, follicles are traumatized. Most physicians still use normal saline to place their grafts in prior to transplantation. Why? Because it is cheap and many others use it. What is the problem with normal saline? First, the ph drops over time because there are no buffers and the water reacts with CO2. Second, when you chill normal saline, the cell membrane is paralyzed and can no longer pump water. Because the osmotic gradient is into the cell, the cell swells and then potentially bursts. Not a good thing for cells or graft survival. The way around this problem is to chill your tissue in hypothermosol. What's the problem with that? It costs over 200.00 USD per liter compared to under 10.00 USD per liter. How many physicians are willing to pay the extra price? Not many based on my expereince. Thus, Acell might even make up for the inherent cheapness associated with doing surgery.

In my opinion, you use chilling, a good cold storage solution, and Acell to maximize the growth potential of your grafts. that's the solution given todays current optimal standard of care in my opinion.

Dr. Cole, do you feel ACell will permit in-vivo hair multiplication (thereby very greatly expanding the donor supply, if not making it limitless [for all practical purposes]), be it in conjunction with plucking or with intentional-transection F.U.E.? In the latter technique, do you believe the quality of re-growth from transected follicles — that is, the color, texture, and thickness of hairs — will be acceptable? I understand patients, even now, sometimes get wiry or coarse re-growth, perhaps from grafts or recipient-incisions that have been subjected to trauma.

Thank you.

[John P. Cole, MD]

Acell and grafts

There is no question that Acell will benefit transplanted grafts. We encourage all patients to apply Acell fine particle to all the grafts and to have a low concentration of Acell injected into the recipient area. Hair transplant yields can vary based on a number of factors. One is the transection during graft harvesting and preparation. Another is trauma during graft implantation. Another is the storage solutions and temperature that grafts are stored in prior to implantation.

Graft transection is far more common than anyone will admit to in my experience. While visiting a clinic recently, i found that they were trimming off their transected hairs and implanting grafts without the transected hairs. In the absence of Acell, these transected hairs might have a 30 to 50% chance of survival, but not in the trash can. I encouraged them to stop trimming of the transected hair follicles and to also add acell to their grafts in an effort to stimulate growth of the damaged hair follicles.

Even without transection, follicles are traumatized. Most physicians still use normal saline to place their grafts in prior to transplantation. Why? Because it is cheap and many others use it. What is the problem with normal saline? First, the ph drops over time because there are no buffers and the water reacts with CO2. Second, when you chill normal saline, the cell membrane is paralyzed and can no longer pump water. Because the osmotic gradient is into the cell, the cell swells and then potentially bursts. Not a good thing for cells or graft survival. The way around this problem is to chill your tissue in hypothermosol. What's the problem with that? It costs over 200.00 USD per liter compared to under 10.00 USD per liter. How many physicians are willing to pay the extra price? Not many based on my expereince. Thus, Acell might even make up for the inherent cheapness associated with doing surgery.

In my opinion, you use chilling, a good cold storage solution, and Acell to maximize the growth potential of your grafts. that's the solution given todays current optimal standard of care in my opinion.